Unsafe nursing/High nurse:patient ratios

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Reply Mon 2 Apr, 2007 08:53 pm
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:

[email protected]

Reply Fri 6 Apr, 2007 07:05 am
Seriously???? No responses to this? I honestly thought I would have many people sharing their own unsafe conditions, offering suggestions, etc. Maybe the length scared some of you away....if so, sorry about that, I tend to get very descriptive and try to paint a very clear picture...that may be my downfall.
But, is anyone else out there having similar problems with being short staffed, assignments they feel are unsafe and being made to take them anyway? Does anyone else feel as though their license could be in jeopardy by fear of making a serious mistake because we are spread too thin? Anyone have any suggestions as to what type of recourse we have as nurses without union representation? There is only 1 hospital in the area here that is unionized, and unfortunately, they are represented by a group of local food workers, not exactly a group that knows anything about nursing.
So, I welcome stories, ideas, suggestions, anything. I'll check back later. Have a great day!!

mrsA rn
Reply Mon 9 Apr, 2007 07:10 am
dear born2run,
i'm speechless. and yes, similar situation at my facility as well (although that night you describe is just horrid). i keep trying to find out how to document these incidents...do i fillout a formal incident report for unsafe working conditions? do i just keep emailing the DON?... I have filled out med error reports and added 'high acuity' as a factor of why the error was made. i have attended meetings, offered suggestions, asked questions and always get the same old "we're working on it", in one ear out the other type communication. i thought of writing a letter to the editor in our small town paper but i'd probably lose my job. i work in a rural facility in maine. we get m/s, tele (no drips), peds, snf level ( w & w/o dementia), comfort care on this unit. the next hospital is 25miles away...my choices are limited.
i work nights too with a skeleton crew as well. i don't have any answers for you, just empathy. i have gotten to the point that agruing with supervisors over the admit is much more mentally draining than just taking the damned admit. i have reached and passed exhaustion. i trained an entry into practice recently and learned that my views on patient care changed drastically since i started 6yrs ago. safety still being #1 but other aspects comprimised. i hate that feeling. call-outs is a huge issue too. everyday for the last 3 months there has been at least one callout per 24hrs.(this IS a FACT told to me by our scheduler person) whether it be an aid, secretary or RN. i'd guess it's because everyone is exhuasted.
i would love to hear some body's fairytale story were they fought short staffing and won. WHAT DID YOU DO TO WIN????!!!! i AM up for the fight
RV Traveller
Reply Thu 19 Apr, 2007 05:08 pm
high patient ratios
I looked into going to Florida last fall instead of Calif. where we normally go. I was told they are 30,000 nurses short when the snowbirds are in season. I then find the license is $200 and takes 2 months to process. I get a questionair that is the equivelant for a top secret clearence. I have nothing on my record I'm ashamed of but no one needs all that info for a 13 week assignment. It's no wonder their short nurses.
As far as working with too many patients, most every telly floor I've worked is that way. Calif. by law limits nurses to 5 patients, then they assign two LVN's drips and vents so the RN has 8 to 12 patients while the LVN's set on their butts with the nursing assts. And on weekends you have to go to the Pharmacy to get you patients Meds.
As a Traveller you will get the worst cases and the on staff Nurse will tell you straight out that's the way it's going to be. Until Nurses wake up and get Union Representation it WILL be like this.
Reply Thu 26 Apr, 2007 12:20 pm
Hi RN Traveller!

I guess I have to ask what hospitals in California do you go to? I haven't ever gone to an assignment in the last 6 years of traveling that the travelers were treated any different than the staff nurses. I have never gotten assigned the "bad cases" while the staff got better cases. In my original post, the night that I was describing was like that for ALL on that shift, core and travelers alike. The entire hospital that I am currently at in St. Louis is horribly unsafe and high ratios, etc.

I plan to go to California in the fall. I am going to do one more assignment here in St. Louis at a different facility then go. I am currently working with several nurses that recently came back from assignments in CA and every one of them loved it there and all said they were treated fairly and none had encountered what you describe. As far as the telemetry floors, I must have just been lucky in all the other places that I have gone to as I have never had to take more than 5 patients on nights and 4 on days....rarely if there were lots of call offs or something, it may have happened but not usually the norm. Maybe I have just been fortunate in that respect. Honestly though, I don't mind having to stretch myself thin to take more patients in a pinch, but not when I have all high acuity patients, then it isn't feasible. I am not one who wants to lounge around when I am working or anything, actually I prefer to be busy as the shift gets on much faster that way but busy is one thing and dangerous and unsafe is another.

