[chriscolin]

I am a new nurse on a small tele floor. I love the people I work with and the small setting makes learning a lot easier. However, I do end up with 4/5 pt. a night. I work the 3-11 which gets very busy with admits/discharges. Well, right now I feel like I do my initial assessment as quick as possible, give out meds and do paperwork. I dont' feel like I have time to talk to my pt's research what's going on with them, and think about their diagnosis and try to really assess their conditions to help with whatever the best care I could give would be.... It's frustrating because I am sure I am not managing them as well as I could if I didn't have as many pt's and really had time to do a better assessment. I think my paperwork is rushed and not as accurate or thorough as it should be, I feel like I am just running around without really "nursing". Admissions take at least an hour and I end up with 2 most nights. That leaves other pt's with little contact from me other than giving meds. I feel like a babysitter who gives out medications and just passes them off to the next shift. I know I could give better care with less pt's. But let's face it that isn't going to happen. I also know with this pace I will make a mistake or miss a symptom or sign I should have caught with a pt. Critical thinking is so emphasized in nursing school but I know I don't have the time to even properly assess my pt's never mind really think about what's going on with them! I feel I can't give the best care without really knowing my pt's that is impossible with 5 pt's and no time to really assess them. Maybe it's time for school nursing! No rush there! Except for flu season..... Anyone with any thoughts.

[Tait]

I think 3-11 can be a devastating shift for a new grad, and I think it can cause almost instant burnout. My suggestion? Try to swap to nights. I worked in a tiny rural hospital for my first job, on nights, and I really loved the time I got with my patients, AND my charts.

Best of luck!!

Tait

[chriscolin]

Originally Posted by Tait

I think 3-11 can be a devastating shift for a new grad, and I think it can cause almost instant burnout. My suggestion? Try to swap to nights. I worked in a tiny rural hospital for my first job, on nights, and I really loved the time I got with my patients, AND my charts.

Best of luck!!

Tait

Thanks for the reply, I knew this shift wasn't going to be easy. There was another new grad who started on thisi shift too, and immediately requested a shift to nights! But we can't all switch, I'm trying very hard to learn to manage time. But you can't manage time when the time doesn't exist! I take the care of my pt's seriously, I want to be known as a smart, caring nurse. The smart part isn't being met because I don't have time to think! I can't think of any nursing other than critical care where the ratio is 2/1 or maternity,where I won't have so many pt's. But it seems clear to me that when I have 2/3 pt's my care is excellent my charting is better and my pt's are happier as a result I am more content and secure in my skills. I was told it would be this way, but I am not willing to risk injury or error to a pt because of staffing, it's not worth my license or peace of mind. When I graduated I wanted to do maternity, but that's hard to break into so I am trying to get experience then make the swap. Until then I just do the best I can and go bed with a massive headache worrying about what I may have missed (meds etc..) not a great way to start a career!

[Chloe'sinNYNow]

Originally Posted by chriscolin

I take the care of my pt's seriously, I want to be known as a smart, caring nurse. The smart part isn't being met because I don't have time to think! I can't think of any nursing other than critical care where the ratio is 2/1 or maternity,where I won't have so many pt's. But it seems clear to me that when I have 2/3 pt's my care is excellent my charting is better and my pt's are happier as a result I am more content and secure in my skills.

Chriscolin,
just a little ps here. I am a new grad orienting in OB and I'm currently doing 4 couplets. That's 8 pts a shift, plus admits in the middle of the night and trying to get the chart together and educate the pt for d/c the next day. You mentioned maternity where you thought there'd be a lower ratio, but perhaps you were thinking L&D? Not ante-partum, nor post-partum will you find low ratios!! It's actually harder in PP because it's 2x the charting. 2x the assessments. 2x the feedings and pumpinp and helping moms to latch...etc...

I have no idea why so many think that maternity is so easy. I'm amazed at how many think that it's cushy detail. It isn't. And so many things can go wrong so quickly and so easily. An OB nurse has to learn to think critically and react efficiently.

But if it helps, I do understand and empathize with your fears of being a "stepford" nurse just acting robotically at med passing, and being overwhelmed. It takes very little to throw our unconditioned skills out of whack and mess our entire shift up. But I'm constantly reading that time management comes with time. It has to, right?

Just my here Chris.

Good Luck
Chloe

RN-BSN, BA

[Daytonite]

Originally Posted by chriscolin

Anyone with any thoughts.

1. The manager who hired a new grad to work on a busy telemetry unit should be horsewhipped. I worked this kind of unit for over 5 years as an experienced nurse and was a nursing supervisor and manager. This is an inappropriate place for new grads.
2. If you are willing to stick this out, your only choice is to hit your books when you get home to learn all the information you don't have time to look up at work. Invest in a good nursing textbook or care plan book of critical care or med/surg that specifically includes assessment information. Don't take it to work because it will disappear because I am willing to bet that you are not the only one who is having and feeling this same stress.
3. It won't be long before you will be floated to the intensive care units when they are short staffed or need help, so this concern about not being good enough with assessments and being organized isn't going to end.
4. I'm sorry you are in this situation. I hope there are helpful people around you, but I've worked in these units. Your coworkers are most likely just as busy and stressed out as you.

