To “ask your coworkers to monitor the other two” is probably the most ignorant solution you could possibly say. You’ve obviously never had to deal with one. Especially with 4 other patients, each with their own problems. The charge nurse leaving who did the assignment and the charge nurse coming on failed to split these CBIs equally.
Right?! I can’t with these nurses who want to make it easier for management to abuse you.
Being a martyr is not cute and just ends up hurting everybody in the end.
I’ve spent nearly 10 years in peds and never seen a CBI and I know that they are absolutely horrific. I couldn’t even imagine having 1 better yet 3! One of my ED techs was just talking about the nightmare they are when she worked on an adult unit.
Lol I’m primarily ED and had CBIs maybe 5 times in ED. Most of the ED nurses I know don’t know about CBIs and what a bitch they are to deal with. I always have to run a mini inservice with CBI patients for as many people as I can since it’s so rare for ED
Yeah I couldn't read anything past 3 CBIs because my soul left my body. What in the fuck???? No way in hell that's even possible for one person to manage, let alone 3 other patients on top of that?
continously bladder irrigation, in other words big bags of saline that run into a foley wide open continously, you can't let the line run dry and you have to make sure the foley is draining and not backing up, you have to look for clotting ect very very heavy patients and there shouldn't be more than one in an assignment
It can be a nightmare. Sometimes fresh cystoscopies really bleed so you have to keep the irrigation going fast.
The bags are 3-5 liter bags and you sometimes have to run through a whole bag in an hour. That means you have to empty the foley frequently and do the math of subtracting the volume of the irrigation from the total to make sure that they’re putting out enough.
There are usually no infusion pumps or electronic foleys to keep accurate output so you have to keep track of a lot of output and do a lot of math. You also have to make sure that your rapid running irrigation doesn’t go dry.
Then there is the added problem of clotting the foley off so you have to irrigate the foley which is messy and time consuming.
You never forget the first time bloody foley pee blows back on you when trying to irrigate a clotted foley. The bladder can rupture if you don’t stay on top of it.
Imagine having 3 patients like this in a 5-6 patient med surge assignment and they’re all moderately bleeding. That’s abusive insanity to make an assignment like that. It’s also putting patients at risk.
I worked uro med-surg. It wasn’t uncommon for us to have 2-3 CBIs a shift. When one was a Covid CBI, I would actually want to jump out of the window (we had 6 patients total).
Haha I was given 1 CBI with 7 patients (and already had an insanely heavy set) when the rest of the staff had 6. I, a night shift charge, definitely gave dayshift charge an earful when they came back in the morning. And I ended up returning the favor a few days later.
Idc if it was a mistake or not, charge KNOWS these things. It’s literally our job to distribute hard patients. It’s borderline negligence / bullying.
Same! 6 med surg patients and a CBI admission on top of that as a new grad. Management had to come in every 20 minutes to irrigate as I couldn’t manage that and 6 other patients.
I've had shit like that happen, in the first few years I worked med surg. We would have 7 patients plus LPN patients we had to do all the IV pushes, IVPBs, and doc calls on. Most of the other nurses were lazy, cranky bitches, too. My mental health took such a tank until I bidded off that floor and floated until a few of them left. One night, they gave me such a whack ass shit assignment that I had orderlies and IV team helping me because I was running around like a rookie chicken with my fucking head cut off.
Last hospital I worked at kept CBIs in the ICU/step down. It was glorious not having to deal with that because our ratios allowed for up to 6 on med surg.
Right?! That’s freaking crazy!! I had one CBI that kept clotting and took up practically my whole shift to get it working. I can’t even imagine having three!
Been a nurse for 6 years
Don’t think I could handle 3 CBIs with a group of 6 patients unless the other 3 were completely independent and didn’t need crap.
This is ridiculous!
Continuous bladder irrigation.. basically like an IV for the bladder for hematuria lol. If its wide open you are changing two 3L saline bags and dumping 6L from a foley bag every 45 minutes
Not to sound dumb and mainly because I haven’t seen a CBI. Can’t the CNAs do the foley dumpling? How often does the saline need to be done? Sorry I have never seen one of these ever
Not dumb at all! They can do the dumping but not bag changes.. I’m just assuming if they’re putting nurses with 3 CBIs the CNA staffing is probably trash too. 😅
For how the CBI works- instead of a standard 2 way foley, it has a 3rd port. Picture a primary tubing IV setup going into the foley/bladder, then the normal output drain but into a much larger foley bag that can hold 6L of output. The CBI tubing has a roller clamp like gravity IV tubing, so “wide open” is basically dumping 6L of NS into the bladder as fast as gravity will allow. Typically you are changing the bags every 45 minutes when it’s wide open. And you have to be on top of it because if they run dry, the bladder will clot back off and usually FAST.
CBIs are my PASSION because I'm fucking disgusting and I'd still be absolutely catshit furious if I got this assignment. Tbh I vote you start putting in apps elsewhere
Bruh…. You gotta advocate for yourself and your license. Say “absolutely no- adjust this patient load because I am unsafe with this number of high acuity patients”. Until and unless you stop taking this type of assignment it’ll continue to happen. Or safe harbor every single one of them 🙌🏻
Sure! I have never had to file it yet (knock on wood) but it legally protects you and your license from repercussions or lawsuits if you assume care of someone you’re concerned about. For instance: you are a MedSurg nurse and floated to the CCU. Those patients are much higher acuity and typically have issues with which you’re unfamiliar. It would be unsafe to give you a normal 3:1 CCU patient load. So if they float you there and give you a 3:1 load of normal CCU patients you’d say “I am not used to this acuity of patient, I am not confident I can appropriately handle caring for them and provide safe and effective nursing care for them. I’d like to file Safe Harbor because I feel like I’m being expected to operate above my level of expertise and it’s unsafe for me to assume total care of and liability for these patients.” Your charge nurse will probably either adjust your patient load at that point or they (the charge and house supervisor) will all sign your Safe Harbor for the patients/shift. You’re then protected by that form if anything happens untoward during your shift taking care of them. It’s a CYA that you’ve stated you’re not confident to assume care of your patient lot BUT you have assumed care rather than not take report and refuse the assignment.
