I floated to a different unit yesterday, one with a reputation for lousy staffing. Rather than the typical “step down” ratio of three patients to one nurse, they often have four patients to one nurse, with multiple admissions and discharges. This is also a unit where there are never enough supplies, and where there are often no nurse assistants or relief nurses to help.
Sure enough, within an hour of my arrival I was given an additional patient to go along with my already heavy load: two bed bound patients (one of whom could not move at all, one of whom was on continuous morphine for pain) and a third who couldn’t ambulate past the bathroom. All three were post-op spinal patients and required careful handling when turning and getting out of bed. The fourth patient who arrived had had a significantly low heart rate for several hours (in the 40-50’s) and was post-op brain surgery, requiring every two hour neuro checks.
Four patients, all heavy, and no nurse assistant on the floor to answer call lights, get patients to the bathroom, bring ice chips or water. Around three o’clock, after being on my feet for eight hours running from room to room, I called my charge nurse and said, “I haven’t sat down since eight, I haven’t had a single break, and I haven’t eaten.” She said, “You’ll have to get another nurse to watch your patients, we don’t have any relief.”
So I gave report on my four patients to a nurse who already had four patients of her own and rushed to the break room to swallow a few bites of food. When I returned, ten minutes later, a very large pizza had arrived, the gift of some nurse administrator. “Instead of buying us a pizza,” one of my colleagues commented, “why not send us a nurse?” To which I replied, “Better yet, let’s have the pizza answer all the call lights.”
Did I eat three slices of that staffing by pizza? You bet I did.
Aside from issues in patient safety (that patient post op brain surgery with a low heart rate, for example), this is just insulting to the people doing the job. We all worked very hard yesterday, harder than we should have, for someone somewhere who thought it didn’t matter that we couldn’t provide good nursing care, or have the right supplies (no wipes for cleaning dirty bottoms?!) or the right help. Call lights rang all day, family members loitered at the nurses station, hoping to get help, the one charge nurse took patients of her own when it all became so awful and desperate. Yes, we survived, and yes, we made it work, but we shouldn’t have had to, and patient care truly suffered. I wish whoever thought it was okay to go through a shift like that would have come onto the floor for one second to see what it was like to work under those conditions. I wish they had sent a nurse instead of a pizza.