Help, I hate my job

DUDERNGUY, BSN, MSN · Aug 23, 2014

I am a new grad, working at a LTAC and I absolutely HATE it. If this was all nursing had to offer, I would quit the profession. I cry every single day at the thought of going back, even on my days off. The nurse/patient ratio is 1:10, this is very overwhelming to me as a new grad (I am still orienting, so my preceptor still guides me), this is not a place for a new grad to work. It feels like a step-down ICU to me. Does anyone have any advice for me? Stick it out in misery until I find something else? Would quitting make me look like a quitter? I am so overwhelmed. Is this a normal part of being a new grad in the work force? Hating it? Thanks for any advice.

sounds like you are stressed. it can be somewhat normal when you start a job in nursing. sounds like you want to give up and quit. Dont. Jobs are hard enough to come by. Try to stay organized. Have a paper system that allows you to understand who your patients are, there dx, code status, pmh, reason for admit, labs/tests that are relevant, and assessment. Gather as much information as you can from report. Then look at your patients meds/treatments/orders for the day. Plan you day according to those and assess during your first med passes. Work on developing a system that works for you. dont give up. it can be very hard.

SquishyRN, BSN, RN · Aug 24, 2014

Is this a normal part of being a new grad in the work force? Hating it?

Short answer? Yes. Read this article by Ruby Vee: New Grad/Hate My Job/Life is Miserable!

You are not alone. If you'd like to read a snippet from my own first year in nursing, you can read my post in THIS thread. And yes, LTACHs are hard. The patient population we get at my LTACH were the "hard" patients on the Med-Surg floors at the hospitals I did my RN clinicals. When I would tell the nurses at my clinicals where I worked as an LVN, I would automatically get props since they were familiar with our patient population because the hospital is a feeder hospital for my LTACH.

Anyway, now that you realize the first year of nursing is hard regardless where you start, before you consider quitting, think about this: Where would you like your nursing career to end up? What specialty are you interested in? Will working at that LTAC help you develop skills that will allow you to be marketable to whatever field you chose? BTW, if the specialty you are aiming for is anything in acute care, the answer to that last question is a huge resounding YES. Many of my former coworkers got their first year experience at my LTACH and now work in regular acute hospitals, some in ICU because of their familiarity with vents and drips, both of which are very common at LTACHs.

amzyRN · Aug 24, 2014

Wow that sounds crazy! How can they justify such a high ratio if the patients are so acute. Are they all DNRs or something. How do you give meds to that many people and do an assessment? There's got to be some skimping on something, right? I've heard of med/surg units with 8/1 ratios, but ICU level patients 1/10. Insane! I'd be worried about my license. Maybe it's time to consider relocating out of state for your first job.

Ruby Vee, BSN · Aug 25, 2014

The first year of nursing is absolutely miserable, and the only way to get through it is to GO through it. Easy for me to say now that I've BEEN through it, but we've all been there. It's miserable. You hate your job, your life is miserable and you cry more often than you ever thought probable. It gets better, but it takes a year, more or less. Changing jobs won't help . . . you just have to start all over again. Sometime toward the end of that first year, something just "clicks," and you realize that you CAN do this, and maybe it isn't so horrible after all. I hope you find that moment sooner rather than later.

CapeCodMermaid, RN · Aug 28, 2014

Wow that sounds crazy! How can they justify such a high ratio if the patients are so acute. Are they all DNRs or something. How do you give meds to that many people and do an assessment? There's got to be some skimping on something, right? I've heard of med/surg units with 8/1 ratios, but ICU level patients 1/10. Insane! I'd be worried about my license. Maybe it's time to consider relocating out of state for your first job.

An LTAC is NOT an ICU. The med surg nurses around here complain if they have more than 6 patients...really?

