New RN job feels like nightmare help!!

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    I have been working in a NYC small community hospital for 3 months. I had 6 weeks of orientation 1 weeks of classroom time and have been on my own since mid november. Every day before I go to work I have the feeling of impending doom. My anxiety level has been through the roof! My average patient load is anywhere from 7-11 patients per shift. That Does not include discharges, admissions or transfers. Most days it's 9 or 10 I am overwhelmed have been making alot of mistakes. I feel like I got thrown into this job. They couldn't wait to get me off orientation. My first day alone I had 11 patients and over new years weekend I had 9- w of which 2 expired 3 nh discharges and a transfer to telemetry with 3 still left to care for Now yesterday I had 9 PTs I feel like I made a med error. I gave fragmin 2500 to a patient whose h/h was 7.7/23.6 and ptt was 335. I called the dr after my shift had officially ended to tell him the CBC results and he order the Pt to get blood but I still feel awful. There is no pixus so my day is filled with searching for med cart keys and narcotic keys. There are no computers. 10 am meds are not in the med room by 10 am so the majorty of stuff is late. I can't find the time to do my notes during the day so I don't stay until 9 pm. When my Pt expired my manager said that it through me for a loop and I had other patients to care for. It was my first one as a nurse ever!!! I'm sorry if this sounds like a rant but I don't know if I should stay. I'm in the union and I have filed 3-4 protests since I have been there and joint commission is coming this month. Other places get 5-7 PTs. I'm getting an average of 9-10 what do I do should I just quit cuz it's so hard to find work in ny right now. But I'm really scared for my patients and my liscence. It's really hard to give the care I want to give them. And when I ask the nurses aids for help they always have something else to do. I don't know what to do. Everyone says if you can make it at this hospital you can make it anywhere but I don't know how handling 9-10 PTs proves I'm going to be a good nurse? Just means I can give limited care to many Ppl in my opinion. We also get alot of DNR PTs so when a patient is going downhill and I tell my manager that this Pt doesn't look good the first thing out of his mouth is "is the Pt a DNR". And if it is well just give o2 and fluids. Doeant seem to matter what the Pt is here for. I hear alot how things cone with experience and it will get better. I just don't know what to do. Please help could really use the advice from all of you on here. I am very nervous and um afraid I'm gonna harm someone and that's the last thing I want to do. Please help what should I do and if I'm gonna stay how do i manage all this better. Thanks in advance for takin the time to read this.
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  3. 7 Comments so far...

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    I think most nurses have experienced some level of the chaos you are experiencing. I always had a "story of the day" after every shift I ever worked, mostly involving either odd patient behavior or what I called deficient medical decisions! We see more than anyone could imagine! Right now, I suggest you take this as a huge learning opportunity and collect yourself. If you quit now, you will leave with low confidence and your job prospects will be even slimmer.

    Start you day by doing something empowering for yourself. Eat some real and not junk food to help yourself getting grounded. You could at least stretch if you don't want to take the time to walk or do anything else. Learn how to get grounded, as that will drop your anxiety and improve your energy. You are there for your patients, even if the hospital standards seem a bit (ahem) low.

    Yes your work load looks impossible. Do what you can, and put your attention on your patients, not on what you aren't doing as well as you would like. This isn't your career job, but your job is to be professional and that means not acting scattered and complaining. Act like the strong nurse you know yourself to be. This too shall pass. You're there for a reason and can emerge stronger and smarter, and certainly more confident. Best wishes. Don't let ... anyone get you down.
    Last edit by wellnessnow on Jan 14, '12 : Reason: needed to expand a thought
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    I don't understand why the union is allowing the hospital to give the nurses so many patients. That is too much, no wonder you are stressed out. The union should be getting the patient ratio down to a safe level 5 or 6 at most!

    Definitely start looking for a new job, don't stick it out with this place anymore than you have to. The union is useless and the hospital doesn't respect its staff or patients with those type of ratio's. I'm sure they have high turnover! You now have experience and I doubt another hospital would be as bad as the one you are currently in so start interviewing other places and quit this place ASAP!
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    Quote from brandy1017
    I don't understand why the union is allowing the hospital to give the nurses so many patients. That is too much, no wonder you are stressed out. The union should be getting the patient ratio down to a safe level 5 or 6 at most!