I hear you on Florida though. I have no clue why the license is so high the first time, renewals are only $50 which is only $5 more than here in MO. I know I was told 2 months for my FL license, but I think they just tell you that. I got mine in less than a month and I did have something minor in background but I still had to provide them all this extra documentation and certified papers and such so i thought it would be forever but was around a month. I remember that they sent me a temporary license good for 60 days that I could use as soon as I got it but if the real one wasn't in at the end of that 60 days yet, you couldn't work anymore til the real one came in, fortunately that didn't happen to myself or anyone else I know. There is a huge need in FL, but at both the hospitals I worked at in Orlando, we always kept our 1:4 ratio and if we didn't have enough nurses to take more admissions in the hospital, the hospital went on diversion as a means to prevent dangerous situations from having unsafe ratios. I personally loved it in Orlando and the hospital I worked at I loved. I only came back to MO because I had health issues. Now, I want to try CA just because of all the great things I keep hearing from everyone. I will do one assignment and if it is bad, I can always leave. Oh, and about the FL license, even though it is around $200, your travel company should reimburse you if you take a position in that state.
Thats all my rambling...LOL
If you have any questions/comments, feel free to post on here or email me privately at [email protected]

Have a great day!

Reply Thu 26 Apr, 2007 12:28 pm
Hi fem007!

Nice article and so very true. I am just waiting on my Genie in a Bottle to be able to "POOF" and make the "suits" and "policy and procedure big wigs" REALLY be able to see why and how the current trends in staffing and safety are detrimental and not instrumental in patient care and satisfaction.
RV Traveller
Reply Fri 27 Apr, 2007 12:06 pm
California Travel
Hi Born2Run
I don't mean to say all Ca. hospitals are terrible. l have had some very good experiences here. But in my experiences at most l will get the patient needing the most care or the one with the problem family, or like last night the one with dementia, removing IV's, and using the floor as a restroom. I have seen staff Nurses refuse patients that were then given to me or another traveller. Not just in Ca.
For the most ,in 13 years of nursing, l have seldom seen travellers treated the same as staff anywhere l've been, even when l was staff, though seldom as bad as my current assignment. As l said before, the hospital is short staffed in a community that has a 28% increase in population in 5 years. It's not just the hospital, but schools and other services have suffered. We stay in our RV in a retirement park. No one in the park uses the local hospital. They all prefer hospitals in Riverside. The first thing we heard when we got here was a trip to the emergency room here was a 7 hour wait if you were not bleeding. I have had an na tell me she would not do anything l ask of her and would actually do things for a staff nurse. She even called me to tell me one of my patients(who she was also assigned) needed help to the restroom while she set at the Nurses station gabbing with a staff nurse.
You may read this and think, boy, RVTraveller must be hard to work with.. the fact is l go out of my way to get along and have few problems with other RN's, tech's or na's. My biggest problem is I try to be as through as possible with my patients and at times I'm not as fast as some, but my patients come before anything else.
Reply Sat 28 Apr, 2007 08:33 am
RV Traveller,

No, I don't think at all that you are probably hard to work with. I was sitting around thinking about this again the other night, and I guess I do see more predjudice towards travelers from the techs more than anyone else. I think I really lucked out when I was in Florida though because the hospital system that I worked in was largely staffed BY travelers, and I think they were just so glad to have us that I didn't once feel like I got a bad assignment in favor of the staff nurse. I stayed at one hospital for 3 years, just renewing my 13 week contracts over and over....there was supposed to be a rule that you couldn't renew for greater than 1 year without taking at least 13 weeks off and going elsewhere for that time then coming back. There were quite a few of us that did this. It was almost like we WERE the staff and after a short while, many people forgot we even were travelers. We had a really good group of strong, intelligent and competent travelers. Management was even letting us get their "premium" bonuses...you know, where they call you at last minute and beg you to come in for $20/hr OVER your base rate!! Yeah, it was nice there....I only left because I had to go "home" for personal reasons, but I am sure I will go back in a year or 2. I think I had been there less than a month and I was doing charge at least 1 of 3 shifts a week.

