no critical thinking here

Tait, MSN, RN · May 23, 2008

I think 3-11 can be a devastating shift for a new grad, and I think it can cause almost instant burnout. My suggestion? Try to swap to nights. I worked in a tiny rural hospital for my first job, on nights, and I really loved the time I got with my patients, AND my charts.

Best of luck!!

Tait

chriscolin · May 23, 2008

I think 3-11 can be a devastating shift for a new grad, and I think it can cause almost instant burnout. My suggestion? Try to swap to nights. I worked in a tiny rural hospital for my first job, on nights, and I really loved the time I got with my patients, AND my charts.
Best of luck!!
Tait

Thanks for the reply, I knew this shift wasn't going to be easy. There was another new grad who started on thisi shift too, and immediately requested a shift to nights! But we can't all switch, I'm trying very hard to learn to manage time. But you can't manage time when the time doesn't exist! I take the care of my pt's seriously, I want to be known as a smart, caring nurse. The smart part isn't being met because I don't have time to think! I can't think of any nursing other than critical care where the ratio is 2/1 or maternity,where I won't have so many pt's. But it seems clear to me that when I have 2/3 pt's my care is excellent my charting is better and my pt's are happier as a result I am more content and secure in my skills. I was told it would be this way, but I am not willing to risk injury or error to a pt because of staffing, it's not worth my license or peace of mind. When I graduated I wanted to do maternity, but that's hard to break into so I am trying to get experience then make the swap. Until then I just do the best I can and go bed with a massive headache worrying about what I may have missed (meds etc..) not a great way to start a career!

Chloe'sinNYNow · May 24, 2008

I take the care of my pt's seriously, I want to be known as a smart, caring nurse. The smart part isn't being met because I don't have time to think! I can't think of any nursing other than critical care where the ratio is 2/1 or maternity,where I won't have so many pt's. But it seems clear to me that when I have 2/3 pt's my care is excellent my charting is better and my pt's are happier as a result I am more content and secure in my skills.

Chriscolin,

just a little ps here. I am a new grad orienting in OB and I'm currently doing 4 couplets. That's 8 pts a shift, plus admits in the middle of the night and trying to get the chart together and educate the pt for d/c the next day. You mentioned maternity where you thought there'd be a lower ratio, but perhaps you were thinking L&D? Not ante-partum, nor post-partum will you find low ratios!! It's actually harder in PP because it's 2x the charting. 2x the assessments. 2x the feedings and pumpinp and helping moms to latch...etc...

I have no idea why so many think that maternity is so easy. I'm amazed at how many think that it's cushy detail. It isn't. And so many things can go wrong so quickly and so easily. An OB nurse has to learn to think critically and react efficiently.

But if it helps, I do understand and empathize with your fears of being a "stepford" nurse just acting robotically at med passing, and being overwhelmed. It takes very little to throw our unconditioned skills out of whack and mess our entire shift up. But I'm constantly reading that time management comes with time. It has to, right?

Just my :twocents: here Chris.

Good Luck

Chloe

:nurse:

RN-BSN, BA

Daytonite, BSN, RN · May 24, 2008

Anyone with any thoughts.

The manager who hired a new grad to work on a busy telemetry unit should be horsewhipped. I worked this kind of unit for over 5 years as an experienced nurse and was a nursing supervisor and manager. This is an inappropriate place for new grads.
If you are willing to stick this out, your only choice is to hit your books when you get home to learn all the information you don't have time to look up at work. Invest in a good nursing textbook or care plan book of critical care or med/surg that specifically includes assessment information. Don't take it to work because it will disappear because I am willing to bet that you are not the only one who is having and feeling this same stress.
It won't be long before you will be floated to the intensive care units when they are short staffed or need help, so this concern about not being good enough with assessments and being organized isn't going to end.
I'm sorry you are in this situation. I hope there are helpful people around you, but I've worked in these units. Your coworkers are most likely just as busy and stressed out as you.

chriscolin · May 24, 2008

Chriscolin,
just a little ps here. I am a new grad orienting in OB and I'm currently doing 4 couplets. That's 8 pts a shift, plus admits in the middle of the night and trying to get the chart together and educate the pt for d/c the next day. You mentioned maternity where you thought there'd be a lower ratio, but perhaps you were thinking L&D? Not ante-partum, nor post-partum will you find low ratios!! It's actually harder in PP because it's 2x the charting. 2x the assessments. 2x the feedings and pumpinp and helping moms to latch...etc...
I have no idea why so many think that maternity is so easy. I'm amazed at how many think that it's cushy detail. It isn't. And so many things can go wrong so quickly and so easily. An OB nurse has to learn to think critically and react efficiently.
But if it helps, I do understand and empathize with your fears of being a "stepford" nurse just acting robotically at med passing, and being overwhelmed. It takes very little to throw our unconditioned skills out of whack and mess our entire shift up. But I'm constantly reading that time management comes with time. It has to, right?
Just my here Chris.
Good Luck
Chloe
RN-BSN, BA

Thanks, I was referring to L&D, in our area L&D gets only 1 pt. 2 at most and are trained for the postpartum floor. Also even on postpartum we are only given 2 pt's because technically you have 4 or more if you include the newborns.

L&D here is pretty good. But again hard to break into. Thanks

november17, ASN, RN · May 24, 2008

I used to feel the same way.

I took up the mantra, "All my patients are alive and doing ok at the end of my shift.."

Sometimes just keeping them stable while they heal is the best you can do. You're a nurse, not a miracle worker.

chriscolin · May 25, 2008

I used to feel the same way.
I took up the mantra, "All my patients are alive and doing ok at the end of my shift.."
Sometimes just keeping them stable while they heal is the best you can do. You're a nurse, not a miracle worker.

