My first few days, as a new RN

Nurses General Nursing

Published

Here I am, it has been 6 days, since I have been off of orienation, I am disgusted. I took boards yesterday, keeping fingers crossed, but actually I'm a little worried about having the RN title, because that means more things that I have to do. Which that would be no problem, besides the fact that today alone I had a 9 patient assignement! Come on 9 patients? A experienced seasoned nurse shouldnt be taking care of 9 patients. I am a new graduate with 6 days under my belt, by myself. We are on a med-surge unit specializing in orthopedics and gynecology, due to the recent close of our OB/Gyne floor that is our newest addtion. My head is spinning, I cant keep up, I am trying like heck to get everythign that needs to be done, but I am not even coming close, I do not feel that it is my inability to do things quickly, I am moving at a very quick pace but, here is the question i pose, Why is it that a new graduate nurse or any nurse for that matter should have to take care of 9 patients on a daylight shift? Why do we allow these things to happen. I am curious to know from the California RN's how the patient:staff ratio is working out, does it work to have mandatory Ratios? Make no mistake it was not an easy patient assignent load either, I had 2 patients on complete bed rest, which were complet cares, I had 4 post ops, which besides PCA's, Foleys, dressing changes, and routine meds, have to be down for Physical Therapy twice a day. Also you have all your routine meds, pain management for the other patients, I was lucky if I say 2-3 of my patients once in the 9 1/2 hours I was there, and that was to give them there medications and give them a very brief once over, which is complety inadeuquate, but what are you to do... I was still passing medications at noon, of course no breaks, no lunch, and the 2 RNs, and Myself along with the LPN whom which all carried the same load today were sinking. We have a charge nurse who was taking off orders ect, and another RN that got mandted due to not having a unit secretary. Another RN came out at 11 to take over for the mandated night shift nurse. Why are these things happening, I feel fortunate enough that I am able to keep my cool and keep moving and doing the best job I can do. I feel that this is such a joke, and such an inadequate way to do nursing, THIS IS NOT WHAT THIS PROfESsion is about , I feel like im doing TURBO nursing. You walk in the room, and are trying to keep moving you cant talk to the pateitns, your in their for only 5-10minutes at the most, how are the pateints getting good care, why is our patients not getting excellent care! Why are we not able to do what we are taught a nurse is suppose to do? Doctors are coming in and out writing orders that you come and find or are told about 2-3 hours later. You simply dont have time, I did not sit down today, until 4pm 1/2 hour after I should be on my way home, I sit down to chart, and try to look at my hands my papers, and sort through and see who had what going, and what I need to chart, I finish that after about 45minutes, and I am not satisfied with it, but hey its 5:15, I am exausted my feet ache. One of my co-workers come to me and says, do you have heart burn yet? Dont worry you'll get it, and turns to our other co-worker and asks what do you take, prilosec or protonix? I sit and wonder to myself, they are serious aren't they? This is so sad. I love this profession, I love what a nurse is suppose to do, I want to help people and I want to go to work everyday and do the best job I can possibly do but this is rediculous, I am managing for the moment but I do not know how long this will last, until it catches up to me. I knew this was a tough profession, and that is one of the reasons I got into it becuase I wanted a challanging profession, BUT i didnt want a unsafe, tiresome, work yourself into the ground, barley remember your patients names at the end of the day. On account of HIPPA, I can not paint a complete picture of my patient assignment, but believe me when I say, It was definitly not an assignment anyone should have. My manager and charge nurse, knew it was bad they were trying to help, I can't complain about my co-workers, they try as hard as they can to help you, but they have 9 patients a piece, and their own problems to worry about, I cant blame them for not being a little annoyed, but again why is this happening?

I know this is not new, I know this is not a new concept, I also know this is happening all over the US. I just am very disgusted. My question to all of you out there is, WHat can we do to change this? Or has anyone encountered this at their hospital or facility and took a stand and decided to do something about it? I know that my co-workers want these things to change, but nobody knows what to even do about it. We dont even have time to think about it, we cant even stop for a moment to think, wereway to busy trying to give our patients 1/10th of the care that they deserve. Were doing our best, I am doing my best. I just cant keep asking myself WHY, and What can I do to make a change?

:madface:

Specializes in Psych, Med/Surg, Home Health, Oncology.
Hey Everyone thanks for all the support!!!

Just as an update to some of the questions that were asked

Yes, I am off of orientation, today was my eighth shift being off of orientation.

Yes, I just graduated June 2006, and I just passed boards as of 2 days ago!

I had 5 1/2 weeks of orientation which they offer 6 on that unit. Now do not get me wrong, If I would be handed 4-6 patients I do feel as though I could somewhat manage in a decent safe manner, busy but safe at least. Which is why I was cut a little short, and before yesterday, I did have the poor souls, that I was working with had to cover me while I was still a "graduate nurse"

I have one problem in regards to quiting or leaving, I went through the hospital and they paid for my school and I owe them 3 years. I really really really dont want to pay them back almost 20,000 dollars plus my student loans that I took out just to live for the 22 months in which at the time I thought was hell, wow was I wrong. That is one of the nagging things in the back part of my head, as I go through each day.

The second question I have to pose to everybody is Is it actually legal to not accept the patient assignment given to you, can you actually say no I am not taking that, because I was told that if you do so then you are neglecting your duties and your patients and can be held liable for that. That is why I pose how is the best way to handle that.

I do believe that my next step is to speak to my manager, she is for the most part a reasonalbe person, I do believe she is managing the best way she can minus, the fact that she is not fighting for her staff to the "powers that be"

Also to add the last 2 days have not been any better I didnt have 9 patients but I did have 7 yesterday and 8 today!!!

I dont know I am just very disgusted, and it is definitly unsafe, I just guess Im still in shock that this occurs. Of course only the patients suffer and maybe my bladder!

Hi,

First off, Congratulations on becoming an RN.

Well, as you can see I am DEFINITELY NOT a new RN. i have been doing this for the last 40 yrs. I have been a Manager and I have been staff for a MUCH longer. The Politics of Management go to me early in the game & I knew I wasn't meant for that. SO........ it was nack to staff.

The last 30 yrs has been on 8 hr. nites--full time.

It has been quite a trip!!

First off-- It is most certainly legal to refuse an assignment--as long as you have not yet accepted that assignment. I have always been told that once you acctually accept the assignment, if you then try to refuse, you could be cited for patient abandonment. So, If you come in & see that type of assignment, you need to refuse & speak to whomever is in charge BEFORE getting any type of report. You need to say that you feel this is an unsafe assignment & the reasons; Also your license is at risk here.

You know, I know you have worries about loans & such, but this does not sound like a really good place for you.

If by some awful circumstance, you end up sued or whatever for some mistake you might make when you have this unsafe assignment, you will have even more money problems. Just remember that if you get sued, they can say that a prudent RN would NOT have accepted an unsafe assignment.

Our Hospital is owned by one of Illinois's largest employers. We are a not-for-profit teaching hospital. Our management has been trying to go by california staffing guidelines. They really are trying & most nites now we don't get more then 6 pt's. Our day shift 5 at most. we also have Nurse Aides who are terrific. We are not Perfect, but better then it has been; HOWEVER, patient's today are sicker then ever. 10 yrs. ago, my patient;s would all have been in an ICU; Today, however, they are on my Med/Surg/Hem/Onc floor. The patient's in the ICU wouls probably not have made it, so nursing is a harder job then ever.

I know, at my age, you'd think I'd give it all up--it's TEMPTING--Believe me as the old bady is failing, it is tempting. However---I DO LOVE BEDISE, HOSPITAL NURSING!! And you know, there are not so many of us left anymore.

I also need the really good benefits I get here--a great HMO & a good pension plan. At my age, we think about those things.

However--Like I said---you can REFUSE an unsafe assignment; I have done it--i did not get fired.

Think about yourself and your future career.

mary Ann

Specializes in Education, Medical/Surgical.

I'm not sure if I should post this link as it comes from the RWJ site, but here is a good picture of how it should be.

http://www.nursesworldmag.com/articles-on-nursing/care.cfm/id/23.html

The title is something like after 15 years of tepid from the top management.....anyway maybe the tide is turning.

Specializes in ICU, ER, HH, NICU, now FNP.

As far as the legality of refusing any assignment - that varies from state to state and the method for doing so may need to be qualified using a certain form or process of notification.

If you are not familiar with this - contact YOUR STATE's BON - Do NOT rely on the advice of posters on this board who may or may not be in your state and under your contract situation.

You might also need to contact a labor attorney because some of this may fall under whistleblower protection laws in your individual state.

Whatever you do DOCUMENT EVERYTHING!!

Specializes in Med/Surg < 1yr.

I am a pre-nursing student due to start school in Feb 07. More and more I'm becoming increasingly frightened that I will regret going into the field of Nursing. I know this is what I'm meant to do but I can't imagine working for hours on end and not being able to eat a lunch or use the bathroom. Not only has this entire thread scared me (which I know was not intentional) but a recent experience also has my eyebrows raising. When my mother was in the hospital, she needed her PICC (sp?) tubes removed. The first person came in and I asked if she was a nurse. She said yes. I said I only ask because I'm going to school in Feb 07 to become a nurse. She said what in the world for? She wasn't able to remove the tubes from my mom's arm because she needed more pain med so about 3 hrs later another person came to remove the tube from my mom's arm (she was going home). I asked if he was a nurse and he said yes and I told him I'm going to nursing school in Feb. He didn't reply. I said what's wrong? He said you are crazy to enter this profession and if I knew then what I know now, there's no way I'd be doing this. He said we are overworked and are treated with little respect from the doctors. He said DO NOT GO INTO MED-SURG, people think you have to start there when you get out of school and that's not true. He said to start in ICU. But wouldn't I need at least a year or two of experience before I can work there?

Specializes in ICU, ER, HH, NICU, now FNP.

Many facilities hire new grads right into the ICUS - you do an internship instead of just an orientation though. (Which in my mind is a bit better)

In addition - some med surg units are better staffed than others. I worked float in one place where the tele floor was very well staffed and had a great manager, but the ortho floor was just a short staffed, under managed wreck.

Also - many companies own more than one facility - just because you have signed an agreement to work for a company in exchange for tuition and such, doesnt necassarily mean that you don't have options. There are other departments, other units, other facilities and often other locations.

Despite being completely overwhelmed at times, 12 hour days of missing lunch, and working in places I knew I'd never work again - I still wouldn't trade nursing for any other career. I still love the people I have met, the things I have been honored and priveleged to be present for and the human-ness of it all when I have not been working in a hell-hole such as the one you describe.

Standing up for yourself, sticking together with your co-workers, and going to management - or further - may be what you have to do to advocate not only for yourselves but for the patients in your care. Sometimes, that means changing jobs and telling managers and corporate types why.

At the end of the day - nurses just want to know that they have provided excellent care for patients and that they had the supplies, assistance and time to do so.

Specializes in critical care transport.
I have to say a contributing factor to the shortage would have to be at the nursing school level. I will soon be applying to a program that accepts once a year. Along with myself, about 500-600 other people will be praying they get one of the 40 spots. Many people wait 2-3 years to get into the program. This is not an anomolie (sp) and it is certianly not an elite school, this is a community college. If you read through the student nurses forum this problem exists across the country.

I am not proposing any solutions for this b/c I do not have any that have not already been discussed. However I truely beleive that the small number of students being accepted into nursing programs (in the US) influences the shortage immensely. Take care.

