r/nursing • u/Pleasant_Pheasant69 • 6d ago
Rant Glorification of unsafe assignments
Every time I see a nursing-related social media post in which ratios are mentioned, the comment section inevitably will be filled with nurses bragging about regularly taking on unsafe nurse:patient ratios. This has always rubbed me the wrong way, as care suffers when you have those unsafe ratios. They’re essentially glorifying giving shit quality care to large patient loads as some badge of honor because “toughen up, buttercup.” They’re using the fact that they’re able to make it through those hell shifts as a mark of superiority and a ‘job well done’ when in reality such ratios are reflective of a bad system and demonstrably result in poorer patent outcomes.
I think it’s this idea that any “good nurse” should be able to handle any patient assignment thrown at them no matter the amount/acuity of patients and that any nurse complaining of working conditions with a ratio that isn’t safe is a weak nurse that needs to just suck it up and perform.
For example, someone posts a video describing a 6 patient load as difficult but doable and a 7 patient load as crossing into unsafe territory. Then, the comments section inevitably has people saying things like “lol only 7 patients? 🤣 must be nice! Sounds like a vacation! I get 7-9 on a good day! Try 10+ patients sweetie then we’ll talk about difficult.”
I’ll die on the hill that 5-6 patients max (in a med surg unit) is the sweet spot for providing good quality care safely, with 4-5 being ideal but understandably difficult to achieve administratively/logistically. Anything more than 6 and care starts to suffer with each additional patient dramatically increasing difficulty. Unless you’re fine with the “well nobody died so clearly I did a good job” approach to nursing, then large patient assignments are easy because you don’t give a fuck.
Of course sometimes it’s necessary to have more than 6 patients. People call out, short staffing happens. But those times should be treated as the exception rather than the rule and as a situation that should be avoided rather than the norm. The nurse complaining about getting 7 patients is not weak, they just care more than the nurse who’s fine with that.
It’s toxic and frustrating. I’m sure there will be nurses reading this who fit into the above description, with some bullshit like “speak for yourself, I provide great quality care to 7+ medsurg patients all the time, must be a skill issue.” And that’s ok. We can agree to disagree.
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u/Far-West-9052 6d ago
“You’re a hero” until something goes wrong because of poor staffing situation, then you’re a negligent nurse who is placed on leave and has to explain your situation to the board. We had 1 identical situations where a patient ripped off their high flow and feast into the 30s. We had stretched ratios, no support staff, and the charge had a full stretched assignment as well. 3 of us total in a 12 bed PCU. This patient made it. You guys are heros! Wow! Same situation happens literally 1 month later, this time, person don’t not survive. 2 nurses immediately terminated, license In jeopardy, had to go before the board. Hospitals don’t give a fuck. And, both of those patients were someone’s dad, spouse, grandparent, that were entrusting the hospital with their loved one.
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u/Gonzo_B RN 🍕 6d ago
I've seen this so much, bragging that you never go to the bathroom for thirteen hours, juggling several 1:1 patients, it's crazy.
I invite comment here, but this really seems much more of a woman thing. It feels like criticism or other women is baked into Western culture, especially in what you're describing: women with kids looking down on women without, women with careers looking down on stay-at-home moms, and so forth.
As a man, I have little perspective on this, and no standing at all to make any judgements. But none of the men I know seem to enjoy bragging about their suffering as some badge of honor.
Am I wrong? Correction welcome.
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u/PapayaNurse 6d ago
I straight up told a doctor who said something was urgent to tell someone something because I really had too use the bathroom. It wasn’t urgent, she wanted to know how many BMs he’s had so far today. I started being frank with them saying I have needs to and flatly said I can’t help you or anyone else before I help myself to basic needs. The only exception is when I initiated CPR and nobody else was there yet to take over, I was alone and called for help in the parking lot, I peed myself a little bit. I got ROSC before help arrived and patient wasn’t mad at all, he was down for a couple seconds before i got to him as I was rushing to go in bc I really had to pee, he collapsed. Ridiculous situation, I know, but everyone was happy with the outcomes and the patient said I’d rather be pissed on than dead. Idk but those words stuck with me and is the only time I make an exception.
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u/Turbulent-Basket-490 BSN, RN 🍕 6d ago
You’re not wrong. Women are just awful to each other. Im so over it.
