Unsafe nursing/High nurse:patient ratios
I just posted and then saw how LONG this is!! Sorry, but if you actually make it through this long posting...your feedback would be appreciated. Thank you in advance!
Hi everyone! I decided to post this to see how widespread of a problem this really is. It seems that every single shift I work lately is more unsafe than the last and that it just gets worse with no end in sight. I am currently working a telemetry floor where the nurse:patient ratio a year ago was in the 4-5 patient range and now is always 6 patients but more and more frequently we are taking 7 patients. Now, I have no problem with working my entire shift and not having any down time, I expect that, and I also do believe that if the acuity of patients is low enough that 7 patients can be manageable. I am not posting in regard to situations like that. As we all know, with the way insurance and such is these days, the patients we are taking care of are sicker than in the old days where the patients came in for a cholecystectomy and stayed for a week. Now you have to be much sicker to even get admitted in the first place.
I know this situation isn't unique to my facility and I am wondering what everyone else is doing about it. There just doesn't seem to be much recourse that we have. Management says they are hiring, doing what they can, etc, but nothing changes. I and my coworkers feel many shifts that our license really could be on the line because we can't possibly give the patients the care that deserve and need. I don't like leaving work feeling like my patients are getting their needs met. All too often it seems as if you are the sickest patient in my assignment, you get all of my attention. While that may be necessary at the time, my other patients ARE STILL SICK TOO. There really isn't anyone backing us if we feel too overwhelmed or feel unable to take another admit because we are too busy. If we try to refuse to accept a patient assignmen or new admit, we are told "You can't refuse", "That's patient abandonment", etc.
Again, I am not someone who would ordinarily refuse to take a patient or an assignment but let me give you a true example of the situation I am speaking of. This situation happened last night and is the latest of this ongoing problem. It was based on this example that prompted me to post this topic. Let me preface this by saying this was a night shift and that means that there isn't phlebotomy, transport, IV therapy, EKG techs, etc at this hospital at night. OK, the night was already crazy busy. I think the full moon had something to do with it! Ha! Anyway, my coworker was told she was getting an admission. It was a 80y/o with CHF and GI bleed. I was trying to hurry and get caught up so i could help her and she was trying to get caught up as well. Well, about 30 minutes later, the ER called and gave her report. This patient came in for severe shortness of breath. During the work up his BNP came back around 600 so he was obviously in CHF, but the patient also had and H&H of 2.3/8.7!! I kid you not! Personally, I have only in my 15 years as an RN only seen the lowest of around 4.5/12 and that patient was obviously very sick and needed an ICU bed. She brought this concern to the charge nurse, that H&H defintely warranted an ICU not a telemetry bed. The patient had orders for 6 units of PRBC's. Six units of blood for a patient ALREADY IN CHF does not an ideal patient make for a telemetry floor to a nurse that already has 6 other patients. The charge nurse called the nursing supervisor to voice concerns about this. The supervisor stated that there were not any other beds and that the patient was not visibly ACTIVELY BLEEDING!! Well, no, not anymore..there wasn't any blood left TO actively bleed! Now, what are we supposed to do? We have been told we can't refuse, they won't let the patient stay in the ER where they are better equipped to deal with this situation until an ICU bed opens or something. It just isn't a good situation all around. The ER reported that the patient is actually "fine", not short of breath, nothing. Well, I am sure you have all had the ER report, and then find out that either the patient suddenly deteriorated in the elevator from the ER (yeah right), or the ER sugar coated it to get that patient out of the ER. (BINGO!!) So the patient gets to the floor and can't even catch his breath sitting straight up, and is sweating profusely. Somehow, his oxygen saturations were good, but he was so anxious because he couldn't breathe and was scared to death. He was unable to sit still, while we tried putting in another IV, foley, etc. The orders said to give each unit over 2 hours which we can't do on the floor anyway...it has to be a minimum of 3 at this facility unless in ICU, plus we can't give it that fast anyway with him in CHF.
The 2 of us worked on him for awhile and finally got him to were he could braethe and all that, but it took a good 2 hours working with him that we didn't leave his room the whole time. The patient by morning was actually doing quite well by the time we left, but honestly I think we just got lucky and that shouldn't be the point because once managemetn/supervisor knows that, they start thinking, "OK, well they did it once, they can do it again". That just shouldn't be the way things go. Now, yes, the patient did do ok.....but for the 2 hours that the 2 of us were in that room, our other 12 patients between the 2 of us essentially didn't have anurse because we couldn't get to them! I don't feel good about my care during my shift when its like that.
So, I know this is long winded, I just wanted to paint a proper picture of this situation. Unfortunately, this is just ONE instance, I literally could post a different similar situation EVERY shift I work. I love bedside nursing and would not do anything else but I also don't want to feel as if my license is in jeopardy every time I work. Other than leaving the facility, which I am doing in a few months, does anyone have any ideas or anything that we nurses can do as recourse, or anything? Even though I will be leaving this facility, I know that this facility isn't unique amd have encountered this to varying degrees elsewhere. Leaving isn't the ultimate answer because the worse the shortage gets the more norm this situation will get elsewhere.
One last thing I want to say is if I didn't paint a clear enough picture about the taking of the 7 patients and such is that even with having to draw the blood, do our own EKG's, transport, etc, is also the fact that these tele patients most are on drips as well, and many times we also have patients on insulin drips with hourly accu checks as well. I just didn't want anyone to think that taking 7 was no big deal because as i said it is manageable if their acuity is such that they aren't on drips or anything else tht raises the acuity.
Sorry this is so long. I am wrapping it up now. I am still upset about last night so i tend to write/talk too much as it helps me vent a bit. :-)
Thanks for taking the time to read this. If anyone has thoughts suggestions, their own war stories to tell, please do so. I am eager to hear how others would or do deal with these types of situations. If anyone wants to email me privately, my email addy is: