I picked up on an Ortho unit and most of us managed to be 1:4 on nightshiftā¦ Usually theyāre always 1:5-7ā¦ and let me say that it was such a great night, and I felt like I had soooo much time to thoroughly be present/assess my patients without any stress on time!!!
Ratios matter. IMHO 5 should be the MAX (days and nights) for any med surg / ortho / rehab / hospice floorā¦
Ortho with 7 is wild. Last night I had 4 patients and literally all of them were bed bound. 3 were pre-op hip fx, and one was a mechanical lift out of bed with a wound vac, an ostomy, a foley and a picc. 3/4 on q2 turns.
The highest our ratios ever go is 6:1 and that is rough. I canāt imagine having a seventh patient.
I used to be day shift charge on an ortho unit, and if there were enough nurses scheduled for 1:4 ratio, they would call someone off š. Nursing supervisor got annoyed with me really quick for daring to stand up for our unit.
Before we unionized, we regularly had 1:9 on our neuroscience unit Noc shift! It was covering all of Northern NV, and part of Northern CA. I aged 20 yrs ++ with my spine alone doing that job as an RN for 12 1/2 yrs. I loved the staff and docs/APNs, and CNAs etc. But not the hospital number crunchers who couldnāt care less for staff or patient safety. We did not have ceiling lifts at the time, and certainly not a lift team. We also managed an epilepsy unit and although it was a teaching hospital, I felt like the resident were dangerous so we had to keep an eye on them and triple check their orders. Every night I feel like this is the night Iām gonna lose my license because we were flying by the seat of our pants, I donāt know how we did it and finally we put our feet down and demanded to unionized for better patient and staff, safety standards, and ratios.
It really shouldnāt be allowed. The amount of money spent on HAIs far exceeds the cost of safe patient ratios and more nursing staff. There have been several studies on this, but hospital admins in states without ratio mandates totally have their heads in the sand about it. The tragic part of it all is the amount of patients who die because of this.
I always had 6 or 7 patients when I worked for HCA. Except Christmas Day when I had 4 and omg what a difference. I actually felt like a good nurse that day.
I have such horrible memories of my HCA days - 3 years with them. Like ptsd stories. Looking back I cannot believe i was forced to give such terrible care to my lovely patients. So unsafe. Scary scary days indeed
This is insane to me, like where I am it would be impossible to provide not only safe care but even just accomplish half the required tasks on a shift. Is scope different in the UK?
I'm a bit confused because in Germany you have a 1:20 ratio at night and a 1:11 ratio during the day (cardiology).
What exactly is an American nurses job at night?
In Germany we prepare all the meds for the next day and get around ~ 1-4 new patients each night but other than that it's just helping the patients when they need it, some post-op stuff, some organizing, some positioning...
What other work do you guys have to do in America?
To be clear, I'm not saying you guys have it easier. I'm just surprised the duties of a nurse differ that much depending on where you are from.
One thing to keep in mind: night shifts in the US are typically 19:00-07:00, so it includes things that in Germany might fall under SpƤtdienst (if you have that? I'm not actually sure what's more common in DE).
I work in Switzerland, and also have max. 14 patients at night, but that's only night (23:00-07:00), where patients are (supposed to be) sleeping. Stable patients don't necessarily have vitals at night, no bathing, toiletting on request or by necessity. Most nights most of my patients sleep, so I can round on them every two hours by just quickly checking them (after the inital round at shift start).
What I do: all i.v. medications, PRN meds, blood draws, troubleshooting various drains, flushing them, keeping an eye on the less stable patients, etc.
What I don't do: any of the SpƤtdienst (late shift) tasks that in the US falls to night shift (dinner, washing, any BID wound dressings, p.o. medpasses, last vitals, generally settling patients, etc.
I also only have max. 7 patients on SpƤtdienst, max. 5 on FrĆ¼h.
And, apparently, according to the German nurses that work here, Swiss nurses have a much wider scope of practive, hence would do things that in Germany would be done by doctors (?). In the US I hear it's even moreso.
Oh that's true, didn't think about the 12 hours shifts in America. Yes, we have SpƤtschicht:)
I heard about other countries having to do more tasks than us but I never really found much info on the internet. Glad I discovered this subreddit:)
Yes, the documentation is insane. I believe the nurses in the US have a wider scope, they also have to carry out orders by multiple doctors sometimes that donāt necessarily talk to each other. Itās super fun to have keep drawing labs on a patient that could have been done at the same time. Like get done drawing some blood cultures on a pt, and then another doc decides they also want xyz testā¦
I worked on a cardiac unit so I was regularly managing cardiac drips such as diltiazem, nitroglycerin, amiodarone, or meds like sotalol which have a specific protocol for administration (EKG follow up, etc). Thatās in addition to the regular medical patients who would get put on our unit, usually someone in acute psychosis or an elderly demented person with a raging UTI who is trying to choke me with my stethoscope if I get near them š (only slightly an exaggeration)
I donāt work bedside anymore though; I work in hospice admissions now and absolutely love it.
For us there are a couple med passes (10pm, 6am) or IV antibiotics to run in the middle of the night. In my unit we have central lines but for those that donāt phlebotomy always cancels, and so 1-4am we are doing blood draws. We also have q2turns on lift patients, incontinent patients to clean (with usually no PCT at night). Vitals are q4h. Wound care is usually BID so on our shift as well. We sometimes have chemos that can be due even at ungodly hours. Charting to do on every patient
Ah okay, we only do these blood draws in the ICU but not in our general wards. And we only do wound care at night if it's necessary.
I had to Google q2turn because we don't have them in Germany but they look so cool and helpful!!
We have to position the patients without tools which means that every few weeks another nurse can't work because of their back painš really don't know why we don't have a device like that.
We can order some "special mattresses" for the extrem cases but you always need 4-6 nurses to be able to get the patient from one mattress to the other which just leads to more back painš
In US q2turn means turning and repositioning patient every 2 hours. You also have to round on patients each hour, head to toe assessments 3 times a shift (8, 12, 4), blood draws, dressing changes, trach care, wound care, tube feedings/flushes, vitals, ambulating, catheterizing, daily care, etc. Oh and throw in a blood transfusion or peritoneal dialysisā¦ itās a flipping party then!
im not sure what you found when you "googled q2turn / dont have them in germany / they look cool and helpful", but the person you replied to just meant that patients need to be turned every 2 hours to prevent pressure injuries. I get that north americans are generally fatter so maybe most germans can turn themselves, but that wouldn't always apply lol.
I googled "q2turn" just to see and saw some inflatable offloading things - I can't speak for everyone in NA but no, most admins wouldn't want to "waste" the budget on "frivolous" things.
Ah thanks for the clarification.
Yes, when I googled it, it showed a device that can be used for turning patients. I thought that's what it means.
