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Day 8 and I'm expected to take 4 patients?

calirn05 calirn05 (New) New

Hi-I am working my first RN job on a med-surg floor and had a preceptor for 5 days. The past 3 days I was on my own but was encouraged to ask lots of questions of anyone, "everyone will help you". Well these 3 days this week, 2 of my 3 patients had between 12-14 9am meds and with checking the dr's orders with the MAR on those, doing assessment, charting, running around for each of them, dressing changes, I am swamped and find myself about 45 min behind each morning on my meds. I didnt grab a bite to eat until 6.5 hrs into my shift. Well one nurse, the one who precepted me last week said when I turned down the offer of a new admit this morning when I was bogged down, said "you gotta take four sometime". Well is "sometime" being day 8 and trying to keep my head above water, enough time? They sure are pushing me to be as good as the rest of them in only 8 days!

RosesrReder, ASN, BSN, MSN, RN

Has 18 years experience.

Welcome to the site. Seems like you have a handful. Hope everything gets better and good luck. :)

Four patients is not a full load in lots of places. You cannot learn to manage your time until you are in a situation where time is of the essence. Just remember to call for help when you need it. Remember too that nursing is a 24 hour job and if you cannot get it all done then someone else will pick up, just as you do when you come behind another nurse. Plan your work then work your plan. This too shall pass!

baby&mommynurse

Has 10 years experience. Specializes in OB.

I'm sure they aren't expecting you to be as good as the experienced nurses or in any way perfect, but it's true, "you have to take four sometime." You have been training for over a week and you do need to learn how to manage your time on a full assignment... in some departments, you'd have to take more patients. The other nurses are still there to answer any questions that may arise or help you if your hands are too full. All you have to do is ask. I've been at my current job for over 6 years and I still need to ask questions or ask for help sometimes. BTW, Welcome to all nurses.com and good luck, it does get easier.

USA987, MSN, RN, NP

Has 20 years experience. Specializes in Behavioral Health.

Hi-I am working my first RN job on a med-surg floor and had a preceptor for 5 days. The past 3 days I was on my own

Am I the only one who finds it a bit troubling that only after 5 days this brand new RN is taking her own load???? What ever happened to adequate orientation??? Heck, my first job when I was an LPN was as a med nurse and I got a 4 day orientation...just to pass meds all day!! :uhoh21:

dutchgirl

Specializes in peds, peds ICU, OB, Cath Lab,home health.

Hi-I am working my first RN job on a med-surg floor and had a preceptor for 5 days. The past 3 days I was on my own but was encouraged to ask lots of questions of anyone, "everyone will help you". Well these 3 days this week, 2 of my 3 patients had between 12-14 9am meds and with checking the dr's orders with the MAR on those, doing assessment, charting, running around for each of them, dressing changes, I am swamped and find myself about 45 min behind each morning on my meds. I didnt grab a bite to eat until 6.5 hrs into my shift. Well one nurse, the one who precepted me last week said when I turned down the offer of a new admit this morning when I was bogged down, said "you gotta take four sometime". Well is "sometime" being day 8 and trying to keep my head above water, enough time? They sure are pushing me to be as good as the rest of them in only 8 days!

A five day preceptorship for a new grad is ridiculous...These are things we need to look for when applying to hospitals - ie do you have an internship, how long is orientation, when will you expect me to be counted as full staff -i know i'm just dreaming... find a mentor fast,help her as much as you can and hang in there. (They're taking 6-8 at my hospital)

grinnurse, RN

Specializes in Med/Surge.

And I thought my orientation time was not enough :uhoh21: Five days, are they crazy? Where you an LVN in a previous life before becoming an RN? Was that all the orientation that you were scheduled to have? Oh My Gosh!!! I find this a huge problem you only getting 5 days of orientation :devil: !! Was this the plan when you accepted the position? I would be mad as heck if that happened to me. Not only would I be mad I would so scared of jeapordizing my license.

It's true that you will eventually have to take four patients, but, give me a break please. IMHO they are setting you up for disaster. Now, if you had had a good amount of time for orientation then yes, that should be expected but not like this. You need to talk to someone and quick-how bout your nurse manager. I see huge warning flags going up. Even if you have nurses their to ask questions, this is not the same as having a decent orientation. Girl, I would be running from that place as fast as I could if this was all of the orientation that you are to get. You worked and sacrificed way too hard to earn that RN degree. You should really think of an exit plan if at all possible!

BTW-welcome to Allnurses and keep us posted on what you do. Heck, I've been on my own now for about 1 month and I am still "bogged" down!! Good luck and keep us posted how it goes for you!!

JentheRN05, RN

Specializes in OB, ortho/neuro, home care, office.

