This is actually my second year as a nurse. I was working at a LTC/SNF for a year. The whole time I dreamed and pray of a job at the hospital figuring I need that 1 year of med-surgical experience. I finally got called for a job in a big hospital here. I felt really excited at first. However, I finally know now why they say nurses eat their young.
I got a really awesome preceptor during day shift. However, I was schedule for night shift so I had to get a preceptor at night. this preceptor is fairly young around my age and has been a nurse the same amount of years as I. However, she has been working in the hospital the whole time.
I really feel stress out and overwhelmed. My old job was a lot of physical work but less mental stress. This job is a little less physical work but 2x the mental stress.
My preceptor told me that my charting is falling behind. She told me that I should be done charting around 10pm and that each assessment should only take around 5 to 10 minutes. Last night I had 6 patients. I literally was on my feet from 7pm (beginning shift) to 2 am passing meds. Then I got a small break ( I didn't want to because I wanted to get everything done but she insisted I have one. She told me that orientees should get 30 minute break so the hospital wouldn't have to pay). Anyways she said I should only focus assessing on the reason why the patient came to the hospital. In my head I figure how can you assess a person in 5 minutes without taking your stethoscope out and listening to their heart, breath sounds, and bowel sounds. You should check them from head to toe. There is no way she could assess those patients in 5 minutes. I never see here pulling her stethoscope out or even checking the patient feet. She told me I miss two medications for a male patient so she pulled the medication out. I was so tired that I didn't even check the name on the box. Luckily the computer caught it and pop up a warning sign saying this medications wasn't in the patient MAR. I went back and told my preceptor. She made me look like a total fool. She said well first of all its the wrong name. Well she should of looked at it before pulling it out and at least tell me it was for the right patient.
Most of the nurses at night pulls their computer to the nursing station to talk to each other and chart. I mean how could you possibly chart on the patient if you are not using the bed side computer. Then they drink their coffee and sleep. I literally saw one nurse slept throughout the whole shift. I was basically on my feet from 7pm to 2 am. Then got a 30 minute break and walked around till 9 am (Stayed over almost 2 hours to get things done). I had to hold my pee in until I got most of the medication and charting done at 2 am. I also heard my preceptor telling other nurses at the nursing station that I'm not up to par. I walk really fast and quiet so they don't know I'm coming up and I could hear them. Then they get quiet. I also talked to other 2 orientees and they also heard their preceptor talking about them. One of the orientees told me he overheard a preceptor for another orientee stating, "Oh gee, I have this person today (not mentioning any names), I'm going to be here till 9 at least." My friend heard his preceptor telling other nurses (Man this guy is too slow). Luckily the charge nurse is very cool and nice. I just don't know how they find that much time to sit down and chatter while I'm on my feet giving meds. I do my assessment while giving medications and at the patient bedside.
I don't think I'm meant to work in this environment. The turnover rate is extremely high. The longest one orientee work there was for 2 years. I'm just really stress out basically walking from beginning to end of shift and still hearing from my preceptor how I miss this and that. She basically sits and text on her phone then call me on the hospital phone to come check on a patient pump or that she need me to do something.
The sitters and CNA gather in one room and use the patient bedside computer. I had to chart and scan a patient. However, I was new and I didn't want to bother them so I just pull my computer in and even have to navigate through them to scan the patient and medication and do my charting while they look up houses and see if they could look up their background online.
I'm ready to quit. Its almost 2 months, and I don't think if I will be happy in the long run. I was happy at my old job and love my patients and want to go work. However, this new job almost made me cry and I'm a guy. I'm just afraid that I will lose my license at this job. I don't know if it would affect me finding another job. i was able to go to school fulltime and worked at my old job. I got my BSN this December. My old manager is also at a new LTC facility and told me to come work for her so I will probably do that. Any advice guys? Sorry for the grammar and mispelling. I have been up for 15 hours.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I probably know if I quit this hospital job than I would probably not get another job in the hospital setting ever again.
Is this such a bad thing? I personally would spend the rest of my career away from the acute care hospital if I could. If you enjoy SNF, LTC and LTAC, why be concerned about never working at a hospital again?
