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How many patients is to many?

on May 7, 2011

This week was a tough one for the patients and staff at Tufts Medical Center and Floating Hospital for Children.  The union had voted to strike, and it was going to start today at 6am if things were not resolved.  Thankfully they were, and all is well – for now at least.

This topic has been very interesting to me as both a Nurse and the mother of a former patient (and the friend of other parents who kids are still patients)

One of the main sticking points was Nurse to Staff Ratio.  The nurses wanted it capped at 5 patients, the hospital wanted them to go up to 6 patients.  From what was in the news, it is unclear of what the parameters would be to give a nurse 6 patients

When I was working as a nurse, I was on a “SNF” or Skilled Nursing facility floor.  They got paid like they were a nursing home from Medicaid, which is not much.  Because of that, even if we had a full house of 40 patients, we never go more than 4 nurses at a time.  On Average we would have 5 nursing assistants, maybe 6 if we were lucky.  At this facility, the assistants could check patients blood sugars, which was a big help (this is not so at all hospitals)  On our floor the “acuity” level of our patients was suppose to be something like 60/40 – 60% Rehab, 40% “medical” – it didn’t always seem to work out that way. Some days we could have very “easy” patients and work was great.  But other days, we could have 5 easy patients and the rest more difficult.  I might have two different patients on IV antibiotics every 6 hours, at different times, or even at the same time!   Some patients had a few medications, others had MANY medications.  Some were pleasant, some were down right rude!   When I was in school, the joke was “you never get a bathroom break as a nurse” – I thought No way would that happen to me!!  Well, yup, it did.  I would think “I need to go to the bathroom” and then 2 hours later, realize that because this patient or that patient, needed my help I never did remember to go!

Okay – back to my point – setting patient limits for nurses is very important!  Sure there might be some nights you get all “easy” patients – but then you can help the other nurses with their more difficult ones!  There were many nights that I helped someone finish their med pass, or someone helped me so I could get out on time.

On the unit that Alexander spent most of his time on, there were only 5 patients and 2 nurses.  Except in rare cases, there was never a nurses aid to help out.  These nurses worked incredibly hard!  I remember one particular weekend – Alexander was very sick – and so was another young girl that the nurse also had that day.  It seemed as if they were competing for her attention – He would throw up, nurse ran down to us clean him up, buzzer went off – other patient was throwing up!  She spiked a fever, deal with that, Alexander spiked a fever!  on and on it went.  I can’t even imagine how it would have been for her had she had even ONE more patient to have to help!   Cancer patients require a lot of work and attention.  When they are getting Chemo, they can have a reaction, and need a skilled nurse to be able to see that reaction right away.

Alexander spent some time on the main unit of the hospital as well.  Those nurses did have a 5 patient limit, and they put up a good fight for the Cancer patients, that if they were giving them Chemo, then they would only have 3 patients at a time.  Thankfully, Alexander had a wonderful “Team” on the 7th floor – who of course fought over him at times!

I always find the “comments” on news stories interesting. Some of the writers clearly don’t have a clue about things.  One in particular was “complaining” at how much the nurses make. (the article said the the average nurse makes $114,000 a year – I am sure that was more based on nurses that have been there a LONG time, as many of them have! )  I would like to ask the writer of that comment “just how much do you think a nurse, who is giving life saving treatment to your mother, father, CHILD, should make?”  In my opinion, the nurses that worked with Alexander deserved every penny they got!  Another writer wrote something about “Nurses only have to have an Associates degree and pass a 75 question test”.  Actually, I think it is 85 for RN (74 is LPN) – get your facts straight!  And the test is as FEW as 85, but could be as many as 225.  And, they just don’t take a test – they have graduate from School!!   As for the Associates Vs bachelors degree:  I actually have both – (not in nursing)  And I have looked into both kinds of programs.  From what I can see, the main difference is more school time, and more “non-nursing” classes.   The state mandates how much clinical time is needed, so that is the same.    Sorry – I don’t really see the difference.  I would understand if an RN with a BSN made a few bucks more an hour.  I also read in a nursing magazine, how they didn’t like Associate Degree nurses being called “professionals” because “only people with bachelors degrees are professionals”.  That was a crock of baloney!  But that will be a topic for another day!
So thankfully for now, the nurses are back to work, and hopefully all will be well.   Today is the start of nurses week – if you know a nurse, send her lots of hugs, love, and chocolate!  And remember, always be nice to the nurses, they are the ones that keep the doctors from killing you!


2 responses to “How many patients is to many?

  1. Marge lukas says:

    Nancy, Congratulations on your new blog. Anyone who ever visited your “Care Pages” knew what a wonderful writer you are. Please keep writing. I love reading what you write. As for nurses, my alltime favorite nurse is YOU! So, here is a very big HUG for you and lots of love. Sorry I can’t send some chocolate by blog. Love, Margie A.

  2. Marie Nader says:

    Nancy: I am new to blogging, so please be patient with me. I want to read the Globe artlcle chemo being poison. They’ll only give me a one paragraph abstract for free. Do you have it in a form that you can forward? Did you read the recent article in the Times about what not to say to someone with cancer? For you, it’s slightly off point, but only slightly I think. I’ll be sewing with Alexander’s buddies Tuesday. You and Richard try to enjoy the rest of the holiday weekend.

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