[merellis2009]

Hey everyone,

I'm a newbie who has been on the floor a little over 2 weeks. I am on a cardiac stepdown/tele unit where the patient ratio is 3-5 per nurse. Sounds great right?! I'm not so sure yet... The upper management has decided that we are going to utilize an all RN model meaning that we have no nursing assistants, PCA's, or PCT's at all. The nurse does it all. I know that I am a newbie and will definitely be slow, but I was wondering if any others out there are in a similar environment. My preceptor and I have decided that the best approach to train me is to act as one body, not the "divide and conquer" method since I won't be able to do that after orienting anyway. Even with her guidance, I don't feel like I have enough time in the day to get everything done with doing PCA tasks and RN tasks. Any advice? I am constantly tweaking my report sheet so that I can try and visualize it all at a glance and get things done in a more organized fashion, but I feel like I'm always behind. The worst part is that many on the floor are looking for other jobs because things are just getting so crazy with all the demands, so I am scared that we'll be even more short staffed pretty soon.

Any help (or report sheets) from anyone on a similar floor would be appreciated.

Thanks!

[lochness1]

Unfortunately I have no words of wisdom, I can only say, OMG, no aides??? I am also on a stepdown unit and we take 3-4 patients. I could not survive without our aides, they rock! I don't know how they expect you guys to do it all without lowering the ratio.....

I can only say good luck to you and I hope it gets better.

[Angie O'Plasty, RN]

I also worked a stepdown unit without aides. You know, the care was a lot better there because the nurses really pitched in and helped one another, and they really cared about the patients.

I miss that dedication and commitment especially when I'm working with a tech who isn't that great and doesn't really care about the patients or doing a good job.

Point: Your coworkers truly make the culture of the unit, and if the culture is one of nursing excellence, commitment to the patient, and collegiality towards one another, it can make all the difference in the world.

[carebearRN08]

I work on a tele floor with no aides on night shift (my shift). Like Angie said, its all about helping out your fellow nurses and they will also help you when you need it. Everyone has a total care/bedridden patient at some point and can identify with how difficult it is to care for them, so they will understand when you need the help. Something I just learned last night is that you can try and "rotate" your help so you don't keep asking the same nurse for assistance (once you are on your own). Also, prioritize and know that sometimes "personal care" things have to wait if you have a more important thing that needs to be done first (like meds or assessing an unstable pt.)

Also, try not to worry about people quitting and staffing issues just yet. You have other things to worry about, don't stress on it until it happens, IF it happens. Try not to get caught up in any ugly gossip, just focus on yourself and your learning right now I say this because after only 1 week on my unit, I can see the politics and union reps blazing (staffing, floating, blah blah blah). But worrying about that stuff isn't going to make me a more proficient nurse, so I can't let it get to me.

Good luck!

[Sarah F]

Hi
I am also a new grad and work the step down/tele unit. I have been a nurse for 7 months and have been caring for 4-5 pts without aids during the night. And, let me tell ya, its wearing me out. I feel that the pts aren't getting the care they deserve and I am always behind. I feel that are unit needs to either beef up the nurse to patient ratio or give us some aides. I would greatly appreaciate some time mgmt tips. I love nursing and don't want to leave the profession, but im afraid I might burn out if things dont change.

[DutchgirlRN]

Originally Posted by merellis2009

I'm a newbie who has been on the floor a little over 2 weeks. I am on a cardiac stepdown/tele unit where the patient ratio is 3-5 per nurse. I don't feel like I have enough time in the day to get everything done with doing PCA tasks and RN tasks. Any advice? I am constantly tweaking my report sheet, any advice

I think your employer is cutting costs at the expense of patient safety which in turn can jeopardizes your new license. I would be job hunting and voicing my opinions.

[Tony1790]

Hi,

I'm an aid on a cardiac step down unit on the night shift while waiting to go to LPN school in Sept. Our LPN/RN's have 5-6 patients each, but we usually have 2 PCT's for 3 halls. I'm always running, weights, vitals, baths, call lights, etc, but I get 10-14 patients, the nurses are great and help out with patient care if I'm busy. I'd hate to see if they had to do all the stuff that I help them with, with all of the paperwork, charting, audits, etc that they have to do now, it's not like they are sitting around all shift, I can see burnout happening.

Personally I'm still evaluating whether I still want the nursing route, I'd hate to be on a floor where people don't help each other out.

Take care

Tony

[missninaRN]

I have no words of advice for you, but I feel for you. I can't imagine doing the work of the aid in addition to my job.

[chinBSN_RN]

Hang in there, concentrate on learning. They will not expect you to be an A1 Tele nurse overnight. Find your rythm. As for not having CNA or aides, welcome to this world they call "Nursing." I used to work full time in a 32 bed telemetry floor, and we have 5 to 6 patients, 2 aides, sometimes one or none. I am just lucky to work with nurses that values team work. We bathe patients, feed them and give their meds. review their charts and finish our nursing notes. We have this buddy system and it really worked. We have charge nurses that act as resource but sometimes they have their own patients too. It was tough and several nurses left our hospital but most of us stayed.We believe that instead of being part of the problem, we became part of the solution, we trained several new grads. I guess we trained them well because now they are the preceptors in Tele and ICU. When I see them I always tease them because these very smart looking nurses, very confident and exudes authority used to cry on the floor, frustrated and their stress level is higher than Mt. Everest.(by the way I was like that too x years ago!) Our shift was 7a-7p but they go home late because of their unfinished chart notes.

Give it time enjoy your preceptor, let her guide you, don't depend on her to finish things for you, know your comfort level. Are you the type who will want to assess patient first before reviewing charts or charts then patients. It is a trial and error, hard but let experience train you to become one of the best nurse ever!!!!

[chinBSN_RN]

Hang in there, concentrate on learning. They will not expect you to be an A1 Tele nurse overnight. Find your rythm. As for not having CNA or aides, welcome to this world they call "Nursing." I used to work full time in a 32 bed telemetry floor, and we have 5 to 6 patients, 2 aides, sometimes one or none. I am just lucky to work with nurses that values team work. We bathe patients, feed them and give their meds. review their charts and finish our nursing notes. We have this buddy system and it really worked. We have charge nurses that act as resource but sometimes they have their own patients too. It was tough and several nurses left our hospital but most of us stayed.We believe that instead of being part of the problem, we became part of the solution, we trained several new grads. I guess we trained them well because now they are the preceptors in Tele and ICU. When I see them I always tease them because these very smart looking nurses, very confident and exudes authority used to cry on the floor, frustrated and their stress level is higher than Mt. Everest.(by the way I was like that too x years ago!) Our shift was 7a-7p but they go home late because of their unfinished chart notes.

Give it time enjoy your preceptor, let her guide you, don't depend on her to finish things for you, know your comfort level. Are you the type who will want to assess patient first before reviewing charts or charts then patients. It is a trial and error, hard but let experience train you to become one of the best nurse ever!!!!