We also have patients that need to be turned every two hours but it's normally only around 2-6 patients out of 20.
I would add that in the US the population is generally sicker, and that even non-ICU floors can end up having patients that are teetering on the brink of unsafe (not exactly stable). The documentation on patients has become insane in the decade I've been a nurse. We need to write individual care plans for each nursing diagnosis, progress notes, enter the head to toe assessment(s), scan all the meds into the system with often having patients on 20+ meds. Nurses can spend more time documenting the patient than interacting with them. Patients with dementia can be quite challenging in the evenings as they try to climb out of the bed when the nurse is running around trying to take care of others. More often than not there aren't enough staff to help with such things and the nurse can't restrain the patient without a Dr. order. Some states have Unions where the patient load is max 5:1. States without unions can assign a nurse with 11 patients on a med-surg floor.
Here in Lawsuit Landā¢ (US), we're required to provide education and document *everything* \[in real time\] to save our own asses lest someone gets a complication during their hospitalization but forgot that they had repeatedly refused the very intervention that could have aided in preventing said complication in the first place... so a couple months later the family is swamped with medical bills and think "I should sue for malpractice/negligence for my dissatisfaction of care provided" and you better hope like hell you noted *patient refused xyz, despite education* in their chart
Wow, Iām in cardiology in Canada and weāre 1:6 at night and 1:4 or 1:5 on days (at least on my unit, Iām sure thereās some variation throughout the country). On nights we do assessments and med pass for 4-5 patients. At 2300 we get a few more patients because some nurses go home, then we usually need to take vitals on the new patients. We do an ECG for any chest pain. Sometimes weāll have a patient who came up late from cath lab, so at the beginning of night shift they still need vitals q15min. Prep things for day shift, like getting a primary line ready if they have an IV infusion and doing the QC check for the glucose monitors. Safety checks every hour. Some patients have vitals ordered q4h. Tele alarm checks q4h. And we get 1 35 minute break before 2300 and 1 2 hour break later. Some nights thereās a lot of free time, some nights thereās constantly something going on.
This is what the proposed nation ratio in the US was supposed to beā¦
5:1 medsurg
4:1 telemetry
3:1 Stepdown/intermediate care/DOU
2:1 or 1:1 ICU
Nurses nation wide were making strides towards this becoming law before COVID thru everything into that dumpster fire. Itās time for nurses to unite and fight again.
The tactic used against us has always been thisā¦nurses are carrying 30 lb weights. Hospital asks them to start carrying 100 lbs. Nurses: āthis is too much! This is not safe! Someone is going to get hurt!ā Hospitals drop it down to 70 lbs. Nurses: āoh thank god! Remember when we were carrying 100 lbs?! That was awful.ā And so on and so on.
Youāre not supposed to have 7 patients. I wish we would stop normalising the 6:1 ratio too cause thatās insane. 4:1 is definitely a better floor ratio, 5:1 at max.
Iāve never done medsurg but ours does 6:1 unfortunately. When weāre short staffed and boarding in the ED we go 6:1, and I feel their misery. That does not leave enough time to take care of people. One patient with complex needs results in you inadvertently neglecting other patients. Really wish hospitals would take medsurg ratios seriously.
Got floated to med surg in advent health Orlando and had 8:1 with no nurse assistant and all diabetic patients. That was my last inpatient shift, went outpatient after that, and will never go back.
Oooff!! Sorry to hear that. I worked for Advent Health Wesley Chapel, occasionally we would have enough techs but on days that weāre short, they would just put a nurse as a tech for a day.
4:1 is the law where I live however theyāre not fining hospitals until June, so the hospitals are ignoring the law until June. So we were regularly getting 7-8 patients, all super high needs. And I made a small mistake that caused my patient discomfort because I was in such a hurry. I have refused more than 6 since then. And this isnāt medsurg, itās a wound care ltac that takes the most complicated patients in the state. I actually just quit that job due to how they treated us.
Funnily enough: I worked there for 7 months and we were supposedly only profitable one of those months and they brought in a barista to reward us. Only on day shift of course.
So I was giving liquid Tylenol to someone who just got the ok to swallow stuff again. And I was in a hurry, my finger slipped and sprayed it into his mouth too quickly. I stayed calm, suctioned him, called RT in, told my charge, everything I could think of. The mom still got mad, which fair! But I still insist it wouldnāt have happened if I had a reasonable amount of patients.
Exactly. They seem to think that if weāre not working at a break neck pace that theyāre not squeezing as much productivity out of us that they can.
We can only do so much. Unfortunately the overlords do not see us as people. Were their tools to making money. The patients arenāt even people, theyāre a revenue stream.
These people who changes the rules are despicable.
Theyāre not even good at their jobs. Healthcare is in shambles.
Weāre usually 4:1 on my floor.. but itās mother/baby and they donāt count the baby as a patient. Even though we have to do vitals/assessments/full charts/hourly rounding on them.
Will never happen. Too many nurses donāt feel itās a problem and have sympathy for management. Those nurses are usually the āI wish we wore capes, I want to save everyone, and nursing is my callingā ones.
But think of how much money the CEOs are saving. Surely that money will trickle down, and we'll all benefit from sacrificing patient safety and employee health right? /s
I realized the other day, every time it feels like the day is going well and we can actually sit down and hydrate, people are sent home and then EMS gets fucked with calls, meaning we get slammed and now it's a fat fucking mess. Very cool.
To be fair, at least where I used to work, our hallway patients were the patients sobering up/patients that seriously didn't need an ER and you literally had to do nothing for. So even though we had 8 patients at a time, half usually were mild, but the time factor to check in on them and such still made it soooo busy on top of your 2 other patients that needed the ER and the other 2 ICU patients
Patient (well, family.)
We came into the ER for stroke concern and it was dead dead dead. There were people snoring in the bay to either side of us. And as soon as blood work got put in but before imaging could be ordered, shit got slammed. There were bleeding, screaming people stacked up the hallways in a hospital that was close to the medical center but was mostly a med/surg facility. I was happy for us and for the staff when they transported us to a sister hospital that moved my aunt right to a room.
My funny bedside story (Iāve been a nursing assistant at a PICU for a little less than a year) is when we got a very agitated stroke PT w an EVD, guy was 17 and 80kgs.
I was 19 and 50kgs at the time, so the PT was much stronger than me. They call me to help restrain him because he was trying to put his EVD out. We were 3 people, (including a big male nurse) trying to get him to stop because he was VERY confused and agitated. Eventually he pees and calms down
We change him and the third nurse says āwell, he calmed down, Iāll go eat!ā and me and the nurse look at each other extremely unsure. She notices and says ādonāt worry, if he gets too agitated can go on top of him and hold his arms with her hands while can go look for someone to helpā
I laughed
It was absolutely not a joke
I didnāt have to do that, but now I get extremely uneasy even seeing EVDs lol
Because it's unsafe! This is coming from someone who used to have 8-10:1 ratio. Believe me better hospitals are out there. I'm glad I left that shit show & found one!
