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- Mar 10, '12 by dudette10Quote from OCNRN63Good call. It sounds like the OP was planning to become part of that statistic, too.I wonder if people just use that floor as a jumping-off point to get into more critical-care areas like ICU/CCU. That could account for some of the retention problem.
- Mar 10, '12 by PMFB-RNQuote from diligent-trooper*** Sounds to me like you passed up a pretty good job. Only 4-5 patients on a busy tele floor? Wow those nurses are lucky. A strait shooter NM who tells you like it is? A rare find in my experince. v-tach & blocks? Bread and butter nowdays. Anything less and they likely wouldn't be in the hospital. 8-12 week orientation? Very generous if you ask me, you after all are not a new grad but an RN with a years experience. More than enough orientation I would think. The narative charting should be looked at as a blessing as it will likely be far, far less time consuming than whatever cheap computer charting system they buy.I recently interviewed with a Nurse Manager of a medical-surgical floor combined with Telemetry. From what I gathered, these patients would be admitted with an acute/chronic condition related to the heart, in addition to another medical/surgical issue. I am fairly new nurse with one year's experience, and I am eventually wanting to work in one of the critical care areas (ICU, CCU.) I was willing to give this job two years, to gain telemetry experience with less critical patients.
A) Job description presented" "No experience is required, but 2 years is preferred." :spin:
B) What are you looking for in a candidate? "Someone who has integrity/honesty, Someone who will be here everyday, on time. Someone who wants 'to do' the job."
(Code: Warm-body) These are nice traits of a hard worker, but will this ensure someone's success?
C) NM: "You will be given a 8 to 12 weeks orientation. You will work with the same preceptor throughout your orientation, unless they are absent. Then, you will be placed with another Nurse for that day." (Why would they not show up for work?)
D) NM: "During your 8 to 12 weeks, you will complete the telemetry class. Upon completion of the class, you will have an examination. If you do not pass the telemetry examination the first time, We will help you to pass it the second time." (a...a.. do what?)
E) NM: "I will not lie to you, this is a fast-paced floor." (what medical floors are not fast-paced.) Majority of the "day-shift" Nurses are having difficulty getting their medications passed on time." (Oh, that's bad!)
F) NM: "Nursing culture around here can present one with a challenge." "Night-shift nurses seem to assist each other, and support each other." "Day-shift nurses seem to not help each other out, and stick to completing their own work." (Great, new guy on the floor with no co-worker support.)
G) For an entry-level person what acuity level should I expect, less critical?.
NM: "Oh no, you would have the same patient acuity level as the experienced nurses." "And, we get several admits during the day." 4 to 5 patient ratio. Total of 3 nurses on the floor. (Nice!)
H) What is the Nurse retention rate for this floor?
NM: "Actually, it is low. Approximately, 26%.
I) What heart dysrhythmias are Nurses presented with on this floor?
(Are we talking afib?) NM: Oh, no... V-tach, heart blocks, anything, and we run "Codes" too! (Three Nurses on the floor, and 'we' run codes, with the combined Nursing year's experience around 10 fingers.)
J) NM: The Nurses do narrative charting at the present, but a computer system is on
the way..to do Electronic Charting- Maybe by June." (Critical patients, and the Nurses are still doing narrative charting...no wonder the Nurses are unable to complete their Med- pass on time.)
K) The unit also has 16 rooms with double beds. Total census is kept around 16. This enables the patients to have a "private" room. That is nice, but the work ergonomics is destroyed. The nurse is forced to walk a great distance between the 4-5 assigned patients, not congruent with time management. Then, if another patient is admitted to an occupied room, the nurse has to deal with the fall out of a disgruntled patient ." I WANT A PRIVATE ROOM!"
NM: "Would you be interested in this position?" ME: I think I will pass... where is the elevator, I am really distraught right now. Where is my truck, I got to get out of here!
Please post the hospital here, I am sure many nurses would like to work there. I would if I was a tele nurse. Especialy I like the idea of only having 4-5 patients rather than 6-8 as would be normal in lots of places.
