New Nurse Needs Orientation Advice

[Silvergem800]

Hi everyone...Thanks for taking the time to read this

I am a new nurse working 5 weeks on a busy med surg floor...now let me say I am overwhelmed...I know this is normal for where Im at in the stage of the game. im not used to this level of responsibility, time management is lacking...im not sure how to manage my day or what things take priority and my confidence is lacking.

my orientation has been very hard. My first day I was given two patients and found myself pulling my hair out. my preceptor the next day asked if i was comfortable taking 3...when i said i wasnt she said that I need to build up to 10 patients by end of orientation. orientation is only 6 - 8 weeks. now im up to 5-6 patients. I was adament about my comfort level but it seems that I am being pushed to build up to this expected load. I am afraid by this for myself an my patients.

I found myself with 6 total care patients who were of heavy acuity and struggling to get my meds out on time. so when I asked for help in distributing the meds after I had checked all the orders, I was told "If i give out the meds to your patients then they wont be your patients" it wasnt until my manager came over and asked if I needed help did I recieve it.

I recieved an admited pt who was in respiratory distress with a very low bp and when I called the dr, I was told the pt should go to ICU. When I told my manager the situation, he asked if the pt had a DNR. I said yes he was 55 y/o and had a DNR. He looked at me as though I had done the wrong thing and asked why did I do that. Was that not the right thing to do. My confidence ha been low ever since.

My first week a patient fell off the bed because the bed locks failed. I find this on most of the beds as im performing pt care the beds move. The blood pressure cuffs are manual and some of them dont pump up and wait for realease....they release on their own so as you pump them off they fall right back down making you have to catch the beats in the middle. I am not sure when to fit in a physical assessment in my day and I havent seen my preceptor take L/S or B/S. so when I tried taking my assessment and putting it in my notes I was told I shouldnt write too much just write what I see.

Most of the patients are on prophalactic heparin and fragmin, even the ambulating ones and when I mentioned the H/H was in the 8-9 range with 26-23hct my preceptor tells me to give it and then call the Dr. I am also told if I have questions, to ask and am left on my own most of the times. Im too needy and dont trust myself enough....and ofcourse....to relax. I have also heard Im not aggressive enough. I hear alot of what Im doing wrong and not alot about what Im doing well with. I dont expect praise every 5 mn but some support would be appreciated I guess.

I know many of these things are in my control but I also feel that where I am is not safe either. I need an expert opinion, someone with more experiece than myself...which is all of you. What can I do different, is this kind of beginning normal? or should I be looking for another job...which is very hard to come by right now.

is this to be expected in the beginning f my career, or is this too much? not sure!!! just tell me what I can d to improve myself and my situation. My gut tells me to leave but I need the job but I dont want to quit without another job or if this kind of experiece is to be expected and I just need to handle it better. What Should I do. Your candid and blunt feedback is welcomed and appreciated.

Sincerely

a Nurse who wants to learn and do the right thing

[jemaro67]

stick it out. let this situation teach you something. this is an opportunity for growth on your part. things will get better. i'm a new grad myself and have only been working for the last 4 months. remember what was taught in nursing school and how to keep you, your patients, and your license safe. hang in there!

[nohika]

Normally I'd agree that it's first-job terrors, but TEN PATIENTS? Holy hell. That is a ridiculous amount.

[Guest 360983]

You're going to have 10 patients on a med/surg floor? I'm still a student, but that sounds insane to me, and makes me worry.

[Silvergem800]

yeah its not supposed to be 10 though I have been told that a safe number of pts is 8...most institutuions i know of have 8 pts per nurse and even that is alot

10 is due to being short staff and some of the nurses file protests when the load is too much not sure what to expect from the first few months but the general concensus is that the situation isnt typical

[nurseygurlie]

I think the best thing you can do is just pick one task or aspect to work on at a time. Like work on mastering a three minute or less assessment. Or try to find ways to shave time off of your med passes, develop a system for yourself.

