Cardiac Unit as a New Grad

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I graduated from nursing school last May, took a couple of months to take my NCLEX and then relax for a little - I started looking for a job in August. I did not intend to stay in my hometown but after applying all over the East Coast and having no luck, I finally got an interview in December at a local hospital with a good reputation and got a day shift position on a Tele/Med Surg unit - can't turn that down! So I was hired for January and have been off of orientation since about March/April. It's been awful.. I was talking with some of the nurses who have been working there for 3+ years and they said this is the worst it's been in that time frame. Patient acuity, staffing, full census everyday, and just plain low morale at the hospital is so bad! Turn over rate right now is insane, many staff members leaving. People used to apparently get called out at least every couple of weeks VTO, I can't even imagine that happening now. We usually start with 5 patients every morning, and they tried to bump us up to 6 a few days ago! How can we possibly be taking care of acute patients 1:5 nurse patient ratio, running around giving meds, juggling all our other tasks? Sometimes we only have 1 aide on the floor for 30 patients, and 5 or 6 nurses for the unit when we should have 7 at least. A couple of weeks ago the night nurses had 10 patients each. Aren't these unsafe patient conditions? I don't understand how I can train to be a good nurse when I am just running circles all day in full fledge chaos. If anything, I am learning good time management skills and prioritizing, but I feel as though I am learning no actual medical skills, critical thinking, reading notes and understanding the patients' diagnosis. All the management and supervisors at the hospital know this is happening and are apparently trying to hire more people, but how many more months of this is bearable? We have residency courses with other new grads (anyone under 1 year) and all of us were feeling the same way, all over the hospital and in every unit, especially the med/surg units. No one is enjoying the job, either wants to leave or is already planning their way out. I know I am.. but is it like this in other hospitals? I know I am not the only new grad feeling like I am drowning every day trying to just make sure all of my patients make it through the shift. I am feeling very frustrated and wanted to see if others were experiencing anything like this as well?? HELP!

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Just a few word comes to my mind when I read this....YIKES.....SHUDDER.....HORRIFIC....and RUN!!!!!!

I have to agree with you that you are wise to be planning your ESCAPE NOW!! Hopefully there will be something for you soon. All I can give you is a big hug and say hang in there hopefully the nightmare will end soon. I have never worked in a hospital myself, but I'm sure there are some that may have the same kind of days you are having and others that are 10 times better then where you are.

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I:5 seems pretty standard on a med surg tele unit... Did I miss something?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

1:5 seems like a pretty standard ratio on a Med/Surg tele unit for day shift. 1:10 seems thin for the night shift, but that's not a standard ratio, right?

The first year of nursing pretty much sucks for everyone. You spend most of your time in a frazzled state, running from one med pass or crisis to the next. You dread coming to work, cry on your way home and spend most of your time wondering if your patients are safe and if you've done everything for them that you can. That's pretty standard, too. Most new grads everywhere hate their jobs. Somewhere around the one year mark, things start to "click" for them, and around the two year mark they become fairly competent -- assuming they've stayed in their first job. It takes longer to become competent if you keep switching jobs. My advice is to grit your teeth and stick it out.

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I:5 seems pretty standard on a med surg tele unit... Did I miss something?

Thanks My reply was based on she said there were 5 to 6 nurses and thought that there should be at LEAST 7 which gave me the image that they were short in staffing, and 10 patients for one nurse also seemed really high to me. 30 patients for a CNA on a hospital floor seemed high to me as well, but then again I could be wrong

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Specializes in LTC Rehab Med/Surg.

Your first clue of problems should have been a job offer for a new grad on day shift. The warning bells should have been going off.

The wait for day shift on the unit where I work is almost a year.

The best advice is to stick it out.

The one change you could affect would be the morale. You can make a conscious decision to go to work with a positive mindset, and maybe improve the atmosphere. One person CAN make a difference. At least in the morale department.

There are also incredible personal rewards for facing down the monster and winning. As long as the monster doesn't kill you first.:cyclops:

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Specializes in cardiac/education.

