I want to quit first RN job after a few weeks.

  1. Hello,

    I've been working at a sub-acute facility for about three weeks now and quite frankly, am having anxiety about the job. I have a high patient load of about eighteen to twenty patients. Many of them are complex patients with GTubes, trachs, and blood sugars. I didn't realize how different of an environment it is in a nursing home. I feel like I spend all my time passing meds and then I have to stay 2-3 hours after to document. I only had one week orientation and don't feel adequately trained to take on this much at a time. I'm really considering leaving and finding another place to work, but I would like to get some insight on other options or hear what other people's stories are. Employment at this place is "employment at will" so I believe that means I don't have to give notice?
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  2. 63 Comments

  3. by   TheCommuter
    For some context, I worked as a sub-acute floor nurse for several years. It was one of my first jobs as a new grad. Admittedly, it is not for everyone. I am sorry you are feeling anxious about this nursing job.
    Quote from newgradrn2016
    Many of them are complex patients with GTubes, trachs, and blood sugars.
    Patients who require trach care, finger stick blood sugar checks, and tube feedings are not necessarily complex. In fact, these tasks are essentials of basic nursing care.
    Quote from newgradrn2016
    I only had one week orientation and don't feel adequately trained to take on this much at a time.
    The brief orientation time is normal. I never received more than four days of training in this setting, even as a new grad nurse. Extended care subacute nursing facilities generally do not have extensive budgets to provide for lengthy new hire orientations. You learn via baptism by fire.

    In subacute LTC facilities, time management is fundamental. As mean as these words may come across, always remember that the subacute patients and their families not our buddies. Kindness is expected, but we have no need to chat with them for more than a few minutes. In summary, hurry up, pass the meds, change the dressings, and swiftly start on the next patient. Do not permit any single individual to waste your time.

    A 'to-do' list kept me organized. If you wish, keep reading to see one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a subacute unit years ago and that is how I stayed organized.

    I usually had about 15 residents. At the start of the shift I looked over the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I would not forget to complete my tasks.

    9-23-20XX
    DIABETICS, FINGER STICKS: Linda (BID), Nora (AC & HS), Billy (AC & HS), Paula (AC & HS), Rex (BID), Jackie (BID), Evelyn (AC & HS), Marcia (0600, 1200, 1800, 2400)

    NEBULIZERS: Marcia, Evelyn, Billy, Jackie, Paula

    DRESSING CHANGES: Paula, Billy, Johnny, Jackie, Lily, Rosie, Lucy

    IV THERAPY: Paula (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)

    COUMADIN: Linda, Rosie, Johnny, Lucy

    INJECTIONS: Linda (lovenox), Lily (arixtra), Rex (heparin), Billy (70/30 insulin), Evelyn (lantus), Mary (vitamin B12 shot)

    ANTIBIOTICS: Paula (wound infection), Rosie (UTI), Rex (pneumonia)
    1200, 1300, 1400 meds: Marcia, Lily, Rosie, Johnny, Merle, Jackie
    1600, 1700, 1800 meds: Rosie, Johnny, Rex, Lucy, Lily, Shirley, Louisa

    REMINDERS: assessments due on Linda, Jillian, and Louisa; restock the cart; fill all holes in the MAR; follow up on Nora's recent fall, fax all labs to Dr. Taylor before I leave, order a CBC on Rex...
  4. by   roser13
    Quote from newgradrn2016
    I'm really considering leaving and finding another place to work, but I would like to get some insight on other options or hear what other people's stories are. Employment at this place is "employment at will" so I believe that means I don't have to give notice?
    I am not an expert on "at will" employment. All I really know about it is that employees can be fired for any reason. I also know that it can be a career-killer to walk away from a nursing position without giving proper notice. Regardless of the size of the community in which you live, the nursing community is tight. Word travels fast. The circumstances that you describe for a sub-acute facility seem par for the course. The patients that you describe are not complex.

    I think you should give it more time. Think carefully before you quit, and if you do quit, give adequate notice.
  5. by   Cat365
    You can quit any job anywhere (at least in the USA) "at will". They can't force you to work. However there may be consequences. A person who signed a contract might violate that contract and be held liable for the consequences that are set forth in that contract.

    If you didn't sign a contract most places expect a two weeks notice. Though that can vary. The consequence of not giving sufficient notice is that the facility will usually label you as not rehirable. This may not seem like a big deal because you don't want to work there anyway but if this facility is owned by a larger company you could be blacklisted by every facility that this company owns. That could include hospitals, Dr offices, LTC, and rehab facilities.

