advice needed......thanks

TazziRN, RN · Jul 1, 2007

I agree with you, but is there anything you can do about it?

caliotter3 · Jul 1, 2007

I did one of my clinical rotations in an ICU when I was in school. One of the nurses there had been hired right out of nursing school and was precepted for nine months. She didn't have much more time on the job when I met her. She was competent and helpful to me as a student. All of the nurses on the unit were good toward me, a student, in general. I wish I could have started there. With a nine month preceptorship, I think I would have worked out. The circumstances you describe, though, don't sound so good. When somebody is being trained, there should be enough personnel present to give that person attention and still get the work done well.

aainme · Jul 1, 2007

the first thing i did was express my concern to our manager....i also gave what i thought was an answer ...that she remain on days for few months as the second nurse where she would be able to get extra help from management while she was refining her skills.....i explained that we have no resources on nights to pull from if all %$#@ breaks loose....so.... i do feel i may need to change hospitals......the threat to my license looms over my head...

loricatus · Jul 1, 2007

Maybe it would help if you can get to speak with her to ascertain her level of competency, along with her thoughts on coming to nights in a 6 bed ICU unit with only 2 nurses.

Truthfully, you should have 3 nurses on if the ICU is full. To have to share 6 patients with a relatively new nurse, who needs instruction/guidance, is a recipe for disaster. If you have no say in the matter, call in sick on the nurses first night and see what management does/says.

happybunny1970 · Jul 1, 2007

I'm with Tazzi -- sounds not so good, but what, if anything, can you do about it?

I remember when I graduated wanting to jump in head-first into the most stressful, crazy, adrenaline-charged unit I could find... I really thought ICU was the most glamorous thing. For me, it was a huge mistake, because there is just so much that you don't know fresh out of school.

I didn't get into ICU right away... if I had, I would have gone into one of those extended preceptorship programs like caliotter3 mentioned (ICU is a good 6-9 months around here). Instead, I found myself in ICU when I did some agency work, and had been working in cardiac stepdown (after a 3-month preceptorship program) for a year. To the agency, it was the same thing. To me, not so much.

I'm surprised that anyone would want to place a new grad on a night ICU position with so little training. My best guess is that they see you as an excellent nurse and resource for her, and probably intend this responsibility as a compliment to your work. If you're not comfortable with that, or just want some clarification of what is expected of you (and her) as a result of this situation, by all means ask! Maybe it's a simple misunderstanding and you can get some additional help for awhile while she gets her feet wet on days... All they can do is say 'no'!

Good luck!

Hoozdo, ADN · Jul 1, 2007

Does management expect you and the new nurse to man a FULL 6 bed unit? I would refuse. I can't even imagine how horrible 6 critical care patients would be with a seasoned nurse and a new nurse!

The new nurse will still have many questions once she comes to nights. The problem is answering her questions, taking care of your 3 patients and overseeing her 3 patients too.

IMHO, it is unsafe staffing. So........when you go to the bathroom she will have SIX patients? Unacceptable.

**canoehead, BSN, RN** · Jul 1, 2007

Absolutely no to six patients and two nurses. Will your manager cap the census at four until your new grad gets her feet under her? Will the new grad get ANY orientation time on nights?

Do you have a supervisor, or a good relationship with the ER or medsurg so they can send you an extra experienced nurse if the poop hits the fan? Is your manager willing to approach the other managers to make it semi-official? With a few options of people to call you'll be more likely to muddle through. Even a secretary at night would take some heat off, give you more teaching time.

Will your coworkers set up a call schedule so if you absolutely are drowning you know who to contact for help? When I started OB I had a partner for a while at night, then when they decided I was OK to fly on my own (one RN for OB, imagine...) they still posted someone on call for a few months so I could phone with questions, or call and say "Get in here NOW!" We also had a house sup who was expected to be a second pair of hands prn.

Even if you had some per diems working as nurse #3 for the evening part of the night...just half shifts, and if you really needed it you could ask them to stay.

tencat · Jul 1, 2007

If you have no say in the matter, call in sick on the nurses first night and see what management does/says.

Hmm.....I agree that the whole situation is a disaster waiting to happen, however if one is going to pull something like that, it would be nice to let the other nurse at least know that it's going to happen. It's situations like these that cause nurses to burn out in a hurry, and if you didn't let her know, that's just setting the stage for a really bad working relationship. JMHO

aainme · Jul 2, 2007

i have to say that when the unit has 6 patients they staff us with three nurses...but....the problem is that when your shift starts at 7 pm and there are 4 patients in the unit and two nurses, anything can happen.....the codes on m/s, the direct admits from the other hospitals in the area with no icu and they come by ambulance crashing...... or just admits from the er.... once the shift starts there is no one to call in to help....there are times we have to bump out a patient to get in a more critical patient, that is when there are 6 patients and two nurses....it is these times we are crazy.....even with two nurses with plenty of experience the night can be more than you can handle....and we do the best we can in sometimes dangerous feeling situations...... we have had two people coding in the unit at the same time and the er dr at a code on m/s and the icu nurses had to run our own codes in two different rooms.....the whole thing is to scary.....i do feel that the new grad has no idea what could happen...only experience can show you that....i know these things don't come up every night....but we all know they do....and then what?

cardiac.cure03 · Jul 2, 2007

I'm a new grad (since Dec) and work in critical care. We have a relatively small unit too, just 12 beds. If the census is low and down to 4 pts for ex, we only need 2 RNs. They always try to schedule it to where if there's only 2 nurses working, that they both have decent experience and are not new.

However, that's not only possible. One night it was just me and one other nurse. 3 pts in the unit, I only had one. Then I get a new admit with tons of stuff going on that I had never dealt with. And of course, the other nurse is busy.

That night was terrible... and THANKFULLY no one coded! I would think your nights as well as the new nurse's would be just as bad and likely worse.

With 6 pts, I think you really need 3 RNs. Even with less than that... I think if the new grad is working, you still need 3 RNs.

I hope things work out for you, and good luck!

Hoozdo, ADN · Jul 2, 2007

i have to say that when the unit has 6 patients they staff us with three nurses...but....the problem is that when your shift starts at 7 pm and there are 4 patients in the unit and two nurses, anything can happen.....the codes on m/s, the direct admits from the other hospitals in the area with no icu and they come by ambulance crashing...... or just admits from the er.... once the shift starts there is no one to call in to help....there are times we have to bump out a patient to get in a more critical patient, that is when there are 6 patients and two nurses....it is these times we are crazy.....even with two nurses with plenty of experience the night can be more than you can handle....and we do the best we can in sometimes dangerous feeling situations...... we have had two people coding in the unit at the same time and the er dr at a code on m/s and the icu nurses had to run our own codes in two different rooms.....the whole thing is to scary.....i do feel that the new grad has no idea what could happen...only experience can show you that....i know these things don't come up every night....but we all know they do....and then what?

I hear you on the above. Is it an option to hold the new patients in the ER until day shift starts? We have had to do that in my ICU......we don't have a bed shortage with 26 beds. We DO HAVE A NURSE SHORTAGE! Luckily my unit will not triple up on patients. If we don't have the nursing staff to handle extra patients, then they just have to wait in the ER until day shift and we can get extra registry nurses.

Perhaps you can negotiate with management to hold these extra patients in the ER. You just can't be a safe nurse and CYA with more than 4 patients with you and a new nurse. In your negotiations, make it all about patient safety - not the fact your butt is on the line.

If they still don't see the light, I would definitely started posting my resumes elsewhere.