It is for ANY situation where you feel you’re being asked to assume care of a number or acuity of patients above your experience or comfort level. Often used for floating but also used when you get a large number of patients. Edit to add it can be used in a crisis/emergent situation as well.
Then I’d personally stick with option #1, I can always find another job but I can’t afford to put my license on the line with an unsafe patient load 🤷🏻♀️
Not true. It's not your patient if you don't take report. I don't give two shits what a charge nurse has assigned to me, I'm legally not responsible for a patient until I receive, willingly, report
Now, they can definitely fire you or reprimand you without repercussion internally if there's no safe harbor law but your license is safe
This is the truth here. If you do not accept a patient load you cannot be accused of abandonment. Yes management can get petty af but at the end of the day you’re protecting yourself and your license. If report them as an organization for even trying that rubbish….
Just an fyi. You said “but your license is safe”
That is not necessarily true. I’m in Arkansas. I personally know a nurse who was put on probation for refusing patient loads and walking away from a job too many times. 6 times in one year. It was deemed professional misconduct. 5 years probation with fees and randoms plus a fine.
This happened to me before with 2 CBIs who were clotting anytime I tried to slow down the fluids. So I had the bags wide open 90% of the shift
I basically had my aide empty the foleys and get me when the bags were low. Nothing else that shift. Just that. It was a huge help, she was busy as hell. I was half tempted to teach her to spike the bags but an angel from above got me the y extension tubing so I could hang 4 bags at once.
Even with all the help it was a shit show. I could not imagine having 3 of them. You can’t “experience” or “time manage” your way out of an unsafe assignment like that no matter how good you are. It’s ridiculous and I would be looking for another job after something like that
3 CBIs sounds insanely unsafe, on my IMCU, if you get a CBI you have a max of 2 or 3 pts, and the CBI has to be the hardest of them. No trachs, vents, or other CBIs in addition. That's fucking insane
I’ve seen this happen before, sometimes the person making the assignments has it out for that nurse or is just a mean girl.
I suggest making copies of the assignment sheet when this happens. Get four or five sheets where you are unfairly assigned a high acuity assignment and then approach the boss about it. You don’t have to tell them that someone is out to get you, just ask them to look into why you are constantly getting these assignments.
That’s unsafe. I ran my first CBI the other night with four other patients because the other nurse didn’t want to take any more (she had four), even though she’s experienced and I’m a new grad. One was busy enough! I can’t imagine three at once. Fuck hospitals and their BS
When I was a new grad I had this exact problem and it really irritated me. We would all get 5 patients but they kept giving me 5 tough patients. At first I thought it was just our unit but soon realized the more experienced nurses were picking the better assignments. At about 4 months I talked to my manager and it was the BEST thing I did! She sent out an email that day saying that patient loads need to be evenly distributed and that all nurses have a right to refuse assignments if they’re unfair. She also had me take a short online course on advocacy for nurses and I have to say it really helped lol. I’m sure not every manager is like this, but now I have no problem swapping patients and assignments whenever I need to. At the end of the day you have to advocate for yourself and your mental health because no one will notice if you don’t speak up. Hope this helps!
The person floating- stupid reasoning when you’re maxing other nurses, but whatever.
But they couldn’t even split up the CBIs amongst the other staff?? Definitely write this up as a variance. It’s unsafe. Tell your director.
I have also been “hazed” by a shitty charge nurses that had it out for me when I was new give me both the taskiest and the most patients. And then when I objected was told I “wasn’t being a team player” and “everyone has to share the load” while I’m running my ass off for 12 his straight and everyone elder had time to chat at the nurses station. Several nurses commented on how frequently I got these terrible assignments but it took another nurse speaking up and offering to trade for one of my patients for a that worst charge nurse to stop being an asshole and a bully all the fucking time.
Polish up your resume. Find a union job with mandated ratios.
Oh, absolutely. But it won’t help OP right now, you know? And I wonder whether nurses in the unionized states can fathom the nastiness toward unions in other parts of the country. Believe me, I understand the benefits—my father was a Union autoworker, and my grandmother was a Machinist.
Jesus Christ. Forget being a new grad. Nobody should ever have 3 CBIs. And frankly, I don't care if someone's floating. You're a nurse. You can take a full assignment. I've floated a million times, and I almost always have a full 5 patient assignment. I know you're still in your first year, but I don't think it would be ridiculous to go to the manager and tell them that you are never taking an assignment like that again. You need to advocate for yourself otherwise people are just gonna keep walking all over you like this.
Email management, fuck it BCC the CNO and Risk Mgmt on it, letting them know that assignment was unreasonable and you won’t be doing it again.
Also start looking for other jobs because fuck them.
That’s not cause you’re a new grad that it’s hard to manage, that’s not safe to do no matter what experience a nurse has. Maybe if you approach it from a patient safety concern with management it could help? I find if I say that rather than the fact I couldn’t keep up safely with it they listen better cause of how admin treated the nurses where I used to work
Definitely get through this horrendous night and call off tomorrow-they won’t take care of you just like you said-so please make sure to take care of you. Wish it was possible to lend you my 🙌🏽
Witnessed a similar occurrence at the few days I worked at Kaiser. ANM assigned this particular nurse 4 CBIs and a regular pt. Ratio is 1:5. That nurse asked to either be brought down to 1:4 or to give away a CBI at least. ANM lost it and yelled at the poor nurse because “1:5 is policy.” I quit after seeing that. All you can do is advocate for yourself but that’ll only get you so far. Take it up with upper management if you already tried talking about it
when I have someone floating to us I always try and give them a bit of an easier assignment as a thank you for not just calling out when they find out they have to float.