Here.I.Stand, BSN, RN · Aug 29, 2014

Big hugs!! LTACH is a really, really tough environment, and you're a new grad on top of it. The one I worked in had admits directly from the ICU I work in now (level 1 trauma) and from our Burn ICU. I float to stepdown fairly often in my current hospital, and in my experience my LTACH pts are more acute than stepdown. Or some may not be as acutely ill, but are WAY more time consuming...some of our burn pts and paras/quads with multiple stage IV pressure ulcers had wound care that could take two hours. And the psych issues that go along with being critically ill for months....oh the issues!! I'll tell you, my first job was as a floor nurse in my area's university hospital. We had severe brain pathologies, kids with pulmonary issues since birth (CF, PPH, etc.) yet had aged out of the peds pulmonary world. We had fresh trachs and lumbar drains. Neuro checks every four hours (every two if we were assigned to the stepdown room (yes room, not floor). The most gruesome facial surgeries imagingable--necessitated by cancer related to years of drinking, smoking, and chewing. I found 4 LTACH pts to be more overwhelming than 8 typical hospital pts!

All that siad, I would stick it out. You're brand new, not even on your own yet. It is overwhelming at first, but you haven't even been there long enough to really get it. It will get better! Besides, it doesn't look good on your resume

newbieRN724 · Sep 7, 2014

The ratio. 1:10 is a lot in my LTACH. The most I have ever had is 6 and I had my own pct for my patients. The patients that come into LTACH are very ill with multiple issues.

txspadequeenRN, BSN, RN · Sep 9, 2014

A ratio of 1:10 is WAY to high for LTACH... There is no way care can be completed or even attempted with this ratio. If I were you I would look at other LTACH's and check their ratios.

Esme12, ASN, BSN, RN · Sep 10, 2014

sadly I have seen an LTACH with very high ratios....is this days?

THese are very sick patients with a very high acuity. No they are NOT all DNR patients but they are complicateed recoveries with extensive co-morbidities, complicated wounds, and vents. There are ICU's at some LTACH's and the highest ratio is 4:1 but these patients are sick with lines and vents.

The first year stinks!!!!!!!!!!!!!!! NO way around that. Stick it out you WILL learn a lot and it will suddenly make sense...((HUGS))

MarrahRN91 · Sep 23, 2014

I made a post similar to this a few months ago actually. I was in this exact situation and I stuck it out for an entire year, and I dreaded going to work every single day despite the fact that I worked part-time. I stuck it out simply to gain experience and I definitely believed I have developed quite a bit since then. I thought about quitting multiple times but people would also tell me that being an RN with no job isn't better than being an RN with a job and they were absolutely right. After almost a year I got a job in the area of my interest. Hang in there and if this particular area isn't working for you maybe try a different LTC facility, sometimes there are some really good ones and other times not so much. Also it never hurts to keep applying to jobs of your actual interest. Good luck!

brujacakes · Mar 11, 2015

I too am in my first year of nursing & working my first job as a new grad in LTC, 7 months in. I can say I am as miserable as you sound and think about calling off everyday I have t go into work. 46:1 patient ratio w/ 2 CNA's on nightshift, as the only RN on nights, I am also responsible for the other 45 patients downstairs under the care of an LPN should anything change in a resident's condition.

I have experienced every emotion under the sun in the course of one shift, been written up multiple times for making mistakes on things I was never trained to do (ex. chart checks), been called at home on my day off a million times demanding I work extra, to scream at or to involve me in yet another investigation of some sort of incident which happened.

I have survived 7 months of hell, learned a ton about covering my own azz, prioritization, triage, time management and am grateful for the knowledge & the full-time paycheck & know that I am paying some serious dues as a new grad.

BUT, I am transferring into a med/surg position within the hospital we are attached to hopefully by the end of the month. Bottom line, I can not remain THIS unhappy and stressed out indefinitely, I will have a heart-attack or need to check myself into the behavioral health unit before I make it a year, lol. And, more importantly, I feel my license that I have worked so hard for and spent a lot of money on is seriously at risk. I know the grass is not always greener on the other side but when one door closes.......and I am slamming this one shut and blocking it out at risk of suffering some serious PTSD.....in order to allow a new door to open.

My point is, you are NOT ALONE. I am convinced the only jobs available to new grads are the absolute worst ones, worst shifts, and that is "paying your dues", it will improve/ change when new opportunities become available to you, changing jobs is always an option but be clear on why (my license is at risk/ for me) and never look back. The advice given here is some very good advice but changing jobs (not quitting) is always an option which is a really nice thing about nursing.

I felt my license was at risk at this facility from the first shift I worked by myself and in hindsight, which is always 20/20, I should have got out while the going was good.

Life is too short to be miserable :-)