I've worked at my first job in nursing for just shy of 2 years, 1 year nights and most of the past year days. It has been a ROUGH past year, as I'm seeing everyone is experiencing. I made it through my first year of nursing constantly feeling like I wasn't keeping up, but I've found my groove. I'm still running ragged, but now I recognize that our hospital-wide acuity has increased, folks are delaying hospital services and coming in much sicker than before. Our unit has increased in physical size with a move to a different floor, but we have not increased staffing to match and we can't retain the staff we have. I don't know any different, but generally floating to other floors is a relief, and float pool says our floor is particularly rough due to patient population being minimally mobile and prone to falls, and little to no CNAs. We are severely understaffed with nurses too, but who isn't? However when I go to other floors and have the same number of patients, I don't feel as exhausted at the end of the day. I know my manager is trying to hire nurses and CNAs, but there's not been enough applicants, and we still bleed staff faster than we can get more.
Few people are trained to be charge nurse, and most often a nurse will be thrown into the charge rotation because the scheduled charge called off and someone had to cover. Well, you survived once, so now you're it. The worst case of this was with a new grad RN with only 3 weeks off orientation (back when we were a much smaller unit). She did OK, but she eventually left because she was stressed all the time from being charge most of the time while still learning to be an effective and efficient RN. Recently I had to be charge on a day without CNA coverage and I had a more than full load myself with all other nurses having a 1.75 load. It was pretty awful, but fortunately one of the regular charges (a nurse that has been a nurse a little shorter time than me) came in for the last few hours to help me wrap up paperwork and set assignments.
My manager took some time to train me for charge and the plan was that I would be ready if that happened again. Now one of our full-time day shift charges just quit and I'm terrified that I'm going to be charge every time I work. My manager knows I don't want to be charge, but I don't know who else can do it. For the day shift, there is only one other RN with more experience than me (but less time on this unit and hospital), and the rest are all less experienced and frankly ill-suited for this role. There's a few PRN nurses with more experience, but being PRN means they can't be charge under our pay structure. The experienced full-time RN has charge experience, but doesn't want it any more than I do.
I know I'm a competent RN, but the situation of our staffing and the accuity has made everything so much harder. I frequently have trouble keeping up with charting because I'm doing all the CNA work for total care patients and my load is usually 1.5 to 1.75 of the staffing ratio on our staffing grid.
But I'm not ready to be charge. I don't have the breadth of experience to be charge. I generally know what to do or who to call in an emergency, but that is according to my experience of 2 years. For more complicated things that aren't a clear emergency, I really don't know that I can be a resource for the rest of the nurses. I'm also worried about the patients I have as charge. Generally we give charge the "easy" patients, but I've seen those go downhill fast too, and sometimes there's just no "easy" patients. Our charges also consistently take a full load, while everyone else takes a more than full load.
I'm not done with my BSN (took the COVID year off and had some delays getting back into the program due to the long break), and I wanted to finish that before moving on to a new job. I do like my work, but I know that it isn't what I want to do forever. The unit I want to go, Oncology, is occasionally hiring, but not as often and not the ideal shifts/FTE for me. My manager is fully aware that this unit is not my forever home and supports my growth towards my preferred nursing goals. I think she even knows that I may leave if she overextends me as charge. And in truth, I am already looking.
We had an open round table with upper management yesterday and I attended after a particularly difficult day. I brought up my concerns of new grads being charge and all the other nurses at the table from various units chimed in about how dangerous this is and how much faster these new nurses burn out and leave the hospital or nursing all together. The upper management rep reworded the suggestion to "consider not putting new grads in charge position until they are several weeks off orientation". I stopped her and said "No, my suggestion is to not put new nurses in the charge position until they have years of experience, not weeks or months. Ideally these nurses should have 3 years of experience." The suit pursed her lips and didn't amend her notes. This really bothers me. I don't care if this is the way it is done. It isn't safe. I don't care that they don't have the staff. It isn't safe. They should work more on retaining our experienced nurses, not burning out the new nurses, and providing fair pay all around. Finding nurses is their job, not mine, but I am tired of being put into unsafe situations and being told it is normal.
Ugh. I wrote another book, and as usual I'm not looking for any specific answers. Mostly I just want reactions from those that have been there.