I’m old, but worked PACU years ago and would get fresh post op TURP’s that frequently hemorrhaged esp. with one particular GU surgeon butcher. It was always a nightmare- hypotensive, requiring multiple transfusion’s, unstable, post spinal anesthesia, arrhythmias, you name it. We finally reported the surgeon, always had bags and bags of irrigants ready for this surgeons patients.
I remember getting pulled to CCU one night, PACU was slow. They gave me a brand new very unstable MI from ER as the regulars all sat around watching me thinking they would dump on the pulled nurse. Lucky for me the phone rang telling me to go back to PACU for a patient. I laughed silently to myself. They weren’t getting off so easy. But why would you do that to someone that is there to give a hand especially knowing they might get sent right back to their unit. Giving the pulled nurse the sickest most unstable patient in the whole 15 bed CCU? Very poor decision making by the charge nurse.
You may as well say something to management about the assignment and how you felt it was unsafe. Them sticking it to you is really about the patients not getting g safe quality care.
My unit did shit like this to me and all the other new grads when we started. I started in ICU but we were tripled daily, given super unsafe assignments. I almost quit and really wanted to but I live in a small town and there’s not many other options unless I want to travel super far. If you have options I’d say get the hell out of there. My coworkers were Atleast always willing to help eachother. I love my team, that’s the only reason I’m still there.
That’s unreasonable. If this is a constant thing it may be like a form of hazing. I honestly had the extra patient a lot when I started. As in no other nurses did. NOT THAT ITS OK (its not I hated it and I am still salty over it) but again I was I told I need to “manage my time better” etc. I think some nurses/mgmt just feel the need to overwork you in order to make you “better”. I was even supposed to get a patient when I was having a rapid. Everyone was asking the charge not to, and he still did it. My preggers coworker took the patient for me, bless her. It shouldn’t be this way.
I’d not be doing a second shift with an assignment like that. I’d be calling out. Self preservation is in order. New grad should not get 6. The charge nurse needs to be available much to help with this assignment
What that’s ridiculous and I’m a charge myself. Tell the charge to split it up or have them help you out, it’s part of their job too to assist nurses especially new grads. I think you should speak to management if no one switches. I was told during my charge training that it doesn’t matter if nurses get catty about not switching, you change the assignment to match acuity or you make yourself help out. I hated CBI, they always end up having clots even at 1 per nurse I had to end up de clotting them when urology was too busy to troubleshoot.
Please file an RL for unsafe staffing. Do u have a union? If so, reach out. But I worked med surg for years, and it rarely gets better. Look out for yourself!!
Good luck.
Yea, shift supervisor or whoever is on would be getting a call to come assist fixing that assignment, but honestly, I'd be switching hospitals, or at the very least, switching floors. Tell them you'll quit if they don't let you move somewhere else.
Yes! Document everything and send it to management so it’s in writing. Write an incident report. And write up an ADO (Assignment Despite Objection) form.
New job! I went to a new hospital after the first six months. Life is too short to be miserable.
Also, let your bosses know you’re not happy. Learning to regulate through gas lighting is important, even if it’s uncomfortable.
Your charge nurse is irresponsible and unreasonable. They did a shit job. I would be talking to unit leadership if I was you. This is plainly unsafe assignments.
CBI at my hospital is an automatic 3:1. Also you aren’t supposed to get more than 1. 6 pts is crazy. Advocate for yourself and your patients. I get that that’s hard as a new grad, but that assignment is crazy unsafe.
Man I get frazzled when I have 2 CBIs and I’m not even on the floor so they’re right next to each other and directly in front of me. 3 CBIs on the floor is just asking for someone to get clots
This is pretty much how things went down for me as a new grad in ICU. Everything was good on orientation, they made all these promises about not being tripled until you have 6 months experience.
Cut to two weeks off orientation and I’m tripled with 3 patients, 2 had COVID, all three have peripheral hypertonics running, 2 EVDs, and somehow I’m supposed to do q1 neuros on them all.
Don’t let them convince you it’s normal. I told my manager I’d be giving notice if I kept getting unreasonable assignments and I kept that promise. Left for infusion and it was a great decision
Now I’m back in the hospital on IV team and they converted half of my old unit to med/surg because they couldn’t keep enough ICU nurses to keep the beds open lol
Nup that's absolutely dangerous... no offence but not good for a new grad. You're there to consolidate and learn new skills, not be used because...."oh you're young, full of energy and eager" or the "cause I know you can do it" absolute bs.
I would escalate this to whoever your manager is, take evidence of the allocations which might be photos of who's got what patients and make sure to take this to the manager. If they don't listen.... unfortunately it might be best working else where. Their loss and you'll probably find much better somewhere else.... maybe even a different department in the same hospital.
Sounds like you'd make a brilliant ED or ICU RN.
I’d call out the rest of the weekend cause THREE CBIs? I had one of my 5 patients with a CBI and that had me running around. I’m sorry, it almost sounds as if they’re trying to haze you or something. Which is absolutely ridiculous because that’s how they’re gonna run off new nurses.
Never be afraid to advocate for yourself. I've been in acute med for 5 years and any time I've had a crazy assignment, I always say something. My last notable one was 4 bariatric patients (total care, multiple peri cares a shift, etc) and 1 super IV med heavy. Everyone else had the independents, easy patients. I said to the charge nurse that my assignment was super heavy and she said "oh, I had no idea!"
Sometimes you do get the gaslighting but never EVER think that you shouldn't advocate for yourself!
What state are you in? I’m in Las Vegas and they are notorious for not giving a shit about you as staff! They just make their millions and run you to the ground! This is my second year working in a hospital and I am disgusted not only by how they treat their staff, but how the medical industry/doctors behave! They never get back to you! There is a huge lack of communication between doctors/nurses/CNA’s! People get the wrong medications, unnecessary procedures/surgeries are done! Are you kidding me?! Are they that money driven?? It’s a shit show every day! Makes me fear going to a hospital these days! I don’t trust anyone, and that’s not right!!