I have been on the med/surg floor about 11 days now. The first day I followed a nurse. By the end of that day I picked up my own patient. Second day (remember I float to med/surg - so this was about 1 week later) they gave me two patients. I'm not sure who my preceptor was supposed to be that day, but if I had one I didn't know it. I'm up to 3 patients and seemingly the worlds worst patients on the floor and I'm drowning. I'm told when I go to nights (next month) I will be expected to take 7 - 8 patients. Who am I kidding? Am I truly able to do this? I will likely only be in med/surg 2-4 more times in the next month. I sure hope I become supernurse in that period of time!

madwife2002, BSN, RN

Has 26 years experience. Specializes in RN, BSN, CHDN.

Can i ask a stupid question how many patients should an experienced/non experienced nurse take on a med/surg ward? Just trying to understand, also would you have or do you have any help with these patients? ie a nurses aide

live4today, RN

Specializes in Community Health Nurse.

Can i ask a stupid question how many patients should an experienced/non experienced nurse take on a med/surg ward? Just trying to understand, also would you have or do you have any help with these patients? ie a nurses aide

madwife.......no question is stupid. You ask a very honest question because bedside nursing here in America is atrocious for the most part, especially on the wards where there are 30 beds or more. Med/Surg is a tough area to work nowadays, and it is always treated as if it's "just general nursing". :stone There's NOTHING "just general" about it.

Med/Surg units typically have anywhere from 4 to 8 patients per nurse depending on the shift (ie...day, eve, night). New Grads should NOT be given a full load during the first half of their orientation. That is a learning time for them, and they are not supposed to be utilized as "staff"........YET........it happens all the time -- especially today when hospitals have deliberately cut back on hiring nurses "in secret", but advertise that they are always "short staffed". Nurses know the truth about how that works. :rolleyes:

There are CNAs, Patient Care Techs, or Patient Assist working on the units, but they are scarce as well. They take on a huge load of patients, and are very under appreciated.

I for one won't work where I have to take more than five patients. I tried working where the nurses each had 7 patients.........that's crazy, and the patient care was lousy. It's not safe, and too much is required of each nurse in doing so. I'm not a robot, and won't be treated as one.

Original Poster.........you should be looking for another job. Sounds like you are being dumped on due to lack of staffing where you work. It's unfair to you, and you need to step up and protect your nursing career by not starting out by allowing yourself to be abused on the job. :)

baby&mommynurse

Has 10 years experience. Specializes in OB.

I have a few questions for the original poster... what is your nurse patient ratio for your unit and did you know before hand what kind of orientation you would be getting and how long? I'm not by at all means saying that 4 patients is appropriate for a new grad/new hire to have alone after 1 week, but I'm just trying to understand the situation. It seems to me, if you're not even getting the breaks you should be getting, clearly, no one is helping you out. Something is very wrong with this picture... and you do need to speak to your manager about it.

I have a few questions for the original poster... what is your nurse patient ratio for your unit and did you know before hand what kind of orientation you would be getting and how long? I'm not by at all means saying that 4 patients is appropriate for a new grad/new hire to have alone after 1 week, but I'm just trying to understand the situation. It seems to me, if you're not even getting the breaks you should be getting, clearly, no one is helping you out. Something is very wrong with this picture... and you do need to speak to your manager about it.

What is the usual expectation regarding orientation for a new grad? I am just starting to look into jobs and if they gave me 3 pts after 5 days ...yikes !!!! I don't think i could handle that.

After reading all the replies, I'm starting to worry about what I got myself into. They keep telling me "ask questions of anyone, there's not one person here who wouldnt help you". But you are right, I have worked hard to earn my RN license, I dont want to jeopardize it. I was hired for nights and was told that the load is usually 4-5 per nurse. Well everyday I see on the board under the night nurses' assignments about 6-7 patients each for the experienced ones. The LVN training right now, hired the day as me, she's taking 4 starting tonight.

I'm training days for another 3 days then I go to nights. They tell me "call for help, ask questions". Doesnt sound like orientation to me.

So tell me, how many patients should an orientee take, and how long is an expectable orientation? How long with a preceptor? And having a preceptor, does that mean she's just there for me, checking on me, helping me, or am I helping her with her patients, and not taking my own?

Thanks for all your replies, I have alot to think about. One last thing, how bad does it look to the next place I apply, if I do chose to run? I hate to look like a quitter, but I dont want to jeopardize my license or harm anyone.

Cali

christvs, DNP, RN, NP

Has 12 years experience. Specializes in ACNP-BC.