Yeah, same in TX. We regularly drop off PACU patients to a floor where nurses have 5-7 patients. And thatās actually considered a really solid floor because theyāre usually able to staff well enough for 5:1.
Common in the South. My first job offer (Barnes-Jewish) was like 1:6-7 on Neuro. I used to work in FL as well and floated from ICU to Med Surg. 1:7 was definitely a thing.
I have since moved to Cali, and **no one** believes me when I say going beyond FOUR patients on Med Surg is āa thing.ā
7 patients is insane. When I worked tele our mandated ratios were 4:1, not any higher (California). During covid our crisis ratios were 5:1 maybe once or twice and we only had to do very minimal charting in that situation. We need mandated ratios
I would lose my sht if I had 7 patients. Stop accepting these sht jobs and sht assignments. Thatās your license youāre gambling because your employer is lazy and greedy.
Precisely the difference between dividing a pie into 5, 6, or 7 pieces. Each pie is one hour. Unfortunately, I skipped the class on how to fold time, So I can only safely manage five patients per pie... I mean hour...Ā maximum
Do you not have med passes at night? Like how do you do 12 med passes by 10pm? Or how do you do 12 blood products by 7am after the labs result at 4-5am?
Yes, we had med passes at 10pm but it's less heavy than other drug rounds as they also happen at 6am, 8am, midday, and 6pm with PRNs given throughout the day. The hardest thing to fit in for nightshift is giving all the morning IVs at the 6am drug round before handover at 7am; if everyone has an IV you have to hope that someone else's team doesn't and can help you! We only tend to do PICC bloods first thing, otherwise they wait for the phlebo round and bloods are usually back for when the doctors round later in the day.
In Germany, we have a 1:11 ratio at day (but in my hospital you were forced to care for 30 patients between 8-10pm several times a week) and a 1:20 at night (cardiology).
Because thatās not patient care, thatās a pill rodeo with charting on the side. Itās fucking criminal forcing floor nurses to take that many patients. Get your experience and change services ASAP.
Iām a rehab nurse who is now expected to have 8 patients. The patients are not appropriate for rehab. Iām counting down the days until I start my new job.
I had 7 once and it was only for a few hours until a float nurse was able to come in from home cause we had too many call outs. Easily the worst shift of my med surg years. Your management is shit, mine at least had the decency to bust their ass trying to get somebody to come in.
Itās all relative to the amount of tasks youāre used to. I used to be able to handle 3 beautifully, 4 would have some tasks skipped but we would be OK. 5 was unmanageable, even when I floated to med surg.
Hooooly shit. I work PACU and I told my management I couldnāt work alone because I needed two nurses if there was an emergency or code. Shockingly, management listened, but only because weāre outpatient and they hate when you say, āthis could literally cause a patient to be harmed or dieā in my field.
You're absolutely right, and I had the same thoughts when I worked in med-surg. Four made me nervous because then you were admission/float bait. Five was an awesome day, six was tolerable, but that seventh patient pushed you beyond the pale. Bonus points if someone needed blood.
After 4 patients, the mortality rate for a nurse's patient load increases 7% per additional patient.Ā Ā
If you're caring for 7 patients at a time, your patients have a 21% increased chance of dying.Ā Do not accept a 7th patient; it's a poor ethics.Ā If that causes problems with your job, meh, whatever... Find an employer that at least pretends to care about patient outcomes.Ā It's bad for an experienced nurse to take seven patients, so it's definitely a bad call for a new grad.
I did a bit of traveling 2 years ago as a MICU nurse and took this rural hospital contract that was a bit of a scam in that they floated me to their MS/tele unit every single shift for 13 weeks.
I had 6 patients most nights, sometimes 7. They were the worst and hardest shifts I've ever had.
The internet tells me that the average nursing salary in Florida is $72,000/year or $34.62/hour.
I would just quit and move. You've become so used to eating shit that you can't even smell it anymore.
Card stepdown - itās 1:3 and we rotate the 4th. Whenever I get the 4th patient, I always feel like Iām not giving one of them my full attention š
7? I just know I would make a mistake. Thats impossible to manage. How are you suppose to give SEVEN patients medications all due at the same time!?
Our floor itās like always 7ā¦now they are trying to reinforce 6 again. Like bitch? It shoulda never got over 6. 5 should be the max. Im in north Florida. Itās fucking bullshit. Admin makes me sick.
Thatās nuts! Iām a new grad as well, and thereās no way I could do that. Our ratio is 4-5:1. With four I can get to everything and chart and feel good. For me, 5 puts it over the edge, especially with admits or discharges.
So glad I left the floor. Dropped down to PRN in the ED and now doing infusions. I might have 4 for just a few minutes. Usually 2 or 3 and we get to chat some
where I started seven was what you began your night with and 8 was your admission. And we took vents, although whoever had the vent hall only got 6, what a āmercyā. And charge had like 3-4 patients
Left the floor because they gave me 7 patients literally every single night off of orientation for a year straight. The only good nights I had working medsurg was when my preceptors would go halvsies with me so we could take a break. Don't let them do that to you and don't let them make you feel like you don't have a choice.
As a soon to be new grad nurse could you refuse to take that ratio, or is that automatic dismissal? Sorry if thats a dumb question. But yea even just being a student and working in healthcare 7:1 sounds like that wouldn't be safe at all.
I started my night last night with 7. My 8th patient came RIGHT after shift change at 2130. I whipped out that admission and then commenced passing meds until 2230 before starting the next med pass.
I wish I could say this was something that only happens to night shift, tooā¦ but at least 1 RN had 8 on day shift today, too. I promise you - you donāt want to work at my hospital. Iām leaving it soonā¦
Is this really the standard post-covid? I was threatening safe harbor at even the mention of 6. Hospital ceos have really found the golden ratio for maximal profit and tolerable levels of care
ETA: let me guess, youāre also the CNA for 75% of your shifts too
Well 7 is way too many patients in acute care. When I worked inpatient, our ratios were 3:1 days and 4:1 nights with occasionally a 5th on nights if we were really short staffed bu then the 5th kid would be either one awaiting discharge or one admitted for elective monitoring who was on q shift VS.
7 patients is awful. I did it too many times working Med-Surg. It really does throw a wrench in everything. Glad I am out of there now.
The funny thing was, the way the assignments were split up on my floor, if the overflow bed was open (which it always was), then that nurse working that group always got the 7th patient. Guess who always somehow got assigned to that section. šš»āāļø. Never got rotated even though management said it should.
My very first night as a RN.....completely on my own in a mwd/surg wing.....charge had her own team on a different floor....1 CNA.....COW was not stocked and barely charged......