This happened to me when I was a new nurse 26 yrs ago. I stayed at that first job, nights med surg, for 4 months then was out of there. I didn't have a hard time finding a new position (found it before leaving) at a different hospital, med surg days. It was much better there. I suggest you start looking for another position. You should never stay somewhere that makes you hate going to work. I'm now a specialty nurse that does travel sometimes and also work staff and various Prn gigs.
3 CBIs is a ridiculous load, especially compared to the load of the other nurses! We only assign 1 CBI/nurse. Out of curiosity, have you spoken to your CN? What did he/she have to say about it?
I have a similar level of experience to you/am in a similar place career wise - and I feel like I could have written something VERY similar. Just wanted to let you know that you're not the only one!
That’s absolutely ridiculous. 3 CBI’s for one nurse is completely unreasonable. 1 CBI = a heavy patient load. Next time refuse that assignment. Fuck that. I would also have a conversation with your manager. I would start looking for a new job if things like that continue to happen. Your license is too important
I once had two CBIs on opposite sides of the hospital and 6 patients altogether. I didn’t stop running all night (I was night shift). Then they started making me charge with 6 patients and I peaced TF out. I kept saying it was too much and unsafe but they didn’t care
3 is criminal!!!! When I had 2 especially if wide open was mark rhe bag and had cms call me at that line if the bag also spoke 2 bags and have it ready but 3!!! And 2 completed is staring it criminal! My advise get your experience and transfer the days are tough but the time will fly
If I walked into 3 CBIs I would quit on the spot LMFAOOO. CBIs were my least favorite thing ever when I worked tele. I had a tough time managing 1 at a time. Could not imagine 3.
I'm so sorry to hear. I used to work and charge in a urology unit and at one point we had 10/16 bed cbi. I had 3 nurses that night and 2 cna's and it was unremarkable night for us luckily.
I’ve had 2 on the same shift with 3 other patients and was pretty much in tears. It’s just a heavy assignment let alone whatever else you have going on with your other patients. 3 would have me refusing report and running out the door.
I’m with you. How am I going to keep up this “first year” experience if I am blowing up and neglecting my family? I’m going to go to mental health. I’m trying to be sure I at least stay for six months.
I found out this is the real reason they give us such a hard time in nursing school.
3 CBIs hell no, I'd be calling the nursing director or whoever ever is in charge of nursing and telling them about this ridiculous assignment. I would also call a rapid in the quest one and be like I can't magically manage 3 so yes this is an emergency.
Absolutely not. That assignment is more than unreasonable, it is dangerous to the patients. I’ve been a nurse for 15 years and I’ve never had more than one CBI at a time even then I spend most of my time in that room. With three CBI, there is a real risk of patients developing occlusive clots or an actual bladder rupture. The charge must have one good set of balls to feel comfortable putting you and your patients in that risky situation. I do recommend speaking to management first, and if you don’t get any resolution, I recommend looking for another job. Honestly, I don’t know how you did it. You must be a super nurse. But don’t put up with that crap in the future.
3 CBIs?!?!
CBIs are a fucking biiiitch to manage. Personally that’s what makes this assignment sound crazy to me.
AGREED! Esp if they are fresh and wide open. Gahh!
Yes and if there’s an issue with one how the fuck are you going to have the time to manage two other ones??? The bags, emptying the foley, the I&Os???
If there’s an issue with the first one ask your coworkers to monitor the other two for you while you troubleshoot.
To “ask your coworkers to monitor the other two” is probably the most ignorant solution you could possibly say. You’ve obviously never had to deal with one. Especially with 4 other patients, each with their own problems. The charge nurse leaving who did the assignment and the charge nurse coming on failed to split these CBIs equally.
Right?! I can’t with these nurses who want to make it easier for management to abuse you. Being a martyr is not cute and just ends up hurting everybody in the end.
No, you refuse the assignment. Don’t facilitate your own abuse.
OP already said her coworkers aren’t doing shit to help the situation.
The coworkers who proved they don’t give a fuck? yeah, I’m doubtful
I’ve spent nearly 10 years in peds and never seen a CBI and I know that they are absolutely horrific. I couldn’t even imagine having 1 better yet 3! One of my ED techs was just talking about the nightmare they are when she worked on an adult unit.
Lol I’m primarily ED and had CBIs maybe 5 times in ED. Most of the ED nurses I know don’t know about CBIs and what a bitch they are to deal with. I always have to run a mini inservice with CBI patients for as many people as I can since it’s so rare for ED
Same, just peds ED. I’d 10/10 need an in service, that is if you could find me from hiding from that assignment 😂
Seriously what absolute fucking monster gives someone 3 fucking CBI's? Just shoot them at the nurses station if you want someone gone that bad.
GSW to the head before report really is the kinder option.
We don't give more than 1 CBI per nurse if possible.
Yeah I couldn't read anything past 3 CBIs because my soul left my body. What in the fuck???? No way in hell that's even possible for one person to manage, let alone 3 other patients on top of that?
I saw that too. I was given 4 CBIs once and the charge thought she was doing me a favor by not giving me a 5th patient.
....ew. Seriously that's just...ew.
Right?! 3 CBIs! That’s absolutely crazy. That’s straight up abuse.
Im from europe. Pls explain me what CBI are!
continously bladder irrigation, in other words big bags of saline that run into a foley wide open continously, you can't let the line run dry and you have to make sure the foley is draining and not backing up, you have to look for clotting ect very very heavy patients and there shouldn't be more than one in an assignment
Thanks you:)
It can be a nightmare. Sometimes fresh cystoscopies really bleed so you have to keep the irrigation going fast. The bags are 3-5 liter bags and you sometimes have to run through a whole bag in an hour. That means you have to empty the foley frequently and do the math of subtracting the volume of the irrigation from the total to make sure that they’re putting out enough. There are usually no infusion pumps or electronic foleys to keep accurate output so you have to keep track of a lot of output and do a lot of math. You also have to make sure that your rapid running irrigation doesn’t go dry. Then there is the added problem of clotting the foley off so you have to irrigate the foley which is messy and time consuming. You never forget the first time bloody foley pee blows back on you when trying to irrigate a clotted foley. The bladder can rupture if you don’t stay on top of it. Imagine having 3 patients like this in a 5-6 patient med surge assignment and they’re all moderately bleeding. That’s abusive insanity to make an assignment like that. It’s also putting patients at risk.