Ruby Vee...

I love your posts, I really do. But I am having as much difficulty as the OP describes with a 1:4 patient ratio on a tele PCU. 9 months in I am still "running circles all day in full fledged chaos". I, too, rarely have time to look up anything on my patients. It's all I can do to keep up with whether their vitals are still stable and their lab results throughout the day! 9 months in, it's NOT getting better. I have migraines nearly daily from missed/late lunches and the constant stress at work. I can't shut off my fight or flight thing! So........question is........if we want to "stick it out" or "grit our teeth" without becoming so depressed or ruining our lives at home, how do we get better FAST? I have a brain sheet, I try to fill it out in my colored pens and all but jeez it never seem to matter in the end after the constant people-in-your-face distractions of dayshift. I am so defeated that I honestly feel so out of my element anymore, like a sheep pretending to be a cat! I mean, maybe this is not for me. OP....how sad is it when you have the brains but there is just something else missing that you can't move fast enough/keep up!

For example, yesterday I had 4 patients when I came on. During report, one already gets discharge orders..don't even know her yet. Previous nurse gets crappy report from ED on my new admit that hitting the floor in 15 minutes. I have all morning vitals to do and of course meds. I'm like, OK....how to do this all RIGHT NOW. I called for help with the discharge since I can't be a million places at once. Ok. Then admit comes, find out Hgb 6.2, K 1.8, bacteremia, needs ABX IV, single lumen PICC and super hard nearly impossible IV stick, great. Other patient trying to climb out of bed, constantly yelling out, incontinent, may need Foley. Other patient comes up as new admit after d/c and is urosepsis and needs nephro tube placed. OK, fine. Pharmacy takes forever verifying meds but when they finally do I am waist high in nearly constant populating orders on low Hgb guy. 2 of patients have lines so I have to do all the draws for all these crazy labs I don't understand. Plus...OK, how to run all these lines. So, midday I am panicking, hey sorry I am running my butt but i JUST CAN'T KEEP UP. So I call for help, say I am drowning, people come to help to catch me up. Problem is the catch up was short lived too as blood bank calls to say blood is ready when my urosepsis patient's vitals start crashing, blah blah. Throughout the day two of my patients were also post procedure, hip fx, so frequent vitals/assess. It just seems like they were all SO acute I just couldn't understand how other nurses could maybe keep up with this. They caught me up in "tasks" but then all the charting was left. Not sure if they really thought it was appropriate for me to be drowning or not. They did mention that I got a "crappy" orientation but c'mon...I am NINE months in now! What is going wrong? I ended up leaving at 9pm partially because I had so much charting to do and partially because the night nurse had to hang the 2nd unit of blood STAT. I was sooo exhausted. I did fight for my lunch but not till late after the headache had already started and guess what? Went to bed last night, couldn't fall asleep until after midnight then woke up today, could barely move my head or open my eyes because of my now crazy migraine and ended up having to call off. NO WAY could I have made it through 14 hours today.

WHY does this job have to be killing me physically and emotionally and further, WHY does it not seem to be getting better? Is this the nature of the beast and a typical day on a busy tele floor? If so, maybe things will never change for me? I think this is the really worry for many of us new grads. We need to believe, really believe, that this WILL get easier. Because of course we are all different and many of us struggle more than others.

OP.....don't mean to hijack your thread at all, just perhaps ranting some thoughts that you may share as well......I don't know the answer.....:(

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Ruby Vee...