    Definitely start looking for a new job, don't stick it out with this place anymore than you have to. The union is useless and the hospital doesn't respect its staff or patients with those type of ratio's. I'm sure they have high turnover! You now have experience and I doubt another hospital would be as bad as the one you are currently in so start interviewing other places and quit this place ASAP!
    Unions don't have near the power that people think they do. Sure they can negotiate for safe staffing levels, but they can't force them to be followed, any more than they can force employers to provide every employee with a guaranteed 37 minute lunch break every shift. Filing professional responsibility reports that detail patient and staff safety concerns and high workload are excellent tools, but they do take time to work their way through the system. If there isn't an effective mechanism for resolution of these reports, or there simply isn't the resources to resolve the issue, the union isn't going to be able to do much about it. Unions are only as strong as their membership. It's imperative to present a united front. If only one person is regularly filing workload reports the perception will be that the problem is with the individual and not with the system. There has to be a collective approach with many people all reporting the same issue for it to be viewed as a real and serious problem. I belong to one of the strongest, most militant unions in Canada but even that isn't a guarantee that everything is rosy. The unit where I work has been incredibly dysfunctional for a long time (years!) and is only now beginning to turn around... due to the collective efforts of people who communicated the same message over and over to administration and the union. I'm not saying that the OP should suck it up and work for the common good, because only she can decide if she's willing or able to stick it out. But bashing her union isn't helpful either.
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    Hello, I am also a new grad who just started working in a big NYC hospital. Im in my last week of orientation and I also feel exactly what you feel when you describe "impending doom". Every day right before work my anxiety level sky rockets. On my days off, I feel as though I cant totally relax because I'm stressing about how stressed I'm going to be on my next day at work. However, I believe that in time with proper support those feelings will get better. Now, in your situation, with 9 patients, that's insane. Your still transitioning from student to practicing RN. Being able to handle 9 patients vs. 6 doesn't make you a better nurse. Always remember that you have a license to protect, a license that I'm sure you worked hard for. My full assignment is 6 patients and I sometimes feel like I'm going to pull my hair out. Right now you need support from your fellow nurses and your institution. I would start looking elsewhere if you feel that yor not being supported. Don't get me wrong, I feel that sometimes learning under fire is necessary for you to grow and develop confidence. But what your describing to me doesn't sound safe. Hang in there sweets...
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    That is awful! My reasoning for saying get outta dodge instead of "stay until something else comes along" is that your license is your most precious asset right now and even if you felt invigorated by running around like that every time you work the fact is nobody is a superhero. Your mind isn't receptive when you're in a state of panic.

    I've had a few shifts like that and everything I missed doing on time, getting yelled at by people who are only concerned with their patients getting attention, and knowing the poor sweethearts who are fairly stable and don't complain get the short end of the stick made me feel so darn guilty and inadequate!
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    First make sure you have your own malpractice insurance! Follow the letter of the law to protect your licence, it's not as easy as you may think to lose your licence though.

    I know you want to do more, but sometimes you can only manage to give adequate care as to sustain their previous level of functioning and no more. Continue to advocate for your patients if you feel that their condition could improve with more medical intervention. Just because someone is a DNR does not mean they meant "do not treat" If your DNR starts to take a turn for the worse and they are only in there for IV abts for a UTI or something, then you have to advocate for your patient regardless of the charge nurse opinion, you can call the doctor too. But if it is an expected end to a condition then, well sometimes comfort measures are all that we can do.

    Only you can decide whether you feel this job will not live up to your expectations and needs. I say keep searching for something else and hang in there! (Unless you have a financial situation where you do not have to work)

    Although it sounds like this type of job is pretty much what's out there for RNs w/o experience, because no one else in their right mind would take it.
  10. 0
    If someone says they give most of their meds late, are already (present tense) "making a lot of mistakes", routinely stays up to 2 hours after her shift is over to chart, and to call a doctor re: a med error that resulted in a patient receiving a blood transfusion they otherwise would not have had, gets no help from either her manager or the CNAs when she asks and routinely has 10 patients not counting admits or discharges (what if she were to get 2 admits and no discharges?) that's not really manageable for a nurse with 3 months of experience.

    Anyway to you Silvergem - I hope either your union or the Joint Commission will help improve your circumstances.


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