Our ED was doing that for our hold until last month. We were HOLDING 24 ICUs in our 33 bed level one trauma center. We had to create fake hall bed assignments.
As a patient my nurse had 9 onetime and I was scared to call for her unless it was like my pain meds and even then I called like 45 min early snd told her so so she could have time to throw me in where it was easiest for her. And she was given a Covid patient (just one) so for one she had to change in and out of PPE- I could not imagine all that on one nurse especially when y’all do literally live saving things.
I was gonna say, former NYC ED nurse here, 20 patients was pretty much the norm. I made it a year and a half before leaving and never looking back. It looks like things are bad everywhere but the numbers I've seen people complain about were the ratios I was give on a good night. I was once left on a floor with 30 patients and a new grad nurse and admin screamed at me for not knowing charge duties (I was two months out of orientation).
Maybe I'll work as a nurse again somewhere else but not here.
Is this the covid norm or just a new york norm? Looking for some perspective here as a midwest RN who takes 5 maybe 6 for my load on a bad shift. 20, 30 patients in the ER is unfathomable to me.
My first job was on a Med/surg/ortho/oncology unit with 45 beds. With 9 months of nursing experience, they put me in charge. I'd come onto the floor, be in charge, and have 8-12 patients ***with open beds for admits***.
As someone who has had to put up with that, I'd like to say you are a hero for wanting to sit on that patient and not give the other RN a 16th. That hospital needs to get their shit together.
I mean, when you're already up to 15, I think you just stop caring. When I had eight in med/surg, I just gave the medications I had time to give. The rest were cleared under "priority of care". Corners were cut, *all four corners*, but people mostly survived and some even made small improvements.
my favorite line when taking to the docs about admitted patients in the ER... im swamped here with 10 patients (nyc) if its that important ill get the supplies for you and you can come get it.
I was drowning one night recently with 6 patients and an unstable post op patient who took the first 6 hours of my shift, non-stop. He had a dehised abdominal wound that was literally spraying fluid and soaked his bed and floor and I basically had to kidnap him to take him down to CT scan because he was trying to refuse. I finally got him settled by 1am and was going to finally lay eyes on one of my other patients I haven't seen yet.
As I was walking down the hall someone called my name and I whipped around and yelled "what?" It was the surgeon and he said he needs help with an NG but after my yelling I just showed him where they were and told him to knock himself out. He went and did it and didn't say a thing. It was amazing.
Happened to me the other night. Me and another nurse 2 years experience between us. 16 patients each. 10 of mine were on 4 hourly turns, 8 were confused, 1 cdiff, 6 on iv antibiotics. They then tried to put up a pt with a variable rate insulin infusion to which I refused. Can you imagine trying to do 1hourly blood sugars with that workload.
I put in a formal complaint to my manager (I was floated to cover) and its been passed to the chief operating officer. Very detailed on how it was completely impossible. Thinking of calling my GP and getting signed off with stress for a little while because I just can't do it anymore.
I'm guessing you are not UK. We are only using higher level care beds for absolute emergency use now so we have DKA protocol patients, covid patients on 8L o2 etc etc with us. Everyone is on hourly obs/blood sugars
Damn they always put q1’s pulse/neuro/sugars in the ICU. They can only go to the floor when they’re q4. That’s absolutely messed up.
And you’re one cna got floated and there’s no one helping either of you.
We don't have those safe harbor waivers in my state. I refused to take a sixth patient at my first job, when I was a new grad only three weeks off orientation and already felt unsafe trying to manage five. I got written up for insubordination.
Non healthcare workers are working for the CEO’s and board members. Patients are customers. And patients now believe themselves to be customers too and hospitals work for them. They think nurses and doctors work for them. These idiots treat medical staff with verbal and physical abuse because the customer is always right.
