New nurse staying way past 9:30 pm on day shift

Nurses New Nurse

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Hello everyone,

I am a new nurse and this past week was my first on my own and also my first 4/4. I work at a very busy med surg floor and needless to say I feel very stressed/overwhelmed being on my own.

I am so scared of making a big mistake. I usually end up giving some meds late like very late :((. Even though I try really hard it is very difficult with 9 patients. I had two patients with PEG tubes so those really made me late for meds for all the other patients. On top of that, doctors want me to round with them, management, new orders, critical lab value reports ughh just remembering it all makes me hypertensive lol. I have stayed very late until 10 pm or worsee 12 am (that day was crazy).

I absolutely LOVE my job and my patients, but it is too much. I usually end up thinking of little things that I should have documented but didnt. I stay up late documenting but even then I feel like my documentation is not very good. I am scared those four days I was on my own I made a mistake I didnt catch.

There are a lot of things I could have done better for my patients but could not since I was very busy. I don't know if I should talk to my director and ask her.

Time management with meds and documenting is my big issue. Anyone have any tips to keep up with documentation/passing meds on time/ provider notification? I also give meds one by one so I take out the mediction for one patient and then go give it, then I return to the med room take out medications for next pt. and give them. I dot he same for insulins but I am beginning to see not everyone does that. How do you all pass meds? one by one too?

Any tips/advice/suggestions are welcomed,

Sincerely,

A stressed out new nurse.

9 pts on MedSurg! Omg, what state are you in? That's just insane, you my friend are a nursing rock star for even attempting to do everything for 9 (!!) MedSurg pts! I hope you have good CNAs to help you out. ( I would help you big-time) no wonder you're staying after so late! Our nurses have 5 pts. Of course at night the aides have 12 pts on my MedSurg floor, time management is crucial. Hang in there- I hope it gets easier for you. Hugs

Specializes in SICU, trauma, neuro.

Oh my goodness... in subacute we had 10 pts, and some days that didn't feel safe!! 9 pts is never ever reasonable for med-surg. EVER.

Ok so your manager can't get staff until October... 1) well yeah, nobody with experience would be willing to care for so many pts! so 2) for the love of Florence Nightengale, get agency staff!!!

I am willing to bet that your colleagues are cutting some serious corners to finish on time. And even with 15 yrs' experience and TWO pts -- no I don't pull meds for more than one pt. It's asking for errors.

The docs want you to round with them... yes in a perfect world that would be great; particularly for communication. But you cleeeeeeeearly don't work in a perfect world. You have your own rounds to do, and you can't have them interrupted more than they have to be. If they have questions absolutely they should feel free to ask -- but with 9 pts you DON'T have time to follow drs around.

Specializes in LTC.

Having to grind up pills or dissolve them in water to put it through a PEG is a pain in the ass. I'm so glad the patient I have now only has her meds in liquid form.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Busy med-surg unit...9 patients on day shift...PEG tubes. I can't even imagine. This is definitely where "time-management" becomes synonymous with corner-cutting. The bean counters in your hospital are high-fiving each other for how far they can push the envelope and how much money they're saving.

Do they not harp about how much overtime is getting racked up? Please do not tell me you are working off the clock. Do what you have to do, but I would at least start formulating an exit strategy. This job will eat your life and suck your soul.

I'm sending you hugs. For what it's worth.

Specializes in Med/Surg/Infection Control/Geriatrics.

I must agree with my colleagues. 9 is waaay to many. These patients today are the ones that would have been in ICU 30 years ago.

Perhaps a sit down meeting with your Director of Nursing might be a good idea. Respectfully but firmly explain your staffing concerns for safety and your predicament when the docs want you to round with them.

As for how you are passing your meds, keep doing what you are doing! One patient's meds at a time. Is someone cross-checking your insulins with you???

Take care of your body and your license. And get out of there as fast as you can.

Specializes in Med-Surg, NICU.

Time to start over.

I left my floor because of this crap. Seven patients, being forced to sit 2-3 hours out of a shift, minimal aids..it was terrible. One night I called supervisor and told him he needed to come relieve me NOW. I had been stuck sitting with a patient for over an hour and had seven patients who were being unattended. A couple months after that I put my notice in. Staffing there has gotten better now but I only work there PRN.

Time for you quit before you lose your license.

9 patients at once is way too much.

That said, when giving meds, get your "quick" passes out of the way first. That way they aren't delayed for passes that will take longer (the ones where patients have 20 medications).

It is sad that nurses allow themselves to be put into such terrible working conditions. You are basically doing the work of 2 nurses!

But as long as you and your colleagues are willing to stay in order to protect your resumes and the cost of your contracts, it will continue.

Your hospital does not value safety. If they are short 4 nurses, they should have those empty spaces filled by an agency nurse every single shift. If they say you will have 6-7 patients in October, that's what they believe is a safe staffing ratio. So why are they willing to be unsafe until then????

Have they actually hired those 4 nurses? Have you seen their faces? Because unless they've already been orienting, they will not be working independently on the floor by October.

You sound like an intelligent, conscientious person and a great nurse. Protect your license and sanity and get out. Take the financial hit. On your next interview, ask about staffing/nurse-patient ratio. If they value nurses, your reasons for leaving this job will not be held against you.

