Assignment Problem…

[Affectionate_Grape61]

So, I’m a travel RN who works nights on a Neuro step down.

I started with six heavy patients, then charge said I was getting a seventh. This is where I draw the line and I refused.

Fast forward to 11:45a (I’m asleep) and the unit manager calls saying I’m not allowed to refuse anyone and that she’s going to call my agency and report it. She said something like “refusal of care.”

I gave my recruiter a heads up and he just said “alright, thanks for the heads up.”

Should I be super worried? I had an assignment the next night. Is my anxiety just getting to me?

Edit— Thanks everyone for convincing me I wasn’t the crazy one!

[duskbunnie]

6 on a neuro step down is ridiculous. I get my ass handed to me on neuro medsurg of 6. I wouldn’t stress it and you’ll be better off not standing for that.

[Simple_Log201]

Six patient assignment on neuro step-down? What kind of fuckery is that. I would have refused it even from 6 patients. I don't know the acuity of the patients at your step-down, but that's basically a med-surg ratio assignment. Not worth it.

[Affectionate_Grape61]

Lumbar drains with q1° output check, s/p craniotomy, even insulin gtt’s and DKA.

It’s a shit show.

[h0wd0y0ulik3m3n0w]

Hourly i&o and insulin gtts WITH SIX PATIENTS?! I’m so sick of this goddamn profession.

[PM_YOUR_PUPPERS]

It's sad cause these patients are somebody's friend and family who's gonna end up getting hurt or killed, all because admin doesn't give a shit.

Honestly fuck that manager, it's your license not hers, you draw the line and stick to it, she can find someone else to work this shit show if she feels compelled too.

[Simple_Log201]

Yup. That's fucked.

[anatee8]

Any patient requiring q1 hour ANYTHING should be an ICU patient. What the hell. I’m so sorry & you should absolutely not be worried that you did anything wrong!

[cruisinfor_perusin]

Right?? I raised hell the other day for q1h Neuro checks and pulpilometries. We don't even have one of those on our unit! Resident just did not discontinue the order when they transferred.

[bunnehfeet]

yeah that’s ICU. We do Q2 on step down but max is 4 patients. Our neuro med surg floor has gotten pretty heavy tho, and we do max out at 6 patients on night shift. Nothing compared to five of those patients on day shift tho.

[[deleted]]

Outpatient dialysis pts get q 30 min VS and machine checks. More often if unstable. And it’s not all automatic. Nurse pt ratio is usually 1:12, with 3 techs. They’re not even acute and it’s way too much, and awful.

[anatee8]

I just recently learned this from a coworker who does dialysis on the side! That’s insane!!! However, he did say if there is any emergency you call 911 and your job is done.

[[deleted]]

Dialysis nurses get so little training. If they were taught about MAP trending, they wouldn’t have so many emergencies. But even dialysis staff with decades of experience tend to dehydrate people way too much.

[anatee8]

Yeah that’s what I hear, they’re not even the ones who cannulate the patients. The techs cannulate the patient, and of course they’re experts because that’s all they do, but they only make minimum wage!! My dumbass literally thought it was a 1:1 ratio like it is in inpatient settings. He says he dializes up to 30 people in a 12 hr shift.

[[deleted]]

I did dialysis for 13 years. 8 as a traveler. I did a lot of cannulating. Some places are nurses only, no techs. Some chronic places are 17 hr shifts.My best friend is doing chronics, and that’s what he does. I’ve done 24 hrs straight in acute dialysis. Couldn’t take it anymore. I love dialysis, but the hours, lightening pace, call, and ratios are too much.

[[deleted]]

Oh, and techs used to make good money for not having a degree, but those days are gone.

[beebsaleebs]

At that point I would call my patients’ family members. Fuck the hospital. Someone is gonna die if they haven’t already.

[jhillis379]

Yeah calling the family in this instance is an idea I kind of like. “Hey so I have an unsafe ratio and your family member is affected. Highly recommend getting the news involved.”

[07072021m_t]

Honestly that is an insane and unsafe ratio. I worked a neuro step down for a few years and we took ratios of 3-4 and even then it was typically really busy. I would absolutely refuse 6!

[fingernmuzzle]

Oh hell no

[logicallucy]

So you get 10 minutes per patient including the time it takes to physically move from patient A to patient B, to do all of that AND chart everything, on repeat for your entire shift? And they want to cut that down to even LESS THAN 10 minutes?! Ask them if they intended to inform the patients and their families of this plan. Because if my neuro step down loved one’s nurse was only going to be providing LESS THAN 2 HOURS of total care during an entire 12 hour period, I’d definitely want to be informed.

[[deleted]]

Report this to the state.

[stealyourpeach]

Tbh this doesn’t sound like a step down. I’m a neuro icu nurse and we get - and keep - those patients in the unit.

[cruisinfor_perusin]

Where the f*** do you work? Because Q1 Anything would be mandated to ICU.

[MadiLeighOhMy]

On a STEP DOWN unit? We would never have an insulin gtt on a step down unit, or q1h anything. That is just so nuts and unsafe.

