disallusioned with nursing! psych new grad

StuPer · May 12, 2008

Sorry for the delay in answering, I dont check these forums as often as I used too, and I've been crook for a few days.

Anyway, as for money, well its a tough one to answer as a simple monetary figure doesnt really give perspective. On top of that I am a fairly senior nurse and therefore work monday-friday 0830-1700 (they dont like to pay me overtime.. I cost too much ). Other things include cost of living etc. which I believe is cheaper here in Australia than much of the US... currently the exchange rate between the two countries is about 1au$ = 0.96c US, I think the average ward nurse including penalty rates for evenings and weekends would be earning around 70k before tax.

I dont know how that compares over there, but its a reasonable wage considering the average. We also get 4 weeks holidays a year plus some public holidays etc... overtime is not compulsory, you can take as much or as little as you want.

StuPer

RNdaze · May 13, 2008

OK, so reading through this thread, I'm hearing short staffing is a widespread and often "accepted" practice, albeit unsafe for pt.'s and staff.

I'm a new RN (2nd career -- I'm 38) and in my 3rd week of acute inpatient unit orientation, 2nd (evening) shift. I'm seeing 2 RN's with 10-16+ pts on average with 3-4 PC (Patient Coordinators/techs) shared on a unit. Dayshift is slightly better, might have 3 RN's. 1 RN on 3rd shift with 2-3 PC's. Roaming HUC's .... not sure how they work that out.

Here was last night:

My first night of orientation to the detox / bipolar etc unit (It has a name, I don't know it, um hum). We walk in to a scant report, 17 discharges (many pt's require FAST discharge or they are just left, i.e. transport won't wait more than 10 minutes), 2 pt's needed to go to ER (transport to another facility), not even sure how many holds, and multiple admits ... I was so busy doing discharges I never had time to see the total census. (I'd never done a discharge before this shift.) So much not finished by the previous shift ... orders out the wazoo, tests needed, more orders needed. It was a madhouse. Oh, and it's ALL paper. I have yet to touch a computer since I've started.

My preceptor wanted to get the dc's out of the way .... hmmm .... so it was 3 hours before I saw my first pt. Yeah, then they gave me 7 or so pt's. I know little about detox, but I'm doing CIWA eval on one alcohol detox with chronic pain and PTSD, and after much confusion another CIWA ordered for an opiate detox .... this person was off the charts anxious and angry. Huh?!? A methamp detox with multiple open skin lesions and chronic pain protocols and blood pressure issues .... no BP meds ordered, even though pt reported she took BP meds 2x/day (this is day 3 for her ..... hello?). A bipolar who was set to d/c, who broke down and said she'd kill herself if she had to leave .... call the doc, dc the dc. Another detox with a possible bowel obstruction -- sent to ER .... never even had the chance to check in with him, but heck he was in so much pain he couldn't talk anyway. Couldn't have done an NG tube or any type of emergency intervention for this patient. Yikes. A Bipolar non-compliant diabetic with new skin lesions, also on chronic pain protocols. A couple other borderline's that were Med seeking staff-spliters with various medical issues. One with boundary issues who should have been on constant observations and who frankly scared me.

The 2 RN's took the rest ... roughly 12 pts each give or take (who knows with that turnover). I'm not sure how many PC's we had. (!!!!) Again, this is my first night on this unit. I don't even know the unit capacity. I don't have access to the med rooms yet. I have to trust that my meds are passed and c/o pain are given their prns. Check back ... yeah, sure.

At one point, we had a swarm of pt's around the nrs station (with PC's sitting nearby). Pt's boring holes into our heads, watching us working furiously. I just HAD it. Went out and told them we were working hard for them but they needed to stop staring at us, get out of the hall and into the dayroom or their rooms... NOW. Where is the structure?

OK. Stop. Breathe.

My question is .... WHAT can I DO about this? Who do I talk to? Would talking to anyone help? The nsg supervisors are well aware of the situation, as are the managers. And I'm NEW. But this is about as unsafe an environment as I can imagine. I want to work there. I want psych. I don't think running would help. So how can I be part of a SOLUTION? (oh, and keep my license and not kill anyone.)

Please, if all you have to say to me is "welcome to nursing", don't bother. I'm looking for serious positive proactive responses if at all possible, please.

Whew. Thanks in advance for any insight.

