Am I In The Right Place?

Sherri RN · Aug 22, 2005

The first thing to do is get your personal worries dealt with so you can shine at work. Explore all the caregiver options for your son; you may have to change jobs or move near your mother or aunt or there may be a viable option in your own neighborhood right now. Have back up plans in case a babysitter cancels at the last minute. Talk to co workers who would be willing to fill in temporarily or ask their spouse if it was okay if they be your back up babysitter. I keep toys at my house even though I'm single/no kids because I want to be there for my friends with kids in emergencies. Next take some ACLS caliber classes so you feel more comfortable in emergencies. If you work when it's slow see if you can participate in a mock code. One of the best things I ever did was befriend some ICU nurses. See if you can shadow an ICU nurse for a couple hours; it would be a chance to discuss how you've been feeling with someone experienced in the very stress you are desiring to master. And I'm sorry, but your hospital needs to wake up to the fact that unstable patients that could crash at any time are not appropriate for an acute rehab ward. They need to make room in step down or ICU for them, and your interns need to have a clue. If you feel like you have to go into a patients room every 2 hours instead of every 4 hours just to make sure they have vital signs inside parameters, they are not appropriate for a unit where the nurses carry more than 2 patients at once. On a unit that gets unstable diabetics, I would request a unit in service from the internal medicine department on the critical thinking skills necessary to anticipate problems before they become "an amp of D50, stat." Before then, ensure on your watch that they have a working IV, 20g or better, to accept that D50, before problems start. Find out the nurse to patient ratios in your state laws and expect your unit to live up to that, in writing, and in practice. Tell yourself, you took the time to become a nurse and get a license. Then tell yourself, you're not going to do anything or forget to do anything that takes that license away from you. On my unit we have nurses that have to leave by a certain time to pick up kids from daycare, take kids to classes, karate, etc., and these are the same nurses that come in early, look at the board, look at what patients they're getting and make a stink if they have a hard assignment that they know is going to keep them past their shift, and explain why they have to leave on time. Caught early, we work with them to fix the problem, and give them an appropriate assignment.

BETSRN · Aug 22, 2005

I am very frightened right now. I have only been a practicing nurse for a few months. This is my 2nd career. I've had 2 months in the hospital and 3 months working on a busy acute rehab unit. I could not handle the stress level of the hospital and so I got into rehab thinking it would be more manageable. This is an acute rehab unit and is almost as bad as the hospital where I used to work. I haven't been a nurse for very long and I feel unprepared for a lot of the challenges we deal with on a daily basis. We get some very unstable patients who can crash on us at any time, we have unstable diabetics who are tricky to manage, we're under a lot of pressure to get meds, treatments and charting done in a timely manner. There's also pressure on me to make sure I leave on time to pick my son up. Although the directors are trying to be helpful and supportive, I feel incompetent and wonder I if I should quit before something happens where I could lose my license. Once you lose your license that's it, right? Maybe I need to chose another type of nursing.

Did you have a detailed orientation? It does not sound as though you did. I wouldn't keep quitting however. That won't look good on a resume. If you are ovewhelmed, though, maybe you need to start back at square 1 and go into a nice orinetation program or what they call an internsip (like a critical care internship). Best of luck.

BETSRN · Aug 22, 2005

Wow...what a post. I am definately going to take this advice.Thanks for sharing it with us. Too bad they don't share 'little' things with us like this in Nursing School.

I think this is the reason so many new grads either burn out, quit, or change careers. They are so busy giving all the fluff that no one managers to share information on how it really is when you graduate.

el0489 · Aug 23, 2005

Thanks for all your input. I do live with my mother so the caregiver situation is generally under control. The times when my mother cannot babysit I do have a babysitter who is often available. People I work with generally understand why I have to leave by a certain time and cannot stay to work a double. Some other people I work with have the flexibility to do that but I do not. I've explained my situation at work and they seem to understand. I make it my business to get in early, look at the assignments, count, get report, etc. If my relieveing nurse is late, sometimes I have to leave report for her so I can leave.

Participating in a mock code might be helpful. Unfortunately, at my rehab unit we are expected to be able to manage unstable patients whom the hospital sends our way. It's because of medicare limitations. If someone is really unstable, as in "bottoming out" with vital signs or blood sugars, or very high, we often send them out to the hospital but we are generally expected to manage them. That's why it's called acute rehab and yes, we get some unstable diabetics. I am learning more about how to manage those patients by looking at how their blood sugars generally range and then if they're out of range, acting on it - give the medications or hold them, call the doctor, get vitals, etc. My patient load can go up to 18 patients and then, of course, there's a lot of meds that are given out for 9 AM. And someone could crash right in the middle of your busy med pass. On top of that, I am inexperienced but am trying to learn and grow, sometimes by the seat of my pants!

I have a lot to learn, as I said, but I am trying to be courageous. It's just unfortunate that we have a medical system that really is not well-equipped for extremely sick people.

The first thing to do is get your personal worries dealt with so you can shine at work. Explore all the caregiver options for your son; you may have to change jobs or move near your mother or aunt or there may be a viable option in your own neighborhood right now. Have back up plans in case a babysitter cancels at the last minute. Talk to co workers who would be willing to fill in temporarily or ask their spouse if it was okay if they be your back up babysitter. I keep toys at my house even though I'm single/no kids because I want to be there for my friends with kids in emergencies. Next take some ACLS caliber classes so you feel more comfortable in emergencies. If you work when it's slow see if you can participate in a mock code. One of the best things I ever did was befriend some ICU nurses. See if you can shadow an ICU nurse for a couple hours; it would be a chance to discuss how you've been feeling with someone experienced in the very stress you are desiring to master. And I'm sorry, but your hospital needs to wake up to the fact that unstable patients that could crash at any time are not appropriate for an acute rehab ward. They need to make room in step down or ICU for them, and your interns need to have a clue. If you feel like you have to go into a patients room every 2 hours instead of every 4 hours just to make sure they have vital signs inside parameters, they are not appropriate for a unit where the nurses carry more than 2 patients at once. On a unit that gets unstable diabetics, I would request a unit in service from the internal medicine department on the critical thinking skills necessary to anticipate problems before they become "an amp of D50, stat." Before then, ensure on your watch that they have a working IV, 20g or better, to accept that D50, before problems start. Find out the nurse to patient ratios in your state laws and expect your unit to live up to that, in writing, and in practice. Tell yourself, you took the time to become a nurse and get a license. Then tell yourself, you're not going to do anything or forget to do anything that takes that license away from you. On my unit we have nurses that have to leave by a certain time to pick up kids from daycare, take kids to classes, karate, etc., and these are the same nurses that come in early, look at the board, look at what patients they're getting and make a stink if they have a hard assignment that they know is going to keep them past their shift, and explain why they have to leave on time. Caught early, we work with them to fix the problem, and give them an appropriate assignment.