Level 1 Trauma hospital: Need input

Nurses New Nurse

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I graduated in May and started working at a very busy level 1 trauma hospital in June. I'm on a trauma PCU with is like an ICU at any other hospital in the area minus the vents. I was on orientation until the day after I passed board (August 28th), but I took critical care classes also so I was only on the floor about half of that time. Our unit is very busy and very crazy. Our patients are mostly touch and go and almost all require total care. I feel good about being on my own and I'm starting to get my time management skills down.

Here's my problem. From day 1, I have been treated as an equal to every other nurse on the floor. I have been given the same, if not worse patient load. Most nights are good. Some are very bad. I usually have 2 isolation patients, at least 2 trach patients, and I always seem to have patients in restraints or ones with 1:1 sitters. In other words, I seem to get the very time consuming ones that nobody else really wants to deal with. I dont' mind the work, but some nights I feel like I can't get everything done that I need to. Also, I feel like I'm not giving certain patients the care they deserve because I am so busy getting "dressed" to go into isolation rooms or suctioning other patients every 5 min.

My last shift was one of the bad nights. I started with 4 patients. One was fresh out of surgery, one needed to be prepped for surgery (and she was a cardiac patient on a heart minitor so I had to travel with). Another was in contact plus isolation and having A LOT of respiratory issues. The other was a very confused patient with continuous bladder irrigation and Qhr IV pain meds. Then, right in the middle of me paging respiratory for the isolation patient, I get a new admit: a stroke patient (our hospital is well known for their stroke center, as well as trauma). If anyone reading this deals with stroke patients, they know why this is a bad deal. They require Q30 min VS and neuro checks for most of the first day. I felt like I was going pull my hair out! The shift ended with me shipping my isolation patient off to the ICU and me really needing a good cry.

I was just curious if anyone else is in the same situation. I love my job, and I think it will get easier with time, but I don't want to risk my new nursing license over my manager trying to "break me in". I have voiced my concerns and was told I would not have 5 patients for a while after orientation, but they still give me five on some nights. With our floor, we are never supposed to have more than 4, but you know how that works :) And it's not really the # of patients that is getting to me.....it's the acuity. We rate our patients for the next shift, and I always seem to get all M/H and H patients. Any feedback or encouragement would be much appreciated.

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Specializes in NICU, PICU, PCVICU and peds oncology.

That sounds like a heavy workload even for someone who has been out in the field for a decade. It almost sounds like hazing to me. I used to have nights like that when I did staff relief at a group of hospitals... all the really heavy patients (or the ones who were 'troublesome') spread out all over the unit so that I spent most of the shift walking from one end of the hall to the other. Is there someone on the management team you could talk to? Start off by saying something like, "I'm not complaining, but I would really like to know if all new staff are given such high-acuity patients right out of orientation or is it just me? I'm learning a lot and getting my time management skills sharpened up, but I'm feeling a little overwhelmed at times. I want to do my share and I need some reassurance that it is the same for everyone." Objective, reasonable and whine-free will get you much farther than the other... But you should make management aware that this is happening. If they don't know they can't fix it.

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It's funny that you mention management. My manager is also my charge nurse and tends to take 3 patients, max and by far the easiest load. If any little thing goes wrong with one of hers, she wants to ship them off to the ICU or switch with one of us. She is aware that I'm frusterated, but she is the passive-aggressive type that really gets a kick out of seeing others struggle. Now I really know what people mean when they say "nurses don't leave their jobs, they leave their managers". I would like to stay on my floor because the experience is awesome and honestly, I think I would be bored anywhere else. I guess I could try going to her higher up. I just don't want them to think I can't handle it. I also don't want to take all the lower acuity patients and leave the others with the higher acuities. I'm just between a rock and a hard place I guess. I appreciate the input though. It's nice to know that I'm not overwhelmed for no reason.

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Specializes in NICU, PICU, PCVICU and peds oncology.

But surely to goodness there could be some balance! If you choose to go up the ladder, I'd suggest saying something like, "I really like working on this unit, but I'm finding that with the number of high-acuity patients so-and-so has been assigning to me, I'm not giving the best possible care to all of them. I'm flattered that she thinks I can handle the workload and I'm trying to live up to her expectations and pull my weight. Do you have any advice for me?" It's objective, reasonable and whine-free, but gets the next-level manager thinking. Of course, in the end the choice is yours, keep doing what you're doing and keep your nose clean, or try and fix it.

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Very good advice....and much needed! I just don't want to get burnt out so soon....I've only been a nurse for a few weeks! And I want to be a great nurse, not one that slides by just doing the minimum. Thanks again.

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Specializes in ICU/PCU/Infusion.

I agree with the other's advice.

You might consider switching floors once your time is up. There are other PCU's out there, yanno! ;)

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I agree with the other's advice.

You might consider switching floors once your time is up. There are other PCU's out there, yanno! ;)

That's my point though.....I love my floor and the people I work with. It's very good experience and I would love to be able to stay on this floor. The problem is more with management than anything. The PCU I'm on now is the "trauma" PCU and that's what I love about it.

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Specializes in ICU/PCU/Infusion.
That's my point though.....I love my floor and the people I work with. It's very good experience and I would love to be able to stay on this floor. The problem is more with management than anything. The PCU I'm on now is the "trauma" PCU and that's what I love about it.

I have a feeling there might be another PCU with the same experience you are looking for right in your own hospital. ;)

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