I don't know how any nurse could safely take care of 9 patients! Why isn't your manager hiring some travelers until these new nurses that are supposedly going to be hired start? Also I would band together with my other nurses and send an unsafe staffing report to my manager, CNO, CEO, and anyone else with the power to make a change in staffing. Good luck to you.

I wanna say that this this just happened to me on last shift, yesterday. I am recently a new hire on a acute medicine/telemetry floor. Yesterday I come in thinking it would be an ok shift. That was my first mistake. Right off the bat we are short one nurse so a few of us had to pick an extra patient, which they happen to be heavy. I don't know what it was with doctors and our charge nurse yesterday but they were discharging people left and right. We must have had like 10 and as we all know as soon as you discharged a patient you get an admit. I had 2 discharges and one admit. I ended staying till about 9pm when I should have left at 7pm just to finish documentation. And today my manager emails me and says we need to meet & discuss your end of shift overtime. What pisses me off is that she adds a little blurb saying and I quote "It is very important for staff to not be here late and leave on time." Well I agree with her but how the heck do you leave on time when your short, deal with call bells, give out meds, process orders and lets not forget the documentation. And did I mention we have no support staff meaning no personal support workers. I wasnt the only one that stayed late to finish documentation. The people who stayed late were the ones that had discharges and admits.

I'm so sorry to hear you are going through this, please don't feel bad that you are leaving "late". Seasoned nurses also leave left if they need to. I can relate to you. I agree with other nurses here saying that you might get burned out if you continue working like this, I know because I did. I've loved welcoming new grad nurses because you guys bring into nursing this freshness and passion and excitement about even the little things and you change seasoned&somewhat burned out nurses' outlook. I am a nurse since 2009 and in my first job (usually 3PM-11PM shift, but I was rotating between day,PM and night shifts and even doing doubles) I left work At 1am or even 2am!! and it made me feel like I didn't know how to manage my time even though I basically ran and cut my break to just few minutes to sit down and eat lunch and many times didnt have a CNA because our CNA was floated to different unit because according to the supervisor that unit needed our CNA more than we did) My second nursing job ( I had a good orientation and had better ratio 1:5 on telemetry/stepdown unit and we had resident MDs. I did night shift (7PM-7AM and left work at 7:45) and if had a late emergency I left 8:30 or even 10AM once to finish my charting) In my last job I did observation/telemetry with medical surgical/telemetry unit (they started combining these units because of short staffing) and sometimes I was floated to telemetry only unit, on another floor. The observation/telemetry unit nurses had 12 hour shifts and the medical surgical/telemetry unit nurses had mixed 12 hours and 8 hours shifts. It was extremely stressful working at this job because of the frequent low staffing, I started there on night shift (up to 8 patients and few occasions ended the shift with 9th pt just rolled up from ER and sometimes that pt was endorsed to next shift, but I still did still basic assessment and vitals and set up in the room. When I moved to day shift, I had 5-7 patients at any given moment, and even 8 at times. Honestly, when I moved from nights to days I felt like a new grad nurse when it came to doing discharges lol It was impossible to leave on time, and towards the end of working there I was leaving at 8:30PM, 9PM, 9:30PM (completing my charting of course). Before the units were combined, the typical day on observation/tele was at least 3 admissions, 2 transfers, 2 discharges to home or NH or rehab. After the units were combined (observation/tele with medical surgical/tele, the typical day was at least 2 admissions, 2 discharges, maybe 1 transfer, and when 3PM came, they made us "pick up new patients" because we ended up with 4-5 patients at 3PM so almost everytime at 3PM I picked up 1-2 new patients plus an admission, and had my regular patients whoever was staying. ( Basically, we were picking up new patients from nurses who had 8 hour shifts and were leaving at 3PM ). It was very very very stressful. So basically, I had a total of 8-10 patients during the entire 7am-7pm shift, including all these admissions, discharges, and transfers. ( On night shift, we picked up new patients from 8 hour shift nurses who were leaving at 11PM) There were no resident MDs. There was only primary team, the attending medical doctor and the consultant doctors (sometimes even few) and the RN is supposed to do all the calling for admissions, consultations, etc. We did not have our secretary and sometimes the secretary would come from the unit we were combined with and help out, but would not really stay with us so most phone calls were picked up by RNs and CNAs. It was just very chaotic. Because of all this running around my legs started to hurt really bad, not like regular soreness of typical nurse's day, but really bad, sometimes I cried from pain on the way home. There was so little time to sit during work, I think going to day shift aggravated my problem with legs. Once I put legs high on pillows and slept, I felt better. I noticed BP sometimes got high because of stress and started having more migraines/headaches.

Thank you for your response, workinmomRN2012. I asked about the ratio and was told anywhere from 6 to 8 patients. I really can't say the manager did not warn me that some days we could get 9 patients. I was also told nine new nurses (going for night shift and day shift) were going to be in orientation so everyone would be having 6 patients eventually. Four new nurses will be going to day shift.

During preceptorship we were getting 7-9 patients, but my mistake there was to let my preceptor take over 2 patients. So whenever we had nine patients, she would help me out pass meds and even call docs. She did it to help me out but now I am really struggling because I was basically trained to have 7 patients not 9.

I also see all my coworkers being okay with having nine patients so I really did not think it would be that bad of a situation. They were finishing on time those four days and even checking on me. I always ask questions but I never ask them to do something for me. Anyways, I really thought I was the problem not moving fast enough, but now I see 9 patients is really not safe.

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