Unsafe nursing/High nurse:patient ratios

Posts: 56 · Posted: Mon Apr 02, 2007 6:53 pm

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. Smile

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:

Born2RunRN@aol.com

Denise

Posts: 56 · Posted: Fri Apr 06, 2007 5:05 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!!

Denise

Posts: 3 · Joined: 19 Mar 2007 Posts: 3 Location: Maine

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

Posts: 12 · Joined: 20 Dec 2006 Posts: 12 Location: Ohio

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.

Posts: 2 · Joined: 17 Apr 2007 Posts: 2 Location: Jacksonville, FL

Here is a paper I wrote in my BSN program that support better staffing ratios...
Review--An Integrated Analysis of Nurse Staffing and Related Variables: Effects of Patient Outcomes
You are a nurse. You love your job; the love, the caring, the responsibility, the autonomy, the time to get to know your patients and to work to make them feel better and if everything goes well, the chance to see them go home and live healthy and happy lives. Many times you may have helped them through a harrowing and life-threatening experience, maybe you were able to help bring them back from the brink of death, or maybe, just maybe you were able to make their passage into the next life a peaceful and respected journey. Everyday you work, you help patients, families and doctors, and also your co-workers and managers; and everyday you come in you deal with their expectations and frustrations.
As nurses, we have been taught to be care-givers, listeners, organizers, nurturers, decision-makers, and to be so many other ideals. It is part of being a nurse to give care and consideration to the many people we are consistently responsible to and for, the kind of care they expect and have a right to.
The nursing shortage and recent staffing ratios instituted by many facilities has made giving the right kind of care next to impossible. There is no longer time for all we have to do, more often than not; we are leaving patients in unsafe situations.
This article compares various researchers and their findings on the effects of nurse staffing and the outcomes, difficulties and dangers patients have faced and still face today. “The parallel is astounding. In the late 1990s, modern nursing was under attack from the consulting firms that promoted radically ‘restructured’ care modalities to reduce the costs of patient care. For example, Byron Erwin, President of the APM Consulting Firm, insisted that there should be no nurse above the level of head nurse in any facility (Erwin, 1994)” Curtin (2003). Florence Nightingale was similarly persecuted by Parliament when they tried to blame her for the increase in deaths at Scutari hospital; she was able to exonerate herself by proving the unsanitary conditions in the hospital caused the deaths, Curtin (2003 pg.1). “…Seago (1999) demonstrated that utilizing lower paid nursing assistants to give care actually increased costs. Sovie and Jawad (2001) studied 28 university hospitals that had undergone restructuring and reengineering and found that patient falls increased as nurse/patient ratios increased, while patient satisfaction with pain control decreased as nurse/patient ratios increased” Curtin (2003 pg. 2). In the last five years several studies have been done and they have clearly indicated that there are more patient complications and poor outcomes when nurses are staffed with increasing patient numbers, especially in intensive care units with 1:3 or 1:4 nurse-patient ratios. In another study that included financial risk, these ratios have also been shown to increase hospital costs.
“Dimick and colleagues linked hospital discharge data to a prospective survey of organizational characteristics in the intensive care unit-an indicator that some environments are predictably therapeutic, while others are just as predictably toxic” Curtin (2003 pg. 3). Part of being therapeutic means having nurses with greater autonomy, more nurse control of the unit budgets and resources, and positive communication and collaboration with doctors and the rest of the team providing care for the patients. Studies show that therapeutic environments encourage patient outcomes and toxic ones slow the healing process and increase mortality. “…A higher proportion of hours of care provided by registered nurses was also was associated with lower rates of pneumonia, shock or cardiac arrest, and ‘failure to rescue,’ which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep vein thrombosis” Curtin (2003 pg. 5). Study after study shows that a higher nurse/patient ratio (i.e. 1:2 in ICU and 1:4-6 on the floor) significantly reduces the risk to patients and the adverse affects of their stay. “Results demonstrated that the odds of patient mortality increased by 7 percent for every additional patient (over 4) in the average nurses workload. The same increase in odds was evident with respect to the failure to rescue rate” Curtin (2003 pg. 6).
Several other studies found that staffing and nurse turnover are heavily related to the outcomes, length of stay, and increased hospital costs. Institutions that provide better ratios have less nurse turnover and experience less undesirable patient outcomes/sentinel events, thereby decreasing hospital costs. Just the costs of orienting new nurses would decrease with fewer turnovers.
Nurses’ education has also proven to affect the number of poor patient outcomes. “A 10 percent increase in the proportion of RN’s across all hospital types was associated with five fewer deaths for every 1000 discharged patients” Curtin (2003 pg. 7). Another study showed that “A 10 percent increase in the proportion of nurses holding a bachelor’s degree was associated with a 5 percent decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue” Curtin (2003 pg. 7).
“Only nurses can nurse, but administrators create the environment and circumstances within which care is given. If the environment is toxic, nurses will leave, patients will suffer, and in the end, hospitals will lose the money they are trying to save” Curtin (2003 pg. Cool

.
In conclusion, many nurses feel that most administrations care more about the bottom line than the nurses, and therefore, the patients’ well-being. This would be a result of the non-nursing administrators operating the institutions around this country. With better staffing ratios, patients will receive the care they expect and deserve. Nurses will be able to, if not prevent, at least delay sentinel events, leading to improved patient outcomes. Increasing nurse/patient ratios, encouraging autonomy and allowing nurses more control of their environment and responsibility of its operation will decrease nurse turnovers. It will make them more concerned in maintaining good relationships with doctors and various other co-workers involved in the patients care. With such autonomy and accountability, more nurses will seek higher levels of education and professionalism, and the result will be better patient outcomes, lower hospital costs, and a decrease in continuing nurse shortages.

References
Curtin, L. L. (2003, September 30). An integrated analysis of nurse staffing and related variables: effects on patient outcomes. Retrieved May 8, 2005, from Online Journal of Issues in Nursing Web Site: http://www.ana.org/ojin/topic22/tpc22_5.htm

Posts: 56 · Posted: Thu Apr 26, 2007 10:20 am

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 Born2RunRN@aol.com

Have a great day!

Denise

Posts: 56 · Posted: Thu Apr 26, 2007 10:28 am

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.

Posts: 12 · Joined: 20 Dec 2006 Posts: 12 Location: Ohio

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.

Posts: 56 · Posted: Sat Apr 28, 2007 6:33 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!

Denise

Born2RunRN@aol.com

Posts: 2 · Joined: 16 May 2007 Posts: 2 Location: Nc

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.

Posts: 10 · Joined: 02 Feb 2008 Posts: 10 Location: indiana

Call the doctor with your concerns and DOCUMENT that you did so! Cover you own a-- Exclamation

Posts: 56 · Posted: Mon Feb 04, 2008 4:33 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.

Born2RunRN

Posts: 10 · Joined: 02 Feb 2008 Posts: 10 Location: indiana

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.

Posts: 56 · Posted: Sat Feb 16, 2008 8:32 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!

Posts: 2 · Joined: 18 Feb 2008 Posts: 2 Location: TN

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.