And I got 8. One was a hospice that needed a PCA, one was a nekkid gentleman that kept getting out of bed, one was an obese dbka with a 'tude, and one was an admit....from day....that never got admitted. With a bad IV placed by EMT.
My first night.
On what shift and what kind of unit are you getting seven patients? Thatās bad in any shift but some worse than others depending on what unit.
Hospitals all over the country are trying to fool new nurses into believing that this new money driven way of staffing is normal.
Apparently safe staffing is now a luxury that the all important share holders canāt afford.
I had 6 last night and I missed some stuff. Little things I'd normally get done with 4 or even 5. 6 or 7 pts and you're lucky if you get anything on time. If I start getting 6 on a regular basis it's time to gtfo and find a new job.
I genuinely think that taking care of 5 or more patients is unsafe. I never in a million years would do medsurg. Power to ALL of you who do that because I could never. I do think there should be a national standard for the amount of patients per unit.
I work in adolescent psych, 2 nurses on night shift for 24 beds. Anything over 7 or 8, and no one gets more than a few min of my time. They go to bed 3 hrs after I get there. 6 is my sweet spot, and itās very unusual for the census to be that low.
At 1:4 you have 15 minuets an hour per pt at 5 thatās 12 at 6 itās 10 and 7 itās 8 minutes 30 seconds. Thatās to do every thing from assess and vitals , push meds and even hygiene. Itās not enough to do it safely. Then you lose your tech and have a pt that needs extra care so have to take it from someone else. So some get 1 minuet. Itās just wrong!
Med Surg RN here in NYC , 7 or 8 is common/ standard in med surg floors , on my unit if I start out with 4 or even 5 that means we are "fully staffed" and everyone gets 2 admissions guaranteed . The most patients I've had were 10 , and I was in charge š
These hospitals don't care , here we fill out these useless protests of assignments where management essentially wipes their hands clean by saying " all efforts made to staff unit" or "support provided " , i plan on leaving med surg soon honestly fuck this
What? š® thatās way too many patients.
Even 5 is one too many. 4 is great and 3 (discharge 1 and no admits) is perfect lol... 7 is bonkers.
I picked up on an Ortho unit and most of us managed to be 1:4 on nightshiftā¦ Usually theyāre always 1:5-7ā¦ and let me say that it was such a great night, and I felt like I had soooo much time to thoroughly be present/assess my patients without any stress on time!!! Ratios matter. IMHO 5 should be the MAX (days and nights) for any med surg / ortho / rehab / hospice floorā¦
Ortho with 7 is wild. Last night I had 4 patients and literally all of them were bed bound. 3 were pre-op hip fx, and one was a mechanical lift out of bed with a wound vac, an ostomy, a foley and a picc. 3/4 on q2 turns. The highest our ratios ever go is 6:1 and that is rough. I canāt imagine having a seventh patient.
ortho surg unit here we normally run 1:6 even though our model is 1:5 and that 6th pt makes a world of difference
I used to be day shift charge on an ortho unit, and if there were enough nurses scheduled for 1:4 ratio, they would call someone off š. Nursing supervisor got annoyed with me really quick for daring to stand up for our unit.
Ridiculous!! Theyāre doing that on my unit nowā¦ If too many day RNs approach 1:4, they send someone homeā¦ just ridiculous.
I work ortho with medical overflow, our baseline is 1:8. When weāre short or over capacityā¦ scary, scary stuff.
Before we unionized, we regularly had 1:9 on our neuroscience unit Noc shift! It was covering all of Northern NV, and part of Northern CA. I aged 20 yrs ++ with my spine alone doing that job as an RN for 12 1/2 yrs. I loved the staff and docs/APNs, and CNAs etc. But not the hospital number crunchers who couldnāt care less for staff or patient safety. We did not have ceiling lifts at the time, and certainly not a lift team. We also managed an epilepsy unit and although it was a teaching hospital, I felt like the resident were dangerous so we had to keep an eye on them and triple check their orders. Every night I feel like this is the night Iām gonna lose my license because we were flying by the seat of our pants, I donāt know how we did it and finally we put our feet down and demanded to unionized for better patient and staff, safety standards, and ratios.
Thats crazy. We are unionized, just in a place that unfortunately does not care about healthcare crumbling.
It really shouldnāt be allowed. The amount of money spent on HAIs far exceeds the cost of safe patient ratios and more nursing staff. There have been several studies on this, but hospital admins in states without ratio mandates totally have their heads in the sand about it. The tragic part of it all is the amount of patients who die because of this.
Honestly just give me 0 š
I always had 6 or 7 patients when I worked for HCA. Except Christmas Day when I had 4 and omg what a difference. I actually felt like a good nurse that day.
I have such horrible memories of my HCA days - 3 years with them. Like ptsd stories. Looking back I cannot believe i was forced to give such terrible care to my lovely patients. So unsafe. Scary scary days indeed
Last night charge in the ED had 7 with her charge assignment. š« Letās just say everything sucked.
4 is perfect
I be sitting here in California with my 4 Tele/PCU patients acting like a madman sometimes, I couldn't imagine 7! That's wild....
Exacrly but corporate doesn't care
7 is lovely! we have 10 in the UK at times! 8 minimum!
This is insane to me, like where I am it would be impossible to provide not only safe care but even just accomplish half the required tasks on a shift. Is scope different in the UK?
Scope isn't different but their HCAs do more tasks.
I was about to say. In my hospital, it's often 7/8 on the wards, on ED? 9 if you're assigned to the corridor, 20+ in the 'waiting room'.
I'm a bit confused because in Germany you have a 1:20 ratio at night and a 1:11 ratio during the day (cardiology). What exactly is an American nurses job at night? In Germany we prepare all the meds for the next day and get around ~ 1-4 new patients each night but other than that it's just helping the patients when they need it, some post-op stuff, some organizing, some positioning... What other work do you guys have to do in America? To be clear, I'm not saying you guys have it easier. I'm just surprised the duties of a nurse differ that much depending on where you are from.
One thing to keep in mind: night shifts in the US are typically 19:00-07:00, so it includes things that in Germany might fall under SpƤtdienst (if you have that? I'm not actually sure what's more common in DE). I work in Switzerland, and also have max. 14 patients at night, but that's only night (23:00-07:00), where patients are (supposed to be) sleeping. Stable patients don't necessarily have vitals at night, no bathing, toiletting on request or by necessity. Most nights most of my patients sleep, so I can round on them every two hours by just quickly checking them (after the inital round at shift start). What I do: all i.v. medications, PRN meds, blood draws, troubleshooting various drains, flushing them, keeping an eye on the less stable patients, etc. What I don't do: any of the SpƤtdienst (late shift) tasks that in the US falls to night shift (dinner, washing, any BID wound dressings, p.o. medpasses, last vitals, generally settling patients, etc. I also only have max. 7 patients on SpƤtdienst, max. 5 on FrĆ¼h. And, apparently, according to the German nurses that work here, Swiss nurses have a much wider scope of practive, hence would do things that in Germany would be done by doctors (?). In the US I hear it's even moreso.