[chriscolin]

Originally Posted by Chloe'sinNYNow

Chriscolin,
just a little ps here. I am a new grad orienting in OB and I'm currently doing 4 couplets. That's 8 pts a shift, plus admits in the middle of the night and trying to get the chart together and educate the pt for d/c the next day. You mentioned maternity where you thought there'd be a lower ratio, but perhaps you were thinking L&D? Not ante-partum, nor post-partum will you find low ratios!! It's actually harder in PP because it's 2x the charting. 2x the assessments. 2x the feedings and pumpinp and helping moms to latch...etc...

I have no idea why so many think that maternity is so easy. I'm amazed at how many think that it's cushy detail. It isn't. And so many things can go wrong so quickly and so easily. An OB nurse has to learn to think critically and react efficiently.

But if it helps, I do understand and empathize with your fears of being a "stepford" nurse just acting robotically at med passing, and being overwhelmed. It takes very little to throw our unconditioned skills out of whack and mess our entire shift up. But I'm constantly reading that time management comes with time. It has to, right?

Just my here Chris.

Good Luck
Chloe

RN-BSN, BA

Thanks, I was referring to L&D, in our area L&D gets only 1 pt. 2 at most and are trained for the postpartum floor. Also even on postpartum we are only given 2 pt's because technically you have 4 or more if you include the newborns.

L&D here is pretty good. But again hard to break into. Thanks

[november551]

I used to feel the same way.

I took up the mantra, "All my patients are alive and doing ok at the end of my shift.."

Sometimes just keeping them stable while they heal is the best you can do. You're a nurse, not a miracle worker.

[chriscolin]

Originally Posted by november551

I used to feel the same way.

I took up the mantra, "All my patients are alive and doing ok at the end of my shift.."

Sometimes just keeping them stable while they heal is the best you can do. You're a nurse, not a miracle worker.

Thanks I wish it were so basic. They are alive but sometimes that's not good enough. I can't miss meds, I can't forget to schedule neruo checks or cardiology consults, post telemetry strips. If I miss these things other nurses get stuck with the work and I get stuck with the fact that I didn't do my "job." If I miss an arrythmia spell and something happens later it was my job to catch it and notify someone. There is an enormous amount of stress. Don't get me wrong I find the work very interesting but I just don't know enough at this time and I don't have time to learn it! So I learn as I go, and yes I hope their all alive when I leave........

[Angie O'Plasty, RN]

I understand where you're coming from because even though I had some Med-surg under my belt before I went to tele, I didn't have much hospital experience and I felt like I was under-educated for the tele unit.

Your patient load sounds OK to me, it's about the same at my hospital, and I do get a tech. We have an admissions nurse which cuts down on the admission paperwork so much that it's really easy to take admissions for us now. We still do vitals and assessments, but the whole process is so much faster now, I don't balk when I hear the words "ER admit."

In fact, it is still acceptable in my hospital to come in with no tele experience whatsoever, not even the EKG class. If you can read an EKG, that's good.

New nurses like you have to hope that you have a lot of experienced nurses who can fully mentor you through this in addition to learning as much as you can at home. This website should provide plenty of resources for you.

I've been in telemetry for a few years now and I feel pretty competent at this point, but I still have a long ways to go and I still ask questions and look things up and at the end of the day, I still come home and hope that I've got everything done. The point is, nursing is a lot like raising children -- you never really feel like you got it all right, and you just do the best you can.

[chriscolin]

Originally Posted by Angie O'Plasty, RN

I understand where you're coming from because even though I had some Med-surg under my belt before I went to tele, I didn't have much hospital experience and I felt like I was under-educated for the tele unit.

Your patient load sounds OK to me, it's about the same at my hospital, and I do get a tech. We have an admissions nurse which cuts down on the admission paperwork so much that it's really easy to take admissions for us now. We still do vitals and assessments, but the whole process is so much faster now, I don't balk when I hear the words "ER admit."

In fact, it is still acceptable in my hospital to come in with no tele experience whatsoever, not even the EKG class. If you can read an EKG, that's good.

New nurses like you have to hope that you have a lot of experienced nurses who can fully mentor you through this in addition to learning as much as you can at home. This website should provide plenty of resources for you.

I've been in telemetry for a few years now and I feel pretty competent at this point, but I still have a long ways to go and I still ask questions and look things up and at the end of the day, I still come home and hope that I've got everything done. The point is, nursing is a lot like raising children -- you never really feel like you got it all right, and you just do the best you can.

We have a secretary but she is not there on the evening shift. I did take the EKG course and I passed the ACLS certification course as well. I can read a strip but I still have issues with the more advanced blocks. I had a great preceptor but she doesn't work on my shift now. The people I work with are very good, but they have their case load to handle too! The admits are a nightmare, we all cringe when we see ER on th phone! I am still learning to do IV's and I live in fear of my first code!

Don't get me wrong, the cases are interesting and I feel like I am learning more than most of the classmates I graduated with. Hopefully I will make it through the early years here and relax!