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:

In our hospital you cant refuse an assignment..they say it would be patient abandonment. If you DO refuse, I'm sure you would be fired and as I have worked there for almost 30 years, I would probably never get another job b/c they would not give me a reference, even though i have an excellent record and have always had great reviews. One time I went to my head nurse and complained about a dangerous assignment I had and she responded that "In nursing, Mary, we all have to decide when it's just too much for us". So in conclusion, that was 10 years ago, and I figured I either do it or quit, it's as simple as that. If I quit, I lose a lot of money in pension, I carry the hospitalization for my husband and my college age son. We have lost 4 full time RN's and 3 part time RN's in 1 month, and I've been looking for a job for almost a year now. No one from administration is even addressing the loss of staff or questioning why it's happening. They continue to put "stable?" ventilator patients on our medical telemetry unit and also give us 5-7 other patients. Our head nurse has had NO communication with us about loss of staff. When a new hire comes in, takes about 1-2 months to orient some of them, then they leave in 2-6 months. I've given up trying to change anything. One nurse got called in to her manager b/c a patients family complained that the "nurse looked to busy, you must need more help"...The manager told the nurse that "in the future you are never to LOOK busy even if you are". That nurse took a job in case management where she was also overworked and retired early. Another nurse was called in to her manager and told there was a family complaint that the nurse didn't "dote on her mother' enough. This is the mentality we're dealing with. There ARE NO OTHER NURSES TO call in. I realize ALL professions seem to be like this...they squeeze every last drop out of you and after 30 years, I still cant sleep the night before I work or the night after AND IM ONLY PART TIME! I cant imagine having a family, kids, parents with needs AND working full-time in our facility. Anyway, I dont feel they'll ever change, they just wait for new grads who will stick it out for awhile and leave. ............I wish I had some ideas to change things but nothing I've tried has worked..................................

In our hospital you cant refuse an assignment..they say it would be patient abandonment. If you DO refuse, I'm sure you would be fired and as I have worked there for almost 30 years, I would probably never get another job b/c they would not give me a reference, even though i have an excellent record and have always had great reviews. One time I went to my head nurse and complained about a dangerous assignment I had and she responded that "In nursing, Mary, we all have to decide when it's just too much for us". So in conclusion, that was 10 years ago, and I figured I either do it or quit, it's as simple as that. If I quit, I lose a lot of money in pension, I carry the hospitalization for my husband and my college age son. We have lost 4 full time RN's and 3 part time RN's in 1 month, and I've been looking for a job for almost a year now. No one from administration is even addressing the loss of staff or questioning why it's happening. They continue to put "stable?" ventilator patients on our medical telemetry unit and also give us 5-7 other patients. Our head nurse has had NO communication with us about loss of staff. When a new hire comes in, takes about 1-2 months to orient some of them, then they leave in 2-6 months. I've given up trying to change anything. One nurse got called in to her manager b/c a patients family complained that the "nurse looked to busy, you must need more help"...The manager told the nurse that "in the future you are never to LOOK busy even if you are". That nurse took a job in case management where she was also overworked and retired early. Another nurse was called in to her manager and told there was a family complaint that the nurse didn't "dote on her mother' enough. This is the mentality we're dealing with. There ARE NO OTHER NURSES TO call in. I realize ALL professions seem to be like this...they squeeze every last drop out of you and after 30 years, I still cant sleep the night before I work or the night after AND IM ONLY PART TIME! I cant imagine having a family, kids, parents with needs AND working full-time in our facility. Anyway, I dont feel they'll ever change, they just wait for new grads who will stick it out for awhile and leave. ............I wish I had some ideas to change things but nothing I've tried has worked..................................

So...how do we change this?

We all (including me) vent about it, get angry about it, but, in the end we accept it as "just being nursing." I'm guilty of that, too. But, it's kind of like being in a bad marriage and complaining about it every day: you either have to leave or you have to change it.

I left 10 years ago. I'm going to TRY to come back (and I'll leave just as quickly if I hate it). The only people who can change this situation are the nurses: the hospitals, the administration and even the patients to some degree (most of them get well, go home, and put whatever their hospital experience behind them) have NO incentive to change anything. Our bottom line is that the onus is on us to change this situation.

How? I wish I knew. The only thing I could even guess would be nurse solidarity and a refusal to accept unacceptable conditions. I think it can be done, but it will take a greater mind than mine to achieve it.

9 patients in my opinion is too many for a newly graduated nurse. Actually, 9 is too many for most nurses I would think. When I started out,they started me with 4 patients, then went to 5, and then up to 6. 7 only if short staffed.

9 patients in my opinion is too many for a newly graduated nurse. Actually, 9 is too many for most nurses I would think. When I started out,they started me with 4 patients, then went to 5, and then up to 6. 7 only if short staffed.

Specializes in Med/surg, ER/ED,rehab ,nursing home.

Have you ever had the CNO tell you that you can lose your licence for "abandonment" of patients? Don't know how that works if you refuse to add more to your work load. Our CNO says to assign a tech to the team so that as team leader and precepter I can spend more time teaching a new grad. HAH! Also to get written up because you did not get the coffee to the patients visitor fast enough.....Nuf said. Oh by the way, I earn $28.79 an hour with a $3.50 hr shift dif. I have been at my position going on 17 yrs here in Nashville,TN. Started nursing in the early 1970's at $1.95 an hour. ( pay then in CCU was $3.00 an hour). My plumber, car mechanic, etc make more than this. And they are not held responsible for someone's life.

Well said.Please see General Nursing POLL questions, some good insights could be gained by contributing answers/opinions.

to someone on the outside looking in, I do not understand why people take on more work then they can reasonably handle. Do people accept these unsafe assingments because if they don't they will be fired? Is it because if one nurse refuses, then another nurse feels that they have to accept a bigger load, and then everyone hates the one nurse that refused too many patients?

If you've never worked as a nurse, then you have no idea. We do it, not because we think it's right or safe, but because we care about the patients and can't bring ourselves to say 'no' to caring for somebody if that means they may not receive the care they need.

We know that we are placing ourselves at risk; we know that our decision to take 9 patients only perpetuates the problem; we know that it's false economy to think that if we take 9 patients it is better than taking 4 and doing a good job. But when we're faced with the reality of the ward situation, we still choose to look out for the patients as much as we can because someone's got to do it.

Don't judge until you've been in the situation - you might be surprised by what you would do if faced with it yourself.

One thing you're right about - we do need to stop doing this to ourselves. We need to join together and support each other to force change. Until we do we'll keep giving in when faced with the reality because we just can't help ourselves!

A nurse who complains or refuses her assignment is the nurse that finds herself out on the street looking for a job, only to find out that it is no different anywhere else. Isnt it about time that instead of just saying lets band together for mutual protection, we actually do it? Why so many nurses out there still dont trust unions is a mystery to me. Enlighten me please.Please see poll in General Poll section regarding unionization and abused nurses. How about voicing our opinions to someone who may actually know how to affect change?

Specializes in ICU, Research, Corrections.
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

This is one of the reasons I started as a new grad, almost a year ago, in the ICU. I always planned on working in ICU....but these staffing issues made up my mind for me!

Specializes in CRNA, Finally retired.
I would love to leave the hospital. I just don't know where else to go. Working in a MD office just doesn't really sound any better.

I don't understand why nurses can't organize within the institution. Compile the staff's e-dresses and plan an action. It make take months for come to anykind of consensus but at least the ball is rolling. No one will respect you if you don't respect yourself , and certainly, no one is going to give you any power. What if you leave and pay off your loan $10 per month (hey, you are paying it off - is there a time limit?). And remember, there is no nursing shortage - only a shortage of good jobs. Plenty of RN's would be back on the floors if patient ratios were in effect. The turnover rate in Calif. is the lowest in the country.

'

Specializes in Tele, Infectious Disease, OHN.

OP, I feel your pain. I worked 6 months to the day in a hospital before going to public health. We had horrible ratios, my 12 hour shifts were 14-15 and I ended up on meds for anxiety, blood pressure and GERD before I left. One of my fellow employees did refuse a particularly horrendous assignment and claimed Safe Harbor- a right that Texas RNs are given under the NPA. All the other nurses said watch out, she'll be gone and sure enough in 4 weeks she was written up 3 times and given the opportunity to leave. FYI, this nurse had a year of experience on me and was AWESOME. I could not learn in this environment and prayed every day that I did not/had not killed someone. When I went to my manager he showed me the plans for the new hopsital which was designed to INCREASE patient loads for nurses. :(. That is when I knew I had to find another job becasue it wasn't a matter of IF something bad was going to happen, but when and how many times. I can't help but think if we as nurses could somehow educate the public on what is going on and how bad it really is that someone would make management come to the table and start making responsible decisions about staffing. Okay, off my soapbox.

This is a very scarry, but real scenario for nurses. I am sad and distressed that many are experiencing the same thing. As nurses we need to do something and it has to be more than just complaining. I would be very careful to 'assume' that CA has figured it out. As the saying goes, "be careful what you wish for". In my units, if the we had the same staffing ratio as CA, the nurses would have more patients than they do now, without a nursing assistant on their team!

I wish people would quit spreading myths that ratios mean you have to do without aides. I personally have not seen it in California. If there are some hospitals that have cut aides believe me, you can find plenty of places to work that still provide aides.

And I'm not talking about one aide for 20-25 patients. I'm talking about one aide for 10 patients, tops. Some hospitals even have one aide for every 6-8 patients.

:typing

+ Add a Comment