Anyway, enough of that....the hospital that I am in here in St. Louis now is kinda like that, there are 3 travelers on nights and we have all been there 8 months (we are all leaving in 3 weeks), and besides ONE nurse and a handful of techs, us travelers have been there longer than anyone else on that shift!! Is that not scary? The "core staff" on days is about 9 nurses and nights as I said. So, in that respect, this hospital is similar and therefore we do also get treated like core staff, unfortunately in this case though, that means we are not treated well. They can't keep people on this floor at all. I have seen at LEAST 10 people I know transferred to either ICU or another floor and at least 20 or 30 have quit during this time. It is ridiculous. And, management just doesn't get it!! The 3 or us travelers that I mentioned on nights all started within a month of each other and we have all offered suggestions on what needs to be fixed, ideas, feedback, etc, and to no avail....however, the funny part is they are totally freaking out now since none of us have renewed again and we are all scheduled to be gone in less than 30 days. So far, we are all planning on leaving and we have all been submitted to another local hospital with MUCH better ratios and we are waiting for word on that...supposedly, its pretty much a given. Anyway, we have all told them we are only going to renew if this other deal falls through, and they are litterally SURPRISED we are leaving!! I mean flat out, mouth dropped open, "Are you joking?, Why would you want to leave us?" They are just clueless! LOL!

I am rambling again..sorry. I feel better about California now, your earlier comments worried me a bit. The most positive area I heard for travelers to go in CA is San Diego, but I am still looking around. Also, the current hospital is also a hospital that I don't know a single person that would come here willingly! The 7 hour wait in the ER where you are is pretty good, and I am not joking...its been around 12 hours here. Actually, when I left FL, it was a minimum of 12 hours there also...theirs was based on staffing, if patients in ER needed admitted and were not enough staff to admit to floor, then they stayed in ER sometimes up to 48 hours which backs up others getting in. When that happened, the hospital would divert to other hospitals and close our ER down. That helped the nurses from getting spread too thin and becoming unsafe for patients but also hurt patients that needed to be seen by delaying their care. Its really a no win situation and I don't know the answer to the problem, so its certain to cycle on.

OK, I have rambled too much. I guess i am still wound up as I just got off work. You can email me privately if you wish or post here if any other questions or comments.

Have a great day everyone!


[email protected]
Reply Wed 16 May, 2007 11:09 pm
I'm sorry that you had such a horrible night and understand your frustration. I did want to explain however what it is like for some of the ER nurses. We are under constant pressure to move the pts, either admission or discharge . I have felt the scorn of management when I have suggested to PA's or MDs that I felt the pt was too sick to be discharged. It seems like management only cares about their pt satisfaction scores, Lets not leave that flu, chronic back pain in the lobby until the critical pts have the care they need. I've have 11 pts at a time, some very critical needing or had been intubated, on drips, etc... Sometimes I hardly see some of my pts because I dealing w/ a critical situation. It's a hospital wide promblem affecting every unit. We need a stronger voice to make the changes, JACHO seems to worry about the stupid stuff not the pt nurse ratio. All kinds of article are out there about how hospital can kill pts but nothing is written about supporting laws to protect the pts and the poor nurse just trying to do her job and support her family. We are losing more and more of our new nurses because of the insanity. I am not that far away from the golden yrs and wonder what it wil be like when I need the care. Anyway I guess I made this my own agenda when all I really wanted to say is I feel for you and I appreciate that you do care.
indiana nurse
Reply Sun 3 Feb, 2008 02:52 am
Call the doctor with your concerns and DOCUMENT that you did so! Cover you own a-- Exclamation
Reply Mon 4 Feb, 2008 06:33 pm
Just an FYI indiana nurse,

Obviously in any of these situations, I am documenting very thoroughly, so the concept of covering my a-- is always taken care of. However, based on your response, my immediate thought is that either you are a very new and green nurse or you work somewhere that none of these issues are a problem. My guess is the former, as the latter situation would be very rare indeed.

Calling the physician and telling them of the situation is not really a solution. Obviously, when I am dealing with very ill and critical patients, I am in close contact with the physician. However, being in close contact and reporting my findings to the physician does not help the unsafe and dangerous staffing ratios. The physician has no control on staffing ratios. Even if the physician did get VERY involved and call the administration of the hospital himself, they can't make extra nurses appear if there aren't any TO appear.

