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This is a discussion on I Quit My Job in First Year After Nursing Licensure, part of Nursing Career Advice ... This is what I wrote when I got home after deciding I'm never returning to my first real nursing...by eatmysoxRN Mar 15, '12This is what I wrote when I got home after deciding I'm never returning to my first real nursing job.
Struggling RNI come from a middle class family. There are a lot of gaps in my memory when it comes to my health history, but I do remember one thing from all of the doctor visits and hospital stays: the nurses. More that the physicians, I remember the nurses being there to comfort and care for me. They explained everything to me, even though I was just a child.
Even as I got older, I still relied on the nurses for information and to teach me when my family members were ill. My grandmother suffered with cancer for a couple of years, and it was the hospital and home health nurses who made us feel knowledgeable and comfortable to care for her in a home environment. I was able to administer her medications through her PEG tube and I felt very comfortable doing so thanks to the teaching provided by the RNs.
With all of my positive encounters with nursing, I opted to become a nurse. I have always had exceptional grades. I had the potential to attend medical school, but instead, I chose that nursing would provide a more positive impact on others. I enjoyed every day of nursing school, which is known for being utterly dreadful. I couldnít wait to get out in the real hospital and act as a real nurse, being able to care for and teach the ill and their families.
I graduated in May of 2011 with my Associate Degree in Nursing. I moved to Detroit, MI, and was astonished at the amount of RNs that were needed! In the first week of my job search, I had filed over 500 applications! I felt so confident that I was going to be able to have my choice of a dream job.
Three months and hundreds more applications later, I was an unemployed and frazzled new graduate RN. I couldnít understand what I was doing wrong. I had an ideal resume, showing that I had gone to a University for a challenging summer program since age 12. I had a perfect GPA in college, passed my boards on the first attempt, boasted a huge list of volunteer work, graduated top of my class, had multiple awards and participated in the honor society of my college, and even had some experience in the medical field. Yet, I could not even get an interview to come in.
I had to move again. I moved to a small town in Tennessee, and after receiving my compact-state nursing license, I was offered a staff nurse position at a small community hospital that is affiliated with a large hospital. I readily accepted, knowing that it was my first full time job offer since graduation 6 months prior. I was told it was uncommon for them to hire new nurses, but they thought I had an advanced maturity level.
I was extremely excited to finally be able to do the job Iíd prepared during my college time to do! I had a fantastic preceptor, although she did seem unhappy at times and overwhelmed. The floor I worked on held only 18 rooms, private, but potential to be semi-private if needed. The staffing typically consisted of the RN and either a LPN or CNA.
Three weeks after my first jobís orientation started, it promptly ended. I was told it was ďnow or never,Ē and that I was to be alone. When I say alone, I mean alone. I was the only RN and often the only licensed person on the entire unit, whether there were 2 patients or 12. Due to incompetent training, the CNA and LPN I intermittently worked with were unsure how to do orders, so I did that as well.
A typical day for me consisted of worrying about going to work. I arrived at 6:30 A.M. to being getting my patient information together. If I wasnít assigned a LPN for the day, Iíd write down the time that all my medicines had to be done. I would print my flowsheets, which were 7 pages per patient to hold my assessments and notes. Iíd print extra order and progress note sheets for the chart, and print telemetry strips for my documentation.
Report had to be given in the room. This was a technique used to save time to prevent accidental overtime, but I always felt uncomfortable since usually the patient was asleep or there was family/friends in the room. I felt that telling the patientís information aloud risked privacy, but I was told that I would be written up if it wasnít done this way.
After report, Iíd set off to do vital signs and assessments, since my ancillary staff would mope and disappear most of the time. If my LPN was there, I knew she had her own medications to prepare to be done. Iíd complete vital signs and assessments, sometimes not as thoroughly if I knew I had 10 patients to assess. Iíd do the best I could and be sure everyone was at least safe with nothing life-threatening going on.
Iíd chart all the vitals on the charts and make sure that there were no new orders that were looked over. Meanwhile, when my CNA was eating breakfast and chatting with the laundry man. If my LPN were present, Iíd sit and prepare to open my charts.
Most of the time, Iíd get one or two charted before Iíd get a call from the light requesting bathroom or pain needs. Iíd help the patient, often alone since my other staff member was overwhelmed preparing meds. I did it with a smile on my face and used this time to do more assessment and teach the patient about related teaching material and safety issues.
