Thinking of quitting after orientation

Specialties Geriatric

Published

Hello,

New nurse here looking for advice...

I'm thinking of resigning before finishing my orientation. I'm a new grad RN and this is my first nursing job. I'm orienting at an LTC/rehab facility. I work nights 11 p- 7a. There are roughly 60-70 patients. When hired, I was given the impression that on my shift, there would be 2 RNs and we would split the patient load. However, I've learned that for financial reasons, currently they are having only one RN at night, hence a 1:60 ratio. And there are only 3 aides. Also, there is usually at least one dementia patient who keeps trying to get out of bed so they need 1:1 observation to prevent them from falling so that takes one of the aides away. So therefore I often have to answer call bells and do some other aide duties because they have to watch over a patient. I have a midnight med pass and a 5 am med pass, which is mostly thyroid meds. Plus I usually have to give several PRN tylenol & narcotics throughput the night. I don't feel safe at all doing this shift as a new nurse with this patient load. While orienting, there has been another nurse there with me and we've been splitting the patient load so I've only had to take care of 30 patients. Even with just the 30, I have no time for a break and I'm running around all night I usually have to stay late to finish my nursing notes. If there's a patient fall or any other incident during the night it's complete chaos. I'll be finishing my orientation soon and I'm thinking of resigning as I don't feel that I'm giving safe nursing care and I don't feel that it's worth making a mistake and losing my license. I'm looking for advice since I'm afraid leaving so soon will hurt my chances of finding a future job. Any advice would be appreciated. Thanks.

if this is rehab or skilled nursing and there is no lpn then that is way beyond the norm for staffing. For LTC with stable patients its still a lot but potentially do-able on nights depending on patient acuity, number of meds etc.

I would look into your state's regulations for the type of LTC license your facility holds. mine has minimum FTE staffing for each discipline and the facilities are required to post their daily staffing in a public area. A ratio like that on a regular basis would cause a facility to potentially lose licensure in my state and I would be concerned about working in a clearly illegal setting.

I'm not quick to say quit, but I can't see this being good. I've been in LTC for ever but I would never be able to work with that ratio. I have 50 where I am now. Most are skilled and about 10 or so are LTC with not that many needs. We staff with 2-3 on...never less that 2 on the 11-7.

If they said there would be two on 11-7 and they are now staffing with one, I can't see this being good. I don't think explaining this in an interview would be bad.

Specializes in Developmental Disabilites,.

That sounds horrible. Who would you turn to if you have a question at night or get overwhelmed? You need a more supportive environment for your first job.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I have had up to 68 residents by myself as a night shift nurse in LTC. This number of residents is extremely busy (although manageable) for an experienced nurse, but likely too difficult for a new grad.

I'm thinking of resigning as I don't feel that I'm giving safe nursing care and I don't feel that it's worth making a mistake and losing my license.
Your license is not at risk. The "my license is at risk" chant is greatly overblown.

Most nurses lose their licensure or have their licenses censured for impaired practice, controlled substance diversion, theft, intemperate alcohol/drug use, prescription pad forgeries, and other issues that directly or indirectly involve addiction.

However, it is exceedingly rare for a nurse to deal with a censure or licensure revocation for sloppy or unsafe care (s)he might have delivered at a nursing home. Per the disciplinary action pages maintained by the BON in the state where I live, licensing censures happen to nurses who were working at the hospital.

Therefore, your license is at greater 'risk' when employed at a hospital.

Specializes in Geriatrics, Dialysis.

I've been working in a SNF for 20+ years and I would never work an overnight as the only licensed staff in the building. I don't care how low census dips, still not doing it. 1:60 is a ridiculous ratio even for an experienced LTC nurse, for a new nurse it's insane. As soon as you find something else, don't even feel a little bit guilty about leaving.

I worked alone at night in a 52 bed facility. I had my hands full. One of the clinchers for me was when the ADON did not answer her phone when I called her one night. No sense in telling someone that they have a resource available by phone at night when that person does not answer the phone. For your own peace of mind, I would not take on this situation, even though it might be "doable". Not worth the aggravation.

Specializes in Geriatric Assessment, management and leadership.

This is a difficult position to be in, especially for a new grad. Start by talking with your supervisor and share what you have posted here. Most managers/DONs would rather work with you than lose you. If she/he is able to add a LPN to your night shifts or switch you to a shift with more support and a better RN to ratio, then consider staying. If the answer is there is nothing to be done, start looking for a position that will help you learn and grow as a new grad. Let us know what happened!

I have worked as an RN Supervisor (every other weekend) at a LTC facility. Luckily the LVNs did all med passes. I was relegated to wound care. My advice to you is these older, fragile folks are a very difficult place to start your career. As the RN in the building you are expected to be the expert and the one in charge - an almost impossible call for a new nurse. But my response is probably too late for you by now. What did you end up doing?

+ Add a Comment