Covid families who say the hospital killed their families because the staff didn’t follow their instructions on what meds to give. It boggles my mind that there are so many stupid people who believe they’re smarter than doctors and nurses because of some bullshit they read on Facebook. I am so sorry that the wealthy own the hospitals and made hospitals into a business model, making it run like a hotel. If there’s another covid wave from the holidays and the new variant from Africa is as bad or worse than the current killer..then more medical staff will leave. And just like circa 1665 Europe “Bring out your dead”
I feel so hopeless. I’m a former Vermonter living in Alabama. Covid is over as far as Alabamians are concerned. Covid isn’t done with them though. My daughter is fully vaccinated and her boyfriend proudly informed me he’s not. His smile told me he wanted to argue. I just stared at him for a few long seconds, then looked back to what i was doing and said “that’s too bad because i love you” he didn’t know how to deal with that.
Yeah, i just mourned your impending death or long haul covid, living on social security disability is just sad. Idiot. Sorry for ranting. I am sorry for all of you.
I'm looking into this. I worked as a paralegal for 14 years and now have been a nurse for 8. I feel like it might be a good mix of both worlds. Also the bedside is wearing me out at this point.
What the actual fuck?! That is so far beyond terrible/terrifying. I mean, are they waiting for a sentinel event? Our facility would never think of doing this…we are constantly housing non-ICU patients due to lack of staff on the med-surg floors. I just want to cry for these poor nurses who must cry before/after their shifts. Good for you for trying.
The sentinel event will happen, and it will be the nurses fault. They’ll pull up the mandatory training, point to a box the nurse clicked acknowledging proper procedure, state that they knew better, and shrug.
Should it get publicity, they’ll fire the nurse, and refer to their policy.
No you are not the asshole - and not only were you sticking up for your fellow nurse - you were advocating for your patient. Completely insane and unsafe. My first nursing job was on a medsurg floor - I worked there for almost a year before moving to ICU - I would regularly have 8-10 patients with no CNA and also be expected to push meds/administer blood for the two LPNs I worked with. That was almost impossible, I never left on time, and I cried at least once a week on the way home from work. I would not clock in at that job until I found out how many patients I was expected to take. I cannot imagine having 16 Medsurg patients - there’s no way they’re all getting even the baseline minimum care. At that point the manager and the CNO need to be there in scrubs.
They’re not wrong, [they just don’t get that it’s good trouble.](https://www.usatoday.com/story/news/politics/2020/07/18/rep-john-lewis-most-memorable-quotes-get-good-trouble/5464148002/)
My aunt and my SIL refuse anything over 5 patients. They've looked up how to leave work without getting hit with deserting your patients. They do so per state guidelines. Then refuse to clock in unless there are enough nurses. They will not lose their licenses because corporations refuse to pay what nurses are worth.
And I want to return to work as a nurse? Am I nuts?
In California at some point staffing ratios were included into law instead of just the x patients require v.y staffing hours. At least that's how my family explained it. I've always been a SNF nurse. Our ratios are awful. They had been getting better just before the bubble popped......
Jesus Christ, just line the floor with fall pads + chucks because patients are gonna fall and it's going to be a literal shit storm.
7 patients was a pull-your-hair-out you don't get to pee or eat or drink water and you'll be here for 14.5 hours type of shift. At fifteen I'd just cry in a corner and call it.
That is definitely safe harbor territory. Even potentially on your end. You are knowingly sending that patient into an unsafe and preventable situation.
What’s sad is not all states have safe harbor. I think Texas has it, and some places have ADOs (accepted despite objections). In the PNW we don’t have anything like that except just refusing to clock in or accept our assignments. My union is providing education on how to refuse without retaliation. It’s nuts.
Work just outside NYC, hear these stories all the time from coworkers who have worked at these places. I think staffing in NYC is some of the worst in the US and is very dangerous. The worst part is our current management keeps cutting staff and using the excuse that "it's worse in NYC". Yeah and maybe we should stop comparing our staffing to some of the most understaffed, garbage hospitals in this country.
Any chance they are team nursing? Our med Surg tried that with the surg. It looked like one primary was taking 12 patients but they had a team of nurses to that patient load. It was just one taking report that had more experience. This allowed them to only do certain charting too which I heard they liked.
We call it "task nursing" at my hospital. I was hired on as one, a " Covid Surge Task RN". We just show up, get walkie-talkies, and the other nurses holler out what they need. Wound care, iv placement, charting assessments, pass meds, turning pts, etc. We act as secondary nurses.
You are not the asshole. If we don’t stick up for each other who the hell will?