With frequent patient needs, often it would be an hour or more before Iíd return to chart my vitals. Each day is different, but on a day when the census is high, I donít always even get 8 oíclock vitals charted before the 12 oíclock vitals are due. I would delegate them to the CNA when available, but many times my delegation was ignored, no matter how many times I told the staff to do them.
Meds were sometimes late. Trying to contact the doctor and get yelled at for asking a question about a clarification become a normal occurrence. I was told that I should stop calling so much and the physician and the Ė RN who rounded with him when it was convenient for her Ė would laugh at me and talk about me while I was running around since I get called for 2 admission beds while the doctor lets 4 be discharged.
They are all ready to go right that minute. I, or my LPN and I, are the only ones available to take out IV lines and other lines that are present. We have to do all the teaching and help the patient get dressed. In addition, we have to manually write out medication schedules and dosages and when to take them and often call the pharmacy for new medications for the patient to pick up. When sent home with wounds or new equipment, we had to make sure they understand it. Needless to say, 4 discharges at once is a lot for 1 RN and 1 LPN to handle, much less if it is 1 RN and 1 CNA. The ER calls to say they are bring the new chest pain patient now since we didnít get them yet, and then the others, and I have to take report now.
I have one patient pull out his IV and want to leave stat. I go stop the bleeding and tell him that Iím doing the best I can to get the paperwork together. Meanwhile, the doctor is shouting verbal orders at me, and when I ask him to write it and Iíll get it in the computer, he yells more. My new chest pain patient arrives to a room that isnít set up yet, and the patients already on the floor need noon meds. The baby in one room has a mother call about a fever, and a total care patient hasnít been turned in over 2 hours.
I canít get caught up quickly. As a new nurse, I try to prioritize as well as I can. I see my director at the desk, but she offers little or no assistance. I am running my feet off, and if I werenít so busy, Iíd probably already be in tears.
An hour later, I finally have all my discharges gone with as much teaching as I could provide while the telemetry monitor is alarming and a bed alarm is going off because a patient is trying to get up. I am the only one who is licensed to read the monitor, so I yell for my LPN or CNA to check the other patient.
I check on the telemetry patient and they need a 12 lead EKG since they are c/o chest pain 6 on a 1-10 scale. I have only glanced at my 2 new admissions to be sure they were breathing and not in any acute distress. I run to get the EKG machine and perform it and administer nitro SL x2 and then try to get someone to come to the floor to help me waste the additional morphine that I needed to give right then. After the chest pain patient reports pain relief, I reassure them and hand them the call light, making sure they feel that they are the most important patient I have (because to me, all of my patients are equally important).
I proceed to grab the 20 page admission packet for one of my new admissions and go in to pleasantly introduce myself and assess them. I verify medication records with them and try to get them all written on the MAR, while clarifying insulin orders since there is a new order sheet the doctors arenít familiar with and consistently check one that isnít consistent with the remainder of the orders.
When the CNA is the only other staff on the floor, I have to run back to the ER to get a 2nd nurse to verify insulin dosages with me. Not that it isnít a great idea, but it is very inconvenient to have to leave the floor even for a moment. I donít know which is worse, but it is policy.
I return to more chaos. More febrile children who didnít receive the scheduled antipyretic right at 1600. Patients who must be turned now, and stable patients who I havenít had a chance to see since my assessment this morning.
I feel that I am NOT providing competent care. I decide that it definitely needs to be addressed with management, and I proceed to tell them how I feel that the patient ratio is something I am immensely uncomfortable with. I tell them that I donít feel it is related to me being new, because although I may be a bit slower, I feel that I am still a very good nurse.
I am met with reassurance that it is within expectations for me to be the only RN with however many patients there are, and that staffing guidelines indicate that I will be unless there are 20 patients on the floor. I return to the floor and have to hang a potassium drip on a patient with hypokalemia, and call to verify that I can put the patient on telemetry. I get yelled at for calling, but I feel that it is important.
By 1800, I get another set of vitals. I get a call that in addition to the 3 admissions Iíve already had, I will be getting 2 more. I prepare the rooms quickly, and check behind my LPN to make sure all the medications were appropriately delivered. Before my admissions arrive, I check the potassium drip and see it has started to infiltrate. I immediately remove it and run to gather supplies to start another. I am not an experienced IV starter, but I manage to get one in and restart the potassium, making sure the patient knows the s/sx of infiltration and to call me for any problems.
About that time, an outpatient infusion arrives and must have initial paperwork completed, a peripheral IV started, and medications infused. Sometimes, there are 2-3 of these throughout the day. Sometimes, there are outpatients who come for me to perform EKGs or pull PICC lines.