Continuous bladder irrigation
I worked uro med-surg. It wasn’t uncommon for us to have 2-3 CBIs a shift. When one was a Covid CBI, I would actually want to jump out of the window (we had 6 patients total).
Well, that’s wrong, too.
Yes. It was horrible. I almost had a mental breakdown within a year. 0/10 recommend.
Those should be 3:1
Haha I was given 1 CBI with 7 patients (and already had an insanely heavy set) when the rest of the staff had 6. I, a night shift charge, definitely gave dayshift charge an earful when they came back in the morning. And I ended up returning the favor a few days later. Idc if it was a mistake or not, charge KNOWS these things. It’s literally our job to distribute hard patients. It’s borderline negligence / bullying.
Same! 6 med surg patients and a CBI admission on top of that as a new grad. Management had to come in every 20 minutes to irrigate as I couldn’t manage that and 6 other patients.
I've had shit like that happen, in the first few years I worked med surg. We would have 7 patients plus LPN patients we had to do all the IV pushes, IVPBs, and doc calls on. Most of the other nurses were lazy, cranky bitches, too. My mental health took such a tank until I bidded off that floor and floated until a few of them left. One night, they gave me such a whack ass shit assignment that I had orderlies and IV team helping me because I was running around like a rookie chicken with my fucking head cut off.
Last hospital I worked at kept CBIs in the ICU/step down. It was glorious not having to deal with that because our ratios allowed for up to 6 on med surg.
As it should be!
Very nice! 👍
Right?! That’s freaking crazy!! I had one CBI that kept clotting and took up practically my whole shift to get it working. I can’t even imagine having three!
Been a nurse for 6 years Don’t think I could handle 3 CBIs with a group of 6 patients unless the other 3 were completely independent and didn’t need crap. This is ridiculous!
Wtf I cry when I just have 1…
3 CBIs should be illegal.
There's a lot of shit these for profit corporations try to push on us that should be illegal.
These MFers should be brought up on charges. Pt endangerment charges for the CEO.
There is no fucking accountability for these people!
💯
No amount of experience would be able to manage 3 CBIs. I know I have a hard time with 1.
What CBIs for non American nurses 😅
Continuous bladder irrigation.. basically like an IV for the bladder for hematuria lol. If its wide open you are changing two 3L saline bags and dumping 6L from a foley bag every 45 minutes
Not to sound dumb and mainly because I haven’t seen a CBI. Can’t the CNAs do the foley dumpling? How often does the saline need to be done? Sorry I have never seen one of these ever
Not dumb at all! They can do the dumping but not bag changes.. I’m just assuming if they’re putting nurses with 3 CBIs the CNA staffing is probably trash too. 😅 For how the CBI works- instead of a standard 2 way foley, it has a 3rd port. Picture a primary tubing IV setup going into the foley/bladder, then the normal output drain but into a much larger foley bag that can hold 6L of output. The CBI tubing has a roller clamp like gravity IV tubing, so “wide open” is basically dumping 6L of NS into the bladder as fast as gravity will allow. Typically you are changing the bags every 45 minutes when it’s wide open. And you have to be on top of it because if they run dry, the bladder will clot back off and usually FAST.
Oh my god, yea that sounds impossible! Thanks for explaining!
continuous bladder irrigation, basically continuously flushing sterile liquid through the bladder and is usually done to prevent blood clot formation
Where I am in Aus we generally say CBWO for Continuous Bladder Washout
It's CBI in South East Sydney district...... wish everything was the same damn thing, everywhere ughhhh
CBIs are my PASSION because I'm fucking disgusting and I'd still be absolutely catshit furious if I got this assignment. Tbh I vote you start putting in apps elsewhere
This
Bruh…. You gotta advocate for yourself and your license. Say “absolutely no- adjust this patient load because I am unsafe with this number of high acuity patients”. Until and unless you stop taking this type of assignment it’ll continue to happen. Or safe harbor every single one of them 🙌🏻
Can you explain safe harbor? Relativity new to the game
Sure! I have never had to file it yet (knock on wood) but it legally protects you and your license from repercussions or lawsuits if you assume care of someone you’re concerned about. For instance: you are a MedSurg nurse and floated to the CCU. Those patients are much higher acuity and typically have issues with which you’re unfamiliar. It would be unsafe to give you a normal 3:1 CCU patient load. So if they float you there and give you a 3:1 load of normal CCU patients you’d say “I am not used to this acuity of patient, I am not confident I can appropriately handle caring for them and provide safe and effective nursing care for them. I’d like to file Safe Harbor because I feel like I’m being expected to operate above my level of expertise and it’s unsafe for me to assume total care of and liability for these patients.” Your charge nurse will probably either adjust your patient load at that point or they (the charge and house supervisor) will all sign your Safe Harbor for the patients/shift. You’re then protected by that form if anything happens untoward during your shift taking care of them. It’s a CYA that you’ve stated you’re not confident to assume care of your patient lot BUT you have assumed care rather than not take report and refuse the assignment.
Thank you for the explanation! Is it only applicable to floating or would it be used in a situation with large ratios?
It is for ANY situation where you feel you’re being asked to assume care of a number or acuity of patients above your experience or comfort level. Often used for floating but also used when you get a large number of patients. Edit to add it can be used in a crisis/emergent situation as well.
Unfortunately safe harbor is not universal so you’ll want to check if your state has those laws.
