About to quit med-surg

Cowboyardee · Mar 25, 2016

I suspect that if you were to poll acute care RNs and ask whether they'd support mandating lower ratios, most would readily agree. I would. I didn't necessarily say that 7:1 is all good. Just that it is what it is. Medicine is a business.

The acuity, support structure, unit culture, and organization of your unit all go a long way toward determining whether 7:1 is appropriate staffing or not. I've worked 8:1, and I've had buddies working in a cardiology unit with a 10+:1 ratio (at night) which was a safer and easier unit. The most dangerous staffing I've personally been involved in was a toxicology pod where 4 patients with 1:1 orders were placed in a big room with one RN and one sitter (who usually did nothing) in order to conserve sitters. 4:1, and a freakin nightmare sometimes. On the upside, I've been working in intensive care for a few years now, where I'm happy.

Your unit's acuity and structure might mean that 7:1 is dangerous and below industry standards, and it might not. Without more information, I don't have any way to know. Bluntly though, at three months of experience in your first acute care job, you're not really in any position to know what's dangerous or what's substandard for acute care either. No one's judging you for feeling stressed, wanting to get out, or wanting to try another hospital or another medical specialty. Happens all the time, and it certainly could be that your current gig is operating below industry standards. But I'll tell you honestly - an RN with 3 months of relevant experience who "knows better" is off-putting.

Maybe I'm reading your tone wrong - it's the internet after all. If so, I apologize. But generally speaking, new RNs who are confident in knowledge and insight they don't actually possess tend to have a tough time orienting, a tough time getting along with their more experienced coworkers, and a tough time getting former managers to say nice things about them to potential future employers.

Newbie_1 · Mar 25, 2016

I think that was some sort of backhanded apology? Not that it was needed. What you didn't factor into your "helpful" assessment is that all new nurses aren't 22 year old children. I am a career changer, I have never had problem being trained or landing a new position. Making the right moves I don't forsee too much of an issue besides hanging in long enough to reach the end of the tunnel. That is why I made the initial post. Respect is a two way street. I've noticed some nurses forget that. Doctors too. I treat you how you treat me. It's gotten me through, just fine.

Cowboyardee · Mar 25, 2016

I think that was some sort of backhanded apology? Not that it was needed. What you didn't factor into your "helpful" assessment is that all new nurses aren't 22 year old children. I am a career changer, I have never had problem being trained or landing a new position. Making the right moves I don't forsee too much of an issue besides hanging in long enough to reach the end of the tunnel. That is why I made the initial post. Respect is a two way street. I've noticed some nurses forget that. Doctors too. I treat you how you treat me. It's gotten me through, just fine.

It was only an apology in the event that I was misreading your tone. In this thread, you've managed to call another poster, who was blunt but not exactly disrespectful, an ******* (there are only so many 7 letter words that fit), maintained steadfastly that you know more than people who actually have experience in your new role, and proposed quitting without notice for no particular reason... which if you think about it, screws over your boss, possibly your future job prospects, your coworkers who are already toiling in conditions that you consider to be dangerous, and of course the patients whose safety you claim to care about.

Do apply your finely honed critical thinking skills to your own actions.

Newbie_1 · Mar 25, 2016

I have not maintained steadfastly that I had more knowledge than anyone. I call things as I see them. And in fact in the three months I have been on my unit(going on four months and counting) 4 staff have quit. 2 giving two weeks notice waiting until the end of the schedule. One with 19years experience, one with 5, one with 1yr and the last with only 6months. The newbies left first, and only one was night shift staff. Worst case, I wait 6months. You don't know my situation, so you are correct in saying you cannot fully speak on it.

NurseMegP, BSN, RN · Mar 25, 2016

7:1 is not ok on days and whoever said 4:1 and an aid won't happen, newsflash! That does happen at hospitals that care about their nurses. Where I work I get 5:1 at most, 4:1 is typical. If I were you I would try ICU work and before taking the next job ask them what their ratios are. Ask if you can walk around the unit, see the assignment board, maybe even talk to the other staff.

best of luck to you!

(ps. You're right about some people on this forum being a*holes, I was on it as a student years ago and left because most people just like to pick at you).

Newbie_1 · Mar 25, 2016

Thanks, NurseMeg

Anna Flaxis, BSN, RN · Mar 25, 2016

Sometimes when you post questions, different people will see different angles. That doesn't make them an a-hole.