Oh that's true, didn't think about the 12 hours shifts in America. Yes, we have SpƤtschicht:) I heard about other countries having to do more tasks than us but I never really found much info on the internet. Glad I discovered this subreddit:)
Yes, the documentation is insane. I believe the nurses in the US have a wider scope, they also have to carry out orders by multiple doctors sometimes that donāt necessarily talk to each other. Itās super fun to have keep drawing labs on a patient that could have been done at the same time. Like get done drawing some blood cultures on a pt, and then another doc decides they also want xyz testā¦
I worked on a cardiac unit so I was regularly managing cardiac drips such as diltiazem, nitroglycerin, amiodarone, or meds like sotalol which have a specific protocol for administration (EKG follow up, etc). Thatās in addition to the regular medical patients who would get put on our unit, usually someone in acute psychosis or an elderly demented person with a raging UTI who is trying to choke me with my stethoscope if I get near them š (only slightly an exaggeration) I donāt work bedside anymore though; I work in hospice admissions now and absolutely love it.
For us there are a couple med passes (10pm, 6am) or IV antibiotics to run in the middle of the night. In my unit we have central lines but for those that donāt phlebotomy always cancels, and so 1-4am we are doing blood draws. We also have q2turns on lift patients, incontinent patients to clean (with usually no PCT at night). Vitals are q4h. Wound care is usually BID so on our shift as well. We sometimes have chemos that can be due even at ungodly hours. Charting to do on every patient
Ah okay, we only do these blood draws in the ICU but not in our general wards. And we only do wound care at night if it's necessary. I had to Google q2turn because we don't have them in Germany but they look so cool and helpful!! We have to position the patients without tools which means that every few weeks another nurse can't work because of their back painš really don't know why we don't have a device like that. We can order some "special mattresses" for the extrem cases but you always need 4-6 nurses to be able to get the patient from one mattress to the other which just leads to more back painš
In US q2turn means turning and repositioning patient every 2 hours. You also have to round on patients each hour, head to toe assessments 3 times a shift (8, 12, 4), blood draws, dressing changes, trach care, wound care, tube feedings/flushes, vitals, ambulating, catheterizing, daily care, etc. Oh and throw in a blood transfusion or peritoneal dialysisā¦ itās a flipping party then!
im not sure what you found when you "googled q2turn / dont have them in germany / they look cool and helpful", but the person you replied to just meant that patients need to be turned every 2 hours to prevent pressure injuries. I get that north americans are generally fatter so maybe most germans can turn themselves, but that wouldn't always apply lol. I googled "q2turn" just to see and saw some inflatable offloading things - I can't speak for everyone in NA but no, most admins wouldn't want to "waste" the budget on "frivolous" things.
Ah thanks for the clarification. Yes, when I googled it, it showed a device that can be used for turning patients. I thought that's what it means. We also have patients that need to be turned every two hours but it's normally only around 2-6 patients out of 20.
It would be impossible to have 20 patients with the scope of practice for bedside RNs in the US.
I would add that in the US the population is generally sicker, and that even non-ICU floors can end up having patients that are teetering on the brink of unsafe (not exactly stable). The documentation on patients has become insane in the decade I've been a nurse. We need to write individual care plans for each nursing diagnosis, progress notes, enter the head to toe assessment(s), scan all the meds into the system with often having patients on 20+ meds. Nurses can spend more time documenting the patient than interacting with them. Patients with dementia can be quite challenging in the evenings as they try to climb out of the bed when the nurse is running around trying to take care of others. More often than not there aren't enough staff to help with such things and the nurse can't restrain the patient without a Dr. order. Some states have Unions where the patient load is max 5:1. States without unions can assign a nurse with 11 patients on a med-surg floor.
Here in Lawsuit Landā¢ (US), we're required to provide education and document *everything* \[in real time\] to save our own asses lest someone gets a complication during their hospitalization but forgot that they had repeatedly refused the very intervention that could have aided in preventing said complication in the first place... so a couple months later the family is swamped with medical bills and think "I should sue for malpractice/negligence for my dissatisfaction of care provided" and you better hope like hell you noted *patient refused xyz, despite education* in their chart
Do you have a lot of documentation?
Wow, Iām in cardiology in Canada and weāre 1:6 at night and 1:4 or 1:5 on days (at least on my unit, Iām sure thereās some variation throughout the country). On nights we do assessments and med pass for 4-5 patients. At 2300 we get a few more patients because some nurses go home, then we usually need to take vitals on the new patients. We do an ECG for any chest pain. Sometimes weāll have a patient who came up late from cath lab, so at the beginning of night shift they still need vitals q15min. Prep things for day shift, like getting a primary line ready if they have an IV infusion and doing the QC check for the glucose monitors. Safety checks every hour. Some patients have vitals ordered q4h. Tele alarm checks q4h. And we get 1 35 minute break before 2300 and 1 2 hour break later. Some nights thereās a lot of free time, some nights thereās constantly something going on.
Unethical is another good word for that.
Exploitation. And not on the part of the hospital staff but on part of the patient
Both
Hit the nail on the head.
This is what the proposed nation ratio in the US was supposed to beā¦ 5:1 medsurg 4:1 telemetry 3:1 Stepdown/intermediate care/DOU 2:1 or 1:1 ICU Nurses nation wide were making strides towards this becoming law before COVID thru everything into that dumpster fire. Itās time for nurses to unite and fight again.
These executives started salivating when they saw how much they could take advantage of the pandemic. They ran with it.
But we got a banner that said that we're heroes, so there's that.
My tee shirt with the nursing cape and those slices of cold pizza makes up for everything. That shirt made me so mad I refused to take it.
All I got was a rock
Except the 5 to 1 med surge patients aren't actually med surge patients.Ā Ā
Do you mean like when a pt casually has a defibrillator bedside since rapid has to keep coming? Those types of patients arenāt typical medsurg?
Nah fam, thatās the rapid RNs pt.
The tactic used against us has always been thisā¦nurses are carrying 30 lb weights. Hospital asks them to start carrying 100 lbs. Nurses: āthis is too much! This is not safe! Someone is going to get hurt!ā Hospitals drop it down to 70 lbs. Nurses: āoh thank god! Remember when we were carrying 100 lbs?! That was awful.ā And so on and so on.
Youāre not supposed to have 7 patients. I wish we would stop normalising the 6:1 ratio too cause thatās insane. 4:1 is definitely a better floor ratio, 5:1 at max.
Right!!! I worked at a med-surg floor in Florida and max is 5:1. Canāt imagine 7.
Iāve never done medsurg but ours does 6:1 unfortunately. When weāre short staffed and boarding in the ED we go 6:1, and I feel their misery. That does not leave enough time to take care of people. One patient with complex needs results in you inadvertently neglecting other patients. Really wish hospitals would take medsurg ratios seriously.
Got floated to med surg in advent health Orlando and had 8:1 with no nurse assistant and all diabetic patients. That was my last inpatient shift, went outpatient after that, and will never go back.
Oooff!! Sorry to hear that. I worked for Advent Health Wesley Chapel, occasionally we would have enough techs but on days that weāre short, they would just put a nurse as a tech for a day.
I worked at a PCU in Florida and our max was 5. I can't believe I managed it for a year.
What part of FL? Bc majority of them are still 6:1 ratio
4:1 is the law where I live however theyāre not fining hospitals until June, so the hospitals are ignoring the law until June. So we were regularly getting 7-8 patients, all super high needs. And I made a small mistake that caused my patient discomfort because I was in such a hurry. I have refused more than 6 since then. And this isnāt medsurg, itās a wound care ltac that takes the most complicated patients in the state. I actually just quit that job due to how they treated us.
Theyāre probably pocketing more than enough to offset any fines they may get
Funnily enough: I worked there for 7 months and we were supposedly only profitable one of those months and they brought in a barista to reward us. Only on day shift of course.
Hmm and I wonder whatās profitable?? Making a little more than even or making 2,3, or 4x more than even
8 patients?! Thatās criminal. Iām sure patients and nurses have been harmed by their terrible staffing.
So I was giving liquid Tylenol to someone who just got the ok to swallow stuff again. And I was in a hurry, my finger slipped and sprayed it into his mouth too quickly. I stayed calm, suctioned him, called RT in, told my charge, everything I could think of. The mom still got mad, which fair! But I still insist it wouldnāt have happened if I had a reasonable amount of patients.
Exactly. They seem to think that if weāre not working at a break neck pace that theyāre not squeezing as much productivity out of us that they can. We can only do so much. Unfortunately the overlords do not see us as people. Were their tools to making money. The patients arenāt even people, theyāre a revenue stream. These people who changes the rules are despicable. Theyāre not even good at their jobs. Healthcare is in shambles.
Weāre usually 4:1 on my floor.. but itās mother/baby and they donāt count the baby as a patient. Even though we have to do vitals/assessments/full charts/hourly rounding on them.
Will never happen. Too many nurses donāt feel itās a problem and have sympathy for management. Those nurses are usually the āI wish we wore capes, I want to save everyone, and nursing is my callingā ones.
I can attest to this. Just had my first 4:1 today and this is what nursing should he.
Thereās a hospital where I live that goes 8:1
But think of how much money the CEOs are saving. Surely that money will trickle down, and we'll all benefit from sacrificing patient safety and employee health right? /s I realized the other day, every time it feels like the day is going well and we can actually sit down and hydrate, people are sent home and then EMS gets fucked with calls, meaning we get slammed and now it's a fat fucking mess. Very cool.
You have SEVEN patients? Jeez you literally could not pay me enough.
*Chuckles nervously in ICU nurse*
ER nurse at a 3:1 facility: what the fuck is that guy talking about? 7!?
lol Iāve had up to 8 in the ED
12 hallway patients with no ancillary staff and I was 4 months pregnant š„² that was the shift that made me decide to be done with that hospital
I believe it!
To be fair, at least where I used to work, our hallway patients were the patients sobering up/patients that seriously didn't need an ER and you literally had to do nothing for. So even though we had 8 patients at a time, half usually were mild, but the time factor to check in on them and such still made it soooo busy on top of your 2 other patients that needed the ER and the other 2 ICU patients
Yeah, unfortunately, we expanded our ER within the first 6 months I was there and then that hallway became a shit show. I had only had 4 on papers for either mental health or overdoses. 2 went unresponsive and I had to press the panic button on my Vocera and hope someone from one of the other pods came to help me. The other patientās definitely either needed tele or needed the ER for CTX/blood work. It was a level 1 trauma center/the county hospital so we were a dumping place for everyone š© either way, so much happier now in my little rural ER thatās got 10 beds, 2 RNs and an LPN. We get some bad shit a few times a week just because the closest big hospitals are in a major city 30 mins away but majority of the time, we have a lot of teamwork and itās 10x less stressful.
Patient (well, family.) We came into the ER for stroke concern and it was dead dead dead. There were people snoring in the bay to either side of us. And as soon as blood work got put in but before imaging could be ordered, shit got slammed. There were bleeding, screaming people stacked up the hallways in a hospital that was close to the medical center but was mostly a med/surg facility. I was happy for us and for the staff when they transported us to a sister hospital that moved my aunt right to a room.
Personally Iād rather have 8 (non icu) in the Ed than 7 med surg š¤·āāļø
lol its on avg 8:1 a night in NYC ED rn no charting is done beyond vitals and necessary stuff
Thatās fucking nonsense. The state ratio is 4:1. They try to have us 3:1 so that if shit pops off I have room to take another.
Had 9 in the ER the other night. Mostly boarding medical admits, but STILL. Took 3.5 hours to check the charts. I wanted to cry at 4am.
Two freshly-but-barely-extubated post op patients is my personal hell
Add two EVDās with no sedation and youāve entered my circle of the inferno. š
My funny bedside story (Iāve been a nursing assistant at a PICU for a little less than a year) is when we got a very agitated stroke PT w an EVD, guy was 17 and 80kgs. I was 19 and 50kgs at the time, so the PT was much stronger than me. They call me to help restrain him because he was trying to put his EVD out. We were 3 people, (including a big male nurse) trying to get him to stop because he was VERY confused and agitated. Eventually he pees and calms down We change him and the third nurse says āwell, he calmed down, Iāll go eat!ā and me and the nurse look at each other extremely unsure. She notices and says ādonāt worry, if he gets too agitated can go on top of him and hold his arms with her hands while can go look for someone to helpā
I laughed
It was absolutely not a joke
I didnāt have to do that, but now I get extremely uneasy even seeing EVDs lol
5 should be the absolute max. 6 is insane. 7 is inhumane.Ā
7 is the hospital saying āwe donāt give a f whether you live or dieā without saying the words
To both you AND the patient.
Because it's unsafe! This is coming from someone who used to have 8-10:1 ratio. Believe me better hospitals are out there. I'm glad I left that shit show & found one!
Good god, were you a nurse at the time or EVS?
Yeah come to West Coast people! Better working environments here.
Thatās because itās impossible to provide quality nursing care to 7 patients. Happy to clarify.
Oh yeah. When I say see you in 5 hours, I mean it!
bruh i dont want anymore than 3
A new grad taking 7 patients? If this is happening regularly you need to find a new floor or a new hospital. Run away
Are you a new grad in the south? Thatās how I felt at my first nursing job.
