New Rn Grad. Sub/acute, overwhelmed and sad. Thoughts please???

CryssyD · Nov 15, 2015

I worked for years in sub-acute, and this situation sounds kind of nuts; are you just out of school, or have you had some med-surg experience? Because you're right, 10 patients and 1 admission for a nurse still in orientation sounds really unsafe.

Sub-acute means different things to different people, but I'm accustomed to these patients being ventilated, tube-fed, on tele, on IVs, with Foleys, central lines, wounds, recent surgeries/CVAs, altered mental status, impaired mobility, stuff like that: 10 patients like that are a real workout unless you have superb CNAs and RTs--and even then it can be rough. And on 3-11, when you have families around--yikes.

Now, your co-worker may have a point about time management, because clustering care and being very astute about prioritization are very important skills in this particular specialty. But if everyone seems to be resorting to "shortcuts" like leaving necessary things undone, the patient loads are too high.

If you are brand new at nursing, though, 10 days' orientation is just not enough. Maybe you should have a candid talk with your manager? It's OK to say you're feeling a little overwhelmed and unsure you can provide safe care for so many patients at this point. Always focus on what is safe for the patients--those are magic words: no one wants to put the patients at risk--or, at least, no one should.

If you do have that talk, and get told to suck it up, this is how it is and 10 days is all you're going to get, maybe you should look into a friendlier place for newbies. Brand new nurses need to be fully oriented, not thrown in at the deep end.

Good luck.

TheCommuter, BSN, RN · Nov 15, 2015

With the ratios the OP mentioned, I suspect this is subacute at a SNF or the Medicare rehab wing of a nursing home. In that setting, it is normal to have anywhere from 10 to 25 patients, a.k.a. residents.

Time management is king in this setting. You must hurry up, vitalize the patient, medicate them, change any dressings, and move onto the next person. Spend no more than 10 minutes with each patient because you have a mountain of charting to do.

In addition, get off the 3-11 shift ASAP. It is a horrible shift for new grads due to the volume of new admits and family interruptions.

xanderfan · Nov 17, 2015

It's been still a crazy experience. As you mentioned the load is not unusual for this setting, it's not quite acute nor is it long term but it's still dealing with patients with high acuity, enough to give me chills and palpitations. I've been feeling overwhelmed yes and frightened and that hasn't changed and I've realized from speaking to other workers that it's just the job. They say theres a very high turnover rate, people just don't stay. I spoke to my DON and she gave me 2 more days of orientation, 2 that's it. At this point, i'll give it a month. If it doesn't become at least bearable or even doable i'll quit. I really wanted a job any job so that I could be marketable/hireable as a nurse and that's all i got, other than home care. I don't want to say i'll give up nursing but bedside caring so far especially in that setting is not something i like at all. I can see myself become a very different person if I deal with that stress for long. I've already become short tempered and easily anger and it's only been a few days, imagine doing this for months if not years. I just can't. I'll give it a month and I will try my best, do it the right way, the safe way. If it doesn't work out, I'm going for something else. I'll try another freaking career before I take those scary shortcuts. The loans will wait for me as I learn something else.

Sorry I think I'm seriously depressed and sad and in a funk, don't know how to come out of it. Trying to stay positive but i'm already in the negatives for that battle. I don't mean to be whiner just needed to vent a little and it's best someplace where someone can relate.