New Grad in Critical Care - Patient Ratio too High to Provide Safe Care

  1. Dear Nurse Beth,

    I graduated May 2015 with my BSN. I did my preceptorship in a local ICU. When I graduated I accepted a job in the MICU/SICU at another location. I've been off of orientation for almost a month now and I'm starting to not like my job anymore. We consistently have 3 patients to one nurse, and I always feel like I'm am cleaning up after the day shift with all my patients (both in the room housekeeping wise, and with orders etc...) When I was hired I was told the normal PT load would be 1 to 2 per nurse, and rarely would we get 3. Well, now 3 seems to be the norm, and I feel a little cheated because I can't provide the care I want to.

    I've recently started looking at jobs in my area and would love to entertain the idea of hospice nursing. After seeing the patients I take care of, and we are doing so many invasive interventions that will probably not prolong or save their life, I would love to work on the other end and help people move onto their next journey in life. I'm also thinking that a same day surgery center would be a good fit for me as well.

    I guess I'm just not sure if I should just try to stick it out for a year on this floor since it's good critical care experience, or look for something else? I genuinely LOVE working with critical patients and appreciate the challenges that come with it, I just don't think having 3 critical patients to take care of at once is safe or fair for the patient.

    I just feel lost because I'm a new grad that should be enjoying the opportunity I have been given, but I'm not. I feel like real life nursing slapped me in the face and I'm not sure I like it.



    Dear Slapped,

    Having been off orientation and on your own for one month….you are still going through Reality Shock.

    Being from California, where ICU nurse: patient ratios are 1:2, I firmly believe a 1:3 ratio is too high, and agree your dissatisfiers are valid.

    Having said that, one month is not enough time to evaluate a new job. You are still on the learning curve. Your efficiency and speed are not now what they will be in a few months.

    You love caring for critical care patients, but not the working conditions and workload. Before you jump ship, consider that once you leave acute care, you will not necessarily be able to easily return. Leaving the hospital setting can be a permanent move, so be very sure that you are prepared to be done with acute care before you leave.

    Give yourself at least six months, if not one year, to make such a big decision. Hospice can be immensely rewarding but you will have more to offer once you have a bit more time under your belt.

    Best,
    Nurse Beth

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  2. 7 Comments

  3. by   subee
    Any nurse worth anything is miserable the first year. You have no EXPERIENCE and that is sooo stressful. You can't tell zebras from horses and you have no time mgt. skills. Work smart and it will get easier. In my experience, the ambulatory jobs went to the most seasoned nurses.
  4. by   rnh20
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  5. by   rnh20
    I too have just completed a new grad internship on a surgical telemetry unit (not as acute as SICU) but am also feeling very overwhelmed. Before I go to work and after a shift I am in tears. I'm generally a happy go-lucky optimistic type of person who can keep her head up; but, since I've started this job I feel beat down all the time and my confidence is lower than it has ever been. I'm constantly anxious on the floor and have a hard time concentrating on the tasks at hand. I am a night-shift nurse, which does not help in keeping focused. After three months I have asked to transfer to a Med-surg floor in hope of getting things under control...boy was I wrong. I am so over emotional that is affects my well-being, I'm a wreck when I go into to work, I'm a wreck when I'm not working (just anticipating going back). All this emotional turmoil and lack of proper sleep pattern has affected my school work (BSN).
    The reason I became a nurse was because of the versatility. I just find it hard to swallow knowing that I HATE my first nursing job - I just want to be happy and since I've started it has been everything but happy. I too recognize the clout one has when they have hospital experience but...I just don't know that the hospital setting is for me. Is it so wrong to be a nurse OUTSIDE of the hospital walls?
    -Sincerely,
    Drowning in the chaos
  6. by   Nurse Tess
    Dear Drowning in the chaos,

    It is not wrong to be a nurse outside of the hospital. Making an impact on the lives of patients is not about where you practice it is about how you practice. And just like our patients bodies react differently to stressors so do our bodies. Working nights is a stressor that some just don't adapt to. Also it takes about a year or so on average to get comfortable in a new environment for a new grad nurse. Nurses are not super humans so be easy on yourself. Lastly, nursing is a versatile and rewarding practice. Just because you haven't discovered where you are called to practice nursing doesn't mean you weren't called to be a nurse.

    A word of advice from an old ICU nurse turned Tele-ICU nurse turned administrator, do something that allows you to center your inner self. This might be prayer and meditation, yoga, music or other artistic expression... Whatever it is focus your thoughts, spirit, and energy on something positive every day even if just for a few minutes. Next word of advice STOP listening to the negative tapes and force positve, affirming ones into your thoughts. Negative tapes are those scripts running in your head that creep in and make you feel less than. Lastly seek the same help you would suggest to your patients.

    Sincerely,
    Nurse Tess
  7. by   milady_sohail
    If you think 3 patients to one nurse is alot, try 4. On some days, 5!!! I work in Virginia as a new grad in critical care and they are bombarding us with patient assignments.
  8. by   LovingLife123
    Quote from milady_sohail
    If you think 3 patients to one nurse is alot, try 4. On some days, 5!!! I work in Virginia as a new grad in critical care and they are bombarding us with patient assignments.

    That is insane!! What are nurses doing to stand up against this? That is clearly unsafe.
  9. by   LovingLife123
    OP, I don't think as a new grad you have to be miserable your first year, but your first month off of orientation is hard. Especially with three patients. I count my lucky stars daily my hospital does not allow more than two patients to a nurse in ICU. And I don't think my state has mandated ratios. I think I just work for a system that values nurses and patient safety.

    That being said, even each ICU can have its own acuity level of ICU. ICU in one hospital is not the same as another. I agree with Nurse Beth and give it some time. I felt so overwhelmed those first 3 months off of orientation. I promise, it does get better. I'm almost 2 years in now, and I'm a completely different nurse now. I started noticing real changes about 6 months out. I started getting faster, organizing my day better. Now I can see things happening before it happens. You will get there.

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