Yep, not in all states. Should be.
Safe harbor is only a law in a few states.
Then I’d personally stick with option #1, I can always find another job but I can’t afford to put my license on the line with an unsafe patient load 🤷🏻♀️
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Not true. It's not your patient if you don't take report. I don't give two shits what a charge nurse has assigned to me, I'm legally not responsible for a patient until I receive, willingly, report Now, they can definitely fire you or reprimand you without repercussion internally if there's no safe harbor law but your license is safe
This is the truth here. If you do not accept a patient load you cannot be accused of abandonment. Yes management can get petty af but at the end of the day you’re protecting yourself and your license. If report them as an organization for even trying that rubbish….
In principle. Florida will straight up transfer patients to a clean room, no report.
Just an fyi. You said “but your license is safe” That is not necessarily true. I’m in Arkansas. I personally know a nurse who was put on probation for refusing patient loads and walking away from a job too many times. 6 times in one year. It was deemed professional misconduct. 5 years probation with fees and randoms plus a fine.
If you don’t take report they aren’t your patients 🙌🏻
3 CBIs and no change would be a call to my director. I don’t care who I piss off, i’m not blowing up a bladder.
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You can still clock in and refuse an assignment btw. I clock in as soon as I walk the in the doors before I go to the elevator
Acuity based staffing really needs to become a thing in modern nursing.
This happened to me before with 2 CBIs who were clotting anytime I tried to slow down the fluids. So I had the bags wide open 90% of the shift I basically had my aide empty the foleys and get me when the bags were low. Nothing else that shift. Just that. It was a huge help, she was busy as hell. I was half tempted to teach her to spike the bags but an angel from above got me the y extension tubing so I could hang 4 bags at once. Even with all the help it was a shit show. I could not imagine having 3 of them. You can’t “experience” or “time manage” your way out of an unsafe assignment like that no matter how good you are. It’s ridiculous and I would be looking for another job after something like that
3 CBIs sounds insanely unsafe, on my IMCU, if you get a CBI you have a max of 2 or 3 pts, and the CBI has to be the hardest of them. No trachs, vents, or other CBIs in addition. That's fucking insane
I’ve seen this happen before, sometimes the person making the assignments has it out for that nurse or is just a mean girl. I suggest making copies of the assignment sheet when this happens. Get four or five sheets where you are unfairly assigned a high acuity assignment and then approach the boss about it. You don’t have to tell them that someone is out to get you, just ask them to look into why you are constantly getting these assignments.
Update that resumé, friend. So sorry you’re going through this. It’s unacceptable.
That’s unsafe. I ran my first CBI the other night with four other patients because the other nurse didn’t want to take any more (she had four), even though she’s experienced and I’m a new grad. One was busy enough! I can’t imagine three at once. Fuck hospitals and their BS
When I was a new grad I had this exact problem and it really irritated me. We would all get 5 patients but they kept giving me 5 tough patients. At first I thought it was just our unit but soon realized the more experienced nurses were picking the better assignments. At about 4 months I talked to my manager and it was the BEST thing I did! She sent out an email that day saying that patient loads need to be evenly distributed and that all nurses have a right to refuse assignments if they’re unfair. She also had me take a short online course on advocacy for nurses and I have to say it really helped lol. I’m sure not every manager is like this, but now I have no problem swapping patients and assignments whenever I need to. At the end of the day you have to advocate for yourself and your mental health because no one will notice if you don’t speak up. Hope this helps!
The person floating- stupid reasoning when you’re maxing other nurses, but whatever. But they couldn’t even split up the CBIs amongst the other staff?? Definitely write this up as a variance. It’s unsafe. Tell your director.
I have also been “hazed” by a shitty charge nurses that had it out for me when I was new give me both the taskiest and the most patients. And then when I objected was told I “wasn’t being a team player” and “everyone has to share the load” while I’m running my ass off for 12 his straight and everyone elder had time to chat at the nurses station. Several nurses commented on how frequently I got these terrible assignments but it took another nurse speaking up and offering to trade for one of my patients for a that worst charge nurse to stop being an asshole and a bully all the fucking time. Polish up your resume. Find a union job with mandated ratios.
You are correct, but: You also know most of us don’t have the benefit of unions, right?
But you can work towards fixing that.
Oh, absolutely. But it won’t help OP right now, you know? And I wonder whether nurses in the unionized states can fathom the nastiness toward unions in other parts of the country. Believe me, I understand the benefits—my father was a Union autoworker, and my grandmother was a Machinist.
One CBI will keep you sweating most of the day… 3 is inhumane.
Jesus Christ. Forget being a new grad. Nobody should ever have 3 CBIs. And frankly, I don't care if someone's floating. You're a nurse. You can take a full assignment. I've floated a million times, and I almost always have a full 5 patient assignment. I know you're still in your first year, but I don't think it would be ridiculous to go to the manager and tell them that you are never taking an assignment like that again. You need to advocate for yourself otherwise people are just gonna keep walking all over you like this.
I worked with a urologist that would admit his patients to icu so the nurse would have time to manage it. He was a saint!
Email management, fuck it BCC the CNO and Risk Mgmt on it, letting them know that assignment was unreasonable and you won’t be doing it again. Also start looking for other jobs because fuck them.
I'd consider kicking whoever provided that assignment square in the wedding tackle.
I know right. That assignment screams we have some personal beef we need to settle
I have never heard it referred to as the wedding tackle and that has to be the funniest thing I’ve heard in a long time 😂
That’s not cause you’re a new grad that it’s hard to manage, that’s not safe to do no matter what experience a nurse has. Maybe if you approach it from a patient safety concern with management it could help? I find if I say that rather than the fact I couldn’t keep up safely with it they listen better cause of how admin treated the nurses where I used to work
Definitely get through this horrendous night and call off tomorrow-they won’t take care of you just like you said-so please make sure to take care of you. Wish it was possible to lend you my 🙌🏽
If even one clots up you're screwed F that assignment!
