This is what I wrote when I got home after deciding I'm never returning to my first real nursing job.
I come from a middle class family. There are a lot of gaps in my memory when it comes to my health history, but I do remember one thing from all of the doctor visits and hospital stays: the nurses. More that the physicians, I remember the nurses being there to comfort and care for me. They explained everything to me, even though I was just a child.
Even as I got older, I still relied on the nurses for information and to teach me when my family members were ill. My grandmother suffered with cancer for a couple of years, and it was the hospital and home health nurses who made us feel knowledgeable and comfortable to care for her in a home environment. I was able to administer her medications through her PEG tube and I felt very comfortable doing so thanks to the teaching provided by the RNs.
With all of my positive encounters with nursing, I opted to become a nurse. I have always had exceptional grades. I had the potential to attend medical school, but instead, I chose that nursing would provide a more positive impact on others. I enjoyed every day of nursing school, which is known for being utterly dreadful. I couldn't wait to get out in the real hospital and act as a real nurse, being able to care for and teach the ill and their families.
I graduated in May of 2011 with my Associate Degree in Nursing. I moved to Detroit, MI, and was astonished at the amount of RNs that were needed! In the first week of my Job Search, I had filed over 500 applications! I felt so confident that I was going to be able to have my choice of a dream job.
Three months and hundreds more applications later, I was an unemployed and frazzled new graduate RN. I couldn't understand what I was doing wrong. I had an ideal resume, showing that I had gone to a University for a challenging summer program since age 12. I had a perfect GPA in college, passed my boards on the first attempt, boasted a huge list of volunteer work, graduated top of my class, had multiple awards and participated in the honor society of my college, and even had some experience in the medical field. Yet, I could not even get an interview to come in.
I had to move again. I moved to a small town in Tennessee, and after receiving my compact-state nursing license, I was offered a staff nurse position at a small community hospital that is affiliated with a large hospital. I readily accepted, knowing that it was my first full time job offer since graduation 6 months prior. I was told it was uncommon for them to hire new nurses, but they thought I had an advanced maturity level.
I was extremely excited to finally be able to do the job I'd prepared during my college time to do! I had a fantastic preceptor, although she did seem unhappy at times and overwhelmed. The floor I worked on held only 18 rooms, private, but potential to be semi-private if needed. The staffing typically consisted of the RN and either a LPN or CNA.
Three weeks after my first job's orientation started, it promptly ended. I was told it was "now or never," and that I was to be alone. When I say alone, I mean alone. I was the only RN and often the only licensed person on the entire unit, whether there were 2 patients or 12. Due to incompetent training, the CNA and LPN I intermittently worked with were unsure how to do orders, so I did that as well.
A typical day for me consisted of worrying about going to work. I arrived at 6:30 A.M. to being getting my patient information together. If I wasn't assigned a LPN for the day, I'd write down the time that all my medicines had to be done. I would print my flowsheets, which were 7 pages per patient to hold my assessments and notes. I'd print extra order and progress note sheets for the chart, and print telemetry strips for my documentation.
Report had to be given in the room. This was a technique used to save time to prevent accidental overtime, but I always felt uncomfortable since usually the patient was asleep or there was family/friends in the room. I felt that telling the patient's information aloud risked privacy, but I was told that I would be written up if it wasn't done this way.
After report, I'd set off to do vital signs and assessments, since my ancillary staff would mope and disappear most of the time. If my LPN was there, I knew she had her own medications to prepare to be done. I'd complete vital signs and assessments, sometimes not as thoroughly if I knew I had 10 patients to assess. I'd do the best I could and be sure everyone was at least safe with nothing life-threatening going on.
I'd chart all the vitals on the charts and make sure that there were no new orders that were looked over. Meanwhile, when my CNA was eating breakfast and chatting with the laundry man. If my LPN were present, I'd sit and prepare to open my charts.