Thanks for your input, but I am not of the belief that the physician is the "god" and is all knowing and all powerful. Granted they have their place inall this but it is not in healing the staffing issues.

indiana nurse
Reply Thu 7 Feb, 2008 06:47 am
Wow, you now seem upset with me? So, I will assume that you are very passionate about this issue. Please, consider taking action to improve your work situation. Understand that healthcare is also a business. Our overall economy is very bad right now. Take a deep breath and put things into prespective. I'm glad that you care so much about this, I think most nurses do. Insteed of being negative toward each other, I would rather support each other. I hope your situation improves for you and your patients.
Reply Sat 16 Feb, 2008 10:32 pm
My apologies Indiana Nurse. I didn't mean to snap at you and didn't honestly realize how that came off until I re read the posting. I just get tired of these same situations happening over and over. I am currently in another position where they do not EVER go over the suggested nurse/patient ratios and its kind of a breath of fresh air. So far I am enjoying it immensely!
I apologize for snapping at your answer, just reminded of a time at another facility that I had to call doc because I had eight or nine really sick, confused patients and most of them were on drips. Well, i had gotten a new admit even morse confused andclimbing out of bed and trying to pull out lines and evrything and she was on a high dose heparin drip to boot. Nursing management refused to allow a sitter to stay in there and refused to allow restraints even though physician ordered them appropriately. Adding to this, they had me taking care of only this one new patient on this end of a hall while my other 7 patients were at the complete opposite end of another hall leaving me NO WAY of being able to watch her at all. Those other 7 were sick enough that it would be pure luck if I made it back to this patients room by the end of the night and it was 2am when this occured.

Calling the physician about this, he ordered restraints again, demanded a sitter and when I said nursing supevisior refuses those requests he demanded I write in the progress notes and on an order form this message:

"Patient is very confused and high risk of falling or other injury because she is on high doses heparin and could have a lethal bleed if falls unsupervised. This patient could also exsanguinate if she accidentally removes her IV line in her confusion. I have ordered soft wrist restraints and a sitter for this patient that nursing administration has refused. I also had been aware of the staffing ratios and originally intended to place this patient in the ICU where she could be watched more closely and I was told by the nursing supervisor that she would not allow her to go there because she did not "meet ICU criteria". I am holding nursing supervisor and nursing administration 100% responsible if any injury comes to this patient for refusing to comply with theorders I have written. In addition, in the morning, I will find a hospital in the area that I feel would actually be safe for this patient and any other patients I admit"

The next morning, he recinded his own admitting priveleges to this particular hospital. I documented that note in the orders and in the progress notes as he had requested as well as very carefully documented events in my nursing notes. I was a traveler there and had one shift left the following nite at that facility which I obviously called out from. After that, there was no way I would walk back in there and I am so glad its over. Never heard from anyone about writing that in the chart. I made sure to write it on progress notes and order sheets that already had other notes and orders on them in case they just tried to throw those pages away. Knowing them, they probably did just that, but I didn't stick around long enough to find out.

So, Indiana Nurse, that is why it may have seemed I was mad at you, and i apologize, it just triggered that frustrating memory is all.

Have a great day!
Reply Mon 18 Feb, 2008 04:10 am
Re: high patient ratios
RV Traveller wrote:
As far as working with too many patients, most every telly floor I've worked is that way. Calif. by law limits nurses to 5 patients, then they assign two LVN's drips and vents so the RN has 8 to 12 patients while the LVN's set on their butts with the nursing assts.

I take offense to this comment. I'm an LPN and I feel I work with a great group of RN's and techs. People get so uppity with their RNitis it's pathetic. I would not tolerate someone who "sits on their butts" while others are working theirs off. I feel I'm a very educated nurse who is an asset to our team and it really bugs me when people make these generalized nasty comments about LPN's (or LVN's as the case may be). I've seen plenty of RN's who sit on their butts enjoying an easy shift because they lucked into a cream assignment while others around them struggled to get their 9pm meds given by midnight. It's not the type of nurse, it's the person who is a nurse. We had an RN who cut a peg tube in half because she blew the end of it pushing with too much force, we had an RN who gave adenocard (thankfully over a minute so it was ineffective) because she thought another nurse told her to, we had an RN who gave 10 0.25mg tablets of xanax to a patient because she thought the order said 25mg (thankfully HER math was wrong and the patient had no ill effects), we had an RN whose patient started bleeding from old central line sites on each side of his neck so she put 5 pound sand bags over each bleed! It wasn't because they were RN's, it was because they were stupid idiots. Yet, had an LPN done the same things I bet there would have been an outcry about how LPN's need to have their duties lessened because "they are like monkeys, you can show them what to do but they don't understand why they are doing it" - that was a favorite phrase of a CNO we had hear a while back. Of course, I'm still here but she got sacked a few years after she started. How many of you knew what you were doing until you learned the rationale for the action? Were you born knowing it? No! Nursing is pretty much a learn on the job career for LPN's, RN's, BSN's, etc.

