From PCT to RN, does it get better?

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Hi all! Just wanted to prick some minds for a second. I was feeling pretty down after an awful shift. I work on a busy PCU floor as a PCT with 18 beds. I work both evenings and overnights. During the evening shift we get two techs (each gets 9 patients) and all is usually fine and dandy. Well a past overnight they cancelled the other overnight tech saying that we didn't have enough patients to call for 2 overnight techs and we should only have 2 if all 18 beds are filled. Well through the night of course we had admissions and by the end of the shift I was working with 17 patients. Nearly all of of patients are incontinent, need q2 turns, q4 vitals, and at least 4 needed oral care d/t being on vents or NPO or comfort care or whatever else. I guess my point is that it was completely unreasonable to think that I could take adequate care of these patients alone. It literally burns me to know that I am not providing adequate basic care to someone because there simply isn't the time and the company wants to save $100 by cancelling the other help. I'm not sure what to do it what I can do. Does it get any easier after making the transition to RN? Please by no means take that I think the RN job is "easier" as we all have different tasks and focuses. I just feel like I am burning out. Maybe I just care too much and expect that I can accomplish the impossible? I feel like it's a big safety issue but I also know management isn't likely to do anything since I am 100% replaceable. Any thoughts? Sorry for the lengthy post.

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Well, I wish I could lie to you and say yes, it gets better, but in a lot of cases, it doesn't. I don't know, it depends on where you work (as in geographically....union or not), what kind of specialty you work in, and what kind of setting you work in, really. Nurses are trying their darndest to enact change, but it's slow going, and we have so many battles to fight in healthcare right now that nurse to patient ratio is just one of the raging infernos that we have to put out in an already scorched landscape.

When I was a PCT while I was in nursing school, I worked LTAC at an "upscale" facility that supposedly was the "nice" place to send grandma. I still had 18 total care patients to myself, I still ran my butt off, and I still felt like I was doing a HORRIBLE job with those patients and wasn't able to give them nearly the care that I wanted. As a nurse, things got better for me, but that's because I went into a totally different specialty (OB/nursery/mother-baby), and of course that was almost 20 years ago.

It's hard. There are days when I feel like my care was great, like I really made a difference, and I feel satisfied with what I was able to do and happy that I made positive change in someone's life. There are days when I am just happy to get out of that hospital with my patient alive and my name officially signed off the chart as no longer liable for their care.

I wish I could give you guarantees and promises, but I can't. Some days will really be awful, and some will be great. It's part of the package that comes with being a nurse, and it's something that only YOU can decide if you're willing and able to take on.

Best of luck to you. :cat:

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Specializes in Med/Surg, Ortho, ASC.

Please. No pricking of minds.

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Well, I wish I could lie to you and say yes, it gets better, but in a lot of cases, it doesn't. I don't know, it depends on where you work (as in geographically....union or not), what kind of specialty you work in, and what kind of setting you work in, really. Nurses are trying their darndest to enact change, but it's slow going, and we have so many battles to fight in healthcare right now that nurse to patient ratio is just one of the raging infernos that we have to put out in an already scorched landscape.

When I was a PCT while I was in nursing school, I worked LTAC at an "upscale" facility that supposedly was the "nice" place to send grandma. I still had 18 total care patients to myself, I still ran my butt off, and I still felt like I was doing a HORRIBLE job with those patients and wasn't able to give them nearly the care that I wanted. As a nurse, things got better for me, but that's because I went into a totally different specialty (OB/nursery/mother-baby), and of course that was almost 20 years ago.

It's hard. There are days when I feel like my care was great, like I really made a difference, and I feel satisfied with what I was able to do and happy that I made positive change in someone's life. There are days when I am just happy to get out of that hospital with my patient alive and my name officially signed off the chart as no longer liable for their care.

I wish I could give you guarantees and promises, but I can't. Some days will really be awful, and some will be great. It's part of the package that comes with being a nurse, and it's something that only YOU can decide if you're willing and able to take on.

Best of luck to you. :cat:

Thank you for the thoughts! I have no idea how LTC facilities do what they do because would never make it. I have two classmates one in ED and one in ICU (both techs) and they absolutely love it. Maybe it's time to look for a new floor? I am starting my 9th month but I think you might need to be a full year before making a lateral move which would be in February. I graduate in May. Is there even really a point? Just keep trudging?

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Specializes in Neuro, Telemetry.

Side note: PP said they worked and an LTAC. Very different from LTC. LTAC is a smaller scale hospital that provides acute care in an extended stay environment. Basically patients with complex wounds, vents, and patients requiring hospital level of care past the time frame insurance will cover a regular hospital stay for. Generally 2-3 weeks +.

Anyway, I work at an LTC/rehab as well as an LTAC. My main job is LTAC and I get 4-6 patients depending on acuity. The CNAs get 10-15 depending on census and if we can afford the extra help. However, the nurses are fully expected to be helping with all "basic" cares and it is not solely the CNAs job. Your facility should be doing the same thing and holding nurses accountable.