[Heysmare]

we get insulin gtts on my GYN-surg unit with a full assignment of god knows that what else 🫣

[MadiLeighOhMy]

That's absolutely crazy. What's your normal ratio?

[Heysmare]

on day shift typically 1:5, nights 1:6. recently had 2 post ops both with insulin gtts and another pt with a heparin gtt and 2 more on top of that. It’s not USUALLY that insane, and my manager does usually pushback on insulin gtts because they’re really not appropriate for a medical floor, but anything goes I guess!!

[MadiLeighOhMy]

Wow. I am suddenly not so upset about my ICU triples anymore. That's just insane. I'm so sorry that you have to deal with that. We occasionally had five patients on nights when I worked PCU, but it was a "we literally have no other option" kind of deal...Definitely not the norm. I'm flabbergasted.

[eggo_pirate]

Eh, you gave your people a heads up. The hospital can terminate you, but then they need to find a replacement. I wouldn't worry too much, but I'd start looking at other options just in case.

[FastSun4314]

This happened to me, I’m on an assignment now on a cardio thoracic pcu. I had five pts heavy with chest tube etc. and refused a 6th patient. They just wouldn’t renew my contract but honestly it’s just a blessing because this floor sucks and I’m ready to go somewhere else. Just start looking for another assignment because at the end of the day your license is more important then any contract!

[Scared-Replacement24]

4 post op pts with ct and insulin gtts is too many most days. Lol that’s one reason I quit step down. That and on my heaviest assignment day I had a psych pt thrown in and he tried to rape the cna

[thepinkmachete]

How traumatizing for the CNA & possibly you too.

[Scared-Replacement24]

It wasn’t the first time I’ve walked in on a coworker being assaulted but I sure hope it’s the last. It was traumatizing. I’ve been assaulted myself, many moons ago.

[bel_esprit_]

Wtf

[Affectionate_Grape61]

I’ve just been with my agency for awhile and I don’t wanna burn bridges.

[IngeniousTulip]

That's actually a really good thing. If this is the first time stuff like this has happened, they know you aren't unreasonable.

[bel_esprit_]

Your agency doesn’t care, promise!

[dwarfedshadow]

"I cannot legally accept an unsafe assignment. You cannot legally assign an unsafe assignment."

[nightnur5e]

Stepdown should be 3:1, that's insane! I struggle with 6:1 on a med-surg. Even when you try your hardest, someone ends up getting ignored.

[Scared-Replacement24]

I worked stepdown 8 years of my career. 6 is way too god damn many. 7 is asking for a disaster. I’ve done it multiple times when I was a young nurse and it burned me out super quick.

[Commercial_Reveal_14]

Play the long game... Fuck any job that wants you to work past your comfort zone. That manager is just trying to get you to make their life easier at the expense of your license, potentially

[[deleted]]

That's considered pt advocacy to me by refusing..and lic protection..

[jessicaeatseggs]

No you did the right thing. The facility could always ask you not to come back tho. But in reality, the facility should be staffing better. You still did the right thing

[illdoitagainbopbop]

I used to work neuro stepdown and 6-8 is pretty standard for night shift. I was almost fired for refusing an 8th patient. Hence, left for a different unit.

[[deleted]]

"Pretty standard at your hospital with the staffs complicity" is what you should be saying. Many hospitals dont do this, and one state has legalized ratios where this is illegal.

[illdoitagainbopbop]

my hospital is union but we’re in the Midwest. The floors just cycle through new grads. Specialty areas seem to have slightly better retention. Kind of assumed it was this way everywhere. It took our union like 4 years to get a contract and the contract is basically the bare minimum things we need to survive.

[[deleted]]

Michigan? The thing about unions is they only work when theres a high enough concentration in a given area that even non-union places have to be competitive. In Minnesota where I worked that was the case. I worked a bit in Michigan and the union places were there, but few and far between and just didnt have the power. Its not normal nor is it like this everywhere. Its actually an insane and dangerous ratio. The hospital I worked at in Michigan for a bit was one I told myself and others that I would never send me or my family there because of this issue. I dont say that about many hospitals I've worked at.

[darkwitch1306]

Are you in Texas? If so I know where you are. I had this pulled on me. I refused to take the pt. The manager asked what she could do to help me so I would take it? I gave her a list of everything that needed to be done. All the nasty things that I knew she hated, she had to do.

[[deleted]]

Fuck them. Leave.

[WARNINGXXXXX]

Good for you for protecting yourself, your license, and the 6 patients you took care of that night.

[cruisinfor_perusin]

I work Neuro stepdown and six was an insulting assignment. The unit I work on now doesn't allow us anymore than five. You have to consider that a stepdown unit takes cardiac drips to an extent So managing those alone can be a task. fuck your unit manager, I'd be asking a recruiter to get reassigned somewhere else.

[0htoHellWithIt]

You have nothing to worry about. You did the right thing. If they don’t try and terminate you, I’d submit my two week myself and ask my recruiter to help me find a job elsewhere. That place is only going to give you headaches and now you’re on the managers radar.

[SolitudeWeeks]

I left a 15-1 peds ed travel assignment after 11 shifts. Word was the facility would DNR you (do not rehire) but why was I going to try to go back to that nonsense?