Thanks I wish it were so basic. They are alive but sometimes that's not good enough. I can't miss meds, I can't forget to schedule neruo checks or cardiology consults, post telemetry strips. If I miss these things other nurses get stuck with the work and I get stuck with the fact that I didn't do my "job." If I miss an arrythmia spell and something happens later it was my job to catch it and notify someone. There is an enormous amount of stress. Don't get me wrong I find the work very interesting but I just don't know enough at this time and I don't have time to learn it! So I learn as I go, and yes I hope their all alive when I leave........

UM Review RN, ASN, RN · May 25, 2008

I understand where you're coming from because even though I had some Med-surg under my belt before I went to tele, I didn't have much hospital experience and I felt like I was under-educated for the tele unit.

Your patient load sounds OK to me, it's about the same at my hospital, and I do get a tech. We have an admissions nurse which cuts down on the admission paperwork so much that it's really easy to take admissions for us now. We still do vitals and assessments, but the whole process is so much faster now, I don't balk when I hear the words "ER admit."

In fact, it is still acceptable in my hospital to come in with no tele experience whatsoever, not even the EKG class. If you can read an EKG, that's good.

New nurses like you have to hope that you have a lot of experienced nurses who can fully mentor you through this in addition to learning as much as you can at home. This website should provide plenty of resources for you.

I've been in telemetry for a few years now and I feel pretty competent at this point, but I still have a long ways to go and I still ask questions and look things up and at the end of the day, I still come home and hope that I've got everything done. The point is, nursing is a lot like raising children -- you never really feel like you got it all right, and you just do the best you can.

chriscolin · May 25, 2008

I understand where you're coming from because even though I had some Med-surg under my belt before I went to tele, I didn't have much hospital experience and I felt like I was under-educated for the tele unit.
Your patient load sounds OK to me, it's about the same at my hospital, and I do get a tech. We have an admissions nurse which cuts down on the admission paperwork so much that it's really easy to take admissions for us now. We still do vitals and assessments, but the whole process is so much faster now, I don't balk when I hear the words "ER admit."
In fact, it is still acceptable in my hospital to come in with no tele experience whatsoever, not even the EKG class. If you can read an EKG, that's good.
New nurses like you have to hope that you have a lot of experienced nurses who can fully mentor you through this in addition to learning as much as you can at home. This website should provide plenty of resources for you.
I've been in telemetry for a few years now and I feel pretty competent at this point, but I still have a long ways to go and I still ask questions and look things up and at the end of the day, I still come home and hope that I've got everything done. The point is, nursing is a lot like raising children -- you never really feel like you got it all right, and you just do the best you can.

We have a secretary but she is not there on the evening shift. I did take the EKG course and I passed the ACLS certification course as well. I can read a strip but I still have issues with the more advanced blocks. I had a great preceptor but she doesn't work on my shift now. The people I work with are very good, but they have their case load to handle too! The admits are a nightmare, we all cringe when we see ER on th phone! I am still learning to do IV's and I live in fear of my first code!

Don't get me wrong, the cases are interesting and I feel like I am learning more than most of the classmates I graduated with. Hopefully I will make it through the early years here and relax!

Virgo_RN, BSN, RN · May 25, 2008

I know how you feel. Ten months ago, I accepted an LPN position on a busy tele floor, 3-11 shift (temporary position until I get my RN license).

I felt exactly the same way you have described for the first six months or so. At ten months, I'm just now starting to feel like I'm getting my feet underneath me. I still have nights that are so busy that I feel like much of my patient care is running in, throwing some pills at a patient, and running out. But, where those nights used to be the norm, they are now becoming less frequent.

My most recent night at work, I started out with two, then got two admits. One of the two that I had started out with threw a PE or something, and was busy for me all the rest of the night. The two admits didn't see much of me, but I was able to peek in on them enough to know they were doing okay. I had to do their assessments, call the doc to get their meds ordered, and give them their meds inbetween everything I was doing for the unstable patient. Luckily, my fourth was an LOL who was stable and probably DCing the next day, who didn't want to be disturbed anyway. I gave her her HS meds and that was it for the night, I didn't hear a peep from her.

I guess my point is, that yes, it would be nice to be all organized and have your shift all planned out and be able to take some time to think. I've had this discussion with co-workers before. I think it's a nice ideal, and when it happens, take full advantage of it. But most of the time, I'm putting out fires from the moment I step onto the floor until the moment I leave. Once I accepted that rather than struggling against it, and made a conscious effort to be more flexible and practice moment to moment rather than trying to plan things out, things got a lot better for me. I'm not saying you shouldn't try to plan things out, just that the plan should not be carved in stone and you should be ready and willing to change the plan and shift into a different gear on a moment's notice.

And just as importantly, never be afraid to ask for help. Do not be afraid to go to your charge nurse and let him or her know that you are sinking. You're not a failure if you have to do that. You're new. You simply cannot be expected to handle as much as an experienced nurse can handle.

Dancin'Mom · May 25, 2008

I work a busy telemetry also, night shift though. I also work the same days every week-F,Sa, and Su. If patients haven't been discharged, I get the same 4 (occasionally more) patients every night. I get to know them, will go home at times, and review diagnoses, old notes from nursing school, to better take care of them. I think in time after getting the same types of patients over and over, ie CHF patients, cabbage patients, ect, , I will know their care plans, and what exactly to zone in on and how to better help them, in a more efficient manner. Right now, I feel I am learning more of organization skills than using my critical thinking also. I think that will come and I'm not worried about it really. Hopefully, eventually, you will be able to move to a different shift so that you don't feel so rushed with everything. I think 12 hour shifts, especially nights, allows me to spend a little more time with patients and their charts. Good Luck!:nuke: