Med/Surg too much, what now?

NOADLS · Jul 8, 2015

Hint: there is more to nursing than acute care.

See: LTC

sarbo1010 · Jul 8, 2015

I feel your pain. What state are you working in? If you are in Florida you are basically screwed - almost all m/s units are going to grossly understaff you. I am not really sure what to tell you to help you. #1 it's not for everybody, but I understand that it is important to succeed at your first job. I do remember a more seasoned nurse telling me to take it easy and finish one job before I started the next.

Are you having problems prioritizing? Or are you just letting the number of patients freak you out?

And number #2 quit glamorizing ICU - you were there also with a preceptor. I never want to work there - the stress is incredible - all the machines and the high acuity of those patients. More than likely if you are at a facility where m/s takes 7-8 then in their ICU the nurses will have to double as the rapid response team and/code team which will take them from the bedside and the other nurse will have to triple, they may even triple the nurse on a daily basis. Other floors always look better from the outside but they all have there pitfalls and after being a float nurse for 4 years in an 800 bed level 2 trauma center I learned that everyone is busting there butts and they all think the other floors have it easier.

#3 It took me a good year before I felt like I wasn't "impersonating a nurse". It may take you a year to get your organizational skills honed, give yourself a chance. It sounds like you actually are in a good place as they are willing to give you extra orientation - I know some new grads who have recently just been thrown to the wolves with just days of orientation and a sink or swim mentality.

All this being said floor nursing/ hospital nursing may not be for you, but there are many paths that a nurse can take.

Are they giving you different preceptors so you can see the many different organizational styles?

Sheri Lynn

TheCommuter, BSN, RN · Jul 8, 2015

Is this just going to be a problem on any unit? Is there somewhere I can go where pacing is more even and I can actually collect my thoughts?

I think some time management skills would serve you well.

What I'm about to say might sound terrible, but here it is: the patients are not our friends. They are not our family members. Therefore, be cordial and personable while providing your care, but strictly limit the amount of time you spend assessing and medicating them unless someone's rapidly declining.

I started out as a new grad in the nursing home setting where I medicated 30 residents in a two hour window. I now work in a specialty hospital where I care for anywhere from 7 to 9 patients per shift. With a patient load of 7 to 9, I do a quick five-minute head-to-toe assessment on each patient, another five minutes medicating them, and another five minutes performing treatments (if any). Aim to spend no more than 15 minutes with each patient during rounds.

Time management comes with experience, but you can start practicing it now. Due to my great time management skills, I usually have abundant downtime each shift to sit, collect my thoughts, chat with my coworkers, and so forth.

Good luck to you!

RNperdiem, RN · Jul 8, 2015

The good news is that yes there are places where the pacing is more reasonable and you might even get some time to collect your thoughts.

The bad news is that these areas require a level of skill and experience that a new grad does not usually have. A slower pace sometimes means more patients who are less sick rather than 7-8 who are more acute.

As a new grad, you will develop the ability to do what seems impossible with time management. Don't underestimate your ability to grow.

Since you have already spoken with your manager, did you bring up specific issues and possible workable solutions? Telling your manager that you are not happy does not give them much to work with. It might even be to your detriment since they might see you as having one foot out the door.

Lev, MSN, RN, NP · Jul 8, 2015

I don't know. 7-8 patients is a lot for M/S. I think the high ratios are doing you in..follow Commuters advice. See if your manager will let you transfer to a different unit at the same hospital....maybe a unit that is better staffed/with a lighter patient load....

SierraBravo · Jul 9, 2015

Well my manager and I finally had the big talk. I told her that I was not happy on my unit. Med/surg is too much for me. I graduated school last December. I knew Med/surg was not right for me even then..but I took the job because I had no experience and my mother knew the DON. I cannot handle the stress of having as many as 7-8 patients a day, with admits and discharges. I was fine working in ICU with a preceptor with 1-2 patients that were on a normal schedule.
But I've been working for three months now. I just can't seem to get a pace set down and my own rhythm going. Orientation is horrid, I was on it for 5 weeks, got to work on my own for 2 months then they decided after I had a panic attack on nights to do orientation on day shift. I've not been trying to get back on my own for three weeks now and they still don't feel I'm ready due to my pacing and organization.
The issue is now I need to start looking for another job asap. I need to keep working there until I do find something.
Is this just going to be a problem on any unit? Is there somewhere I can go where pacing is more even and I can actually collect my thoughts?

One of the things that screams out to me in your post is that your hospital only gave you 5 weeks of orientation. Sorry, but 5 weeks for a brand new grad is inadequate. Period. And I know that there are places with less orientation, etc... But the fact of the matter is that you have to set a new grad up for success. Only giving them 5 weeks of orientation and then giving them a patient load of 7+ patients is generally a recipe for failure.

As far as the ICU goes, I would probably steer clear of that if I were you right now. Yes, you only get 1-2 patients, but the amount of work you do per patient is often at least the same amount of work you would do for your 7+ med/surg patients.

Jm0136 · Jul 9, 2015

Omg I can hardly handle six and I've been a nurse for 15 years! Our max in med surg days is six. You def have to have excellent time management skills. Just don't let it stress u out. Unless someone is crashing I try not to let things get to me. My days literally fly by, 12 hours seems like 4 hours. It's insane. I'm exhausted after my shift ends, but that's any nursing job. Nursing is not easy. Plus you've not been there a year. Give it a year. If you can. I'm rambling because I'm exhausted after working with my six patients today. Good luck!!!!

B,RN · Jul 9, 2015

What about working in an outpatient setting such as a primary medical doctors office or urgent care? I have worked both inpatient and outpatient and loved my experiences in the outpatient world. There is NO shame in not working medsurg/hospital positions. An RN is an RN no matter what type of setting you work in.

Caffeine_IV · Jul 9, 2015

Are you wanting to leave acute care or not?

PacoUSA, BSN, RN · Jul 9, 2015

3 months? It will be a year if that before you even START to become comfortable in M/S. While I agree that 7-8 patients is a lot, you need to give it more time and prevent from looking like a jumper. I personally have more than 3 years in a similar specialty (having tele experience helps me work with less patients sometimes) and I am very comfortable with 4 patients. Once the 5th patient rolls around, it starts to get a little hectic. Never worked with more than 6 patients at once, the charting alone is ridiculous. Honestly cannot see how you can quality care for patients any higher than 4.

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Dranger · Jul 9, 2015

I think you are looking at numbers too much. Yes 7-8 patients is a lot but you have to give it more time as 3 months is a small sample window.

Yes you have 1-2 patients in the ICU but some of those patients are EXTREMELY busy to the point where I am in the room for almost the entire shift or talking to specialty docs, lab, pharmacy or family. Being with a preceptor is NOT the same, the responsibility falls on YOU as the attending nurse.