Most of the time, I'd get one or two charted before I'd get a call from the light requesting bathroom or pain needs. I'd help the patient, often alone since my other staff member was overwhelmed preparing meds. I did it with a smile on my face and used this time to do more assessment and teach the patient about related teaching material and safety issues.
With frequent patient needs, often it would be an hour or more before I'd return to chart my vitals. Each day is different, but on a day when the census is high, I don't always even get 8 o'clock vitals charted before the 12 o'clock vitals are due. I would delegate them to the CNA when available, but many times my delegation was ignored, no matter how many times I told the staff to do them.
Meds were sometimes late. Trying to contact the doctor and get yelled at for asking a question about a clarification become a normal occurrence. I was told that I should stop calling so much and the physician and the - RN who rounded with him when it was convenient for her - would laugh at me and talk about me while I was running around since I get called for 2 admission beds while the doctor lets 4 be discharged.
They are all ready to go right that minute. I, or my LPN and I, are the only ones available to take out IV lines and other lines that are present. We have to do all the teaching and help the patient get dressed. In addition, we have to manually write out medication schedules and dosages and when to take them and often call the pharmacy for new medications for the patient to pick up. When sent home with wounds or new equipment, we had to make sure they understand it. Needless to say, 4 discharges at once is a lot for 1 RN and 1 LPN to handle, much less if it is 1 RN and 1 CNA. The ER calls to say they are bring the new chest pain patient now since we didn't get them yet, and then the others, and I have to take report now.
I have one patient pull out his IV and want to leave stat. I go stop the bleeding and tell him that I'm doing the best I can to get the paperwork together. Meanwhile, the doctor is shouting verbal orders at me, and when I ask him to write it and I'll get it in the computer, he yells more. My new chest pain patient arrives to a room that isn't set up yet, and the patients already on the floor need noon meds. The baby in one room has a mother call about a fever, and a total care patient hasn't been turned in over 2 hours.
I can't get caught up quickly. As a new nurse, I try to prioritize as well as I can. I see my director at the desk, but she offers little or no assistance. I am running my feet off, and if I weren't so busy, I'd probably already be in tears.
An hour later, I finally have all my discharges gone with as much teaching as I could provide while the telemetry monitor is alarming and a bed alarm is going off because a patient is trying to get up. I am the only one who is licensed to read the monitor, so I yell for my LPN or CNA to check the other patient.
I check on the telemetry patient and they need a 12 lead EKG since they are c/o chest pain 6 on a 1-10 scale. I have only glanced at my 2 new admissions to be sure they were breathing and not in any acute distress. I run to get the EKG machine and perform it and administer nitro SL x2 and then try to get someone to come to the floor to help me waste the additional morphine that I needed to give right then. After the chest pain patient reports pain relief, I reassure them and hand them the call light, making sure they feel that they are the most important patient I have (because to me, all of my patients are equally important).
I proceed to grab the 20 page admission packet for one of my new admissions and go in to pleasantly introduce myself and assess them. I verify medication records with them and try to get them all written on the MAR, while clarifying insulin orders since there is a new order sheet the doctors aren't familiar with and consistently check one that isn't consistent with the remainder of the orders.
When the CNA is the only other staff on the floor, I have to run back to the ER to get a 2nd nurse to verify insulin dosages with me. Not that it isn't a great idea, but it is very inconvenient to have to leave the floor even for a moment. I don't know which is worse, but it is policy.
I return to more chaos. More febrile children who didn't receive the scheduled antipyretic right at 1600. Patients who must be turned now, and stable patients who I haven't had a chance to see since my assessment this morning.
I feel that I am NOT providing competent care. I decide that it definitely needs to be addressed with management, and I proceed to tell them how I feel that the patient ratio is something I am immensely uncomfortable with. I tell them that I don't feel it is related to me being new, because although I may be a bit slower, I feel that I am still a very good nurse.