- Mar 10, '12 by SeasI am very curious as to see what you thought a Tele floor would be like? What did you expect? Welcome to real world. There is no perfect job. And this job sounds very much like a telemetry floor. I also wonder where you got your year experience? I am thinking a non-hospital job?
- Mar 10, '12 by diligent-trooperThank you all for your comments thus far. I believe that everyone would agree that Nursing has become a lot more difficult than in the past. Many factors have come together to make it so. And, what is adding to the mess of things is most hospitals are attempting to save money. In one attempt, they are combining floors, in another they are reducing staff. Who in the end suffers the most? I believe the patient. Eight patients to one nurse that is plain unacceptable, and if you think that you are providing even the mininum standards of care, you are deceiving yourself.
Also, if a new nurse, or any nurse for that matter, is to be working on a tele floor, then they better know how to read strips. They better understand what dysrhymia is being presented, and have some grasp of why. I do not believe the telemetry requirement should be taken lightly. (We will help you- BS) These patients are being monitored for a reason, and they deserve the proper care, which includes monitoring. There should be no "codes" on a Medical-Surgical floor. If these patients are that critical, they deserve to be on an ICU or Cardiac floor. Gees!
I believe my post brings home a very good point specially for new grads. Do not take the first job offered. Look around and decide where you truly will feel comfortable. I have no doubt I would have been successful at this floor, but I would have been very frustrated in the process. I do not want to be frustrated, specially when I am just getting started, and learning how to be a successful nurse. And, to those who think I am passing up a great deal. So what. I doubt seriously you knew everything when you first started out, and I suspect you had plenty of support. You didn't get where you are at today, without a someone looking after you. You were not that good, Sorry! And, I know that working on that particular "day-shift" floor, I would not have had the proper support.
I also believe nurses have settled for less than ideal working conditions, which has enabled the upper management to continue their attempt new and improved ways to provide care, I mean save money: Combining more floors, and doing it with less staff is just two example of many. Ask yourself, would physical therapy put up with even half the crapola the nurses do? I think- NOT!Last edit by diligent-trooper on Mar 10, '12
- Mar 10, '12 by woohGood luck finding a non-nursing job. Because yes, nursing working conditions do suck. Everywhere. Would physical therapists put up with it? Nope. They don't have to. There's not an overabundance of PTs because while there are plenty of people willing to get an associate degree, not so many willing to get a doctoral degree. If you think you'll find better than that in nursing? Good luck in your job search.
- Mar 10, '12 by diligent-trooperLOL.. you made my point, exactly!
- Mar 10, '12 by GitanoRNneedless to say, is not often when one finds such a manager like the one you encountered, having said that good luck in your job search...aloha~
- Mar 11, '12 by zorabanks[quote=diligent-trooper;6237194]
eight patients to one nurse that is plain unacceptable, and if you think that you are providing even the mininum standards of care, you are deceiving yourself.
[color=#ee82ee]i have had 20-49 patients alone. no it was not in a hospital setting, but ltc/snf. although the pt were stable, they could become unstable at any time. there have been shifts where i was the only nurse in the building. so to have 6-8 patients and at least 2 other nurses on duty is wonderful + doctors in house + nurse manager. if something happened you would not have been alone. i have not meet a nurse/cna yet would would not help in an emergency situation....
also, if a new nurse, or any nurse for that matter, is to be working on a tele floor, then they better know how to read strips. they better understand what dysrhymia is being presented, and have some grasp of why. i do not believe the telemetry requirement should be taken lightly. (we will help you- bs) these patients are being monitored for a reason, and they deserve the proper care, which includes monitoring.