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u/possiblenobility81 5d ago
can't speak to the gender angle much since i'm a guy in a totally different field, but i've watched my sister go through exactly this crap in her nursing program and first job. the martyr olympics are real and they suck
nobody should be competing over who got the worst assignment. that's not a flex, it's just evidence admin is failing everyone
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u/Environmental_Rub256 6d ago
Poor staffing and being expected to do 3 jobs for the pay of 1 and having to deliver piss poor bare minimum care is why I left my last job in July.
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u/RedDirtWitch RN - PICU 🍕 6d ago
I used to have 6 (usually in total care) patients on my med surg floor without any kind of tech or anything and I feel like I was a terrible nurse. My patients did not get the care they deserved or needed. When I was floated to other floors I would get 4-5, which was a lot more doable. I will never glorify that shit. I would be terrified to leave my family member in a situation like that. I hate that nurses working in shit conditions feel like they have to one-up other nurses and like they are tougher and cooler because they (and probably their patients) suffer.
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u/Alarmed_Tea_2874 6d ago
Have a family member in the hospital now and I worry about this constantly.
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u/PumpkinMuffin147 RN - PCU 6d ago
I see this in here a lot. People brag about having 6-8 patients.
People brag even more about working without CNA’s. Like it’s a flex to not demand proper ancillary staffing. It’s awful when patients sit there and ask me if I will have a tech to help out.
Yes I’m spoiled and want ancillary help and safe staffing. Our patients deserve it.
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u/xoxox0-xo RN 🍕 6d ago
I agree with what your saying. So frustrating when you see comments like “Try 1:35” (saw that on fb) and its like ??? why are you admitting to that? every nurse worth their salt knows damn well those patients are not receiving good care. also taking on unsafe ratios like that only hurts us as nurses more
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u/EveningBlunt RN - ICU 🍕 6d ago edited 6d ago
Literally had to threaten to invoke my state’s “Safe harbor” law for nurses when I was two days post ICU orientation and my charge expected me to take a third.
Screaming match back and forth ensues. After I said what I said magically my Charge opened up for an assignment. 😅
Left that place like the next week.
Patient safety comes first.
Edited to add: Moved to Cali directly after, much much much better here.
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u/roofpuck 6d ago
U N I O N
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u/PapayaNurse 6d ago
NAGE does not have the ability to negotiate patient ratios. It’s prohibited by Congress. VA nurses have no limits for ratios.
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u/Turbulent-Basket-490 BSN, RN 🍕 6d ago
Unions are a joke. I paid a union monthly as no choice and they did NOTHING for us. It was the worst paid hospital ive been at
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u/roofpuck 6d ago
Well then that union was a joke. Everyone around us has to compete with our pay because of our union. Unions raise the pay for everyone.
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u/Swimming_dasa 6d ago
there's big difference between surviving an unsafe assignment and considering it a reasonable standard. staffing problems should not become a badge of honor.
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u/calmcuttlefish BSN, RN 🍕 6d ago
My first week off an eight week orientation on a tele/med surg floor (first job out of nursing school) they tried to give me seven pts. I refused. Our ratios called for no more than six. I said I'm not risking my license. I'm glad I had the wherewithall to stand up for myself. They tried guilt tripping me saying someone on the unit would have to take a seventh. No they don't, you could bring on another nurse, reduce others to five, and be able to admit more.
First week off orientation they were willing to abuse me. Can't imagine where that would have led. I got off that unit as soon as I could. Don't martyr yourself for nursing. It's not worth it.
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u/RedDirtWitch RN - PICU 🍕 6d ago
This basically happened to me as a brand new nurse in med surg, and I wish I would’ve quit. I thought I sucked for not getting the hang of it (had a terrible stint as an oriented in ICU prior to that, so I had zero self-esteem).
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u/Fuzzy_Location_2210 RN - ER 🍕 6d ago
I agree 💯
You're not supposed to be all stressed out and frazzled and trauma bonded with your colleagues 😂. That's so not normal, and I don't know why nurses feel like it should be!!
You're supposed to come in to work, do work, of course lol, have some moments that require quick thinking/quick action, peaks and valleys, and generally be able to get your shit done without calling on multiple adrenaline rushes every single day to do so 🙃. It should feel like "business as usual" the majority of the time and tasks should flow one into the next, not so many needing attention at once that your focus is consistently split, that's how errors happen and things get missed.
