Nurscee's Freaking Out!

vablueyes · Feb 22, 2005

We have the same response from our management..their response was "I'm sorry you feel "stretched" but there isn't anything we can do."....in other words, tough crapola, you are the nurse, pull up your britches and handle it. It is a very unsafe environment for the patients, but they won't care until something awful happens.

As for Saskrn....I doubt you were able to give precise care to 13 "acute" patients rightout of school. Perhaps my defininition of "acute" is different than yours. Acute is almost 1:1.....Perhaps 1:4 at best...no WAY 1:13.

SmilingBluEyes · Feb 22, 2005

We have the same response from our management..their response was "I'm sorry you feel "stretched" but there isn't anything we can do."....in other words, tough crapola, you are the nurse, pull up your britches and handle it. It is a very unsafe environment for the patients, but they won't care until something awful happens.
As for Saskrn....I doubt you were able to give precise care to 13 "acute" patients rightout of school. Perhaps my defininition of "acute" is different than yours. Acute is almost 1:1.....Perhaps 1:4 at best...no WAY 1:13.

boy is that the truth. :rolleyes:

melpn · Feb 22, 2005

Well, congrats on being a normal, sensible human being. The job may or may not be too tough for you (the patient load actually sounds pretty reasonable)but it's not appropriate for a new grad. Hospitals, subacute and LTC are famous for giving a lot of lip service to the nice, long orientations but sister, it just doesn't happen in real life unless you demand it. And you should. Don't go in yelling about everything. Let them know you feel you're making progress with (whatever you feel you have a decent grip on), but you do feel a bit over-whelmed with the rest. Let them know you really want to work there and feel you will do an excellent job with the proper orientation. Ask around to other facilites in the area and find out what their orientation programs are like. In my subacute facility, established nurses get 2-3 weeks, new grads get 8 and then we see at that point if the need more help in certain areas. The nursing shortage is no excuse.The potential for making mistakes is higher when your brain is scattered in a million directions. Don't fail to mention this to them as well. Good luck, stand your ground, please know that it isn't always like this. I'd be worried about you if you weren't freaking out. Always remember to take a deep breath, let it out as slowly as possible, repeat x2

nurse01 · Feb 22, 2005

I ran into a similar situation when I first became a nurse, BUT we had a 6 week orientation with a preceptor right there with us. It takes awhile, probably a good 6 months or a year to get the time management thing down. We always have 8 patients, and when someione is discharged, the bed is immediately filled. Do not get discouraged...it does get better, and one day when you aren't thinking about it, you'll just be doing it. You'll be a great nurse--Hang in there!!

Help! I've only been a nurse for a month and a half.
Last two nights I've worked 12 hours (supposed to be 8) that's not the big deal though.
First I had 7 patients alone....won't even go into the hell that was.
Then tonight I had 6 but 5 were on insulin, and one of them was a every hour 20 units of insulin.
That isn't to mention the wet to dry dressings, pegs, brain surgery, and other various and sundrie items.
Not only that but this antiquated hospital still only does handwritten documentation. No computers.
I dissolved into tears. Don't know if I can do this!
YES, I DID ask help. But we have nurses who have 9 pts. They have their own share of problems.
Did you ever feel like you'd freak out????
Did you ever feel too dumb to do this????
Tell me I can make it, or not. Got ANY solutions?
Is my life long dream to be a nurse just a pipe dream?
HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Private Peds Nurse, LPN · Feb 22, 2005

Thats why I do private nursing. Been doing this for the past 8 yr, and the hospitals do not have enough money to make me want to work for them ever again! Try it....it's awsome, and the pay is great!!!!

Help! I've only been a nurse for a month and a half.
Last two nights I've worked 12 hours (supposed to be 8) that's not the big deal though.
First I had 7 patients alone....won't even go into the hell that was.
Then tonight I had 6 but 5 were on insulin, and one of them was a every hour 20 units of insulin.
That isn't to mention the wet to dry dressings, pegs, brain surgery, and other various and sundrie items.
Not only that but this antiquated hospital still only does handwritten documentation. No computers.
I dissolved into tears. Don't know if I can do this!
YES, I DID ask help. But we have nurses who have 9 pts. They have their own share of problems.
Did you ever feel like you'd freak out????
Did you ever feel too dumb to do this????
Tell me I can make it, or not. Got ANY solutions?
Is my life long dream to be a nurse just a pipe dream?
HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

lisamilgrim · Feb 23, 2005

well you see im new out of school as well but working in a nursing home i have 35 pts. My orientation was following the nurse around for 6weeks before i graduated and watching what she did no hands on stuff. We still do documentation by hand no comps and i have to do the insulin and all treatments that have to be done not to mention all the g-tube pts we have. Its tough and only after being on my own the last 6weeks or so i understand fully why there is nurse burn-out. Hang in there because i believe we are in a wonderful profession with great rewards.

lossforimagination · Feb 23, 2005

Actually, I ran my butt off, and was proud of the work I did and my patients were very thankful. I think it's unfair that you are making judgements of my care.
There are plenty of facilities in the US right now that have larger ratios than 7. I have done 13 in the US relatively recently. How long have you been an RN? What kind of patient load are you accustomed to?
I think the most important thing is that you speak up if you are overwhelmed.

