Cardiac Unit as a New Grad

[NYRN241]

I graduated from nursing school last May, took a couple of months to take my NCLEX and then relax for a little - I started looking for a job in August. I did not intend to stay in my hometown but after applying all over the East Coast and having no luck, I finally got an interview in December at a local hospital with a good reputation and got a day shift position on a Tele/Med Surg unit - can't turn that down! So I was hired for January and have been off of orientation since about March/April. It's been awful.. I was talking with some of the nurses who have been working there for 3+ years and they said this is the worst it's been in that time frame. Patient acuity, staffing, full census everyday, and just plain low morale at the hospital is so bad! Turn over rate right now is insane, many staff members leaving. People used to apparently get called out at least every couple of weeks VTO, I can't even imagine that happening now. We usually start with 5 patients every morning, and they tried to bump us up to 6 a few days ago! How can we possibly be taking care of acute patients 1:5 nurse patient ratio, running around giving meds, juggling all our other tasks? Sometimes we only have 1 aide on the floor for 30 patients, and 5 or 6 nurses for the unit when we should have 7 at least. A couple of weeks ago the night nurses had 10 patients each. Aren't these unsafe patient conditions? I don't understand how I can train to be a good nurse when I am just running circles all day in full fledge chaos. If anything, I am learning good time management skills and prioritizing, but I feel as though I am learning no actual medical skills, critical thinking, reading notes and understanding the patients' diagnosis. All the management and supervisors at the hospital know this is happening and are apparently trying to hire more people, but how many more months of this is bearable? We have residency courses with other new grads (anyone under 1 year) and all of us were feeling the same way, all over the hospital and in every unit, especially the med/surg units. No one is enjoying the job, either wants to leave or is already planning their way out. I know I am.. but is it like this in other hospitals? I know I am not the only new grad feeling like I am drowning every day trying to just make sure all of my patients make it through the shift. I am feeling very frustrated and wanted to see if others were experiencing anything like this as well?? HELP!

[VANurse2010]

H/H guy with the 1.8 K should have been in the ICU.

Ruby Vee...

I love your posts, I really do. But I am having as much difficulty as the OP describes with a 1:4 patient ratio on a tele PCU. 9 months in I am still "running circles all day in full fledged chaos". I, too, rarely have time to look up anything on my patients. It's all I can do to keep up with whether their vitals are still stable and their lab results throughout the day! 9 months in, it's NOT getting better. I have migraines nearly daily from missed/late lunches and the constant stress at work. I can't shut off my fight or flight thing! So........question is........if we want to "stick it out" or "grit our teeth" without becoming so depressed or ruining our lives at home, how do we get better FAST? I have a brain sheet, I try to fill it out in my colored pens and all but jeez it never seem to matter in the end after the constant people-in-your-face distractions of dayshift. I am so defeated that I honestly feel so out of my element anymore, like a sheep pretending to be a cat! I mean, maybe this is not for me. OP....how sad is it when you have the brains but there is just something else missing that you can't move fast enough/keep up!

For example, yesterday I had 4 patients when I came on. During report, one already gets discharge orders..don't even know her yet. Previous nurse gets crappy report from ED on my new admit that hitting the floor in 15 minutes. I have all morning vitals to do and of course meds. I'm like, OK....how to do this all RIGHT NOW. I called for help with the discharge since I can't be a million places at once. Ok. Then admit comes, find out Hgb 6.2, K 1.8, bacteremia, needs ABX IV, single lumen PICC and super hard nearly impossible IV stick, great. Other patient trying to climb out of bed, constantly yelling out, incontinent, may need Foley. Other patient comes up as new admit after d/c and is urosepsis and needs nephro tube placed. OK, fine. Pharmacy takes forever verifying meds but when they finally do I am waist high in nearly constant populating orders on low Hgb guy. 2 of patients have lines so I have to do all the draws for all these crazy labs I don't understand. Plus...OK, how to run all these lines. So, midday I am panicking, hey sorry I am running my butt but i JUST CAN'T KEEP UP. So I call for help, say I am drowning, people come to help to catch me up. Problem is the catch up was short lived too as blood bank calls to say blood is ready when my urosepsis patient's vitals start crashing, blah blah. Throughout the day two of my patients were also post procedure, hip fx, so frequent vitals/assess. It just seems like they were all SO acute I just couldn't understand how other nurses could maybe keep up with this. They caught me up in "tasks" but then all the charting was left. Not sure if they really thought it was appropriate for me to be drowning or not. They did mention that I got a "crappy" orientation but c'mon...I am NINE months in now! What is going wrong? I ended up leaving at 9pm partially because I had so much charting to do and partially because the night nurse had to hang the 2nd unit of blood STAT. I was sooo exhausted. I did fight for my lunch but not till late after the headache had already started and guess what? Went to bed last night, couldn't fall asleep until after midnight then woke up today, could barely move my head or open my eyes because of my now crazy migraine and ended up having to call off. NO WAY could I have made it through 14 hours today.

WHY does this job have to be killing me physically and emotionally and further, WHY does it not seem to be getting better? Is this the nature of the beast and a typical day on a busy tele floor? If so, maybe things will never change for me? I think this is the really worry for many of us new grads. We need to believe, really believe, that this WILL get easier. Because of course we are all different and many of us struggle more than others.

OP.....don't mean to hijack your thread at all, just perhaps ranting some thoughts that you may share as well......I don't know the answer.....

[amzyRN]

I am not sure, is that the standard most places? I feel busy but okay with 4, but going up to 5 is a little much and then when they were going to make us 1:6 at 7AM I was very worried. Our unit is a cardiac med surg type of floor, but apparently everyone in the hospital - including the doctors - think we are a cardiac step down unit so they send us patients who are more acute than the ones we are equipped to be handling on a 5 patient assignment. But maybe it feels like this most med surg units, any thoughts?

I work on a tele/step down unit and we can get 5 patients on PMs and 6 or more on nights. Depending how short we are, we usually just have 4 on days, but if we are short, we have gotten 6 before. Even 4 to 1 can be tough depending on the acuity. I've had 4 heavy patients and have been overwhelmed. I think a safer ratio for true step down patients (titrating vasoactive meds, post open heart patients or angios, insulin drips, trachs, etc. should be a 3 to 1). I had a guy that was on cardizem and he started having side effects from it, like 8 second arrests and stuff and he took so much of my time I didn't have enough time to spend with my other patients.