My first few days, as a new RN

Nurses General Nursing

Published

Here I am, it has been 6 days, since I have been off of orienation, I am disgusted. I took boards yesterday, keeping fingers crossed, but actually I'm a little worried about having the RN title, because that means more things that I have to do. Which that would be no problem, besides the fact that today alone I had a 9 patient assignement! Come on 9 patients? A experienced seasoned nurse shouldnt be taking care of 9 patients. I am a new graduate with 6 days under my belt, by myself. We are on a med-surge unit specializing in orthopedics and gynecology, due to the recent close of our OB/Gyne floor that is our newest addtion. My head is spinning, I cant keep up, I am trying like heck to get everythign that needs to be done, but I am not even coming close, I do not feel that it is my inability to do things quickly, I am moving at a very quick pace but, here is the question i pose, Why is it that a new graduate nurse or any nurse for that matter should have to take care of 9 patients on a daylight shift? Why do we allow these things to happen. I am curious to know from the California RN's how the patient:staff ratio is working out, does it work to have mandatory Ratios? Make no mistake it was not an easy patient assignent load either, I had 2 patients on complete bed rest, which were complet cares, I had 4 post ops, which besides PCA's, Foleys, dressing changes, and routine meds, have to be down for Physical Therapy twice a day. Also you have all your routine meds, pain management for the other patients, I was lucky if I say 2-3 of my patients once in the 9 1/2 hours I was there, and that was to give them there medications and give them a very brief once over, which is complety inadeuquate, but what are you to do... I was still passing medications at noon, of course no breaks, no lunch, and the 2 RNs, and Myself along with the LPN whom which all carried the same load today were sinking. We have a charge nurse who was taking off orders ect, and another RN that got mandted due to not having a unit secretary. Another RN came out at 11 to take over for the mandated night shift nurse. Why are these things happening, I feel fortunate enough that I am able to keep my cool and keep moving and doing the best job I can do. I feel that this is such a joke, and such an inadequate way to do nursing, THIS IS NOT WHAT THIS PROfESsion is about , I feel like im doing TURBO nursing. You walk in the room, and are trying to keep moving you cant talk to the pateitns, your in their for only 5-10minutes at the most, how are the pateints getting good care, why is our patients not getting excellent care! Why are we not able to do what we are taught a nurse is suppose to do? Doctors are coming in and out writing orders that you come and find or are told about 2-3 hours later. You simply dont have time, I did not sit down today, until 4pm 1/2 hour after I should be on my way home, I sit down to chart, and try to look at my hands my papers, and sort through and see who had what going, and what I need to chart, I finish that after about 45minutes, and I am not satisfied with it, but hey its 5:15, I am exausted my feet ache. One of my co-workers come to me and says, do you have heart burn yet? Dont worry you'll get it, and turns to our other co-worker and asks what do you take, prilosec or protonix? I sit and wonder to myself, they are serious aren't they? This is so sad. I love this profession, I love what a nurse is suppose to do, I want to help people and I want to go to work everyday and do the best job I can possibly do but this is rediculous, I am managing for the moment but I do not know how long this will last, until it catches up to me. I knew this was a tough profession, and that is one of the reasons I got into it becuase I wanted a challanging profession, BUT i didnt want a unsafe, tiresome, work yourself into the ground, barley remember your patients names at the end of the day. On account of HIPPA, I can not paint a complete picture of my patient assignment, but believe me when I say, It was definitly not an assignment anyone should have. My manager and charge nurse, knew it was bad they were trying to help, I can't complain about my co-workers, they try as hard as they can to help you, but they have 9 patients a piece, and their own problems to worry about, I cant blame them for not being a little annoyed, but again why is this happening?

I know this is not new, I know this is not a new concept, I also know this is happening all over the US. I just am very disgusted. My question to all of you out there is, WHat can we do to change this? Or has anyone encountered this at their hospital or facility and took a stand and decided to do something about it? I know that my co-workers want these things to change, but nobody knows what to even do about it. We dont even have time to think about it, we cant even stop for a moment to think, wereway to busy trying to give our patients 1/10th of the care that they deserve. Were doing our best, I am doing my best. I just cant keep asking myself WHY, and What can I do to make a change?