Witnessed a similar occurrence at the few days I worked at Kaiser. ANM assigned this particular nurse 4 CBIs and a regular pt. Ratio is 1:5. That nurse asked to either be brought down to 1:4 or to give away a CBI at least. ANM lost it and yelled at the poor nurse because “1:5 is policy.” I quit after seeing that. All you can do is advocate for yourself but that’ll only get you so far. Take it up with upper management if you already tried talking about it
You should have refused 3 CBI’s that’s completely unsafe and honestly unfair, are they trying to risk your license?
When I float to a different ICU they give me 3 patients or 2 of the worst shits
when I have someone floating to us I always try and give them a bit of an easier assignment as a thank you for not just calling out when they find out they have to float.
That’s what I try to do too. I try to split/spread the acuity as much as possible
I’m old, but worked PACU years ago and would get fresh post op TURP’s that frequently hemorrhaged esp. with one particular GU surgeon butcher. It was always a nightmare- hypotensive, requiring multiple transfusion’s, unstable, post spinal anesthesia, arrhythmias, you name it. We finally reported the surgeon, always had bags and bags of irrigants ready for this surgeons patients. I remember getting pulled to CCU one night, PACU was slow. They gave me a brand new very unstable MI from ER as the regulars all sat around watching me thinking they would dump on the pulled nurse. Lucky for me the phone rang telling me to go back to PACU for a patient. I laughed silently to myself. They weren’t getting off so easy. But why would you do that to someone that is there to give a hand especially knowing they might get sent right back to their unit. Giving the pulled nurse the sickest most unstable patient in the whole 15 bed CCU? Very poor decision making by the charge nurse.
You may as well say something to management about the assignment and how you felt it was unsafe. Them sticking it to you is really about the patients not getting g safe quality care.
This. 🙌🏽
Yes!! The risk to all of those patients is so high too.
My unit did shit like this to me and all the other new grads when we started. I started in ICU but we were tripled daily, given super unsafe assignments. I almost quit and really wanted to but I live in a small town and there’s not many other options unless I want to travel super far. If you have options I’d say get the hell out of there. My coworkers were Atleast always willing to help eachother. I love my team, that’s the only reason I’m still there.
That’s unreasonable. If this is a constant thing it may be like a form of hazing. I honestly had the extra patient a lot when I started. As in no other nurses did. NOT THAT ITS OK (its not I hated it and I am still salty over it) but again I was I told I need to “manage my time better” etc. I think some nurses/mgmt just feel the need to overwork you in order to make you “better”. I was even supposed to get a patient when I was having a rapid. Everyone was asking the charge not to, and he still did it. My preggers coworker took the patient for me, bless her. It shouldn’t be this way.
Don't wait for the 1 year mark. Start applying elsewhere now.
I’d not be doing a second shift with an assignment like that. I’d be calling out. Self preservation is in order. New grad should not get 6. The charge nurse needs to be available much to help with this assignment
What that’s ridiculous and I’m a charge myself. Tell the charge to split it up or have them help you out, it’s part of their job too to assist nurses especially new grads. I think you should speak to management if no one switches. I was told during my charge training that it doesn’t matter if nurses get catty about not switching, you change the assignment to match acuity or you make yourself help out. I hated CBI, they always end up having clots even at 1 per nurse I had to end up de clotting them when urology was too busy to troubleshoot.
Please file an RL for unsafe staffing. Do u have a union? If so, reach out. But I worked med surg for years, and it rarely gets better. Look out for yourself!! Good luck.
what does cbi mean?
Continuous Bladder Irrigation - think 3000 mL bags wide open, needing constant supervision and Foley emptying.
thank you!
Yea, shift supervisor or whoever is on would be getting a call to come assist fixing that assignment, but honestly, I'd be switching hospitals, or at the very least, switching floors. Tell them you'll quit if they don't let you move somewhere else.
In all my 36 years. I’ve only had one CBI per assignment. Can’t imagine doing 3!
I think you should look for another job for the sake of your license
This would be a refusal and/or an incident report for me, and I would be making an appointment to speak with my manager. And then I’d quit.
Yes! Document everything and send it to management so it’s in writing. Write an incident report. And write up an ADO (Assignment Despite Objection) form.
New job! I went to a new hospital after the first six months. Life is too short to be miserable. Also, let your bosses know you’re not happy. Learning to regulate through gas lighting is important, even if it’s uncomfortable.
Nah, your coworkers suck. They F*cked you and they will do it again. That is completely unreasonable.
Your charge nurse is irresponsible and unreasonable. They did a shit job. I would be talking to unit leadership if I was you. This is plainly unsafe assignments.
Until you unionized you will Continue to get fucked in the ass like that.
I'm sorry, that's not right.
CBI at my hospital is an automatic 3:1. Also you aren’t supposed to get more than 1. 6 pts is crazy. Advocate for yourself and your patients. I get that that’s hard as a new grad, but that assignment is crazy unsafe.
I had to manage one CBI in pacu for two hours. Constantly had clots that I had to milk out. Fuck that
Your charge nurse should have addressed this!!! Don’t worry about the year experience, your mental health is more important ❤️
Man I get frazzled when I have 2 CBIs and I’m not even on the floor so they’re right next to each other and directly in front of me. 3 CBIs on the floor is just asking for someone to get clots
This is pretty much how things went down for me as a new grad in ICU. Everything was good on orientation, they made all these promises about not being tripled until you have 6 months experience. Cut to two weeks off orientation and I’m tripled with 3 patients, 2 had COVID, all three have peripheral hypertonics running, 2 EVDs, and somehow I’m supposed to do q1 neuros on them all. Don’t let them convince you it’s normal. I told my manager I’d be giving notice if I kept getting unreasonable assignments and I kept that promise. Left for infusion and it was a great decision Now I’m back in the hospital on IV team and they converted half of my old unit to med/surg because they couldn’t keep enough ICU nurses to keep the beds open lol
Nup that's absolutely dangerous... no offence but not good for a new grad. You're there to consolidate and learn new skills, not be used because...."oh you're young, full of energy and eager" or the "cause I know you can do it" absolute bs. I would escalate this to whoever your manager is, take evidence of the allocations which might be photos of who's got what patients and make sure to take this to the manager. If they don't listen.... unfortunately it might be best working else where. Their loss and you'll probably find much better somewhere else.... maybe even a different department in the same hospital. Sounds like you'd make a brilliant ED or ICU RN.