I love your posts, I really do. But I am having as much difficulty as the OP describes with a 1:4 patient ratio on a tele PCU. 9 months in I am still "running circles all day in full fledged chaos". I, too, rarely have time to look up anything on my patients. It's all I can do to keep up with whether their vitals are still stable and their lab results throughout the day! 9 months in, it's NOT getting better. I have migraines nearly daily from missed/late lunches and the constant stress at work. I can't shut off my fight or flight thing! So........question is........if we want to "stick it out" or "grit our teeth" without becoming so depressed or ruining our lives at home, how do we get better FAST? I have a brain sheet, I try to fill it out in my colored pens and all but jeez it never seem to matter in the end after the constant people-in-your-face distractions of dayshift. I am so defeated that I honestly feel so out of my element anymore, like a sheep pretending to be a cat! I mean, maybe this is not for me. OP....how sad is it when you have the brains but there is just something else missing that you can't move fast enough/keep up!

For example, yesterday I had 4 patients when I came on. During report, one already gets discharge orders..don't even know her yet. Previous nurse gets crappy report from ED on my new admit that hitting the floor in 15 minutes. I have all morning vitals to do and of course meds. I'm like, OK....how to do this all RIGHT NOW. I called for help with the discharge since I can't be a million places at once. Ok. Then admit comes, find out Hgb 6.2, K 1.8, bacteremia, needs ABX IV, single lumen PICC and super hard nearly impossible IV stick, great. Other patient trying to climb out of bed, constantly yelling out, incontinent, may need Foley. Other patient comes up as new admit after d/c and is urosepsis and needs nephro tube placed. OK, fine. Pharmacy takes forever verifying meds but when they finally do I am waist high in nearly constant populating orders on low Hgb guy. 2 of patients have lines so I have to do all the draws for all these crazy labs I don't understand. Plus...OK, how to run all these lines. So, midday I am panicking, hey sorry I am running my butt but i JUST CAN'T KEEP UP. So I call for help, say I am drowning, people come to help to catch me up. Problem is the catch up was short lived too as blood bank calls to say blood is ready when my urosepsis patient's vitals start crashing, blah blah. Throughout the day two of my patients were also post procedure, hip fx, so frequent vitals/assess. It just seems like they were all SO acute I just couldn't understand how other nurses could maybe keep up with this. They caught me up in "tasks" but then all the charting was left. Not sure if they really thought it was appropriate for me to be drowning or not. They did mention that I got a "crappy" orientation but c'mon...I am NINE months in now! What is going wrong? I ended up leaving at 9pm partially because I had so much charting to do and partially because the night nurse had to hang the 2nd unit of blood STAT. I was sooo exhausted. I did fight for my lunch but not till late after the headache had already started and guess what? Went to bed last night, couldn't fall asleep until after midnight then woke up today, could barely move my head or open my eyes because of my now crazy migraine and ended up having to call off. NO WAY could I have made it through 14 hours today.

WHY does this job have to be killing me physically and emotionally and further, WHY does it not seem to be getting better? Is this the nature of the beast and a typical day on a busy tele floor? If so, maybe things will never change for me? I think this is the really worry for many of us new grads. We need to believe, really believe, that this WILL get easier. Because of course we are all different and many of us struggle more than others.

OP.....don't mean to hijack your thread at all, just perhaps ranting some thoughts that you may share as well......I don't know the answer.....:(

Paragraphs, please! It makes it easier to read long posts.

First, day shift is a whole lot busier than night shift and many new grads find that they have more time to think on night shift. That isn't to say that night shift isn't busy in it's own way, but you do have more control over your shift and there is often some downtime to go through charts and read the physician's progress notes, think about what this lab means to that diagnosis, etc.

Second, it takes some new grads longer to catch on than other new grads. (It took me 18 months to 2 years, and I remember how miserable I was during that time.) I was rotating shifts, and that rotation actually helped me to put things together.

Third, attitude makes a tremendous difference. I started out with the attitude that I was going to make THIS job work, no matter what. That if I didn't catch on or didn't get along with my co-workers, it was most likely MY fault and it was up to ME to fix it. I was supporting a husband who was in school, and health insurance was not portable in those days. If you had a pre-existing condition (as I did), you weren't going to get health insurance easily. Quitting was not an option; I had to make it work. And I did. I notice that a lot of the new grads I'm meeting these days have the attitude that if they don't like their job, they'll just quit and move back in with their parents, who will support them indefinitely. I didn't have that option.