:madface:

Hey Everyone thanks for all the support!!!

Just as an update to some of the questions that were asked

Yes, I am off of orientation, today was my eighth shift being off of orientation.

Yes, I just graduated June 2006, and I just passed boards as of 2 days ago!

I had 5 1/2 weeks of orientation which they offer 6 on that unit. Now do not get me wrong, If I would be handed 4-6 patients I do feel as though I could somewhat manage in a decent safe manner, busy but safe at least. Which is why I was cut a little short, and before yesterday, I did have the poor souls, that I was working with had to cover me while I was still a "graduate nurse"

I have one problem in regards to quiting or leaving, I went through the hospital and they paid for my school and I owe them 3 years. I really really really dont want to pay them back almost 20,000 dollars plus my student loans that I took out just to live for the 22 months in which at the time I thought was hell, wow was I wrong. That is one of the nagging things in the back part of my head, as I go through each day.

The second question I have to pose to everybody is Is it actually legal to not accept the patient assignment given to you, can you actually say no I am not taking that, because I was told that if you do so then you are neglecting your duties and your patients and can be held liable for that. That is why I pose how is the best way to handle that.

I do believe that my next step is to speak to my manager, she is for the most part a reasonalbe person, I do believe she is managing the best way she can minus, the fact that she is not fighting for her staff to the "powers that be"

Also to add the last 2 days have not been any better I didnt have 9 patients but I did have 7 yesterday and 8 today!!!

I dont know I am just very disgusted, and it is definitly unsafe, I just guess Im still in shock that this occurs. Of course only the patients suffer and maybe my bladder!

Sorry to hear that you're having a rough time with your new job, and new role as a nurse!!! It sounds to me as if the facility where you are working is probably not the safest of places, for patients or staff! I do have a question for you though.. If you just passed your boards two days ago, how is it that the facility you are working in has had you off orientation and on your own now for that past eight shifts??? Correct me if I'm wrong, but have you been taking patient assignments and providing nursing care for the past eight shifts???

I have to say a contributing factor to the shortage would have to be at the nursing school level. I will soon be applying to a program that accepts once a year. Along with myself, about 500-600 other people will be praying they get one of the 40 spots. Many people wait 2-3 years to get into the program. This is not an anomolie (sp) and it is certianly not an elite school, this is a community college. If you read through the student nurses forum this problem exists across the country.

I am not proposing any solutions for this b/c I do not have any that have not already been discussed. However I truely beleive that the small number of students being accepted into nursing programs (in the US) influences the shortage immensely. Take care.

Specializes in SRNA.

Get thee to an ICU! I've never had more than 2 patients. Sure there are swans and pressors and vents and all that, but it's totally manageable. I could never do your job and keep my sanity.