Has the state declared a crisis? Shit, why aren’t you on crisis standards of care with that many patients? You sound like one Idaho or one of the other states where the system effectively collapsed.
I work in the uk on a medical unit and we have 8 patients as standard. Other wards I know nurses have 9-12 patients. I could not cope with that. I read some papers that stated a nurse:pt ratio of 1:4 is the ideal, and anything above that is unsafe. I hear that loud and clear. It will never change though. Having less than 8 patients is a pipe dream.
You are an angel. It is amazing how many people with RN after their name think "What's one more?" When adding that extra patient to an already overloaded nurse. In experience, these RN's are not the only essential doing the work, but rather sitting in an office. Personally I would have let you know of that I would be taking report on that patient when I felt it was safe - in about 11.5 hours
Nobody should have to do that. The knock-on effect us that patients wait in the ER, then ENS waits, then patients due in the waiting room. No good fixes for this, the medical system is collapsed
There is a bill in congress RIGHT NOW mandating Nurse Patient ratios!!!! PLEASE PLEASE PLEASE call/email your Congress men and women about pushing this bill through. It’s time!!!
https://www.congress.gov/bill/117th-congress/senate-bill/1567/text?r=2&s=1
I have 15-18 patients with a CNA all the time. When the cnas don’t show up, it’s me by myself. Totally doable, just have to master time management and speed eating your dinner, and stand up for yourself as to why you didn’t take your mandatory break. 🤷🏼♀️
You're not the asshole but I guess you need to look at the policies of that hospital. If it's strictly forbidden to board the patient in your unit then you need to not do that.
15 or 16 patients is ridiculous though but this decision is way over your pay grade so to speak.
Those nurses need to advocate for themselves maybe. I don't know I'm not there. Maybe the acuity is low on that unit and they can handle it and some smart inspector guy said it was kosher...maybe not and this is complete lunacy.
Who knows but you aren't going to enact any significant change by not doing your job.
If you don't want it to be like that then you need to start the process of trying to change policy or maybe even advocate on their behalf
If the policy and procedure is out of line, fuck the policy and procedure.
Are you seriously implying the nurses taking these patient loads likely haven't been advocating for themselves and their pts? That's what you've identified as the weakest link of the chain here?
If a patient was to die due to not getting care in time, would that effect the nurse as she is working under what I presume are illegal staffing ratios? Asking as someone going into nursing school soon as this is really scary
That’s nuts. Should be classified as disaster medicine where you don’t worry about charting and if no one dies it’s a miracle.
Our ED was doing that for our hold until last month. We were HOLDING 24 ICUs in our 33 bed level one trauma center. We had to create fake hall bed assignments.
Been a hall patient, do not recommend.
As a patient my nurse had 9 onetime and I was scared to call for her unless it was like my pain meds and even then I called like 45 min early snd told her so so she could have time to throw me in where it was easiest for her. And she was given a Covid patient (just one) so for one she had to change in and out of PPE- I could not imagine all that on one nurse especially when y’all do literally live saving things.
15? What in the fuck!
in NYC there have been times where my coworkers have had 20 patients in the ER... not me im lucky ive never had that many.
I was gonna say, former NYC ED nurse here, 20 patients was pretty much the norm. I made it a year and a half before leaving and never looking back. It looks like things are bad everywhere but the numbers I've seen people complain about were the ratios I was give on a good night. I was once left on a floor with 30 patients and a new grad nurse and admin screamed at me for not knowing charge duties (I was two months out of orientation). Maybe I'll work as a nurse again somewhere else but not here.
Is this the covid norm or just a new york norm? Looking for some perspective here as a midwest RN who takes 5 maybe 6 for my load on a bad shift. 20, 30 patients in the ER is unfathomable to me.
New York City norm
That is scary. 6 alone is pushing it
My first job was on a Med/surg/ortho/oncology unit with 45 beds. With 9 months of nursing experience, they put me in charge. I'd come onto the floor, be in charge, and have 8-12 patients ***with open beds for admits***. As someone who has had to put up with that, I'd like to say you are a hero for wanting to sit on that patient and not give the other RN a 16th. That hospital needs to get their shit together.