I understand that. for example, a patient coming in for acute exacerbation asthma. I check their breath sounds, respiratory pattern. If I leave dorsalis pedis pulse out she ask me why I left it out. I tried my best to do the radial pulse, but if you want me to do dorsalis pedis pulse I would have to check the patients feet. A patient coming in for acute alter mental status focus assessments should be on neuro checks and such. However, if the patient has an IV line then I must check to see if dressing is clean, dry and intact or any signs of phlebitis. In order to do that I must take a closer look at the patient IV. There were a nurse just last week that didn't check the patient fully. Turns out the next day the morning nurse found out the patient has a pressure ulcer. I just don't want to falsify any charting or leave something out and then someone else finds it. I heard the hospital must eat up the treatment if the pressure ulcer occurs while the patient is at the hospital.
Do not worry so much about what the other nurses do or don't do. Do your own physical assessments to meet your need for info and your standards. Read their assessments to preclude missing something, but do not rely on their work as the be all and end all, especially if you question their thoroughness. You will be held accountable for what you do or do not do, you will not be able to answer for them. Nor will they be able to answer for you.
Everyone else who's commented has been a nurse for several years, so I wanted to give you a new grad's perspective. I've been at my first RN job, a very busy med/surg floor, for just 9 months now. Seven months ago I felt EXACTLY the way you are describing in this post, as well as in a couple other posts I saw you had started. I'm urging you not to quit for several reasons. First of all, the probationary period and the orientation period are not always the same- my "probationary" period didn't even begin until after orientation. And even if you're off probation, it would not look good. To leave and go to this other LTC would be your 3rd job, all before you finish your bachelors. I think you should stick it out at the hospital for at least a few months after finishing orientation. Once you are on your own, things change a lot.
As for assessments- I guess it maybe depends on the hospital? On my unit we do a full assessment. I mean, I'm not testing all the cranial nerves or anything, but I do a quick head-to-toe. There's a couple reasons for this: at least where I work, any hospital-acquired pressure ulcer gets reported to state and we don't get reimbursed. And patients often times come in for one problem and end up having others. Patient comes in from pneumonia... so I'm not going to assess their sacrum? They're elderly, lethargic, not eating well, fragile skin - at risk for skin breakdown! Or patient comes in for COPD exacerbation but also has a history of diabetes. I'm going to listen to their breath sounds, but I also need to check their feet for breakdown or sores. Let's face it, in med/surg nursing, most of our patients have other co-morbidities that may not be the reason they came into the hospital but that we still need to address. Just because your patient is here for a UTI doesn't mean we stop assessing for swelling when they have a known history of CHF. Patient here for ETOH suddenly loses a pedal pulse and starts having warmth and swelling to their calf, you need to be able to catch that possible DVT. That being said, it's totally possible to do a quick but full assessment in 5-10 minutes. Have the patient roll to one side and check their skin while you listen to their lungs, assess LOC/neuro status as you palpate pedal pulses and check for edema, listen to bowel sounds as you mentally take note of tubes/foleys/IVs. Patient has a wound that needs to be dressed on their sacrum? Well you can assess the surrounding areas as you change the dressing. Multitask. It takes a while to learn to do this but the more you practice, the better at it you get.
I don't know why you would need to chart your assessment at the bedside. You can easily round on all your patients, have your assessments done on your 5-8 patients in under an hour, and then go take a seat at the nurse's station and start charting.
Judging from a couple of your other posts, I'm going to give you some advice that a professor gave me and that truly helped me a LOT this first year, especially while on orientation. Buy a small pocket-size notebook and write down everything that you do/encounter throughout your shift. Go home and on your day off, study it. It's exhausting and time consuming but it really helped me. Just a couple weeks ago I had to deep suction a patient with a trach - something I had never done. I had one of the other nurses show me, and then when I went home I pulled out my med/surg book from school and turned to the section about trach care. I now feel comfortable taking care of a patient with one, whereas three weeks ago I was panicky about it.
The first time you catch a DVT in a patient who came to the hospital for a UTI, you will feel good about yourself. When a patient who came in for a leg wound after falling suddenly develops lower extremity swelling, crackly lungs, and a cough, you'll feel good about calling the doctor and re-starting their home lasix (and you'll feel good for thinking to even look at their home meds list). But for the first few months all you can think about is the tasks and how there's not enough time to finish them all. It goes away. And I would hate for you to give up on this because your preceptor isn't awesome or because you're feeling overwhelmed. We all feel this way at the beginning. It takes time and practice. From your questions/posts you sound like a cautious but conscientious nurse. I urge you to give yourself time to adjust to the new setting.
