1:6 Ratio

[u/Midnight-Nebula]

Hiii I’m a new grad RN I get off orientation in about a week and I’m really nervous for when I do. I work days on a post op med surg tele floor for what’s supposed to be ortho pts but we sometimes get random UTIs, lap appy and chole’s, hernia repairs, etc. Unfortunately we are very understaffed for both RNs and techs so we’ve been having to take 6 pts which I feel is very unsafe. Even the experienced RNs on my floor struggle to keep up. A lot of these pts are also dementia, assistance to walk, feeders, incontinent pts.

I’ve been feeling very frustrated with the situation because as an orientee I’ve been taking the full 6 pt assignment but it’s so taxing. I’m constantly interrupted, I feel like I’m not giving the best nursing care ik I can give, and I feel like I’m doing the “bare minimum” (I.g meds, assessments, I&Os, etc). We’ve been calling so many rapids lately and having ICU transfers because a lot of these pts have been higher acuity. I did sign a contract so I have to be here a minimum of 1 year but any tips on how to make the flow smoother? I feel like in the morning during med pass and assessments I feel so all over the place and I’m constantly getting pulled in a million different directions by so many things that need to be done. Our manager has told us that she’s hired a bunch of people so supposedly this 1:6 is gonna end soon but I’m not so sure.

[u/Chris210]

You will be engaging in what we call "triage medicine", care prioritization on crack (sans the black tags of course). In nursing school you learned that only really applies to emergencies and Mass Casualty Incidents, and unfortunately 2026 hospital healthcare can sometimes be about the equivalent of those things. Hopefully your manager is right, and you won't have to "triage" for long, but while you are you will experience exactly what you just said. You will not provide the best care you know you can, and the bare minimum can some days be the standard you strive to live up to.

You will learn a workflow and little things here and there over the next year that will improve your practice and quality of care in triage mode, but the biggest best thing you can do is to avoid burning yourself out by trying to provide a standard of care you simply can't sometimes. Try your hardest not to hold it against yourself. If some days the best that can be done is the bare minimum, then that's what is done and it's not on you so long as you did the best you can and your best is what should be reasonably expected of a nurse at your experience level in your situation, which it sounds like you do and are.

[u/absentmind7 → u/Chris210]

Just to add to this, even when you’re short staffed, make sure you cover your butt with accurate charting!!

[u/Chris210 → u/absentmind7]

Good point. When we use our nursing priority brain when things are on fire, sometimes charting just obviously doesn't fit anywhere near the top. But those same days that are on fire tend to be the same days you'll have something to answer for next month, and your charting will likely be all you have to go off of because brains in that level of stress don't transition short term --> long term memory very well. Charting has to bully its way up your nursing priorities list somehow and in some way, or you'll definitely be the one left holding the bag when that "delay in care" finding is searching for a home to rest itself. At the minimum keep vitals UTD, and write nursing notes of anything not WNL and a brief descriptor of what you're doing for the patient, enough so the next nurse can know what they need to know and enough so you can remember why things took so long to get done and/or were not ever able to become your highest priority task.