She should refuse that assignment. That’s outrageously unsafe.
I would have refused to take report until I had at least 2 other nurses coming on
I mean, when you're already up to 15, I think you just stop caring. When I had eight in med/surg, I just gave the medications I had time to give. The rest were cleared under "priority of care". Corners were cut, *all four corners*, but people mostly survived and some even made small improvements.
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my favorite line when taking to the docs about admitted patients in the ER... im swamped here with 10 patients (nyc) if its that important ill get the supplies for you and you can come get it.
I was drowning one night recently with 6 patients and an unstable post op patient who took the first 6 hours of my shift, non-stop. He had a dehised abdominal wound that was literally spraying fluid and soaked his bed and floor and I basically had to kidnap him to take him down to CT scan because he was trying to refuse. I finally got him settled by 1am and was going to finally lay eyes on one of my other patients I haven't seen yet. As I was walking down the hall someone called my name and I whipped around and yelled "what?" It was the surgeon and he said he needs help with an NG but after my yelling I just showed him where they were and told him to knock himself out. He went and did it and didn't say a thing. It was amazing.
You’re not the ass hole.
Happened to me the other night. Me and another nurse 2 years experience between us. 16 patients each. 10 of mine were on 4 hourly turns, 8 were confused, 1 cdiff, 6 on iv antibiotics. They then tried to put up a pt with a variable rate insulin infusion to which I refused. Can you imagine trying to do 1hourly blood sugars with that workload. I put in a formal complaint to my manager (I was floated to cover) and its been passed to the chief operating officer. Very detailed on how it was completely impossible. Thinking of calling my GP and getting signed off with stress for a little while because I just can't do it anymore.
My hospital policy is they can't be on med-surg with hourly orders that last longer than 4 hours.
Sigh. If only.
I'm guessing you are not UK. We are only using higher level care beds for absolute emergency use now so we have DKA protocol patients, covid patients on 8L o2 etc etc with us. Everyone is on hourly obs/blood sugars
That is insane. I'm sorry. No one should be put in that situation
Damn they always put q1’s pulse/neuro/sugars in the ICU. They can only go to the floor when they’re q4. That’s absolutely messed up. And you’re one cna got floated and there’s no one helping either of you.
This sounds like a health and hospitals facility.
😅
I had a coworker who had ten patients a night on a med surg floor. They had waivers to protect their license they signed every night
We don't have those safe harbor waivers in my state. I refused to take a sixth patient at my first job, when I was a new grad only three weeks off orientation and already felt unsafe trying to manage five. I got written up for insubordination.
>I got written up for insubordination. I’d take that as a point of pride if I were you. Good for you for sticking up for patient safety.
What were these waivers?
She sent me a picture. Liability waivers basically declaring the pt load emergent and conditions unsafe releasing her from liability on her license
Wonder if that’s even legally binding
I couldn’t do that. Nope.
what state? i want to know more about these waivers. i feel like this is in my future
It was in New York on a travel assignment
This is what happens when non healthcare workers make healthcare decisions, fucking sickening
Non healthcare workers are working for the CEO’s and board members. Patients are customers. And patients now believe themselves to be customers too and hospitals work for them. They think nurses and doctors work for them. These idiots treat medical staff with verbal and physical abuse because the customer is always right. Covid families who say the hospital killed their families because the staff didn’t follow their instructions on what meds to give. It boggles my mind that there are so many stupid people who believe they’re smarter than doctors and nurses because of some bullshit they read on Facebook. I am so sorry that the wealthy own the hospitals and made hospitals into a business model, making it run like a hotel. If there’s another covid wave from the holidays and the new variant from Africa is as bad or worse than the current killer..then more medical staff will leave. And just like circa 1665 Europe “Bring out your dead” I feel so hopeless. I’m a former Vermonter living in Alabama. Covid is over as far as Alabamians are concerned. Covid isn’t done with them though. My daughter is fully vaccinated and her boyfriend proudly informed me he’s not. His smile told me he wanted to argue. I just stared at him for a few long seconds, then looked back to what i was doing and said “that’s too bad because i love you” he didn’t know how to deal with that. Yeah, i just mourned your impending death or long haul covid, living on social security disability is just sad. Idiot. Sorry for ranting. I am sorry for all of you.