RV Traveller wrote:
And on weekends you have to go to the Pharmacy to get you patients Meds.
As a Traveller you will get the worst cases and the on staff Nurse will tell you straight out that's the way it's going to be. Until Nurses wake up and get Union Representation it WILL be like this.

I came to this site looking for information on unions. We just had a union contact some of our staff (and, of course, administration did their best to discourage the thought of a union stating how unions hurt patient care). The fact that they over-burdon nurses with 6-7 patients a piece while taking drips and pretty ill, high demand patients isn't a problem to them while they sit in their meetings all day looking for ways to save a buck and protect their paychecks. To me that ratio is a danger. More than 4 patients gets pretty hairy at times but we struggle with it night after night, day after day. I personally don't know how dayshift nurses do it with 5 patients a piece.

We only have a sick time of 3 days a year now (if you call in 2 days in a row it's considered 1 incident). So many are going to work sick being told "we don't want you to come in sick because you'll infect the patients" but yet if you don't come in you get written up. Double-edged sword there.

My last yearly raise was 11 cents. I bet administration gets far more than that.

Anyway, I need to peruse this message board some more. It doesn't say it's an RN only board but from this posting I'm a little leary. I'm all for weeding out the bad eggs, nurses seem to be great at doing that, but we need to stick together as a group on the whole so we aren't divided and conquered when we try to better our lives at work and make things safer for our patients at the same time.
indiana nurse
Reply Fri 22 Feb, 2008 07:55 am
Hey Born to Run RN, I had a similar event. Difference is I was able to get a sitter. However, the sitter was making out checks for her personal bills, cutting coupons,and on the internet etc. The pt pulled out the IV ofcourse. So aggrivating!
Reply Sun 24 Feb, 2008 12:33 pm
Yeah, unfortunately that does happen with some of the sitters...not saying all, so don'tanyone jump on me because of that generalization! LOL! That was not intended for you Indiana nurse, just some of the others defensive on this site.

Those situations are so frustrating. I was so nervous writing that in the chart, both in the progress notes and on the orders and was expecting severe repercussions for that, but at that point, which I made my last nite, I never heard from them. It was comforting because before I left that morning, that doc showed up and took the chart after making his note and headed off to administration and calling social service to get her transferred to another hospital.

I did learn after that experience that I am most definitely there for the safety and health of my patients and would not hesiate to chart like that again. If we don't stand up for our patients, then who will?

Have a great weekend!

indiana nurse
Reply Sat 8 Mar, 2008 10:42 pm
As long as people are tring thier best I never get upset with them. I know I'm not perfect either. I just get so frustrated when people don't do thier work. The ones that act like they have done the hospital a favor by showing up, and work at not working get on my nerves!
Reply Sun 9 Mar, 2008 01:56 pm
You can refuse
If you are in a situation where you judge it to be unsafe and I would say 7 patients with the acuity level you described is unsafe. I know a nurse that was in a similiar situation, she called the house manager and told her that she did not feel it was a safe environment for the patients. The house manager said "that's nursing". This nurse late that day after she was off called the Board of Nursing for the state and related the situation without giving the her name and the hospital. They told her the next time this situation occurred to tell the house manager she was going to call the state and report an unsafe practing situation. Well the situation came up again the nurse call the house manager and ask for more personel, the house manager said there was nothing she could do. The nurse proceed to tell her that she was going to call the state board of nursing an report the unsafe situation. Within 5 minutes there was another nurse on the floor. The autocratic/hierarchical rule of nursing management is a throw back to the dark ages. We live in a different time where we do not have to put up with this kind of idiot thinking.
Reply Sat 15 Mar, 2008 02:05 am
unions, shortages and all around fun.....
Hey all, new to this forum. Just read your orig post and I must say I agree with you about the pt with a Hgb of 2 needing to get off the Tele floor! I am an ER nurse (8 years in Detroit, now in Phoenix) and if that had been my patient, I would've REFUSED to even send him to a Tele bed with that kind of value! It's insane - and yet, the ONLY group of healthcare workers out there that DOESN'T have any kind of protections from "pt abandonment" and "refusal of care" issues for staffing is...... you guessed it. NURSING.
It's why they passed the law in CA - 1:4-5 max. It needs to be that way EVERYWHERE. In the Level I trauma center I used to work in (Detroit), you would START the shift with about 10 patients and try to keep it under 20 all the way thru the shift! Lunch breaks? What lunch breaks? Safety? No such thing. You just try to get thru the shift without anyone on your team coding. If you're lucky you get a tech. The agency nurses come to work early, walk thru the ER, go back to their car and call in. In Phoenix now, my hospital has a 1:5 ratio in the ER. On tele & MS it's 1:7 too. Of course, this particular place doesn't do trauma, but that doesn't mean patients are in any better shape. The drunks looking for detox all go to tele here (god forbid, they drink too much and might have a cardiac issue! LOL) which is a waste of a good cardiac bed. We have snowbird season here too -- lots of elderly, LOTS of cardiac.
I personally hate JCAHO (evil empire akin to Walmart), they make it so much harder for nurses especially. If you feel a situation is unsafe and your boss tells you to suck it up - call JCAHO and your STATE
BOARD. Get em shut down, they'll think 2x about screwing with us again!