Hi CaliRn. I'm a new RN in my 4th week of orientation (I'm doing 40 hours/week). We're orienting on the day shift now (for the first 6 weeks) & then I'll orient for 6 more weeks (total of 12 weeks) on my 3-11 shift. My first day I shadowed my preceptor. The second day I had two patients on my own & had two patients on my own up until the end of last week. Since then I've had 3 patients on my own-but one of the three patients i've had all of this week is such an insanely involved exhausting patient (although-a really good learning experience I have to say with 25+meds to give-Po, IV push, IV antibiotics, creams, powders to mix, a PICC line, blood sugars, CPM machine, you name it!) that I felt crazy & frazzled today. And in the course of my 4 weeks of orientation, I've worked with NINE different preceptors-really! But honestly, I've been basically on my own from day 2. My "preceptor" for the day is there for me to ask questions, but I end up doing most things by myself. i'm fine with that though (for the most part) because i'll just ask any nurse who is around if I need help with something or some new procedure I have not done before. I guess I'm just used to how it is on my floor-everyone is helpful & nice when I ask my questions-& I have really learned a lot by doing it on my own (like admissions, discharging patients, IV pushes, hangin up antibiotics, etc) But even though I feel I can do a lot now, I'm still all frazzled when I have nutty days like today when I am constantly running around trying to get things done.

-Christine

Am I the only one who finds it a bit troubling that only after 5 days this brand new RN is taking her own load???? What ever happened to adequate orientation??? Heck, my first job when I was an LPN was as a med nurse and I got a 4 day orientation...just to pass meds all day!! :uhoh21:

You're not the only one. This is crazy. I am in CT where new grads get about 12-16 weeks of orientation. Now they will move into patient care but will do so slowly.

I precepted a nurse (new to us but had over 15 years experienc) and she still got about 12 weeks. We don't expect our brand new nurses to L&D to even begin to feel competant (and be able to do any part of a labor alone) for at least 4-6 months.

I ahve said it before that this gross lack of orientation is what is burning out our new grads (and nurses new to an area).

Hi-I am working my first RN job on a med-surg floor and had a preceptor for 5 days. The past 3 days I was on my own but was encouraged to ask lots of questions of anyone, "everyone will help you". Well these 3 days this week, 2 of my 3 patients had between 12-14 9am meds and with checking the dr's orders with the MAR on those, doing assessment, charting, running around for each of them, dressing changes, I am swamped and find myself about 45 min behind each morning on my meds. I didnt grab a bite to eat until 6.5 hrs into my shift. Well one nurse, the one who precepted me last week said when I turned down the offer of a new admit this morning when I was bogged down, said "you gotta take four sometime". Well is "sometime" being day 8 and trying to keep my head above water, enough time? They sure are pushing me to be as good as the rest of them in only 8 days!

It is not a secret that some unit managers will try to cut you loose after a short orientation period because they are trying to save money. But, if you feel that you are not yet up to par then you should ask for more time. Besides, eight days is FAR from enough time for any new grad orientation. You need months, not days, of orientation when you are a new grad. You need to speak to your unit manager about this.

grinnurse, RN

Specializes in Med/Surge.

CALIRN-

The way my orientation/preceptorship went was I had it for 6 weeks. The 1st and 2nd shift, I shadowed the RN and assisted where I could. The 3rd day I took one pt, and with each shift I worked I took more responsibility to where at the 3rd week I was taking 4 pts. At that point for the remainder of orientation I had 4 pts and the preceptor "shadowed" me. All the while I was asking tons of questions of all the nurses that I was precepted to which I thought at the time stunk, but, have realized that I learned alot of different things from each of them.

IMHO I don't think the next place that you worked would frown upon the fact that you left for the reasons that you stated-being worried about pt care and your license. In the long run, you would be saving a hospital money from possible lawsuits not to mention the fact holding onto that hard earned degree!! I have been a working RN since June 13th and when they told me I would only be getting 3 (9 shifts)weeks, I was in tears talking to the nurse manager telling her that I was NOT ready to be on my own. Heck, at that point I was still wrestling with the pumps, lines, etc. Luckily, I have a great charge nurse and co-workers who stood up for me. I was ready to walk if they refused to give me the full time. My license means so much to me not to mention my family who sacrificed right along with me to get it!! If you can see on the board what's going on with the night nurses and they are taking 6-7 pts, that's what's going to be expected of you too when you get there!!

Good luck and continue to let us know how it's going ok.

Thanks so much for your replies. I had a long talk with my manager today and she did not want to lose me and has me set up to work side-by-side with the nurse educator all next week and keep me paced. We will re-evaluate after next week. I know it's only one week, but now that they know that I felt like I was drowning and not being safe, they slowed down and spent more time with me today and offered more help. I hope this made a difference in my orientation.

Cali

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