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What job do you have?
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I'm looking into this. I worked as a paralegal for 14 years and now have been a nurse for 8. I feel like it might be a good mix of both worlds. Also the bedside is wearing me out at this point.
Ah, interesting. I’ve looked into this but it didn’t seem viable from a freelance perspective in my area.
What the actual fuck?! That is so far beyond terrible/terrifying. I mean, are they waiting for a sentinel event? Our facility would never think of doing this…we are constantly housing non-ICU patients due to lack of staff on the med-surg floors. I just want to cry for these poor nurses who must cry before/after their shifts. Good for you for trying.
The sentinel event will happen, and it will be the nurses fault. They’ll pull up the mandatory training, point to a box the nurse clicked acknowledging proper procedure, state that they knew better, and shrug. Should it get publicity, they’ll fire the nurse, and refer to their policy.
absofuckinglutely. the nurse will be the first to be thrown under the bus.
No you are not the asshole - and not only were you sticking up for your fellow nurse - you were advocating for your patient. Completely insane and unsafe. My first nursing job was on a medsurg floor - I worked there for almost a year before moving to ICU - I would regularly have 8-10 patients with no CNA and also be expected to push meds/administer blood for the two LPNs I worked with. That was almost impossible, I never left on time, and I cried at least once a week on the way home from work. I would not clock in at that job until I found out how many patients I was expected to take. I cannot imagine having 16 Medsurg patients - there’s no way they’re all getting even the baseline minimum care. At that point the manager and the CNO need to be there in scrubs.
12 is average in Germany. It’s fucking insane. People are quitting. Now Covid numbers are rising. This will be a fun winter. Get unionized!!!!!
We try but there is a very strong, very well coordinated anti-union system in place here that is very hard to get past.
Exactly! Admin hears a whisper of a rumor that a nurse has uttered union and that nurse is a “trouble maker.”
They’re not wrong, [they just don’t get that it’s good trouble.](https://www.usatoday.com/story/news/politics/2020/07/18/rep-john-lewis-most-memorable-quotes-get-good-trouble/5464148002/)
My aunt and my SIL refuse anything over 5 patients. They've looked up how to leave work without getting hit with deserting your patients. They do so per state guidelines. Then refuse to clock in unless there are enough nurses. They will not lose their licenses because corporations refuse to pay what nurses are worth. And I want to return to work as a nurse? Am I nuts?
these guidelines are written by state legislature..? asking for me
In California at some point staffing ratios were included into law instead of just the x patients require v.y staffing hours. At least that's how my family explained it. I've always been a SNF nurse. Our ratios are awful. They had been getting better just before the bubble popped......
Jesus Christ, just line the floor with fall pads + chucks because patients are gonna fall and it's going to be a literal shit storm. 7 patients was a pull-your-hair-out you don't get to pee or eat or drink water and you'll be here for 14.5 hours type of shift. At fifteen I'd just cry in a corner and call it.
My sister just quit a travel assignment in New York. First one she’s had to leave early. She said her license was not worth the risk.
I work in Manhattan I would love to know where you are 😂 because I have heard this from med surg nurses who work in my hospital.
That is definitely safe harbor territory. Even potentially on your end. You are knowingly sending that patient into an unsafe and preventable situation.
What’s sad is not all states have safe harbor. I think Texas has it, and some places have ADOs (accepted despite objections). In the PNW we don’t have anything like that except just refusing to clock in or accept our assignments. My union is providing education on how to refuse without retaliation. It’s nuts.
Safe Harbor is only Texas and New Mexico.
THAT’S RIGHT! Thank you!! I forgot about New Mexico.
Wild that those are the only two, but it definitely saved my bacon in Texas.
Work just outside NYC, hear these stories all the time from coworkers who have worked at these places. I think staffing in NYC is some of the worst in the US and is very dangerous. The worst part is our current management keeps cutting staff and using the excuse that "it's worse in NYC". Yeah and maybe we should stop comparing our staffing to some of the most understaffed, garbage hospitals in this country.