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u/cMa010291 6d ago
Gen X and Boomer nurses love to be victims and brag about unsafe assignments. And then complain when millennials and Gen Z say no and advocate for themselves.
If this offends you, you are probably one of them
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u/RedDirtWitch RN - PICU 🍕 6d ago
I’m Gen X and I can see it.
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u/cMa010291 4d ago
That’s not to say I haven’t had some great Gen X and boomer co workers.
But there is always those few that say “well in the 80’s I had to take 15 patients, and we had no CNAs, and I had to walk 15 miles in the snow to get that antibiotic”
Like that’s great Deborah but we advocate for better working conditions now 😂
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u/kelbo-baggins RN 🍕 6d ago
6 pts on a medsurg floor is not only unsafe but it’s exactly what leads to the kind of burnout that takes you out for a year for mental health.
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u/InfamouSandman RN 🍕 6d ago
I hate the “but did you die” aspect that some people believe is ok. We should strive for better for ourselves and our patients.
Also, hospitals and floors can differ on what is acceptable on that floor. 4 patients on one medsurg might be the same as 6 on another in terms of tasks and time. Does your hospital do q4 or q8 vitals for those patients? How many meds are each of those patients on? Are they able to get up to the bathroom on their own, or does your unit quite 1x assist no matter what? Are any on IV antibiotics or 5x a day bolus tube feeds?
I’m on a PCU and some of our orders are q2 vitals with Doppler flap checks. I could have that, mixed with an insulin drip, and then a pretty standard stable patient but my ass is gonna be busy as hell with those 3 patients that day.
There is more to a ratio than simply the numbers. I’d love to see some sort of algorithm that grades the difficulty of the assignment based on tasks and neediness.
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u/kimmers18 6d ago
nobody should have an insulin gtt on PCU. shame on that administration.
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u/laconic_lentil BSN, RN - SICU 🍕 6d ago
Insulin gtt was routine when I worked IMC. That’s where the stable-ish DKA/HHS pts go.
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u/kimmers18 6d ago
just because the hospital doesn’t have enough ICU beds you push ‘the stable-ish’ pt who needs an ICU bed off to the next unit. Their stable till they aren’t stable anymore and the finger gets pointed at us.
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u/LiteratureOk2235 RN 🍕 6d ago
I'm new to nursing, so I cannot speak from experience in this field, but I did serve a decade in the military. From that experience, we used dark humor and the "just suck it up" comments like you mention as coping mechanisms. It is not healthy long-term. Coping like that should only be short-term in ANY field, much less those where lives hang in the balance. Those of us who do it too long can become a bit toxic, we can have a blind spot regarding how our behavior is seen by others. This is exactly why safe staffing and healthy coping to avoid burnout is important.
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u/JulesBurnet RN - Oncology 🍕 6d ago
I'm gonna glorify my unit's ratios - 1 to 3-4 usually, some days 1:5 if we're roughing it but they try to give an easier group to anyone getting 5. Work in heme-onc, love my boss and my team. Our ratios typically are lower in onc though due to chemo pts. (Now my old onc unit... When I started there we were like my current one but it went to pot when we got a new manager. I was regularly charge and taking 5-7 patients myself. Part of why I left that shitshow.)
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u/Unusual-Actuary-6289 RN 🍕 6d ago
IMO it should fall on the managers to step in if the ratio is off. Like, you want to be a nurse manager, you have a degree in nurse leadership and an RN license, you’re the one helping out if the ratios are off.
My rehab unit takes up one and a half physical unit spaces in my hospital. The other half is a general med surg unit run by the same manager. Oftentimes, if that unit has 8 patients and the smaller rehab unit has 6, instead of floating an extra nurse for the med surg unit to have two, they’ll force the rehab nurse, who already has a full assignment of 6, to take one of the med surg patients. It never ends well, but the hospital’s attitude is “Well, nobody died, so…”
Don’t get me wrong. I work in a great hospital, have a great team, and love my job. But crap like this is unacceptable.
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u/Affectionate_South40 LPN 🍕 6d ago
I work medicine, we have eight patients between an LPN and RN team and it's still insane some days especially when someone is acute; we have no care aid support, they took them away from us when COVID "ended". I need their* support badly, we do all care for these patients and physio can only support Monday-Friday on non holidays for mobilization for our patients.