-S

Here I am, it has been 6 days, since I have been off of orienation, I am disgusted. I took boards yesterday, keeping fingers crossed, but actually I'm a little worried about having the RN title, because that means more things that I have to do. Which that would be no problem, besides the fact that today alone I had a 9 patient assignement! Come on 9 patients? A experienced seasoned nurse shouldnt be taking care of 9 patients. I am a new graduate with 6 days under my belt, by myself. We are on a med-surge unit specializing in orthopedics and gynecology, due to the recent close of our OB/Gyne floor that is our newest addtion. My head is spinning, I cant keep up, I am trying like heck to get everythign that needs to be done, but I am not even coming close, I do not feel that it is my inability to do things quickly, I am moving at a very quick pace but, here is the question i pose, Why is it that a new graduate nurse or any nurse for that matter should have to take care of 9 patients on a daylight shift? Why do we allow these things to happen. I am curious to know from the California RN's how the patient:staff ratio is working out, does it work to have mandatory Ratios? Make no mistake it was not an easy patient assignent load either, I had 2 patients on complete bed rest, which were complet cares, I had 4 post ops, which besides PCA's, Foleys, dressing changes, and routine meds, have to be down for Physical Therapy twice a day. Also you have all your routine meds, pain management for the other patients, I was lucky if I say 2-3 of my patients once in the 9 1/2 hours I was there, and that was to give them there medications and give them a very brief once over, which is complety inadeuquate, but what are you to do... I was still passing medications at noon, of course no breaks, no lunch, and the 2 RNs, and Myself along with the LPN whom which all carried the same load today were sinking. We have a charge nurse who was taking off orders ect, and another RN that got mandted due to not having a unit secretary. Another RN came out at 11 to take over for the mandated night shift nurse. Why are these things happening, I feel fortunate enough that I am able to keep my cool and keep moving and doing the best job I can do. I feel that this is such a joke, and such an inadequate way to do nursing, THIS IS NOT WHAT THIS PROfESsion is about , I feel like im doing TURBO nursing. You walk in the room, and are trying to keep moving you cant talk to the pateitns, your in their for only 5-10minutes at the most, how are the pateints getting good care, why is our patients not getting excellent care! Why are we not able to do what we are taught a nurse is suppose to do? Doctors are coming in and out writing orders that you come and find or are told about 2-3 hours later. You simply dont have time, I did not sit down today, until 4pm 1/2 hour after I should be on my way home, I sit down to chart, and try to look at my hands my papers, and sort through and see who had what going, and what I need to chart, I finish that after about 45minutes, and I am not satisfied with it, but hey its 5:15, I am exausted my feet ache. One of my co-workers come to me and says, do you have heart burn yet? Dont worry you'll get it, and turns to our other co-worker and asks what do you take, prilosec or protonix? I sit and wonder to myself, they are serious aren't they? This is so sad. I love this profession, I love what a nurse is suppose to do, I want to help people and I want to go to work everyday and do the best job I can possibly do but this is rediculous, I am managing for the moment but I do not know how long this will last, until it catches up to me. I knew this was a tough profession, and that is one of the reasons I got into it becuase I wanted a challanging profession, BUT i didnt want a unsafe, tiresome, work yourself into the ground, barley remember your patients names at the end of the day. On account of HIPPA, I can not paint a complete picture of my patient assignment, but believe me when I say, It was definitly not an assignment anyone should have. My manager and charge nurse, knew it was bad they were trying to help, I can't complain about my co-workers, they try as hard as they can to help you, but they have 9 patients a piece, and their own problems to worry about, I cant blame them for not being a little annoyed, but again why is this happening?

I know this is not new, I know this is not a new concept, I also know this is happening all over the US. I just am very disgusted. My question to all of you out there is, WHat can we do to change this? Or has anyone encountered this at their hospital or facility and took a stand and decided to do something about it? I know that my co-workers want these things to change, but nobody knows what to even do about it. We dont even have time to think about it, we cant even stop for a moment to think, wereway to busy trying to give our patients 1/10th of the care that they deserve. Were doing our best, I am doing my best. I just cant keep asking myself WHY, and What can I do to make a change?

:madface:

Specializes in Med/Surg, Postpartum.

I feel your pain. Being a new nurse is hard enough without adding to it with a patient load like you got.

If I was you I would quit IMMEDIATELY!!!!

Run, don't walk. You are putting your license and livelihood at risk, your employer will blow thru yours if you give them a chance. I don't know how the market is for nursing where you are, but don't let this terrible experience scare you away from nursing.

I encountered similar circumstances when I first went to work as a nurse. I actually was suppose to be with a preceptor and she called off and it was just me. I turned to the nurse giving me report(she just expected me to stay alone??) and it was the hardest thing I ever had to do but I told her "I cannot do this alone, I won't stay if no one comes to help me". She was MAD, left me to get the charge nurse, and then I had to tell the charge nurse that I would not stay without a preceptor. Man, I know my face was red but I made the best decision for me that day.

I am now working for a registry, choose where I want to work, when I want to work, and I Refuse to go to facilities that overload their staff. Nurses do have choices because of the shortage. I love what I do, I am a good nurse, but my license took me too long to achieve to allow any facility to put my license in jeopardy.

Nurse to patient ratios will change in the future, how can they not, but in the meantime, look for opportunities in nursing that you can safely work in. Nurses work in schools, clinics, outpatient surgery centers, in prisons, in long term care facilities, in assisted living facilities......