Anyways, I get my new admissions and assess them both. I complete admission paperwork and head out to write up MARs and input orders. I put the chart together and am struggling to complete it when the next nurse walks in, already overwhelmed by the census. I offer a brief moment of sympathy before returning to my madhouse in my own mind.
I turn to see my other patients charts arenít updated. On shift-change rounds/reporting, I make sure that everything is the way it is supposed to be. I get sad when I think about things that didnít get done right on time. I think about my assessments being sufficient but not excellent. I wonder if I forgot to do anything, or if any patients or families didnít get teaching they needed?
I scurry to finish my charting and be sure everything is done on my admissions so I can clock out to avoid overtime. By the time I finally clock out, I realize my bladder hasnít been emptied all day. I have yet to have a drink of water since I couldnít excuse myself to the break room and drinks arenít allowed anywhere near where I work.
I cry when I get in my car. I never imagined being a nurse would be like this. I always thought about the nurses who would hold my hand when I was having a procedure done. I thought of the nurses who would let me talk to them and genuinely sat down to listen. How did they have time to do it? Am I a bad nurse? More times than I care to admit I looked into other professions. I genuinely decided that if nursing is like this, I have no choice but to get out. Other nurses I talked to suggested that I try somewhere else, since this is not the standard.
What baffles me is how I just received a bill for over $1000 for a 3 hour ER visit with 90% covered by insurance. If the hospital is making this much money, why canít they hire enough nurses, since nurses are pretty much the core of healthcare? In my itemized bill, I saw my IV start was over $100. I know the supplies arenít that costly. And if I can start an IV in around 5 minutes, where does that money go? I know I donít make $1200 an hour.
So patients are expected to pay this huge sum of money for care that hospitals donít seem to care about providing? They get by staffing by the skin of their teeth, and seem to blame it on a nurseís poor time management skills. I know that if Iím going to pay so much for healthcare, I expect quality and safe care.
Anyways, I told my administrator last week that since my concerns were snuffed, I had to resign. I never wanted to return. I went in this morning with the flu since I called yesterday and was told I couldnít call in sick. Another nurse was there and she was ecstatic to see me since there were 10 patients and no scheduled LPN, just the CNA. I told her I was sick (she is the ďcharge nurseĒ who does insurance stuff) and she told me to deal with it.
I proceeded to puke in the floor. I had a fever. My manager said she forgot to call and say I didnít have to come in since I was sick. So I spent an hour driving there to be told I didnít have to come at all. I am not going back. I am supposed to work tomorrow and next week, but I donít have to. I donít even want to ever be a part of a hospital that would treat staff in this way.
Patients are the reason the healthcare system even exists. Without patients, there would be no hospital. With that in mind, nurses need to be able to care for those patients. We need adequate staff. We need better ratios. We need the support of trained ancillary staff. We need all of this not only for the nurseís peace of mind, but for the patientís safety as well.
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- Mar 15, '12 by nmychairI am also a brand new nurse and feel completely overwhelmed and unprepared for the assignments of the day. I know I am capable the job but there is so much to do in 12 hours that alot falls thru the cracks. I am in LTC and I can't wait to get out. 6 days in orientation with a crappy preceptor with a poor attitude is not acceptable training. Geesh, I want to tell the LPN (who is training me, an RN) to change professions, cause if she treats her patients the way she treats me, they are getting a raw deal. I thought this profession was supposed to exhibit caring, nurturing behaviors, I would hate to think this witch could be my nurse someday.
- Mar 15, '12 by amandan08I love my LPN when I have one. It's better since she can do a lot of the skills, the biggest meds. She has taught me some more of the core nursing skills, like foleys and baths and stuff. But my management consists of money hungry witches. I just called to tell them I'm still feeling awful and they said to come in. I'm running a fever and the pts on this unit are immunocompromised without me making it worse. I refuse. Screw a notice longer than that. I technically didn't have to give one according to HR at the main facility. I hate this . . .
- Mar 15, '12 by brandy1017With your excellent background please consider applying to med school or pharmacy school. If you can afford it, med school offers the best opportunities and variety as well as more pay. Do not be discouraged, nursing is a grind, they can call it a profession all they want, but it is a lie! The stuff you are forced to endure and put up with, consider yourself lucky that you quit and didn't continue. Read all nurses and see how many of us are struggling and unhappy and burnt out, how many of us have been and are being abused and mistreated by the hospitals and some nasty psychotic patients.
