My first few days, as a new RN - page 4

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,... Read More

  1. by   Avelinne
    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
    Last edit by Avelinne on Sep 15, '06
  2. by   ginger58
    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 nurset 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.
  3. by   RNinSoCal
    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.
  4. by   CametoitlateTexan
    How about "Safe Harbor?" Is this available to you?
  5. by   nursemike
    Quote from thrashej
    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.
  6. by   mandana
    Quote from nursemike
    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
  7. by   Sailingshoes
    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 never thought I would be in the cancer field but just had to try anything besides the floor. Best of luck to you!
  8. by   Sheri257
    Quote from kelliegrl
    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
    Last edit by Sheri257 on Sep 16, '06
  9. by   Sheri257
    Quote from RNinSoCal
    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
    Last edit by Sheri257 on Sep 16, '06
  10. by   nursemary9
    Quote from starryx2
    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!



    Hi,
    First off, Congratulations on becoming an RN.

    Well, as you can see I am DEFINITELY NOT a new RN. i have been doing this for the last 40 yrs. I have been a Manager and I have been staff for a MUCH longer. The Politics of Management go to me early in the game & I knew I wasn't meant for that. SO........ it was nack to staff.
    The last 30 yrs has been on 8 hr. nites--full time.
    It has been quite a trip!!

    First off-- It is most certainly legal to refuse an assignment--as long as you have not yet accepted that assignment. I have always been told that once you acctually accept the assignment, if you then try to refuse, you could be cited for patient abandonment. So, If you come in & see that type of assignment, you need to refuse & speak to whomever is in charge BEFORE getting any type of report. You need to say that you feel this is an unsafe assignment & the reasons; Also your license is at risk here.

    You know, I know you have worries about loans & such, but this does not sound like a really good place for you.
    If by some awful circumstance, you end up sued or whatever for some mistake you might make when you have this unsafe assignment, you will have even more money problems. Just remember that if you get sued, they can say that a prudent RN would NOT have accepted an unsafe assignment.

    Our Hospital is owned by one of Illinois's largest employers. We are a not-for-profit teaching hospital. Our management has been trying to go by california staffing guidelines. They really are trying & most nites now we don't get more then 6 pt's. Our day shift 5 at most. we also have Nurse Aides who are terrific. We are not Perfect, but better then it has been; HOWEVER, patient's today are sicker then ever. 10 yrs. ago, my patient;s would all have been in an ICU; Today, however, they are on my Med/Surg/Hem/Onc floor. The patient's in the ICU wouls probably not have made it, so nursing is a harder job then ever.

    I know, at my age, you'd think I'd give it all up--it's TEMPTING--Believe me as the old bady is failing, it is tempting. However---I DO LOVE BEDISE, HOSPITAL NURSING!! And you know, there are not so many of us left anymore.

    I also need the really good benefits I get here--a great HMO & a good pension plan. At my age, we think about those things.

    However--Like I said---you can REFUSE an unsafe assignment; I have done it--i did not get fired.

    Think about yourself and your future career.

    mary Ann
  11. by   Miss Ludie
    I'm not sure if I should post this link as it comes from the RWJ site, but here is a good picture of how it should be.

    http://www.nursesworldmag.com/articl...cfm/id/23.html

    The title is something like after 15 years of tepid from the top management.....anyway maybe the tide is turning.
  12. by   gauge14iv
    As far as the legality of refusing any assignment - that varies from state to state and the method for doing so may need to be qualified using a certain form or process of notification.

    If you are not familiar with this - contact YOUR STATE's BON - Do NOT rely on the advice of posters on this board who may or may not be in your state and under your contract situation.

    You might also need to contact a labor attorney because some of this may fall under whistleblower protection laws in your individual state.

    Whatever you do DOCUMENT EVERYTHING!!
  13. by   dorselm
    I am a pre-nursing student due to start school in Feb 07. More and more I'm becoming increasingly frightened that I will regret going into the field of Nursing. I know this is what I'm meant to do but I can't imagine working for hours on end and not being able to eat a lunch or use the bathroom. Not only has this entire thread scared me (which I know was not intentional) but a recent experience also has my eyebrows raising. When my mother was in the hospital, she needed her PICC (sp?) tubes removed. The first person came in and I asked if she was a nurse. She said yes. I said I only ask because I'm going to school in Feb 07 to become a nurse. She said what in the world for? She wasn't able to remove the tubes from my mom's arm because she needed more pain med so about 3 hrs later another person came to remove the tube from my mom's arm (she was going home). I asked if he was a nurse and he said yes and I told him I'm going to nursing school in Feb. He didn't reply. I said what's wrong? He said you are crazy to enter this profession and if I knew then what I know now, there's no way I'd be doing this. He said we are overworked and are treated with little respect from the doctors. He said DO NOT GO INTO MED-SURG, people think you have to start there when you get out of school and that's not true. He said to start in ICU. But wouldn't I need at least a year or two of experience before I can work there?

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