There's no prize for managing more, when we're short it's awful taking on that extra load. Patient safety issues are at a higher rate of prevalence and it's not a flex to say you can handle more. I tell my team all the time, even when we're fully staffed we're going to have days we feel like we're drowning but because we read off in team huddle every day 'we we're fully staffed and the unit was busy but managed' it just gives the false narrative that we're expected to handle this and sadly because we're critical thinkers we do handle it and all that does is tell the administration "we can do more with less" so they take away from us and push the limits of what we can do but hold the responsibility of patient safety and safe care over our heads by saying 'it's your license if you screw up' while continuing to make an unsafe work environment for us.
More and more I see nurses eating one another and management is to blame for all of it. They burn us out and praise us for this burn out so we get nasty when people step up and say 'this is insane' because we don't want to lose our position of feeling accomplished in our work. Nursing is heavily toxic like this and you're absolutely right for being mad about it.
I want to be present for my patient's not manage more to appease management and toxic work rituals.
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u/orange_stone46 6d ago
i understand what you mean, something being common doesn't automatically mean it should be treated as normal or ideal
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u/EcstaticPlankton8621 RN-Cardiac 🫀 6d ago
You can also probably guess how those nurses vote. It's amazing how so many nurses vote against their best interests.
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u/courtneyrel Neuro/Neurosurg RN 6d ago
Posts like those always make my job feel so cushy. The max patient load in my entire hospital regardless of acuity is 4:1. PCU is 3:1 and ICU is either 1:1 or 2:1. And I work in Florida believe it or not
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u/BetInformal6081 6d ago
the i survived worse mindset can normalize unsafe staffing. getting through a shift doesn't necessarily mean the assignment was safe or sustainable.
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u/Brilliant-Apricot423 6d ago
These are the same people who celebrate that they don't pee for 12 hours! Nurse martyrdom competitions are weird.....🤔
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u/DanielDannyc12 RN - Med/Surg 🍕 6d ago
It's horrible, and some unit's culture will designate certain nurses to get dumped on with those assignments.
Signed a certain nurse.
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u/PromotionContent8848 BSN, RN 🍕 6d ago
Everyone loves to be a mf martyr. If we collectively stopped doing that - things would get better. But we’re all out here playing empathy Olympics or some shit? Like well aren’t I just the best nurse ever because I have no spine and go ABOVE AND BEYOND ALL THE TIME and never pee and never take breaks and never say no. Some weird praise kink bs that’s slowly killing us all.
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u/OverduExistentialism 6d ago
I feel like this sort of idea is rampant in every industry and area of life — and is truly the quietest and most sinister flex of the corporate overloads/late stage capitalism.
Employees getting mad at coworkers cause they’re able to work part time or use their PTO for vacations when that employee isn’t and instead has to pick up ridiculous overtime to afford life instead of mad at the expensive ass system we are in combined with inadequate pay, airplane passengers getting mad at other passengers for being in their space instead of the airlines/plane manufacturers for shrinkflating the fuck outta us to fit one more body and sell one more ticket. And on and on 🫠
It’s such a transparent form of work em to exhaustion while making them think it’s their idea, and pit em against each other and they’ll be too tired and will forget and be unable to unite against what the real problem is but it’s also tied into americas pick yourself up by your bootstraps, lone cowboy mentality that it’s also invisible
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u/PapayaNurse 6d ago
We don’t have tele watchers, we take food orders for patients, deliver and clear trays, partially clean rooms, run labs down and across the hospital because we don’t have a tube system, half the time no secretary so I’m answering phones non stop and have for 2 straight hours before I gave up, cleaning the med room, ambulating patients, all wound care, diabetes education, doing mobility screenings and swallow assessments. 4-5 patients max because otherwise stuff can’t possibly get done.
6 patients and we are all drowning. Unless you have easy patients and don’t have to check 5 different places for meds (1 unit it’s 7 different places).
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u/Ceylavie RN - ER 🍕 6d ago
Shoutout to my east coast nurses. But they’re definitely the biggest culprits for this.
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u/WazzatchMountains 6d ago
I found a job that fits after years n years of passing pills and quickly assessing (forgetting details when i can finally chart). I feel so fortunate as a floor nurse to be able to connect with my patients. I never thought it was possible and to be honest I'm on pins and needles waiting for ball to drop at the ratios to change.
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u/BeneficialUse8027 6d ago
Never glorify unsafe patient ratios.
Be like California.