I would never take report on 13 patients unless I knew they were all walky talkies, self sufficient types and not inclined to use the call light. I learned that 8 patients was my limit with no aide, but it's bare minimum personal care....forget about a bed bath. To hades with staying overtime to chart, if I had done much of that I would've quit nursing in a few months. If several patients are confused and climbing out of bed, then having 8 is seriously, really dangerous. I just pray I don't have to work the floor again. Ten years was way too much! I can't believe I actually did it that long without ending up a psych case.

Private Peds Nurse, LPN · Feb 23, 2005

Well I don't understand why nurses kill themselves working in nursing homes, hospitals, doctors offices, etc, when I have the best job in the world, and make an excellent salary. No doctors to have to put up with, except when I have to call a doctor, and the one doctor I work with for my private patient is wonderful!!!! And no killing yourself with lots of patients on the floor. I still say private nursing, be it contract, or working for a nursing registry, is the way to go.....and still have your sanity when you get home, and not be burnt out!!!!!!!!! I still say try it, it can't be beaten! :-) Oh and believe me, there is a shortage of Home Health Nurses, why???? Sure beats me:uhoh3: I know this, I sure won't change jobs:)

well you see im new out of school as well but working in a nursing home i have 35 pts. My orientation was following the nurse around for 6weeks before i graduated and watching what she did no hands on stuff. We still do documentation by hand no comps and i have to do the insulin and all treatments that have to be done not to mention all the g-tube pts we have. Its tough and only after being on my own the last 6weeks or so i understand fully why there is nurse burn-out. Hang in there because i believe we are in a wonderful profession with great rewards.

3ladybugsmom · Feb 23, 2005

Aaawwwww, I'm just a CNA and I don't really know what to tell you other than hang in there. (((((((((nurscee))))))))))))

You are not just a CNA. CNA's are important too :wink2:

Be encouraged Nurscee.

kaufmlin · Feb 23, 2005

I feel for you. I am sad to say, the nurse patient ratio overload is occurring all over the USA. I am curious about the acuity level of the patients you were assigned and accountable for providing all the appropriate care and treatments ordered, constantly checking the charts for new orders written that might have been missed, if you had nurse aides available to help or if they were available but had an attitude problem which management should nip it in the bud immediately.Three years ago I took on a job as a telemetry nurse. I noticed that staff were transfering out like rats on a sinking ship and at that time I was in orientation so my case load was low. The hospital marketing did a wonderful job of tv commercials showing that we had bedside computers with all the necessary equipment in each room to do a complete set of vital signs, and O2 SAT check ,etc.this particular area of the state they had the only computer system where you read the bar code on the patients wrist band and checked it against the bar code on an individually packaged medication which allowed you to have made sure that you had the correct med for the correct patient at the right time. The computer checked bar code of the patients ID bracelet against the bar code on the individually packaged medication which you had carried into the room. If it was the right med, right patient, right dose, right time, you gave the medication and then documented each med you had to give into the computer. You had 1 hour to gewt this done, otherwise you were considered having given your medications late. REALITY CHECK: the unit only had at that time 6 working portable computers. Staff assignments were made out by the charge nurse at the beginning of the shift. The staff was kept at bare bones minimum and some were sent home, they were not on call,but yet needed to be available to come in if needed. On a good day you had a ratio of 6 patients to 1 nurse. ( I felt it was still a little excessive for a tele floor that received and required close monitoring of post angiogram/ cardiac cath patients straight from the cath lab. Many patients were older and needed total care. There were days were had no nurse assistants to help..and then on the days we did have some help ...it appeared that the more aggressive, in your face, nurses( few but they were present) always had the extra help and the Charge Nurdse and management played ostrich and chose to pick their battles carefully. They were still losing staff. One day I had 9 patients, all total care, no one going home, all were to be up and walking for their cardiac rehab, and I was to be receiving two cardiac caths back from the cath lab almost back to back in time. Let me tell you, the unit was each man or woman for themselves. No one helped each other. Nurses would pull the computers out of the rooms receiving cardiac caths....they needed them too.....the hospital mandated that we be documenting our caths on the computer.