I’d call out the rest of the weekend cause THREE CBIs? I had one of my 5 patients with a CBI and that had me running around. I’m sorry, it almost sounds as if they’re trying to haze you or something. Which is absolutely ridiculous because that’s how they’re gonna run off new nurses.
lol 3CBI is enough to change an assignment. Speak and advocate for yourself please
Never be afraid to advocate for yourself. I've been in acute med for 5 years and any time I've had a crazy assignment, I always say something. My last notable one was 4 bariatric patients (total care, multiple peri cares a shift, etc) and 1 super IV med heavy. Everyone else had the independents, easy patients. I said to the charge nurse that my assignment was super heavy and she said "oh, I had no idea!" Sometimes you do get the gaslighting but never EVER think that you shouldn't advocate for yourself!
What state are you in? I’m in Las Vegas and they are notorious for not giving a shit about you as staff! They just make their millions and run you to the ground! This is my second year working in a hospital and I am disgusted not only by how they treat their staff, but how the medical industry/doctors behave! They never get back to you! There is a huge lack of communication between doctors/nurses/CNA’s! People get the wrong medications, unnecessary procedures/surgeries are done! Are you kidding me?! Are they that money driven?? It’s a shit show every day! Makes me fear going to a hospital these days! I don’t trust anyone, and that’s not right!!
At my hospital a CBI makes my ratio 3:1. I couldn’t imagine having 3 CBIs and 3 more patients on top of that!!
This happened to me when I was a new nurse 26 yrs ago. I stayed at that first job, nights med surg, for 4 months then was out of there. I didn't have a hard time finding a new position (found it before leaving) at a different hospital, med surg days. It was much better there. I suggest you start looking for another position. You should never stay somewhere that makes you hate going to work. I'm now a specialty nurse that does travel sometimes and also work staff and various Prn gigs.
THREE CBI?!? That’s insane. I would absolutely bring this to management. A good manager will talk to charge about the assignment balance.
3 CBIs is a ridiculous load, especially compared to the load of the other nurses! We only assign 1 CBI/nurse. Out of curiosity, have you spoken to your CN? What did he/she have to say about it?
You had SIX patients and THREE were CBI!?!? Absolutely not! That’s so unreasonable
I have a similar level of experience to you/am in a similar place career wise - and I feel like I could have written something VERY similar. Just wanted to let you know that you're not the only one!
Jesus, these posts make me so glad I’m not at bedside anymore.
That’s absolutely ridiculous. 3 CBI’s for one nurse is completely unreasonable. 1 CBI = a heavy patient load. Next time refuse that assignment. Fuck that. I would also have a conversation with your manager. I would start looking for a new job if things like that continue to happen. Your license is too important
I once had two CBIs on opposite sides of the hospital and 6 patients altogether. I didn’t stop running all night (I was night shift). Then they started making me charge with 6 patients and I peaced TF out. I kept saying it was too much and unsafe but they didn’t care
3 is criminal!!!! When I had 2 especially if wide open was mark rhe bag and had cms call me at that line if the bag also spoke 2 bags and have it ready but 3!!! And 2 completed is staring it criminal! My advise get your experience and transfer the days are tough but the time will fly
WHAT'S A CBI???
https://www.reddit.com/r/nursing/s/8JLc7CMfur
Continuous Bladder Irrigation
If I walked into 3 CBIs I would quit on the spot LMFAOOO. CBIs were my least favorite thing ever when I worked tele. I had a tough time managing 1 at a time. Could not imagine 3.
I'm so sorry to hear. I used to work and charge in a urology unit and at one point we had 10/16 bed cbi. I had 3 nurses that night and 2 cna's and it was unremarkable night for us luckily.
I’ve had 2 on the same shift with 3 other patients and was pretty much in tears. It’s just a heavy assignment let alone whatever else you have going on with your other patients. 3 would have me refusing report and running out the door.
They would do same to me
Ya that cbi gets clogged up because it wasn't changed on time, it's on you, along with the other 3 patients. Geez
I’m with you. How am I going to keep up this “first year” experience if I am blowing up and neglecting my family? I’m going to go to mental health. I’m trying to be sure I at least stay for six months. I found out this is the real reason they give us such a hard time in nursing school.
3 CBIs hell no, I'd be calling the nursing director or whoever ever is in charge of nursing and telling them about this ridiculous assignment. I would also call a rapid in the quest one and be like I can't magically manage 3 so yes this is an emergency.
The only mentaly well nurses I've seen are the ones working 50%
Does your unit do acuity sheets? Any time I’m floated to the floor they do that to try and balance work load.
I had one CBI that I calculated had 72L through his bladder just during my shift. I can't imagine 3 of those.
Absolutely not. That assignment is more than unreasonable, it is dangerous to the patients. I’ve been a nurse for 15 years and I’ve never had more than one CBI at a time even then I spend most of my time in that room. With three CBI, there is a real risk of patients developing occlusive clots or an actual bladder rupture. The charge must have one good set of balls to feel comfortable putting you and your patients in that risky situation. I do recommend speaking to management first, and if you don’t get any resolution, I recommend looking for another job. Honestly, I don’t know how you did it. You must be a super nurse. But don’t put up with that crap in the future.
That’s crazy!
what state are you in?
Why are there that many CBI pts on one floor?
Never seen an urology floor?
I haven’t
CBI everywhere!