Joeydog-

This is why I was willing to move to Missouri! I am from Washington state, moved two years ago because of the slots vs. applicants numbers were not too favorable. I was ready to apply to EVERY community college in Thurston, Pierce, and King county, AND to PLU, even though I'd have to eat my kid's leftovers to do so. Here, they do not require the loads of volunteer, nurse shadowing, 4.0, or statistics for ADN. This year was the first time they had a waiting list, and being used to Washington, I took my dosage and calculation test as soon as I could. Had I waited an extra day, I wouldn't have gotten in.

Part of the problem is that hospitals only have so much room for students. I have to say too, that the programs up there sound (according to my friend) like they could really care less if you pass or not (this would be at two schools) and have heard of horror stories about the instructors making it extremely difficult, not caring or being helpful. I don't know how much so, it is subjective information, but here, it is not a big deal (still difficult, but instructors do care if you do poorly or wash out, and they are very positive and encouraging). Man I'm so glad to be here and be in the program I'm in. I'm loving it, and I can even deal with the couch dates of piles of index cards.

i have to admit that I took one of the lowest paying jobs in nursing in my area because of the promises that were made to me. Step -down icu, 3 patients. I also am a new grad, but thus far all promises have been kept. I would rather make 3 dollars less than my class mates and work somewhere that I feel respected by my supervisors. I hope you can find a similar balance.

here in the philippines some nurses would have 30 patients :) worst yeah

juls02: I so agree with you. Changes in nursing will only come when nurses step up and STOP accepting large patient loads, etc. Sound great in theory, but how do we do it?

We are not unionized in the South, and I don't know how I feel about unions/nursing. But I do know that something has to change. Hospital administrators aren't going to wake up one morning and suddenly feel remorseful for the patients and our plight.

I've been out of the loop for a while. Where's the ANA? Why isn't someone screaming for better care for patients and nurses?

I have been a nurse for 25 years. 5 of them as an LPN...an RN for almost 20 years...Most of the nurses that I now work with here in Georgia all meet in California. Yes... the west coast has a southern accent. 2 years ago on my second shift at a private hospital, there was no house supervisor. Nurses were going to have to have 13 patients a piece unless they had a super...I agreed as I've been there and done that, time and again in my long history...Women/Men... get a clue...I work now in a 44 bed ED level one trauma center in California. Most of the nurses I work with are from my home state of Georgia...Gettin' it now??? We have 4 pts in the ED. or 2 in the ICU or 3 in the transitional care unit. Pay attention. What do you not understand about the word... NO??? We work for an agency that affords us to fly there, pay for extended housing, rent a car for however long you'd like to stay and work. WE COME HOME WITH TWICE THE $$$ and NO BS...even after paying the above...

Fever has a good perspective on nurseing alternatives. Travel nursing is not for everyone but does look damn good on a resume when you find that dream job and want to settle down.

It seems that the OP is a conscientious observer who is getting swamped by the powers that be and I would refuse new admissions based on the acuity of my current assignment, in part being new to the unit, new grad and no preceptor support. Here in California we have wonderful ratios in place, doesn't mean I will get a CNA or LVN to work with, often I am primary. Being registry I tend to get the cast offs, or the frequent fliers no one else wants. It's a busy day for me and depending on the shift, usually wrack up some OT to complete my charting.

I spend a lot of time at the bedside with the patient and family and document every aspect of teaching or conversation, including the care I have time to provide. Wasn't like that in the old days. I often had 11 patients on a med/surg/tele floor. I didn't feel like I was able to make a difference to them at all, just treading water till some help got there.

Good luck new grad, you have a wonderful heart, you can take care of me or a family member anytime!

Specializes in med surg, tele, ortho, preop, recovery.
Quit While U Still Can.

Amen. Shouldn't it be against the law to give a nurse 9 patients? Thats like asking for medical errors and a lawsuit.

I have a good answer to why California is a better state to work in--don't hey have a really powerful nurses' union? Just a thought. To me, the idea of a good union for nurses is all about fighting for the best patient care, which means the best working conditions for nurses. I am not too concerned about the pay, relatively speaking, ours is pretty good.

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