Look around, where you work is not the only nursing opportunity that is available to you. Hang in there, it does get better!!

Good Luck to you!

Avelinne

Specializes in Palliative Care, NICU/NNP.

Been in nursing since the 70s and it didn't used to be like this. Patients weren't as sick, they took a lot less meds, they didn't look at the hospital as the Hotel Ritz, and there was a whole lot less paperwork. Luckily when I went back to work I live in CA with nurse:pt ratios. Even with 5 patients it can be chaotic because patients are unpredictable. So when lunch time comes around and something comes up, lunch goes away. Why do we put up with this? I don't know. Hospitals didn't used to be big business. I still think that inspite of the nursing shortage a nurse is expendible if they don't like the work. They want nurses to do more and more paperwork, take care of sicker patients, do NA work if you don't have good ones or they send them to another floor. With Pyxis machines it's one nurse at a time, some times gathering a mountain of meds, or waiting to have insulin double checked and no nurse is around to do that. More and more complicated dressings. Heavier patients, lack of proper lift equipment and not always available lift teams. Hospitals are abusing nursing. We have a hospital union but they don't control the amount of work we're required to do by the hospital. I'm glad I'm at the end of my career because the nursing environment has become very stressful. If I had >6 patients to care for that would probably do me in now! When I worked NICU as an NNP I sometimes had 12 level 3 infants to do the physical exam, orders, progress notes, procedures, vent management and it was doable. The same with OR. Med surg is a killer.

Specializes in Home health, Med/Surg.

I have noticed an interesting trend in the hospital I work for. There are many nurses working here as travelers because of the deplorable hospital working conditions, poor management, poor pay, and no ratios in other states. This is what the traveling nurses are telling me about what is going on in other states, I have always worked in CA. I am not trying to make it sound like CA is the best place to be, I know there are fine hospitals and nurses all over the USA. I only have info from nurses who left for a better situation. We have nurses from Kentucky, Tennessee, Mississippi, Louisiana, Arizona, West Virginia, Georgia and Florida who are here for the high pay and low ratios. My nurse friend from Tucson says it is like a vacation for her to work here because at home she has 8-9 patients on nights and has to be in charge. Here she has 4-5 pts and never has to be in charge. My nurse friend from Tennessee is making triple the wage she made at home. It seems that the rest of the country is losing some good nurses to CA because we do have the ratios in effect. We do have strong unions here in the Bay Area (I am mid-peninsula for those who know the area). I think something has to change for the rest of the country. Whether it is ratios or staffing by ACTUAL acuity (not supervisor enforced acuities based on staffing grids) nurses need some relief. For those of you who are staying in your home city/state and trying to make things better for your pts, God Bless You all. I hope things change for the better before we lose our new nurses to burn out.

Specializes in Cardiac.

How about "Safe Harbor?" Is this available to you?

Specializes in Rodeo Nursing (Neuro).
This thread makes me not want to wake up tomorrow to go to clinical.:uhoh21:

I am starting to see how it is going to be. And I am sad it took me so long to see it. AND I know don't have a clue until I start working, which makes me even more sad. What was I thinking?

I guess the light at the end of the tunnel is there are other jobs out there for nurses OTHER than bedside nursing??

So depressing.:(

It doesn't have to be like that. My maximum patient load is 5-6, and while that does keep me busy, it can be done. I work 3-12s on nights, and while I'm pretty tired by the end of the third, I don't dread going to work. I'm learning a lot, making a decent living, and even having fun.

The lesson, here, is not that bedside nursing sucks. It is hard work, but in a good facility it can be a wonderful job. Don't go to a job interview feeling desperate to get any job. It's a seller's market, so ask questions about the orientation process, patient loads, scheduling--anything that concerns you. If the answers you get don't satisfy you, keep looking.

I work in a not-for-profit, teaching hospital. From what I hear, for profit hospitals aren't usually so nurse-friendly.

It doesn't have to be like that. My maximum patient load is 5-6, and while that does keep me busy, it can be done. I work 3-12s on nights, and while I'm pretty tired by the end of the third, I don't dread going to work. I'm learning a lot, making a decent living, and even having fun.