I am met with reassurance that it is within expectations for me to be the only RN with however many patients there are, and that staffing guidelines indicate that I will be unless there are 20 patients on the floor. I return to the floor and have to hang a potassium drip on a patient with hypokalemia, and call to verify that I can put the patient on telemetry. I get yelled at for calling, but I feel that it is important.
By 1800, I get another set of vitals. I get a call that in addition to the 3 admissions I've already had, I will be getting 2 more. I prepare the rooms quickly, and check behind my LPN to make sure all the medications were appropriately delivered. Before my admissions arrive, I check the potassium drip and see it has started to infiltrate. I immediately remove it and run to gather supplies to start another. I am not an experienced IV starter, but I manage to get one in and restart the potassium, making sure the patient knows the s/sx of infiltration and to call me for any problems.
About that time, an outpatient infusion arrives and must have initial paperwork completed, a peripheral IV started, and medications infused. Sometimes, there are 2-3 of these throughout the day. Sometimes, there are outpatients who come for me to perform EKGs or pull PICC lines.
Anyways, I get my new admissions and assess them both. I complete admission paperwork and head out to write up MARs and input orders. I put the chart together and am struggling to complete it when the next nurse walks in, already overwhelmed by the census. I offer a brief moment of sympathy before returning to my madhouse in my own mind.
I turn to see my other patients charts aren't updated. On shift-change rounds/reporting, I make sure that everything is the way it is supposed to be. I get sad when I think about things that didn't get done right on time. I think about my assessments being sufficient but not excellent. I wonder if I forgot to do anything, or if any patients or families didn't get teaching they needed?
I scurry to finish my charting and be sure everything is done on my admissions so I can clock out to avoid overtime. By the time I finally clock out, I realize my bladder hasn't been emptied all day. I have yet to have a drink of water since I couldn't excuse myself to the break room and drinks aren't allowed anywhere near where I work.
I cry when I get in my car. I never imagined being a nurse would be like this. I always thought about the nurses who would hold my hand when I was having a procedure done. I thought of the nurses who would let me talk to them and genuinely sat down to listen. How did they have time to do it? Am I a bad nurse? More times than I care to admit I looked into other professions. I genuinely decided that if nursing is like this, I have no choice but to get out. Other nurses I talked to suggested that I try somewhere else, since this is not the standard.
What baffles me is how I just received a bill for over $1000 for a 3 hour ER visit with 90% covered by insurance. If the hospital is making this much money, why can't they hire enough nurses, since nurses are pretty much the core of healthcare? In my itemized bill, I saw my IV start was over $100. I know the supplies aren't that costly. And if I can start an IV in around 5 minutes, where does that money go? I know I don't make $1200 an hour.
So patients are expected to pay this huge sum of money for care that hospitals don't seem to care about providing? They get by staffing by the skin of their teeth, and seem to blame it on a nurse's poor time management skills. I know that if I'm going to pay so much for healthcare, I expect quality and safe care.
Anyways, I told my administrator last week that since my concerns were snuffed, I had to resign. I never wanted to return. I went in this morning with the flu since I called yesterday and was told I couldn't call in sick. Another nurse was there and she was ecstatic to see me since there were 10 patients and no scheduled LPN, just the CNA. I told her I was sick (she is the "charge nurse" who does insurance stuff) and she told me to deal with it.
I proceeded to puke in the floor. I had a fever. My manager said she forgot to call and say I didn't have to come in since I was sick. So I spent an hour driving there to be told I didn't have to come at all. I am not going back. I am supposed to work tomorrow and next week, but I don't have to. I don't even want to ever be a part of a hospital that would treat staff in this way.
Patients are the reason the healthcare system even exists. Without patients, there would be no hospital. With that in mind, nurses need to be able to care for those patients. We need adequate staff. We need better ratios. We need the support of trained ancillary staff. We need all of this not only for the nurse's peace of mind, but for the patient's safety as well.