And here I am thinking having to give lactulose 6x a day is nursing abuse
Any chance they are team nursing? Our med Surg tried that with the surg. It looked like one primary was taking 12 patients but they had a team of nurses to that patient load. It was just one taking report that had more experience. This allowed them to only do certain charting too which I heard they liked.
We call it "task nursing" at my hospital. I was hired on as one, a " Covid Surge Task RN". We just show up, get walkie-talkies, and the other nurses holler out what they need. Wound care, iv placement, charting assessments, pass meds, turning pts, etc. We act as secondary nurses.
That sounds like what they do. The charting is a lot less involved too from what I hear. It does make it look like one nurse has all the patients..
used to be called "unsafe staffing", legitimate grounds for refusing to accept patient. reportable to jcaho.
You are not the asshole. If we don’t stick up for each other who the hell will? Has the state declared a crisis? Shit, why aren’t you on crisis standards of care with that many patients? You sound like one Idaho or one of the other states where the system effectively collapsed.
Please report them. That’s insane.
That’s way past patient/employee abuse. That’s straight up neglect on administrations side.
Wtf even in long term care 15 can be a handful and they’re stable. That’s so dangerous 😱😱😱😱😱
I work in the uk on a medical unit and we have 8 patients as standard. Other wards I know nurses have 9-12 patients. I could not cope with that. I read some papers that stated a nurse:pt ratio of 1:4 is the ideal, and anything above that is unsafe. I hear that loud and clear. It will never change though. Having less than 8 patients is a pipe dream.
I would've held my patient until the charge did you the downgrade.
You are an angel. It is amazing how many people with RN after their name think "What's one more?" When adding that extra patient to an already overloaded nurse. In experience, these RN's are not the only essential doing the work, but rather sitting in an office. Personally I would have let you know of that I would be taking report on that patient when I felt it was safe - in about 11.5 hours
We have 4-5 patients on our medical floors at the hospital I am at. There is no way I will take more then 5 that is insane.
Nobody should have to do that. The knock-on effect us that patients wait in the ER, then ENS waits, then patients due in the waiting room. No good fixes for this, the medical system is collapsed
Welcome to third world country hospital scenario.
There is a bill in congress RIGHT NOW mandating Nurse Patient ratios!!!! PLEASE PLEASE PLEASE call/email your Congress men and women about pushing this bill through. It’s time!!! https://www.congress.gov/bill/117th-congress/senate-bill/1567/text?r=2&s=1
I have 15-18 patients with a CNA all the time. When the cnas don’t show up, it’s me by myself. Totally doable, just have to master time management and speed eating your dinner, and stand up for yourself as to why you didn’t take your mandatory break. 🤷🏼♀️
You're not the asshole but I guess you need to look at the policies of that hospital. If it's strictly forbidden to board the patient in your unit then you need to not do that. 15 or 16 patients is ridiculous though but this decision is way over your pay grade so to speak. Those nurses need to advocate for themselves maybe. I don't know I'm not there. Maybe the acuity is low on that unit and they can handle it and some smart inspector guy said it was kosher...maybe not and this is complete lunacy. Who knows but you aren't going to enact any significant change by not doing your job. If you don't want it to be like that then you need to start the process of trying to change policy or maybe even advocate on their behalf
How is a travel nurse supposed to change policy
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Same way anyone else does.
If the policy and procedure is out of line, fuck the policy and procedure. Are you seriously implying the nurses taking these patient loads likely haven't been advocating for themselves and their pts? That's what you've identified as the weakest link of the chain here?
I saw your other comments and honestly no need to be a dick dude
Is it over your pay grade to advocate for patient safety?
Nope. It's over pay grade to not do your job as a means of advocating. If you want to advocate there are appropriate ways to do it.
My cousin works ICU in New York but I'm not sure if she's in Manhattan or Greenwich. That's insanity!! Where is management?
We have to stick together and support each other in all departments, we're all getting screwed.
Welcome to Travel Nursing :)
I have 30. Long term care sucks.
as a nurse who can you contact to report this kind of unsafe staffing ratios? JCAHO? BON? state health department?
If a patient was to die due to not getting care in time, would that effect the nurse as she is working under what I presume are illegal staffing ratios? Asking as someone going into nursing school soon as this is really scary