Chaoticdreams33, MSN, RN · May 13, 2008

OK, so reading through this thread, I'm hearing short staffing is a widespread and often "accepted" practice, albeit unsafe for pt.'s and staff.
I'm a new RN (2nd career -- I'm 38) and in my 3rd week of acute inpatient unit orientation, 2nd (evening) shift. I'm seeing 2 RN's with 10-16+ pts on average with 3-4 PC (Patient Coordinators/techs) shared on a unit. Dayshift is slightly better, might have 3 RN's. 1 RN on 3rd shift with 2-3 PC's. Roaming HUC's .... not sure how they work that out.
Here was last night:
My first night of orientation to the detox / bipolar etc unit (It has a name, I don't know it, um hum). We walk in to a scant report, 17 discharges (many pt's require FAST discharge or they are just left, i.e. transport won't wait more than 10 minutes), 2 pt's needed to go to ER (transport to another facility), not even sure how many holds, and multiple admits ... I was so busy doing discharges I never had time to see the total census. (I'd never done a discharge before this shift.) So much not finished by the previous shift ... orders out the wazoo, tests needed, more orders needed. It was a madhouse. Oh, and it's ALL paper. I have yet to touch a computer since I've started.
My preceptor wanted to get the dc's out of the way .... hmmm .... so it was 3 hours before I saw my first pt. Yeah, then they gave me 7 or so pt's. I know little about detox, but I'm doing CIWA eval on one alcohol detox with chronic pain and PTSD, and after much confusion another CIWA ordered for an opiate detox .... this person was off the charts anxious and angry. Huh?!? A methamp detox with multiple open skin lesions and chronic pain protocols and blood pressure issues .... no BP meds ordered, even though pt reported she took BP meds 2x/day (this is day 3 for her ..... hello?). A bipolar who was set to d/c, who broke down and said she'd kill herself if she had to leave .... call the doc, dc the dc. Another detox with a possible bowel obstruction -- sent to ER .... never even had the chance to check in with him, but heck he was in so much pain he couldn't talk anyway. Couldn't have done an NG tube or any type of emergency intervention for this patient. Yikes. A Bipolar non-compliant diabetic with new skin lesions, also on chronic pain protocols. A couple other borderline's that were Med seeking staff-spliters with various medical issues. One with boundary issues who should have been on constant observations and who frankly scared me.
The 2 RN's took the rest ... roughly 12 pts each give or take (who knows with that turnover). I'm not sure how many PC's we had. (!!!!) Again, this is my first night on this unit. I don't even know the unit capacity. I don't have access to the med rooms yet. I have to trust that my meds are passed and c/o pain are given their prns. Check back ... yeah, sure.
At one point, we had a swarm of pt's around the nrs station (with PC's sitting nearby). Pt's boring holes into our heads, watching us working furiously. I just HAD it. Went out and told them we were working hard for them but they needed to stop staring at us, get out of the hall and into the dayroom or their rooms... NOW. Where is the structure?
OK. Stop. Breathe.
My question is .... WHAT can I DO about this? Who do I talk to? Would talking to anyone help? The nsg supervisors are well aware of the situation, as are the managers. And I'm NEW. But this is about as unsafe an environment as I can imagine. I want to work there. I want psych. I don't think running would help. So how can I be part of a SOLUTION? (oh, and keep my license and not kill anyone.)
Please, if all you have to say to me is "welcome to nursing", don't bother. I'm looking for serious positive proactive responses if at all possible, please.
Whew. Thanks in advance for any insight.

:no:Well, that does sound quite unsafe and scary! :confused:I wish I had the answer to the short staffing issues. Part of the issue may be that the staff on this floor are used to these ratios and are not bringing the issue up to management, I saw that happening on an acute floor recently. You say the manager knows, but does the manager know how everyone feels about it? Just because you are new does not mean that your opinion does not matter, you could even bring up ratios in other units/floors you have been on in clinicals. I am a new nurse as well, about a year exp, so I don't have that much to offer. I am looking forward to suggestions by other nurses.

Good luck and stay safe:)

Chaoticdreams33, MSN, RN · May 13, 2008

PS, finding other staff who agree with you may be helpful too. more support for the cause.

aloevera · May 13, 2008

I have no answers, I am dealing with the same issues....I have gone to management about the short staffing situation, especially on the weekends., there are always call-outs and very few to call to see if they will come in...and hardly no one ever does..would you give up your sat or sun. off?? I don't blame them...I have asked for agency nurses to call upon and they said they would look into it....so I am waiting...and yes, most facilities I have worked in seem to have similar situations....it is both stressful for us that are working and neglectful of pt. issues that we just don't have the time to deal with or we forget because we are doing so many things at once....After my 3-12 hr. shifts it takes me a whole day of rest to recuperate....I would welcome any other suggestions on how to deal with this also. I think the bottom line is $$$ the people in charge do not want to hire more staff for us.........unfortunately we are not the only profession that deals with this issue....

aloevera · May 13, 2008

oh, about the pt. structure issue...our pt.s do not have much time to hang around the desk...we keep them in group therapy, rec therapy, and ind. sessions with their therapist most of the day....if there is any lull time. one of us will do a group session to keep them occupied while the other catches up on charting.....that works out well....

