Floor Nurses... How do you organize your day and survive?

I have been working as an RN for 1 year a brand new very small hospital. This is a Rural hospital, and our Medical floor has 10 beds. We staff 2 RN's and once CNA. Management says we should be able to hand a 5 to 1 ratio no problem. I can tell you that when this happens, I do not get any breaks, and I often feel like I am not giving my patients the care they deserve... I know all of the RN's I work with feel the same way, and it has become a very popular topic to complain about at work. Our argument is that they want us to build this great reputation, and start taking sicker patients... well we want to feel safe doing that. My Manager (who does not work the floor EVER), says we need to become better organized, because other hospitals do a 5 to 1 ratio just fine. (Keep in mind, we are the only support staff we have. There is an ER, but they are having the same problem, no respitory therapy, nothing...) So for you nurses that do have a high ratio, how do you do it? We do 12 hours shifts. I start my day by doing all my physical assessments, I try to keep it basic overall, and then focus on the reason they are with us. Then I try to chart. (We are all paper charting still, and we have to chart multiple things in multiple places.) Then I start my morning med pass and am usually done with in two hours. Then its lunch, which usually consist of taking off Dr orders and discharging or admitting. Then there is another med pass and dinner. That's usually how it goes as long as NOTHING goes wrong. Any tips is very much appreciated. If I need to be able to take 5 patients, then that's fine, I want to learn how to do it well.
I'm in Australia so my nurse to patient ratio is 1:8 on days 1:11/12 on nights. Here is how I do it. 0645: get in a a few minutes early. Check charts. Create a brain sheet for the day. Check orders. Check who is being discharged. I do all of this so I can mentally get a picture of what my day is going to look like and get organized before the shift starts.0700-0730: Get report from previous shift. Walking rounds let me do a "mini" assessment on the patients condition- is anyone in distress? Pain? I check drains/wounds and IV sites. If a see a near empty fluid bag in my walking round I know to get a fresh bag when I go in to do my assessment. 0800-1000: Generally the most hectic part of the shift. I'm assessing patients, putting out fires from the previous shift if they were run off there feet. Dispensing medications. I also feed the patients that need help and shower/bed bath patents that require assistance. We have one "AIN" for a whole ward, so nurses do all the ADL assistance here. In the mean time Drs are rounding asking questions. Physiotherapy wants my help getting patient so and so up out of bed. Radiology is calling me about patient "x's" MRI time. Dietician wants to discuss patient "y's" current diet. A patients relative wants to discuss the current treatment plan. 2 of the patients are waiting to get discharged. You know what it's like. My biggest tips are to get super organized. And cluster care but ONLY when it's appropriate. Eg: a patient needs a dressing changed. While I'm in the room ill also check their blood glucose level, check vital signs and assist them to the bathroom all while I'm in the room. Going back and forth for these tasks is just a waste of time. Another tip is to hourly round. It may seem tedious and annoying but it actually works and will end up saving you heaps of time and the patients really like it. Chart as you go- don't leave it all to when the day is over.That's all I can think of right now.

Bringonthenight. Where are you working at 1:8? I work in Melbourne so its 1:4 with 50% loading which means 2 nurses may have an extra pt. We have no AIN but the charge deals with a lot of the phone calls and family enquiries.

Quote from K+MgSO4Bringonthenight. Where are you working at 1:8? I work in Melbourne so its 1:4 with 50% loading which means 2 nurses may have an extra pt. We have no AIN but the charge deals with a lot of the phone calls and family enquiries.

I knowww! I'm so jealous of Victoria. I'd move there in a heart beat but we all know the job situation down there!

If the nurse to patient ratio is 1:4 in general wards, what is it in critical care areas like CCU, HDU?

HDU is 1:2 CCU I think is 1:3 ICU 1:1 CCU will only take a certain level of infusions. You could be extubated in ICU and still be 1:1 if you are sick enough. ED is 1:3. Plus charge resource nurse and waiting room nurse who looks after. The pt in the WR so the triage. Nurse can just triage.

Thank you for the info! Lol we kinda hijacked this thread. Sorry OP!

What about working nights? I am a new grad...been working 4 months now on the medical floor and I LOVE my job. Typical patient load is 4-5 patients/nurse. And nights are a lot less stressful/busy

Quote from bamaguy1989What about working nights? I am a new grad...been working 4 months now on the medical floor and I LOVE my job. Typical patient load is 4-5 patients/nurse. And nights are a lot less stressful/busy

Its your time management. Your taking to long to pass meds. Two hours to pass meds to five people? I used to pass meds to 30 people in four hours, including taking HRs, BPs, and Blood sugars, while working long term care. Get faster on passing your meds and you will have more time for other things.

Quote from IsisCI used to pass meds to 30 people in four hours, including taking HRs, BPs, and Blood sugars, while working long term care.

Here's what I do. Granted I work an 8 hour day, but still:0700-0730: Get report. * Take a few minutes to organize yourself. Who needs to be seen first? Who has the most pressing need? What can be delegated to the CNA? * Write down your patient's labs and vital signs before you assess them. This should give you a hint of what to be aware of (low/high BP and pulses, high/low electrolytes, low H&H, etc., are all very useful things to consider during your general head to toe assessment). 0800-0930: Assess your patients and give them their morning meds while you are in the room with them. This means, do your head to toe assessment, and then medicate them as ordered. Bring the meds in with you to save a trip. Make note of what needs to get done for your patients, on my floor, home meds are a biggie. I write a note to myself, with a check box. 0930-10ish: Chart my assessments, write notes, call docs. Yes you will probably get interrupted. Whenever you get done with charting: Round on your patients. If someone's getting discharged, I see them first and go over everything with them. Followed by: lunchtime! (hopefully your docs don't come in at 11 and then write all new orders timed to start at 1200!) and then round on everyone again. You mentioned a second med pass - I suppose it depends on the facility when they bulk most of their meds together, ours are at 0900 and 2100. We usually have TID meds, Coumadin at 1600, etc. There will be many interruptions - patients going for tests, patients who want to leave OMG RIGHT NOW at 0800, people who need frequent toileting or on isolation or try to climb out of bed or admissions - but you gotta go with the flow. TLDR; Combine your med pass and assessment.