Disappointed with Nurses at first job

Editorial Team / Admin · Dec 27, 2016

The way of healthcare is to pile more and more on the nursing staff with fewer and fewer resources. Triple and quadruple documentation. Increasing patient ratios even though patient acuity is increasing as well.

It's not that nurses don't want to have the patient contact; it's that they just don't have time. Only you can decide if nursing will be the right path for you. You also won't know the full scope of what a nurse does until you are one- it's so much more than passing meds, changing dressings, and communicating with doctors and pharmacies.

ChristiHamm8, CNA · Dec 28, 2016

The way of healthcare is to pile more and more on the nursing staff with fewer and fewer resources. Triple and quadruple documentation. Increasing patient ratios even though patient acuity is increasing as well.
It's not that nurses don't want to have the patient contact; it's that they just don't have time. Only you can decide if nursing will be the right path for you. You also won't know the full scope of what a nurse does until you are one- it's so much more than passing meds, changing dressings, and communicating with doctors and pharmacies.

I agree that they do a lot more, that's all that I could recall at the time. I also know their nurse: patient ratio is ridiculous (unless this is normal). I believe there are 2 nurses for 54 patients on our wing and 2 nurses per 55 patients on the other wing. We will have 5 CNA's per side most evening shifts. I have normally had 10-11 patients every shift.

Is it normal for a LTC facility? Will I see a much more different dynamic in a hospital or clinic setting?

OrganizedChaos, LVN · Dec 28, 2016

I agree that they do a lot more, that's all that I could recall at the time. I also know their nurse: patient ratio is ridiculous (unless this is normal). I believe there are 2 nurses for 54 patients on our wing and 2 nurses per 55 patients on the other wing. We will have 5 CNA's per side most evening shifts. I have normally had 10-11 patients every shift.
Is it normal for a LTC facility? Will I see a much more different dynamic in a hospital or clinic setting?

Yes, that is very normal in the LTC setting. In a hospital setting you might have 5-7 patients depending on the hospital. It may sound a lot better but the people in hospitals are often a lot sicker & require more treatments than in LTC.

Bcraven · Dec 28, 2016

I was a CNA in a LTC before I became a RN. I vowed that when I became an RN I would ALWAYS help my CNA's because I know what it's like to run around like a chicken with its head cut off while your nurse is just "sitting on her ass". Let me tell you though, there is a lot that goes on behind the charge nurse desk that CNA's don't see. For one, when you as a CNA report a fall to the charge nurse most likely you may be able to go about your day and get off at your regular scheduled time(not saying that your day will be easy by any means because I KNOW what a day in the life of a CNA is like). For nurses however, the paper work for a fall or even just a skin tear is absolutely ridiculous. That's not counting all the doctors orders you have to transcribe and all of the medication you have to give on top of that. You as the nurse will be responsible for 54+ patients. All falls, all skin tears, all elopements are on YOU. YOU will have to do all the paperwork. YOU will have to report to the doctor. YOU will have to inform the family and most likely get cussed out by them. Please don't think that nurses don't do anything behind the desk. Most nurses are just very good at keeping their composure because if charge nurse were to go around panicking that would freak out my residents and my CNA's and it would be ALL chaos from there. Being a nurse is by no means a cake walk. There would be times I didn't get off work until 2 hours after my shift but you would never know how stressed I was from "behind the desk" because I never showed it.

ChristiHamm8, CNA · Dec 29, 2016

I was a CNA in a LTC before I became a RN. I vowed that when I became an RN I would ALWAYS help my CNA's because I know what it's like to run around like a chicken with its head cut off while your nurse is just "sitting on her ass". Let me tell you though, there is a lot that goes on behind the charge nurse desk that CNA's don't see. For one, when you as a CNA report a fall to the charge nurse most likely you may be able to go about your day and get off at your regular scheduled time(not saying that your day will be easy by any means because I KNOW what a day in the life of a CNA is like). For nurses however, the paper work for a fall or even just a skin tear is absolutely ridiculous. That's not counting all the doctors orders you have to transcribe and all of the medication you have to give on top of that. You as the nurse will be responsible for 54+ patients. All falls, all skin tears, all elopements are on YOU. YOU will have to do all the paperwork. YOU will have to report to the doctor. YOU will have to inform the family and most likely get cussed out by them. Please don't think that nurses don't do anything behind the desk. Most nurses are just very good at keeping their composure because if charge nurse were to go around panicking that would freak out my residents and my CNA's and it would be ALL chaos from there. Being a nurse is by no means a cake walk. There would be times I didn't get off work until 2 hours after my shift but you would never know how stressed I was from "behind the desk" because I never showed it.