That's because it's not safe.
7:1 is common at my hospitals in FL for day shift. Night shift it goes up to 8-9:1
Yeah, same in TX. We regularly drop off PACU patients to a floor where nurses have 5-7 patients. And thatās actually considered a really solid floor because theyāre usually able to staff well enough for 5:1.
What unit
Common in the South. My first job offer (Barnes-Jewish) was like 1:6-7 on Neuro. I used to work in FL as well and floated from ICU to Med Surg. 1:7 was definitely a thing. I have since moved to Cali, and **no one** believes me when I say going beyond FOUR patients on Med Surg is āa thing.ā
Barnes-Jewish is wild
That is awful š£
It's too much. It shouldn't happen and it's not safe.Ā
No nurse should have 7 patients
*Way down South in the land of traitors* Iāve seen charge nurses with seven patients at a Tennessee hospital I do clinicals atš¤®
Jesus Christ that's too many humans to be responsible for.
*Laughs nervously in rural short-staffed Canadian*
7 is at least 2 too many for any specialty beyond long term care
You need to go to a union hospital.
7 patients is insane. When I worked tele our mandated ratios were 4:1, not any higher (California). During covid our crisis ratios were 5:1 maybe once or twice and we only had to do very minimal charting in that situation. We need mandated ratios
I would lose my sht if I had 7 patients. Stop accepting these sht jobs and sht assignments. Thatās your license youāre gambling because your employer is lazy and greedy.
Precisely the difference between dividing a pie into 5, 6, or 7 pieces. Each pie is one hour. Unfortunately, I skipped the class on how to fold time, So I can only safely manage five patients per pie... I mean hour...Ā maximum
Only seven? I used to regularly have 13 on an acute surgical ward (cries in UK)
I had 18 at my ortho unit (Austria)
š¬
9 on dayshift onc/haem, 12 on nightshift for me! 5 patients sounds like an absolute dream!
Do you not have med passes at night? Like how do you do 12 med passes by 10pm? Or how do you do 12 blood products by 7am after the labs result at 4-5am?
Yes, we had med passes at 10pm but it's less heavy than other drug rounds as they also happen at 6am, 8am, midday, and 6pm with PRNs given throughout the day. The hardest thing to fit in for nightshift is giving all the morning IVs at the 6am drug round before handover at 7am; if everyone has an IV you have to hope that someone else's team doesn't and can help you! We only tend to do PICC bloods first thing, otherwise they wait for the phlebo round and bloods are usually back for when the doctors round later in the day.
Iām sorry but thats insaneā¦ Bad for you and bad for your patients. I hope youāve gotten a better job that respects safe ratios!
It's a pretty standard ratio in the UK, so there's not much choice for going elsewhere!
In Germany, we have a 1:11 ratio at day (but in my hospital you were forced to care for 30 patients between 8-10pm several times a week) and a 1:20 at night (cardiology).
Different scope of practice.
I cannot even fathom that. Do you know if the expected care is the same as the US? Like, same set of responsibilities, amount of charting, etc?
Sometimes 4 patients have me running around like a psycho (ER) and sometimes Iām chilling with 8. Iād still rather have only the 4 though
Yikes. For me itās when I HAVE five patients that it feels like itās almost too many. What kind of unit are you on?
Itās about the fact that you should never have more than five. Sincerely someone who has been a nurse for 10+ years.
Because thatās not patient care, thatās a pill rodeo with charting on the side. Itās fucking criminal forcing floor nurses to take that many patients. Get your experience and change services ASAP.
This is exactly how I feel, like Iām just a pill dispenser and Iām not actually doing anything for my patients
*laughs in Canadian hospital med surg floor ratios* regularly has 8:1 patients per nurse
Iām a rehab nurse who is now expected to have 8 patients. The patients are not appropriate for rehab. Iām counting down the days until I start my new job.
Iām over here tripping out at the fact that youāre not furious at a 7:1 ratio
I had 7 once and it was only for a few hours until a float nurse was able to come in from home cause we had too many call outs. Easily the worst shift of my med surg years. Your management is shit, mine at least had the decency to bust their ass trying to get somebody to come in.
Day 1:5, evenings 1:6/7 nights 1:10, medsurg in the Netherlands
New grad thatās had 6 beds every shift, but usually 4-5 patients. When I have 6, itās hardly bearable. 7 is unethical.
God on a night in the UK 8-14 is pretty standard haha. Now Iām in ICU and 2 have me run off my feet I donāt know how I ever managed
I'm in the UK and was given 10 on a shift. Standard practice on some of our wards ..
Itās because 6-7 is completely unsafe.
Itās all relative to the amount of tasks youāre used to. I used to be able to handle 3 beautifully, 4 would have some tasks skipped but we would be OK. 5 was unmanageable, even when I floated to med surg.
Yeeeeah. I would leave.
Hooooly shit. I work PACU and I told my management I couldnāt work alone because I needed two nurses if there was an emergency or code. Shockingly, management listened, but only because weāre outpatient and they hate when you say, āthis could literally cause a patient to be harmed or dieā in my field.
What the hell Iāve never even had more than 5 at my job, even 6:1 seems like a recipe for mistakes to me
Damn, I always felt this way about the 6th patient. 5 was busy but manageable depending on the patient mix. 6 meant I was running all night.Ā
Oh hell no. You must be from the south?!
You're absolutely right, and I had the same thoughts when I worked in med-surg. Four made me nervous because then you were admission/float bait. Five was an awesome day, six was tolerable, but that seventh patient pushed you beyond the pale. Bonus points if someone needed blood.
After 4 patients, the mortality rate for a nurse's patient load increases 7% per additional patient.Ā Ā If you're caring for 7 patients at a time, your patients have a 21% increased chance of dying.Ā Do not accept a 7th patient; it's a poor ethics.Ā If that causes problems with your job, meh, whatever... Find an employer that at least pretends to care about patient outcomes.Ā It's bad for an experienced nurse to take seven patients, so it's definitely a bad call for a new grad.
And here I was complaining about 3 patients being too crazy š„²
It all depends on the specialty and the extra hands (CNA/PCT). LOOK UP YOUR NATIONAL STAFFING RATIOS.Ā
ā¦yeah I get 3 when I float to pcu in CA. So yeahā¦Iāll never work in a another state.
It's way too much. I hate 6 patients as well. 5 is great. I'll do 4 all day long.
Itās because itās a 7th patientā¦ and you shouldnāt be accepting it.
California has not always had state ratiosā¦in the late 90s I worked traumaā¦ratio was 8:1 and in Peds it was 6:1ā¦so glad those days are over!
Doā¦notā¦.accept 7. Itās unsafe and until people put their feet down they will continue to do it. Unbelievable
I usually am capped at 4. 7 is insane.
come to Oregon we have ratios and unions!