If a patient gets a pressure injury, develops pneumonia, falls out of bed, gets poor dentition, whatever, it is on the nurse for. It ensuring care was done, not the CNA. I help my CNAs as much as I can. When I say I can't help, it's because I really have to be doing other things they can't do and they understand. But 75% of the time I help. Gives me the chance to get a good assessment in, I usually pass any meds due, change lines, whatever. If nurses bundle their care a bit around helping the CNAs with turns, oral care, bed changing, bathing, answering lights, then both the nurse and CNA can get more done more efficiently.

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You have those days, do your best and move on. I kind of enjoy those days when I'm moving around a lot. You should be asking the nurses to help you. They can do their own sugars, take a few vitals, oral care etc. Don't be stuck in a silo by yourself, communicate with the nurses. I do my own sugars and vitals when we're short a tech. I've given baths by myself etc, patient care comes before my charting.

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Side note: PP said they worked and an LTAC. Very different from LTC. LTAC is a smaller scale hospital that provides acute care in an extended stay environment. Basically patients with complex wounds, vents, and patients requiring hospital level of care past the time frame insurance will cover a regular hospital stay for. Generally 2-3 weeks +.

Anyway, I work at an LTC/rehab as well as an LTAC. My main job is LTAC and I get 4-6 patients depending on acuity. The CNAs get 10-15 depending on census and if we can afford the extra help. However, the nurses are fully expected to be helping with all "basic" cares and it is not solely the CNAs job. Your facility should be doing the same thing and holding nurses accountable.

If a patient gets a pressure injury, develops pneumonia, falls out of bed, gets poor dentition, whatever, it is on the nurse for. It ensuring care was done, not the CNA. I help my CNAs as much as I can. When I say I can't help, it's because I really have to be doing other things they can't do and they understand. But 75% of the time I help. Gives me the chance to get a good assessment in, I usually pass any meds due, change lines, whatever. If nurses bundle their care a bit around helping the CNAs with turns, oral care, bed changing, bathing, answering lights, then both the nurse and CNA can get more done more efficiently.

Aaaaaaaaaaaaand, I realize I misspoke. I worked LTC. Sorry about that. Let me make that correction. It was LTC, not LTAC. Thank you for pointing out such a critical error, so sorry about that.
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Specializes in Neuro, Telemetry.
Aaaaaaaaaaaaand, I realize I misspoke. I worked LTC. Sorry about that. Let me make that correction. It was LTC, not LTAC. Thank you for pointing out such a critical error, so sorry about that.

Hope me I didn't come off as snarky. Some people just truly don't know the difference. LTACHs are becoming more popular, but still not well known everywhere yet. It's easy to mix the two up.

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Hope me I didn't come off as snarky. Some people just truly don't know the difference. LTACHs are becoming more popular, but still not well known everywhere yet. It's easy to mix the two up.

No, not at all! I really appreciate the correction, truly. :)

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The monetary compensation definitely becomes better when you transition from PCT to RN. When you are being paid three to four times more money to deal with the crap, the work suddenly becomes a less bitter pill to swallow...

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Specializes in Critical care.

There are good days and bad days. I worked this past weekend and to be honest, it was awful. I work work day shift on a tele unit and I had 4-5 patients on Saturday (1 was discharged halfway through my shift) and 5 on Sunday. Saturday was the worst of the 2 days. We had very needy and heavy patients (workload and assist wise) and only 1 aid on my unit for the day. There simply wasn't enough time to get everything done. I kept up with turns and did them on my own when I could, but wasn't as spot on as I usually am. I did oral care and a partial bed bath for my patient with a peg (who required time consuming bolus feeds) and needed turns. I did as many vitals on my patients as I could to help out the aid, including all of the 8am ones- my unit is q4. I wish I could have gotten certain patients up and walking more, but I at least got them OOB to their chairs and up for 1 walk if appropriate. I missed a couple of bladder scans and ortho BPs (I don't think it made a difference in care for the day and I made sure they were done the next day). Overall I'm satisfied with the care I provided- I ran my butt off and truly did my best- but I am not happy that I feel like certain aspects of care were compromised d/t short staffing.

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There are good days and bad days. I worked this past weekend and to be honest it was awful. I work work day shift on a tele unit and I had 4-5 patients on Saturday (1 was discharged halfway through my shift) and 5 on Sunday. Saturday was the worst of the 2 days. We had very needy and heavy patients (workload and assist wise) and only 1 aid on my unit for the day. There simply wasn't enough time to get everything done. I kept up with turns and did them on my own when I could, but wasn't as spot on as I usually am. I did oral care and a partial bed bath for my patient with a peg (who required time consuming bolus feeds) and needed turns. I did as many vitals on my patients as I could to help out the aid, including all of the 8am ones- my unit is q4. I wish I could have gotten certain patients up and walking more, but I at least got them OOB to their chairs and up for 1 walk if appropriate. I missed a couple of bladder scans and ortho BPs (I don't think it made a difference in care for the day and I made sure they were done the next day). Overall I'm satisfied with the care I provided- I ran my butt off and truly did my best- but I am not happy that I feel like certain aspects of care were compromised d/t short staffing.[/quote']

That's the awful part, right? Like literally knowing that it is physically impossible to do it all. I have no idea why management thinks it's ok to cut staff on the weekend. Just because we discharge 4 people doesn't mean there isn't 5 people waiting in the ED. Like what's the worst case scenario sol you have extra staff? Patients get better care? Better staff morale? Obviously that doesn't matter.

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