The lesson, here, is not that bedside nursing sucks. It is hard work, but in a good facility it can be a wonderful job. Don't go to a job interview feeling desperate to get any job. It's a seller's market, so ask questions about the orientation process, patient loads, scheduling--anything that concerns you. If the answers you get don't satisfy you, keep looking.

I work in a not-for-profit, teaching hospital. From what I hear, for profit hospitals aren't usually so nurse-friendly.

I totally agree with you. I'm a new grad in a for-profit hospital and I would never, ever for any reason accept a patient load like this. It IS a seller's market and one can afford to be quite particular in selecting their place of employment. From my graduating class, the majority went to hospitals - about 50/50 in regards to non or for profit. Several went to clinics and those who wanted to went into specialty areas with great orientations. It makes me so sad to see nurses say "why is it this way?" when the answer is simply that it shouldn't be and you shouldn't risk YOUR license, YOUR well-being and YOUR conscience if it is.

Amanda

I have been a nurse for 8 years and can't imagine having 9 patients! Please speak up, try transfering to a different department, or resigning for the sake of your patients and yourself. Floor nursing is difficult even under more reasonable conditions. I now work in a cancer center which can be trying but I am much happier than being in the hospital. Becoming a nurse was the best thing I ever did for myself and I hope you will feel the same. Remember, there are many different types of nursing besides hospital. I :monkeydance: never thought I would be in the cancer field but just had to try anything besides the floor. Best of luck to you!

Starry that's insane!! No one can or should be expected to provide care to that many pts. Regarding the staffing in CA, I think it depends on where you work and how they interpret the law. I'm in SoCal, and at the hospital that I work things were GREAT right after the ratios were put in effect. The unit I work on is called a medical specialty unit, almost all pts. are tele/step down, s/p heart cath, fresh MI, etc, most have multiple system issus such as renal failure/CHF/copd, etc etc. Intitially the change took our ratios to 1:4, with an aid for about every 15 pts. (31 bed floor,all open at that time, part of it closed at present, that's a whole 'nother story, currently working with 20 beds) That was really good, very manageble most days. Then admin decided we no longer qualified as a step down unit, just a plain tele unit(which is crap to say the least) so they took our ratio to 1:5 and then on top of that there is only one aide for 20 pts. (if we fall to 19 no aide they send 'em home). Before ratios we could at times go 1:6 for rn but had an aide for every 10 pts. There is no language in the law regarding unlicensed workers (nurse aides) and so it falls to individual hospitals to decide when and if they will use them. I know of a couple hospitals that have gotten rid of aides altogether. I'm sure when the ratios change again in 2008 (straight tele units will go 1:4) they'll probably take away our aides altogether too. Now, I can see that my situation is nowhere near as bad as yours, but it still sucks. I haven't worked outside of CA so I have no comparison, but from my experience the mandated ratios haven't been a cure-all. I'm interested to see how other CA nurses feel.

Funny ... I haven't seen that many cutbacks with aides at the Cali hospitals I've been in. At the hospital I work now, the aides only get 6-8 patients which is really great. They did convert the DOU unit to a Tele floor where they can assign them five patients instead of four but, the RN's rarely get more four patients ... even with the switch.

And I've seen the RN's refuse to take five patients when they feel like they're overloaded. I guess management figures if they anger the RN's by giving them five pts. they'll quit and work elsewhere ... which they can do easily since there's so many other places to work.

I guess it all depends on the facility but, if they want to cut back on aides ... it's not like the RN's don't have tons of other job options. They can easily go elsewhere.

:typing

My nurse friend from Tucson says it is like a vacation for her to work here because at home she has 8-9 patients on nights and has to be in charge. Here she has 4-5 pts and never has to be in charge. My nurse friend from Tennessee is making triple the wage she made at home. It seems that the rest of the country is losing some good nurses to CA because we do have the ratios in effect.

I have heard the exact same thing from travelers who've worked in Arizona and Florida. To them ... California really is a vacation. All of them told me they won't leave because they can't stand going back to higher ratios. One of them did go back to Arizona but came back to Cali because she couldn't stand the higher patient loads.

:typing

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