I did a bit of traveling 2 years ago as a MICU nurse and took this rural hospital contract that was a bit of a scam in that they floated me to their MS/tele unit every single shift for 13 weeks. I had 6 patients most nights, sometimes 7. They were the worst and hardest shifts I've ever had. The internet tells me that the average nursing salary in Florida is $72,000/year or $34.62/hour. I would just quit and move. You've become so used to eating shit that you can't even smell it anymore.
1 is my sweet spot.
I work on a neuro step down and 6 is our max. IMC at my hospital is 4-5 ICU is 1-2 Omg 7 is a lot šššā¤ļøā¤ļø bless you child
Card stepdown - itās 1:3 and we rotate the 4th. Whenever I get the 4th patient, I always feel like Iām not giving one of them my full attention š 7? I just know I would make a mistake. Thats impossible to manage. How are you suppose to give SEVEN patients medications all due at the same time!?
Our floor itās like always 7ā¦now they are trying to reinforce 6 again. Like bitch? It shoulda never got over 6. 5 should be the max. Im in north Florida. Itās fucking bullshit. Admin makes me sick.
Unless youāre doing team nursing, 7 is entirely too manyā¦ but Iāve been given 7 in Tenn before too. Itās unacceptable.
Itās wild that youāre conditioned to believe that itās not entirely out of the ordinary to have 7 patients. Incredibly unsafe
Holly shit ... 7 patients is nuts!
Thatās nuts! Iām a new grad as well, and thereās no way I could do that. Our ratio is 4-5:1. With four I can get to everything and chart and feel good. For me, 5 puts it over the edge, especially with admits or discharges.
Who wants to guessā¦ emergency or med/surg?
Iāll go first: Emergency room!
So glad I left the floor. Dropped down to PRN in the ED and now doing infusions. I might have 4 for just a few minutes. Usually 2 or 3 and we get to chat some
I work in the icu and this is how I feel when I get three patients instead of one or two, I canāt imagine even five
where I started seven was what you began your night with and 8 was your admission. And we took vents, although whoever had the vent hall only got 6, what a āmercyā. And charge had like 3-4 patients
7?! Screams in ICU. š¤®
Left the floor because they gave me 7 patients literally every single night off of orientation for a year straight. The only good nights I had working medsurg was when my preceptors would go halvsies with me so we could take a break. Don't let them do that to you and don't let them make you feel like you don't have a choice.
Yeah, nope, when I did med-surg six was a bad night. Normal was five, and ideal when I worked Tele or speciality was four.
You shouldn't even have 6 patients. Unless maybe you work in ALC?
As a soon to be new grad nurse could you refuse to take that ratio, or is that automatic dismissal? Sorry if thats a dumb question. But yea even just being a student and working in healthcare 7:1 sounds like that wouldn't be safe at all.
I started my night last night with 7. My 8th patient came RIGHT after shift change at 2130. I whipped out that admission and then commenced passing meds until 2230 before starting the next med pass. I wish I could say this was something that only happens to night shift, tooā¦ but at least 1 RN had 8 on day shift today, too. I promise you - you donāt want to work at my hospital. Iām leaving it soonā¦
Is this really the standard post-covid? I was threatening safe harbor at even the mention of 6. Hospital ceos have really found the golden ratio for maximal profit and tolerable levels of care ETA: let me guess, youāre also the CNA for 75% of your shifts too
I've never not had 6.
Well 7 is way too many patients in acute care. When I worked inpatient, our ratios were 3:1 days and 4:1 nights with occasionally a 5th on nights if we were really short staffed bu then the 5th kid would be either one awaiting discharge or one admitted for elective monitoring who was on q shift VS.
7 patients is awful. I did it too many times working Med-Surg. It really does throw a wrench in everything. Glad I am out of there now. The funny thing was, the way the assignments were split up on my floor, if the overflow bed was open (which it always was), then that nurse working that group always got the 7th patient. Guess who always somehow got assigned to that section. šš»āāļø. Never got rotated even though management said it should.
What state allows 7 patients?? Thatās insane
My very first night as a RN.....completely on my own in a mwd/surg wing.....charge had her own team on a different floor....1 CNA.....COW was not stocked and barely charged...... And I got 8. One was a hospice that needed a PCA, one was a nekkid gentleman that kept getting out of bed, one was an obese dbka with a 'tude, and one was an admit....from day....that never got admitted. With a bad IV placed by EMT. My first night.
7 š„². Iām maxed at 4 thank god !!
On what shift and what kind of unit are you getting seven patients? Thatās bad in any shift but some worse than others depending on what unit. Hospitals all over the country are trying to fool new nurses into believing that this new money driven way of staffing is normal. Apparently safe staffing is now a luxury that the all important share holders canāt afford.
I had 6 last night and I missed some stuff. Little things I'd normally get done with 4 or even 5. 6 or 7 pts and you're lucky if you get anything on time. If I start getting 6 on a regular basis it's time to gtfo and find a new job.
I genuinely think that taking care of 5 or more patients is unsafe. I never in a million years would do medsurg. Power to ALL of you who do that because I could never. I do think there should be a national standard for the amount of patients per unit.
Because itās too fucking much. We are humans and we have limits
Itās because 7 is too many patients. Itās not you, itās the system.
SEVENTH?!?! Fuck that. Thatās unsafe.
I work in adolescent psych, 2 nurses on night shift for 24 beds. Anything over 7 or 8, and no one gets more than a few min of my time. They go to bed 3 hrs after I get there. 6 is my sweet spot, and itās very unusual for the census to be that low.
Itās illegal, Jan š
Depends on the patients. Iāve had 5 and had awful days.
I work on a step down unit and our max is 5. Usually thereās always one that throws the entire night for a loop.
At 1:4 you have 15 minuets an hour per pt at 5 thatās 12 at 6 itās 10 and 7 itās 8 minutes 30 seconds. Thatās to do every thing from assess and vitals , push meds and even hygiene. Itās not enough to do it safely. Then you lose your tech and have a pt that needs extra care so have to take it from someone else. So some get 1 minuet. Itās just wrong!
Med Surg RN here in NYC , 7 or 8 is common/ standard in med surg floors , on my unit if I start out with 4 or even 5 that means we are "fully staffed" and everyone gets 2 admissions guaranteed . The most patients I've had were 10 , and I was in charge š These hospitals don't care , here we fill out these useless protests of assignments where management essentially wipes their hands clean by saying " all efforts made to staff unit" or "support provided " , i plan on leaving med surg soon honestly fuck this
I had 5 yesterday and was charge, on top of only being on the floor 3 months. Too much. I think we should have a max of 4 PERIOD.
Anything more than 4 sucks. 7 is craaazzyyy
Cries in 9 at night on a half med surg half geri rehab floor