I wouldn't dare assume that nurses aren't doing anything, I know they are swamped with paperwork and management duties. I've observed them and what they do and I have seen many of them not get lunch breaks and I myself have even added to their long list of patients demanding pain medications all at once. I also know that they have overwhelming responsibilities and liability all on their shoulders. I just assumed they would be more one on one with the patients and more hands on. I find it really sad that nurse duties are more paperwork than bedside tasks or at least the bedside tasks that they need to do are so short. Where is the patient connection? My job as a CNA compared to theirs is simple and a cakewalk although it is very hard on the back and feet but I also get to say " I will ask the nurse" instead of being held accountable for something. I get that their jobs are overwhelming and there is a lot I don't see but I just want to know will I be able to get to have a relationship with my patients like I do as a CNA when I become an RN?

Has anyone ever gone from a CNA to RN and missed it? How different is the relationship?

I hope I am making sense. This is in no way demeaning the nurses role and responsibilities. There is so much that I can't even comprehend until I am actually an RN and I hope I live up to those expectations.

Leonardo Del Toro, RN · Dec 29, 2016

First you have to realize that health care is for profit. The priority is profit. The owner of these business is doing everything according to - how can I make more money with this business? Nurses and other professionals have to realize that they perform their services within this context of a Business for profit. Sad, but true.

allnurses Guide · Dec 30, 2016

Has anyone ever gone from a CNA to RN and missed it? How different is the relationship?

I was a CNA for over 20 years before I became a nurse. I loved being a CNA. I often miss the hands-on care and so I do it whenever I can.

Yes. It was nice to be able to just get the nurse when things got sketchy. It was nice to then help the nurse and just be Robin and not Batman. It was nice to go home on time!

I filled in as a PCT last week. Thought I'd died and gone to heaven. It was a break from admissions, doctor calls, treatments, family visits and med passes that usually are fraught with niggly glitches and complications that drive me up the wall!

I will say, I do like my paychecks better as a nurse, so there's that.

RescueNinjaKy · Jan 1, 2017

As an RN I feel that I have plenty of appropriate patient contact and interaction. I've worked in cardiac step down and icu, and for both I have had plenty. Whenever I do something I like to utilize distraction by asking them questions. Especially when I'm giving injections and I know that they aren't a big fan of needles. So frequently I'll ask them where they're from and they will say much more.

When i give pain meds I ask them what usually helps with pain at home. I educate them and I get to know what their home situation is for discharge purposes. There are plenty of times in which I am interacting with the patients. In the icu it's more with the family since the patient is often intubated and sedated.

As far as CNAs doing all the work, I can assure you that is not the case at least where I work. Nurses do a lot of behind the scenes work. We communicate with other disciplines for discharge planning. We do the education, we are monitoring the patient. Yes CNAs monitor the patients too but they do not have the same assessment skills that we do. There are often times that we are doing something or thinking/planning something already and CNAs don't know because it is not part of their education nor scope.

Don't get me wrong, I love CNAs and I bought them coffee often, but by no means do CNAs do all the work from what I've seen. Nurses are doing plenty of work, just work that may not always be visible to others or as physical. We often delegate tasks to CNAs because we are the only ones who can do our task while we have you guys to help with others.

In the icu setting I had to do all my patients bed baths and clean ups and turns. Often there was only one CNA on at a shift and all the above tasks are at least a two person job. So I had to either find a cna or a nurse to help. Boy did I miss having 4 CNAs on the floor like when I was on my step down unit.

ClaraRedheart, BSN, RN · Jan 1, 2017

I kind of felt that about psych nursing. I really enjoyed my rotation to psych, but my favorite part (group therapy) wasn't even done by the nurses! The nurses hung out behind windows handing out medications. It looked incredibly boring. I was only a tech then, so I'm sure a lot more went on that I didn't get to see. I saw enough to make me not want to go into psych though. I think at the hospital, we have the opportunity to be more involved than in LTC. Not EVERY day is like that, some days I'm doing good to pass meds and change dressings and keep up with doctors orders, but some days are slow enough that I'm able to help ambulate patients, change them, toilet them, etc.. Some days I have patients that are so demanding on the delegatable tasks that my tech absolutely cannot do it all and I have to step in or someone will fall. Usually, it's a good balance. When it's not, bad things happen and I'm cleaning up 2 hours past my shift. That doesn't happen too often though, thank goodness.

AlwaysLearning247, BSN · Jan 2, 2017

At a rehab facility there is generally more CNAs and less nurses, meaning nurses have more patients than CNAs. The med passes are time consuming, reviewing labs, calling MDs, dressing changes, talking to family, getting admissions/discharges, etc. I'll admit, when I was a nurse in a rehab facility I felt like the only time I saw my patients was to give meds and that's it. I work at a hospital on a busy med-surg/cardiac floor now and we get a lot of sick patients. Now the roles are flipped, we have about 8-10 nurses per shift (we get 3-5 patients) and 2-3 CNAs. At the hospital I spend a lot more time with my patients. I usually have time to help them get ready or go the bathroom. They are also much sicker, which requires my time being in with them a lot more.

Paws2people · Jan 2, 2017

I work in a hospital. I'd love to have only 10 patients each night.