But don't throw away all the education, truly consider going to med school. Even if you need to go back to take a few pre med classes such as biochem, calculus, physics if those weren't part of your nursing program. Looking back, I wish I had done this when I was a new nurse and maybe I wouldn't feel as sad, trapped and helpless as I do. They say nursing has so many opportunities I don't see that. To me finding a good fair decent nursing job is looking for a needle in a haystack and only a few lucky people actually find a job that doesn't demoralize and destroy their emotional and physical health.
I feel trapped and have been a nurse for almost 20 years and what do I have to show for it, injured twice from work, stressed out and burnt out to the point of needing medication, HTN and worried about hep C exposure which is much more contagious than HIV. Granted it can be treated and for some people you can be cured of hep c but not everyone.
If you go back to med school you will have greater options and if you choose a specialty vs family practice or internal medicine you will have much better working conditions than you would ever have as a floor nurse and also almost no risk of back/neck injuries or HIV/hep C etc, unless your a surgeon. Family practice/internal medicine is still a grind because most doctors are now under the hospitals who work them to death, just like they do the nurses. Specialists still have better pay and most importantly autonomy. I find it so disrespectful that hospitals could set up a system where doctors are supposed to see a patient every 7 minutes at a clinic, turning medicine into a assembly line, just like hospital and nursing home nursing already is.
But if you go into a medical specialty you could still have a good job helping people and not being rushed and stressed out to death on the medical assembly line trap that is healthcare in America today!
Sure you could join the many nurses rushing to become NP's to get away from bedside nursing, but you will still be stuck in the assembly line rat race that is hospital clinics and poor working conditions. With your great college GPA and background shoot for the stars and go to medical school. Just keep your student loans as low as possible and stick to govt loans if you can. Avoid Sallie Mae like the plague as it is a private for profit known for screwing people over!
I wish you the best and a brighter future than being a floor nurse!
- Mar 15, '12 by brandy1017That is the worst hospital staffing I've ever heard of. You should definitely look for another job if you stay in nursing, on day shift I woud say 4-5 with 6 maximum patients per nurse with at least a PCA before I would take another job.
You'll probably have to fight your insurance to get them to pay. They pull crap all the time hoping you'll give up and pay yourself then they get the exta money/bonus for themselves and your employer!
The hospital you work for is a nightmare, we need patient staffing ratio's like CA has, but I still stand by my previous reply that you should seriously reconsider nursing and consider going to med school. Sure in the hospital you see the nurses, but for most people they do see and talk to their doctor at the office so you'd still have face time with patients. If you can specialize you'll have the most autonomy over your practice and how many patient's you see in a day. If you go into FNP or Family practice or Internal medicine they are now under the control of hospitals and HMO's and will run you into the ground!
Good luck to whatever you decide!
- Mar 15, '12 by calinurse11WOW I dont think I have ever been so exhausted after reading a post. That is horrible, and that is NOT how it is everywhere. You seem like a wonderful caring nurse with experience on both sides of the fence, you know how it is to be a patient and a caregiver.
I think you should take a well needed break, get the heck outta dodge for a while to clear your head. If you want to leave nursing for good, then you should follow your heart. I do think that the future patients of the world would benefit from your caring personality. If you decide to stay in nursing, I would definitely get the facts straight first. Know what the staffing ratios are, how much orientation your going to get ect, and get it in WRITING.
Best wishes to you with whatever you choose.
- Mar 15, '12 by phattassI read your whole post from top to bottom even though I'm fresh off a long shift myself. Your ratios are totally wack. This is not the norm. Please don't give up nursing based on this crappy experience. Give at least one or two more jobs a chance. It's a tough world, but a fabulous profession if you find the right place. Good luck in finding your place in this world!
- Mar 15, '12 by vwgirl22Wow. I don't know where to begin. This story moved me greatly. I am so sorry you have had such a horrible new grad experience. You are the epitome of dedication. I am glad you left that hospital. I am sure this experience has prepared you in ways you do not even know yet. You are a strong, amazing nurse who can now accomplish anything. Good luck to you in the future! You are an amazing nurse and person!
- Mar 16, '12 by Epic_RNThis is one thread that make me grateful to live in CA with mandated ratios. Only advice I can give (new grad myself) is to not make life changing decisions when you are this upset. Leave this job, take a break if you can afford it financially, be kind to yourself, and look for a position where the working conditions are more compatible with providing safe patient care. Good luck!
- Mar 16, '12 by CrunchRNOutrageous. What a nightmare. 99% of the time I would advising giving notice and working it, but not in this case. Just get the heck out of that place.