    My best advice is if you really want to quit contact HR and see what they want as far as notice. It's always best to leave under the best terms possible.
  6. by   Joanie49
    If you are feeling uncomfortable at this job with only a week orientation I would request further job training before I quit or did anything drastic. If they can not accommodate that simple request I honestly would start looking elsewhere due to you being a new grad with limited experience. I do not feel one week is enough training at all personally.....I have only worked in acute hospitals where I got 3 months of job orientation before so I can not compare to your current job experience but patient safety comes first and it sounds like this job is lacking in that or you at least feel it is being compromised which is just as important..... Possibly talk with other nurses how they organize their days/shifts and get in a routine. I would try and give it a little longer then three weeks, it is really not a long time to be working anywhere so maybe once you get in the groove of things it will start going smoother. Being a new grad at a new job always starts off rocky honestly.... BTW if you did decide to leave the position I would DEFIANTLY give notice no matter what...... My best wishes to you!
  7. by   newgradrn2016
    Quote from Joanie49
    If you are feeling uncomfortable at this job with only a week orientation I would request further job training before I quit or did anything drastic. If they can not accommodate that simple request I honestly would start looking elsewhere due to you being a new grad with limited experience. I do not feel one week is enough training at all personally.....I have only worked in acute hospitals where I got 3 months of job orientation before so I can not compare to your current job experience but patient safety comes first and it sounds like this job is lacking in that or you at least feel it is being compromised which is just as important..... Possibly talk with other nurses how they organize their days/shifts and get in a routine. I would try and give it a little longer then three weeks, it is really not a long time to be working anywhere so maybe once you get in the groove of things it will start going smoother. Being a new grad at a new job always starts off rocky honestly.... BTW if you did decide to leave the position I would DEFIANTLY give notice no matter what...... My best wishes to you!
    At the end of my orientation I have brought it up with my supervisor that I would like more orientation time, but it was denied because we're short staffed and they need an RN to start working ASAP. During orientation, I have noticed some of the nurses start passing meds right away after receiving report or will prepare them an hour early and leave the meds in the med-cart for when it's time. But that to me seems high-risk for med errors. I want to do things properly, especially since I'm a new grad, but it's hard when all the nurses tell me I should start prepping early because I'll run out of time (which is incredibly true). The EMR system won't even let us document we've passed meds until an hour before the scheduled time.

    But everyone's advice on giving notice two weeks early does seem the right thing to do. I'll email my employer thanking them for the opportunity of course. I am worried though that word will get out that I'm quitting. And co-workers will stop helping, judge me, or shut me off completely.
  8. by   jennylee321
    I think you need to give it more time, it's only been 3 weeks. You are going to get faster, more organised and more comfortable. If they won't give you more orientation, explain to them the difficulties you are facing and ask for some advice.
  9. by   roser13
    Quote from newgradrn2016
    At the end of my orientation I have brought it up with my supervisor that I would like more orientation time, but it was denied because we're short staffed and they need an RN to start working ASAP. During orientation, I have noticed some of the nurses start passing meds right away after receiving report or will prepare them an hour early and leave the meds in the med-cart for when it's time. But that to me seems high-risk for med errors. I want to do things properly, especially since I'm a new grad, but it's hard when all the nurses tell me I should start prepping early because I'll run out of time (which is incredibly true). The EMR system won't even let us document we've passed meds until an hour before the scheduled time.

    But everyone's advice on giving notice two weeks early does seem the right thing to do. I'll email my employer thanking them for the opportunity of course. I am worried though that word will get out that I'm quitting. And co-workers will stop helping, judge me, or shut me off completely.
    Please keep in mind that you are not likely to find a position in sub-acute that is much different from what you currently describe. Worse, perhaps, but not better. If your coworkers are friendly and supportive, then you're already ahead of the game. Also, I don't know what the job market looks like in your area, but it is always best to have a new job lined up before you jump ship on the old one.
  10. by   ericaej
    It does not sound like a safe environment to begin your nursing practice. I have been a nurse for a short time: about three years. I have practiced on med surg most of that time. However, I also worked in long term care and skilled nursing for a brief period of time while I was also working med surg. Skilled nursing is difficult because the level of care may be stable but the volume is more. Also, people can develop problems, just like anyone, and require immediate assistance. This means one gets way behind in caring for the 13-14 other patients under your charge. I would recommend looking for a different job before quitting this one. But also trust your gut. If the environment is not safe, it won't be safe in the long term for your nursing practice or license. The best advice I have gotten from my late Aunt (an RN for 40 years) is always protect your license. There are jobs everywhere. Good luck!
  11. by   TheCommuter
    Quote from newgradrn2016
    I want to do things properly, especially since I'm a new grad,
    The textbook world of nursing where all things are done properly (and by the book) will not fly in most settings unless you work in a critical care environment where you render care to one or two very sick patients.

    Even on hospital floors such as med/surg, stepdown, telemetry or ortho where you may have anywhere from five to eight patients, practicing by the book will ensure you stay behind several hours after the end of your shift. This may sound controversial, but here it is: safe shortcuts are essential to real world nursing practice.

    You will notice I said safe shortcuts. As long as these shortcuts do not harm the patient, they benefit you and the patients via the provision of timely care.

    Good luck to you!
  12. by   Workitinurfava
    There will always be some stress related to working as a nurse as you are caring for lives. I remember working in that environment. It was hard but it helped me get a job working with less patients. Take it until you can get something better because at least you will be getting experience.
  13. by   gaylarn4
    This is not where I would start as a new grad. That said, personally I wouldn't work in LTC at any time LOL! Unfortunately, with the way these facilities staff (actually, DON'T staff appropriately!), is IMO, unsafe and unsatisfying, if you are the type of nurse who got into nursing to be able to give real care to patients. LTC patient loads many times mean you have no time to spend time with your patient, other than to give meds and do dressing changes, etc. like a bat out of hell! I work in a correctional facility, and found that this is my niche-found this to be safer than the dementia units I have worked on! If you could, I would try to get a year under my belt on a med/surg unit in a hospital. Best wishes on your nursing career-we need you!!!
  14. by   caliotter3
    Your feelings of anxiety are normal. The one week orientation is about par for such a facility, in fact, many people receive less than that. That number of patients is about normal for the RN working in the Medicare section (G tubes, trachs, and blood sugars are not considered complex). You could just as easily have been placed on the floor with the responsibility of 80 or more residents. As a rule of thumb, you should start to feel better about your time management skills and ability to handle what comes up after about a year or so on the job. You want to avoid looking like a "job hopper". Moving on to another place that is similar will more than likely just get you into the same boat again.

    You can decide to start looking for a new job when you have been at this one long enough that you don't have to explain your short tenure. Strive for the one year mark. You can learn a lot in that amount of time that will help you to do better at your next place of employment.

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