This is a NETY situation how? I want to scream every time I see someone write it here.
I didn't think anyone here was implying it was a "nurses eat their young" situation. I think OP is just very overwhelmed, as many people are in their first hospital jobs, and doesn't click well with his preceptor. It happens and as OP stated, his preceptor only has 2 years experience as well. She is relatively new herself.
I didn't think anyone here was implying it was a "nurses eat their young" situation. I think OP is just very overwhelmed, as many people are in their first hospital jobs, and doesn't click well with his preceptor. It happens and as OP stated, his preceptor only has 2 years experience as well. She is relatively new herself.
The OP contained the statement "However, I finally know now why they say nurses eat their young."
"My old manager is also at a new LTC facility and told me to come work for her so I will probably do that."
Get that job lined up and guaranteed then go for it.
If if you have no desire to work in acute care and you know you are happy at the LTC facility, then go for it. Leaving after a few months does not look good, but if you stay a few years at the LTC facility, then no one will hold it against you. LTC experience is still relevant to many non-hospital jobs.
I agree with the other comments that you shouldn't quit while on orientation. You didn't say how long you've been at the hospital (I didn't see if you did), but everything changes when you're off orientation. While with a preceptor, you are basically at their mercy, following them and doing things the way they would do it. Their way, is not necessarily going to be your way. When you're off orientation, and have your own rhythm, you will find a way to get everything done, and they may include a complete head to toe assessment on every patient. I work in the ED, been off orientation now for about 4 months, and it is so much easier to function without somebody watching me, and telling me what they would do (not that I didn't appreciate the guidance or safety net, but just sometimes the comments were too much for me to handle, trying to remember the way that particular person likes things done, and remember that I should be doing things somebody else's way and not the way that I think is more comfortable or right for me). Give it more time, I think it will make you a better nurse. And if I heard people talking about me, I would probably confront them. Not only is it rude, but it's not right. Everybody has been a new nurse at some point in time, and they should not be pairing you up with somebody who doesn't want to be a preceptor.
I agree with the other comments that you shouldn't quit while on orientation. You didn't say how long you've been at the hospital (I didn't see if you did), but everything changes when you're off orientation. While with a preceptor, you are basically at their mercy, following them and doing things the way they would do it. Their way, is not necessarily going to be your way. When you're off orientation, and have your own rhythm, you will find a way to get everything done, and they may include a complete head to toe assessment on every patient. I work in the ED, been off orientation now for about 4 months, and it is so much easier to function without somebody watching me, and telling me what they would do (not that I didn't appreciate the guidance or safety net, but just sometimes the comments were too much for me to handle, trying to remember the way that particular person likes things done, and remember that I should be doing things somebody else's way and not the way that I think is more comfortable or right for me). Give it more time, I think it will make you a better nurse. And if I heard people talking about me, I would probably confront them. Not only is it rude, but it's not right. Everybody has been a new nurse at some point in time, and they should not be pairing you up with somebody who doesn't want to be a preceptor.
THIS.
Look here on AN for "Brain sheets" and tailor it to what you need that will help you become organized.
Also, not every preceptor is ready or a good fit; however, continuing to have honest upfront conversations with your preceptors to ensure that you get the most and the best outcome of orientation.
Also, you are going to have to do self-studying; you are in a new specialty; you have to learn to bridge the gap of what you learned in LTC and the higher acuity that you have on a Med Surg floor.
I will try to stick it out. The thing is my preceptor had a talk with the manager. She wanted me to come in an extra day next week. I already was schedule for 4 days next week. Coming in an extra day will make it 5 days on 12 hour shifts. (She feel that I need more time) 2 days straight with one day off then 3 days straight again. I'm already tire as is walking on my feet for 14 hours a day. I stay about 30 minutes from the hospital without traffic. Then I don't sleep right away as I get home either. I don't know if I'm will able to do that many days in a week. She already talked to the manager about it and the manager said its ok. I will have to call the manager to ask her to extend the week instead of trying to fit it in one week.
TheCommuter, BSN, RN
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