Lucky me, the cath lab came up and delivered a patient who had a clean cath and had been perclosed. They wheeled her into her new room. I began my head to toe assessment while hooking her up to our telemonitor and WOW WEE!!! The patient had a huge grapefruit sized hematoma to her right side, way above the cath site and her B/P was 60/ systolic. I started a fluid challenge, set the dinamap to take vitals every 4 minutes. The nurse from cath lab said, " Oh, that was not there in thecath lab, it must have happened when we moved her into this room." ( She had not yet been transferred off the cath lab cart...and had not been in the room a full minute when I saw this. I said there was no way that this occurred " just now", that she had to have had it in cath lab or it developed during their transport. I went and got a C-Clamp and put it on until I could speek to the cardiologist who had done the cath. I paged him over head, I called the Cath Lab and they were not answering their phone which meant they had started another procedure. I paged the Dr. on his pager. In runs my helpful Charge Nurse, best friends with the cath lab nurse. The patient was moaning dueto pain from the C-clamp. What does my great and helpful charge nurse say??? Why did I not call her. OOPS! So Sorry. " You did not post your number of the phone you were carrying today"...and I also thought the patient was my first priority and finding out the truth of the matter, and receive a full report from the cath lab RN. The other nurse with her kept her mouth shut and never said a word. My charge nurse then thought she would give some morphine for the pain without looking at the vital signs, asking what had been done so far, etc and did such a beautiful job of quickly pulling out of her pocket and pushing 10 of Morphine IV. Well great, now my Systolic B/P was 40/. The Charge nurse commanded to the nurse at the head of the bed, " Give her a fluid challenge!!! Run it wide open!!!" We took the C-Clamp off. The doc later came up and said the patient was going to have a nice sized bruise but would be fine. I continued to monitor her and check on all the other patients I was overseeing. LESSON #1.

ALWAYS AND IMMEDIATELY FIND AND WRITE OUT AN INCIDENT REPORT.. IF THE PATIENT IS STABLE, RUN, DON'T WALK AND GET ONE QUICKLY!!!FILL IT OUT, STATING THE FACTS, NAMES OF THOSE INVOLVED, TIMES,ETC,WHO GAVE ANY MEDICATIONS,, VITAL SIGNS AT THE TIME,ETC. YOU GET THE PICTURE??? I am sorry to say that I was too busy taking care of my patient to think I was going to be set up. The next day the Department Director called me into an office on the unit. She had a Green Incident report form filled out by guess who??? The helpful Charge Nurse. I was blamed for the patient having the hematoma. It was documented that I gave the Morphine 10 mg IV that caused her B/P to bottom out more to 40/systolic. It was documented that I did not give a fluid challenge, and that I just stood their and watched making no efforts to help the poor suffering patient. I was told to sign the form..which I refused and I said that what was documented was no where close to what REALLY OCCURRED. I was told signing the incident report did not mean I agreed with what was written but that I had read it. I still refused to sign. I wasthen told that I was being placed on two months probation due to this incident. I was also told ( I had 7 patients on this day ) that I would be receiving two patients from the cath lab and that they would be coming back at pretty much the same time. I was furious inside. I have seen nurses set other nurses up before but I had never had it occur to me. You can bet your money I will never ever fully trust other nurses. There were motives by the Charge Nurse .. she would cover her Cath Lab friends butt and cover her own for pushing the morphine. It was documented that I had given the morphine. I asked the Director for a clean white sheet of paper. Several nurses had been allowed to go home early this particular morning. Sorry guys.

Some one would be returning. I wrote on the whitesheet of paper that I was resigning my position on telemetry, effective immediately. I documented that what was written by the Charge Nurse on the incident,false statements, lies, and was not anywhere close to what had truly taken place. I documented that it was the Charge Nurse, not I who had given the Morphine ,nd she had bottomed out the patients blood pressure by running in the room and taking over on a patient that was being appropriately cared for and being observed.

When you go look at new job possiblities in the future, notice the stability of the unit, just because they say staff? patient ratio is 1 nurse for 6 patients, plan on having a larger case load than this after you are done with your orientation. And always, always, be sure to carry your own malpractice insurance coverage. Do not expect that the hosapital is going to always be there to stand behind you and be your buddy. Healthcare is a cut throat business now, they look at profits and losses. If it helps them save money by sending some RNs home..even though its going to put added pressure and stress on the rest of the team, to bad. I know this all sounds very negative but I have been burned more than once. You learn your lessons quickly.

Best of luck to you in your new role. Think about how the staff on the unit you are working on ... are they true team players and will help you. Is it I will help you only if you help me? Is it I am in overload sorry dear you are on your own? Keep your eyes and ears wide open.

tinkerwomp · Feb 24, 2005

I empathize and sympathize entirely. I am just into my first month on Med/Surg Oncology/Hospice. I love it and do not regret my decision to become a nurse, but I am totally whipped! THEN when you ask for help (sometimes, not always) they tell you the ten other things you forgot to do in addition to trying to juggle the immediate problems. I threw a hissy the other day and told them that if they wanted competent care done, they had to back off on my patient load until I felt comfortable. If you have a preceptor for orientation, it is her license too. Remind them of ....the .....LEGALITIES!!! :rolleyes: :Melody:

BETSRN · Feb 24, 2005

I empathize and sympathize entirely. I am just into my first month on Med/Surg Oncology/Hospice. I love it and do not regret my decision to become a nurse, but I am totally whipped! THEN when you ask for help (sometimes, not always) they tell you the ten other things you forgot to do in addition to trying to juggle the immediate problems. I threw a hissy the other day and told them that if they wanted competent care done, they had to back off on my patient load until I felt comfortable. If you have a preceptor for orientation, it is her license too. Remind them of ....the .....LEGALITIES!!! :Melody:

Wait a minute here..........if you are already an RN (even though you have a preceptor) and a new grad, it is NOT on your preceptor's license, it is on YOUR license. You need to remind yourself of the legalities. You are NOT working under another's license if you are already licensed yourself.