To try to answer your questions, yes I think leaving a job after only 3 months will look bad on your resume. Completing orientation really does not count as experience, and I would toss your resume into the round file were I in the position of selecting job candidates.

Office jobs and outpatient surgery jobs are hard to get, and no, a BSN will not necessarily be a foot in the door.

Applying to a better hospital isn't a bad idea, but without actual job experience (again, three months of orientation doesn't count) and with a demonstrated inability to commit for at least one year, you don't look too great as a potential new hire.

Of course, there are always exceptions. Some people will say "Well I did this" or "I did that, and XYZ happened, so if it happened for me, it can happen for you". But in general and by and large, quitting a job at only three months in does not look good on the resume.

NurseMegP, BSN, RN · Mar 28, 2016

I agree that it won't look great on a resume, but saying "I left due to unsafe working conditions" is a very really thing and something that many managers who have been in the field understand.

jena5111, ASN, RN · Mar 28, 2016

I am a new grad ASN nurse. I have been working as a school nurse per diem for 5 months and med surg full time for just over three months (just off orientation). I wanted the year of acute care experience. My unit is severely understaffed, ratios 7:1 most shifts, 5:1 on a good day. 5:1 is perfection as far as I'm concerned. Sometimes we have only 1 aid. Which means primary care in addition to RN duties. My last shift was 7:1 with three patients as primary. I was still passing morning meds at 1p. I don't feel like experience will change the fact the unit is understaffed with no resource pool with a few floaters, and more importantly not safe for the patient. I don't want to risk my license for this place. I am at my wits end, and the toll is pulling at my personal life. As I end this partial vent, I plan to give my letter of resignation while I'm off to be effective immediately. I will pick up more days as a school nurse, but my question is this... The three months I spent is now a waste of space on my resume? I will finish my RN- BSN program in 8months, and want to apply to better hospitals; a different area like outpatient surgery, or an office position. Is this realistic?

Next week I begin my third month as a new grad RN on a tele/med-surg floor. I work 7p-7a with a 6:1 patient-nurse ratio and either zero or one techs. I'm off orientation now and I've been on my own for about two weeks. I had never spent time in a hospital prior to nursing school clinicals. So we sound very similar, experience-wise.

We don't have 6:1 because we're understaffed per se--that's just the PM ratio on my unit. I experience challenges every single shift. Heck, sometimes the whole shift is a challenge from start to finish. But I've noticed that our more seasoned nurses generally don't struggle with their workload. This leads me to believe that the workload is a) generally manageable and b) will become more manageable for me as I get better at my job.

What keeps me from worrying about the "safeness" of my assignment is prioritizing my patients. The most acute and/or direct care-intensive patients will get more of my time and immediate attention out of necessity. The less-critical walkie-talkies who sleep through the night will be rounded on every hour. But they won't get much of my time beyond an initial head-to-toe assessment, focused reassessment, pain control, and med pass.

In my short time as an acute care RN, I learned that the nurse's role is dynamic and often hard (and includes plenty of primary/direct patient care). But I know my nursing abilities have improved since my first shift, and based on feedback from peers, preceptors, and management, I'm doing an overall good job--even on shifts that make me frustrated and anxious on the inside. I can feel myself becoming a stronger nurse each time I work.

To answer your question about the past three months being a waste: I don't really know how hospitals would view such a short stint. It may disqualify you from new hospital opportunities (regardless of BSN), especially if you quit without notice.

My advice is to stick it out. I bet you'll surprise yourself by the progress you can make in the next several months. And in the process you can learn more than you thought possible.

Good luck!

RNKPCE · Mar 28, 2016

AFAIK California is the only state to pass a set-in-stone mandatory ratio to be followed at all times for med-surg floors. And the mandate is 6:1.it.

California is 5:1 med-surg

Newbie_1 · Mar 30, 2016

If I were on nights. I may feel differently. But night and day shifts are different struggles. Perhaps I should have started nights. I will consider that as I look for a new position. Thanks for your input. Good luck to you as well!

plainfieldguy · Apr 16, 2016

If you can hold out, I would suggest staying at least a year and then look around the hospital for a transfer to another department (if you like the hospital setting). Perhaps ambulatory surgery, mother/baby, or some other department might be just the escape you need!