The numbers game

"Almighty Staffing Grid"

We've all heard of that one before. That hallowed piece of paper that quotes "If there be X number of patients on the floor, there shall be Y number of nurses and Z number of techs. No more... but certainly less".

Yep. I walked onto the floor yesterday, took one look at the census and instantly lost half my energy and strength.

You see, we were at "cusp" - A special combination of 'numbers' which guarantees 'absurd staffing'. Last night was 22 patients - which means 3 nurses. No doubt some of you realize this means, two nurses with 7 patients a piece while one poor slob gets saddled with 8.

Guess who was the gopher last night? Yep, yours truly.


We don't "technically qualify" for an additional nurse until census hits 24. Anyone want to think about the absurdity of that equation? At 23 - two nurses would be juggling 8 while the third would be hacking through 7. For a surgical floor - 6 patients a nurse is the safe max limit. 7 is asking for trouble. 8 is just irresponsible.

Keep in mind, two of the 'new' patients would be admits - which means admit paperwork and assessments and chasing down primary docs and putting together charts (naturally, we don't rate a secretary for nights. I mean 'admits on nights? Whoever heard of such a thing!') and the other myriad bullshit that comes with the territory of "admit" (and while all this is happening, all the other patients and their needs are magically taken care of by the ghost of Ol' Flo').

Now if this wasn't numbing enough - add another admit before we are allowed to call in the on call nurse. Where are we now? At 24 with 4 nurses, which equals? 6 patients a piece --- full ****ing load again!!

Every night is just a race - running from one crisis to the next. Putting out one fire after another. You manage to do your job - barely - and the price you pay is immense personal dissatisfaction. Some days, I run my tail off yet I feel like I accomplished nothing - the entire shift turning into one big, blur of crises merging into each other.



Last night was no different. I started with 6 when I got out of report at 1930. By the time I got done with my assessments, hanging meds, antibiotics, pain interventions , I/O for the shift - it was shift change time. Which means staffing ratios were about to increase - I would have to pick up an extra 1 - 2 patients at this point.

I haven't charted or documented at any point in my shift now. And if I thought I could get away with picking up one, I was sorely mistaken. The other nurse working the 12-hr with me was assigned patients all over creation. No possible way she could take 8 patients. The new nurse coming on to cover the 8 hrs till morning could not possibly start off with 8 - she is yet to see a single patient and if she started with 8, she'd never get done and we'd never leave the floor till noon!

So I was stuck with 8 - three of them being TPNs (which meant lab draws in the morning besides additional interventions), two of them confused/combative post-surgicals (which meant a bitch of a chart-check for each one), one with wildly fluctuating blood sugars and one in isolation for antibiotic resistant illness.

Oh and did I mention that I had only one nursing assistant all night? Who was new and not yet certified to pull foley's or do blood glucose testing? Not only did the poor dear have the whole floor to herself, we nurses had to pitch in and pull her slack (she has but two arms and two legs. There is only so much she can do).

Forget the fact that I was also "Charge" for the night. Which means I was the "go to" guy for the floor - any idiot anywhere in the hospital had a question, a comment or an itch - I was obligated to answer 'em.

Joey from 5th Floor: "Hey Spook! Are you guys busy tonight?"
Spook: "Heck no! We're never busy here. I only have 8 patients to sweat out. How may I serve you?"
Joey from 5th Floor: "Well, we're at 11 patients and have three nurses, but no assistants! Can you imagine that?! We're short staffed! Can you send us one of yours?"
Spook: "Sorry Joey! I only got one for tonight and it's a zoo up here. I can't spare a warm body."
Joey from 5th Floor: (hurt showing through her voice) "Oh! But we're really short, can't you send her down for a half shift?"
Spook: "Joey, I'm sorry but I absolutely can't. Take it up with the House Supe(rvisor)".

A little while later:
Spook: "This is surgical. Spook, RN. How may I help you?"
ICU Sandy: "Heeeeey! Spook! What's up?
Spook: "Uhh, can't talk now Sandy. Sorry. Really busy."
ICU Sandy: "Uh huh. Hey, is Tasha (float pool nurse) working up there?"
Spook: "Nope."
ICU Sandy: "Really? But I was sure she was. See I talked to her last week at the gym and we were going over her schedule. I mean, you know what she's like right? Working all those crazy hours. So any way, we were talking and ..."
Spook: "Uhhh, Sandy, I'm not kidding. I gotta go. I'm super busy here".
ICU Sandy: "Oh ok. If you see Tasha, be sure to tell her to call me, yeah?"

Momentarily -
Spook: "This is Surgical. Spook, RN. How may I help you?"
CVCU Kelly: "Uhhh, this is Kelly in CVCU. Can I speak to the charge nurse?"
Spook: "I'm it. Surgical doesn't rate a charge for nights..."
CVCU Kelly: (astonishment plainly apparent in her voice) "What?!! Really? Wow! I've never heard of that. How do you guys pull it off? It must be..."
Spook: "Was there some thing you needed, Kelly?"
CVCU Kelly: "Oh yeah. Do you guys know how to hook up a CBI to irrigate a Foley?"
Spook: "Didn't you call the House Supe?"
CVCU Kelly: "Yeah, but she doesn't know. She told me to call you guys up in Surgical"
Spook: (Unbelievable!) "Find the Bard access package from CS. If you can't find one, you can always steal one from OR 10. Insert like you would a regular Foley. Remove stopper from third port and connect CBI tubing. Run CBI at rate sufficient to keep Foley output tubing free of clots.
CVCU Kelly: "Thanks!"
Spook: "Yep".


So on and so forth. All freaking night long. And I get to field them calls... "Burden of responsibility" and all that...

To say this was a tough assignment would be an understatement.
And some of the day shift folks couldn't understand why I was 'moody' in the morning...

It took me two and half hours after the end of my shift to finish charting for the night.


It's good I have two nights off. I need the break - unfortunately, I have a 200 mile round trip drive to look forward to tomorrow - need to see my car dealer and finish installing parts on my new car.

No rest for the weary.


Until later...