This job is killing you emotionally because it's your first real job. Before that, you were a student. You had the option of turfing problems you felt inadequate to handle to "the nurse." Now you're "the nurse". It's an enormous responsibility and it's crushing at times. You have to get through your first year (or 15 months or 18 months or however long it's going to take YOU) to get to the point where you can handle it without the emotional strain. Unfortunately, the only way to GET through it is to GO through it. Even if it takes 18 months, you're halfway there.

The thing is, the nurses who put the most into their careers get the most out of them, and they're usually the ones who struggle most in the beginning. I wonder about the nurses who say their first year was easy peasy. The few I've actually known who say that weren't someone I'd want taking care of my mother. Either they don't fully appreciate the gravity of their responsibility or they just don't care. I'm not saying everyone who has had an easy first year is like that, but the ones I've actually known are.

So grit your teeth, suck it up, carry on and get through your initial period. You'll be happy you did once you've gotten through it.

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Thank you for all the input. I understand that this feeling of drowning or incompetence is to be expected for quite some time - maybe even after twenty years of experience - and I am not simply posting this to complain or vent, I was just looking for answers on whether this really occurred everywhere or specifically in this hospital due to the current situation/stressors in the area. I guess I got my answer though, that nurses will feel like this anywhere.

I am definitely trying to "grit my teeth" and get through it, and I know I can for at least 1 year. Of course the first year of nursing is not going to be easy.. each day driving to work I dread it and feel like I have a brick in my stomach. But I keep doing it, and once in a blue moon I'll even have a day where I don't cry at the end of the day on the drive home..

I am hoping that I can try to do travel nursing and/or relocate to Europe next year. Does anyone have experiences in that department? Would be great to hear what that was like.

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Your first clue of problems should have been a job offer for a new grad on day shift. The warning bells should have been going off.

The wait for day shift on the unit where I work is almost a year.

I actually applied right when one of the day shift nurses moved out of state and became per diem, so I replaced her spot, and an influx of nurses that came in a few weeks after me all went to nights but are now starting to move to days as well due to the shortage. So I didn't really take it as a bad thing or a "clue" that this would be a bad job when I accepted the offer.

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I:5 seems pretty standard on a med surg tele unit... Did I miss something?

I am not sure, is that the standard most places? I feel busy but okay with 4, but going up to 5 is a little much and then when they were going to make us 1:6 at 7AM I was very worried. Our unit is a cardiac med surg type of floor, but apparently everyone in the hospital - including the doctors - think we are a cardiac step down unit so they send us patients who are more acute than the ones we are equipped to be handling on a 5 patient assignment. But maybe it feels like this most med surg units, any thoughts?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Thank you for all the input. I understand that this feeling of drowning or incompetence is to be expected for quite some time - maybe even after twenty years of experience - and I am not simply posting this to complain or vent, I was just looking for answers on whether this really occurred everywhere or specifically in this hospital due to the current situation/stressors in the area. I guess I got my answer though, that nurses will feel like this anywhere.

I am definitely trying to "grit my teeth" and get through it, and I know I can for at least 1 year. Of course the first year of nursing is not going to be easy.. each day driving to work I dread it and feel like I have a brick in my stomach. But I keep doing it, and once in a blue moon I'll even have a day where I don't cry at the end of the day on the drive home..

I am hoping that I can try to do travel nursing and/or relocate to Europe next year. Does anyone have experiences in that department? Would be great to hear what that was like.

You're going to need at least (at the very least) two solid years of experience in the specialty you wish to travel in (poor grammar, I'm sorry) before you become a travel nurse. You'll be in a new hospital every 13 weeks, and you'll need to hit the ground running. Travelers in my unit get five shifts or orientation, and that's plush. I got 1.5 shifts when I traveled.

I have no information on relocating to Europe. It sounds like fun, but I wouldn't count on getting work as a nurse. A least, that's what my European friends tell me.

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