I for one will NEVER work ANY FLOOR EVER AGAIN. That's why I got into ER - treat em and street em - whether it be to the floor or the door.
Reply Wed 21 Mar, 2012 09:32 am
After reading this, it is so scary to me how widespread this problem is. I work on a medsurg unit in Louisiana. And just recently we have been experiencing some staffing issues that administration doesn't seem too concerned about because they are wanting to "tighten our budget" and restrict the use of agency nurses. Usually, our nurse to patient ratio is 1:6 during the day and 1:7 at night. But lately, since budget cuts and shorter staffs we have been seeing that 7th patient during the day try to ease its way into being the norm. I agree that if the acuity of the patients are low then that 7th patient really wouldn't pose that big of a problem. But unfortunately where I work, we do not staff by acuity because EVERY patient scores as high acuity! After a visit from DHH last week, one of our nurse managers decided to have us try "team nursing". Each LPN is paired with an RN and the RN is to do the assessments and the LPN to pass out medications. These were the only guidelines that were given to us. Now mind you, when this decision was made it affected the night shift coming on (these night nurses had no idea what they were walking into!) This was not something that was thought out and then executed. So the following day when we came on, my partner and I had a total of 12 patients! Now me being the LPN, I had to pass 12 patient's medicines in the allotted 1 hr time frame we are given for 0900 meds. We were never given guidelines as to how many patients we are suppose to take, if there's a max, which nurse is suppose to answer the MDs' questions, phonecalls, take or give report, etc. They do not take into account that this is NOT a nursing home, we are working on an acute unit with very sick people ranging from any age and post-op patients. My partner (who is usually the charge nurse) was also responsible for these 12 patients and was still expected to charge! so while shes doing her assessments and rounds on 12 patients (as am I), who's taking off orders?? Day shift is extremely busy with doctors staggering in writing new orders, sometimes bombarding the nurses' station all at the same time, surgeries are scheduled so we are having to preop patients, tests and procedures going on, IVs going bad and needing to be restarted, ER calling for beds, Case Management calling for beds for direct admits, ICU trying to get patients stepped down. And our managers are telling us we have NO MAX! When is ENOUGH enough?? This past Monday wasn't as hectic because we had 7 patients as a team, which was doable! But then the next day we walk in to 8 patients and 2 admits first thing in the morning. So now we are up to 10 patients before 8am. The other team had gone through a total of 15 patients by the end of the shift, having a total at one time of 12. The one RN that was by herself was actually orienting an RN fresh out of school! They started out with 6, was given a 7th, and then was almost given an 8th! Of course this nurse was extremely upset because she did not have a true TEAM. Our managers actually tried saying because she had the orientee with her that she could take those patients, which is not the case because this new nurse is FRESH out of school! When she brought this concern to our managers, she was told that there is no max! So we should just keep taking patients. I feel like my license is on the line with things becoming this way, and I am sure she felt the same way! It's not the managers that have to worry about losing their jobs or licenses if a patient dies from something that could have been prevented if we were staffed properly, its the nurse who's responsible for that patient! I feel like administration doesn't care about the patients or the nurses. Because they want to save some money, we are overworked and understaffed and its the PATIENTS who are suffering because we cannot provide them the adequate care they are expecting when they put their lives in our hands. We are getting burntout and doing these patients a big disservice. Changes that are being made are being made by those sitting at a desk and behind computers, NOT working the floor to know what works and what doesn't! Something has to be done, but we can't seem to get anyone to stand behind us to make the right changes. I went into nursing because i have a true compassion for taking care of PEOPLE. So, my question to these people setting the rules we are suppose to follow is, "What did YOU come into health care for??"

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