RNdaze · May 15, 2008

Aloe, Thanks for your responses. :)

I have since talked to a variety of people, on all levels of the management ladder. To sum it up: That's just the way it is, we don't like it, we hope it will get better, this is a temporary low for us, expect 16 pt's a shift, hands are tied. :banghead:

I'm starting a few projects, gathering info from peers, and research on the issue at large. Maybe try to get active in the local association.

I am going to try to inform my supervisor in writing when I think a shift is particularly unsafe. Trying to figure out the best way to do it, i.e. non-threatening, yet CYA. I don't want to cause trouble or grief OR get labeled either. :bugeyes:

Here's to "keep keepin' on"!

~Daze

aloevera · May 15, 2008

I just got off the phone with one of the Supervisors, who is also a dear friend....(lives by me, too) we are at our wits end with the staffing situation...she has written letters to Administrator, CNO, and anyone else that could possibly help...One even told her we didn't have a problem on the weekends !!! and he has never been there on a weekend !!!! She has pleaded with all to get us some agency help, PRN help to call or anyone...the nurse on call is the only resource we have on the weekends and depending on who it is you may or may not get any help....I am up this weekend so will see how it goes, if another dangerously low staffed weekend, I am ready to look elsewhere....

I read these other posts about having 8-12 pts. and I am so envious..we sometimes will have up to 35 and one RN, 2LPN med nurses and, if we are lucky, 2 techs....it is just not safe for pts. or nurses. Let me know your progress....

inthesky · May 27, 2008

Hi guys! I certainly dont have answers for you guys except for continuing to complaining to management. If management won't act, it might be time for the state to step in. There is a point in which this becomes unsafe to the point of illegal.

im afraid to go to work tomorrow.. im going to have one patient who is constantly in restaints for trying to kill herself and assault staff.. one patient who has just left jail and wants to hurt someone else to go back to jail. One patient with out of control diabetes. The unit will probably be nearly emptied by the holiday and we'll be slammed with new admits. and who knows what else..

I care about the patients so much and sometimes i just dont feel strong or competent enough to protect them.

as much as you care about your patients, get out for your own emotional health (and physical safety!) if you need to

Mish56, BSN, RN · May 27, 2008

Rumor has it the State of California is legislating patient/staff ratios. I think Vermont is toying with the idea also. I hate government intervention in life (in general); but I think that's the only way things will change. BUT we are going to hit a bottleneck here in the next few years...the nursing shortage is going through the roof; we older folk, won't have a soul to take care of us (I don't have to worry about this at all tho, I'll HAVE to work til the day I die....I can see it now; my patient walks up to the charge RN and demands a "new nurse!! Mine is useless!", "what do you mean? she's quite qualified", "she used to be, but she dropped dead after she handed me my meds":bugeyes: LOL!!!!!!!!!)

Back to my point...check around and see what other hospitals are doing with this, and present "just the facts" to management, see if you can find out about CA law. Check with NAMI too. AND, the cost of a lawsuit is way more than a few nurses salaries.

My unit (adult inpatient)..census 25, RN on days and evenings=4, 2 on nights. 4 "other" staff (ie:MHW's or techs). That's the standard anyway, we do sometimes have to work with less...but if we are short an RN, I always try to get an extra MHW. We pass our own meds, I can't stand the "med nurse" thing. I want to know exactly what my patient takes and when. How the hell else would I be able to acureratly be able to document response? And what if the goal is to help them employ better coping skills vs. a pill.

Hospitals need to remember, they are selling nursing care, that's the end product. Think about it, take the nurse out of the hospital! What do ya got? Doctors giving orders to the air? Patients shuffling down to the pharmacy to get their own meds? That's called OUT PATIENT!

just my :twocents:

inthesky · May 28, 2008

i like to give my own meds as well.. plus, it is a great opportunity to talk about the patient's day. but i will need a med nurse if management insists upon taking admits during med pass >_

aloevera · May 28, 2008

our facility has LPN's give the meds (usually from 25-40 pts. and 2 of them) the RN does all the admits, all the treatment team mtgs. with Dr. and therapist, some groups, and ALL THE CHARTING...and all pt.c/o, all pt. care.....

I would rather have fewer pts. and do everything, too... but no way the way our hospital is...can barely do what we are suppose to do with that many.....