[color=#ee82ee]i have to think that you knew what type of job you were interviewing for before the interview because you asked great questions. of course the nurse would have to have the skills to take care of the pts on that type of floor. why would you interview for that type of job if you didn't already have that type of experience or want to gain it??? that is why they have the 8-12 weeks orientaiton program in place. do you know how hard it is to find a hospital that is willing to train a nurse who does not have acute care experience, yet alone experience with telem?
there should be no "codes" on a medical-surgical floor. if these patients are that critical, they deserve to be on an icu or cardiac floor. gees!
another statement that is odd!!! i was in the hospital on the m/s floor and almost coded!!! thank god for the quick actions of the "code team", which saved my life!!! a pt may be admitted on m/s and have to be transferred to icu, which is what happened in my case. a person can code anywhere, so maybe i just don't understand that statement.
i believe my post brings home a very good point specially for new grads. do not take the first job offered. look around and decide where you truly will feel comfortable. i have no doubt i would have been successful at this floor, but i would have been very frustrated in the process. i do not want to be frustrated, specially when i am just getting started, and learning how to be a successful nurse. and, to those who think i am passing up a great deal. so what. i doubt seriously you knew everything when you first started out, and i suspect you had plenty of support. you didn't get where you are at today, without a someone looking after you. you were not that good, sorry! and, i know that working on that particular "day-shift" floor, i would not have had the proper support.
[color=#ee82ee]that is true, if you interview and the job is not for you, then no, don't take it. but the reasons you gave, other than the 26% retention rate, have "holes" in them. of course you are going to be "frustrated" on some level with any new job that you take. esp in nursing when you are dealing with ppl and their health, life or death situations. no job is perfect. a nurse should be a life long learned. none of us learned everything in nursing school. there is always something new to learn. just because you have frustrations on a new job, doesn't mean that that job is not for you. frustrations lessen and even go away with time/experience. true learning does not take place until you are on that floor, puting into practice what you have learned in school. i am currently in a totally new are of nursing for me. i have experienced many "frustrations" during this process and have even reached out for advice from the nurses here (thanks so much to those whou have given advice) and have been reminded that it will get better with time. no, you many not always have a lot of support, but i have found that you will have some type of support, even if it is that one nurse. you also have to take it upon yourself to look for resourses to help yourself.
i also believe nurses have settled for less than ideal working conditions, which has enabled the upper management to continue their attempt new and improved ways to provide care, i mean save money: combining more floors, and doing it with less staff is just two example of many. ask yourself, would physical therapy put up with even half the crapola the nurses do? i think- not!
again it is true that working conditions are not ideal. too many patients, too much paper work, etc. i can't speak for pt, but i have a close friend who is a ot, and they face many of the same problems that nursing faces. so, i think it is healthcare in general, not isolated to nursing field. it is always about the [color=#00ff00]money.
[color=#ee82ee]god bless you on your job search. i hope you find the job that is perfect for you!
please excuse the long response
- Mar 11, '12 by Aurora77Quote from diligent-trooperHave you ever worked in a hospital? Crap happens. A pt can be doing fine and then go bad (happened to me the other day, got him to CCU before a code happened, thank God, but it was that quick). I was with you on some of your reasoning, but this just makes no sense.There should be no "codes" on a Medical-Surgical floor. If these patients are that critical, they deserve to be on an ICU or Cardiac floor. Gees!
- Mar 11, '12 by PMFB-RNalso, if a new nurse, or any nurse for that matter, is to be working on a tele floor, then they better know how to read strips.
*** of course. who are you arguing with on this?
they better understand what dysrhymia is being presented, and have some grasp of why. i do not believe the telemetry requirement should be taken lightly. (we will help you- bs)
*** there is no indication it is taken lightly. it's nice they are willing to provide assistance to those who don't pass the first time. some places just fire you.
there should be no "codes" on a medical-surgical floor. if these patients are that critical, they deserve to be on an icu or cardiac floor. gees!
*** lol! you almost made me blow soda out my nose! what a silly thing to say. i take it that you have never worked in a hospital.
i doubt seriously you knew everything when you first started out, and i suspect you had plenty of support.
*** they are offering you generous support. more than many nurses get. also you presented yourself as an experienced rn, not a new grad.
i also believe nurses have settled for less than ideal working conditions, which has enabled the upper management to continue their attempt new and improved ways to provide care, i mean save money:
*** well i agree with you on this. however the unit only expect you to have 4-5 patients. any rn should be able to handel that patient load, especialy since you told us you are an experienced rn who is being offered 8-12 weeks of orientation with a designated preceptor.
i also think you are discounting the value of having a strait shooting nm.