Turn your frustrations into something productive and you will start to feel more control over your day. Aggressive is not a good way to handle yourself in any work setting, but it's important to try to be more assertive. Be deliberate and strong in your words and actions, because its your license. Practice speaking up when you would normally keep things inside. If you don't want to appear confrontational, try using the phrase, "Help me understand why/how/etc".

It's okay to call the doctor unnecessarily, you will learn about that as you go. It's better to call (annoy the dr/manager/whoever) than not call (lose your license).

So if your gut tells you to call the dr before giving a med, when you have labs to back up your concern....listen to your gut. Protect your license.

Did you have an instructor that you connected with in nursing school? See if you can schedule a meeting with them to talk and maybe build an action plan to help you through this stumbling phase.

[SanFranSRNA]

Hi Silvergem....I used to work in Nevada and the Med/Surg ratio is 1:8 patients with tech assigned. I can't imagine that the facility can justify giving you up to 10 patients. Total care should be taken into consideration and reduce # of pt assigned. In regarding to the h/h question...that's where your preceptor comes in. I understand your concern regarding low h/h and administration of blood thinning medications, however h/h is not usually used as a hold parameter. Some pt lives like that for years so the benefits outweigh the risks. Given that you are new, you won't necessary know that. I have only one advice...get the experience you need and move on.

Best of luck

[cmcoulis]

i'm a new nurse as well...but while in school one of my favorite prof's once told me that it tells a lot about your place of work the way they treat you in orientation. If they push you to rush too quickly through your orientation and do things that are not at your comfort level, is that really a place you want to work at?

I know in this day and age it is really a crap market to get too picky about things though...but my advice is if you find yourself really unhappy at this place, that you try to make a switch.

Best of luck to you

[jelly221,RN]

10 patients is insane!!! What state are you in? Seriously? I have 3 (in a stepdown) and sometimes THAT can get insane if one isn't doing well and I still have to keep up with the others. BTW, for heparin @ my institution, we usually monitor platelets and INR/PTT, FWIW.

[bmac84]

Good Lord! I know this is a year late, but I really hope you got through that rough time! I don't know how you did it! With 10 pts there is absolutely no time to learn or know anything about your patients or time to safely assess them.

I happened to come across this article while researching patient ratios/staffing laws/staffing disclaimers throughout the country. When I started nursing in 2008 (in CA), I was on tele. Some nights I would have four patients which is perfectly easy and do-able, then other nights, according to state law, as long as I was with another "license" (in this case an LVN who couldn't assess, chart, start, or hang IVs), I would have 8. It was absolutely the most scary and unsafe thing I have ever experienced. This unit had heavy acuity patients, frequently transferred to PCU or ICU, and here I was a brand-new grad with EIGHT SHIFTS of orientation and eight patients. I got out of there as soon as I could to ICU where we only have 2 patients :)

I'm curious to know what you ended up doing. I'm still in CA and working in SICU at a research hospital that is sooo strict and by-the-book when it comes to staffing laws. Nobody is allowed to miss a break or lunch and once you have more than 5 titratable drips on your patient it's a 1:1. Do you think staffing laws would improve morale, decrease burnout, improve productivity, reduce mistakes, etc.?

[nats2012]

10 patients is too much mines is 5

[lp36245]

First of all, I feel for you - 10 patients sounds absolutely insane! But, I am a new nurse 6 weeks into my orientation at a major hospital and I am finding the same thing. I work on a busy Step-Down unit with high patient acuity levels. I am also being pushed to take on more patients as quickly as possible, regardless of how I'm doing and regardless of patient status. For example, my preceptor gave me four patients for the first time, 2 of which she predicted would "go downhill" that day. 3 of the four ended up being very high acuity with 1 going to ICU. I was completely overwhelmed. I was behind on passing meds, charting and implementing MD orders. The feedback I got was about what I did wrong and that I have "no critical thinking skills." (If I have no critical thinking skills, why would she give me 2 patients she expected to deteriorate that day?) There were no suggestions or helpful tips on how to improve.

I have not worked in a hospital before (outside of clinicals) plus it has been over a year since I graduated from nursing school. The way I'm being oriented seems unfair and unrealistic. It makes you wonder what they expect from new nurses??