Is this normal for a first year nurse?

[Ellie-Mae]

I graduated in May of 2013 & started on a postpartum/mother baby unit in September. I moved from New Mexico to Tennessee for this job and I took it mostly because I had put in nearly 100 applications as a new licensed grad and got one interview and one offer which is where I currently work. There were some red flags when I first applied for the job, first HR refused to send my application to NICU and would really only send it to my current unit, the manager had asked me to fly out for 2 days but after my interview and shadow day I never heard from her again until a week to 10 days later so I spend my second day in a hotel room confused and upset. She never called to offer the job, HR emailed me the offer. I was the only new grad out of 7 of us to be put on nights but I requested days. I got a 3 month orientation which I felt was acceptable for my floor but right when I got off orientation I felt like I could no longer ask questions or for help from certain nurses including the nurses the oriented and trained me. Since January I have seen 5 nurses leave (4 of those were on nights), we have also lost a CNA and secretary on nights but my floor continues to fully staff day shift. My nurse manager left suddenly about 2 months ago and we still have no replacement. Guidelines set by AWON which is what we follow says my patient load should be 8 patients which is usually a mom and baby couplet. However I have had up to 12 patients some shifts and that includes total patient care because we are short on CNAs. I feel like I can never ask for help and I end up getting the worst assignments or admissions. My floor is high risk and we take everything from basic postpartum/newborn patients to high risk postpartum and newborns that would typically be seen in a transitional nursery and even sometimes the NICU. The level of acuity of our patients don't affect our assignments or admissions. I never had a desire for postpartum but I was desperate for a job, my thought process was it involved newborns and I eventually want to do NICU (which is what I always wanted) so it was experience that would help. I told my manager when I interviewed I wanted to do NICU and that I didnt see myself doing postpartum forever. We continue to loose nurses on nights with no immediate relief to fill their spots. My dream NICU is vanderbilt and they have an opening right now that requires a years experience. I find myself fighting to not apply and risk ruining my chances there because I'm not quite at a year yet. Is this normal for a new grad to yearn and pine to get out of her/his current job for one that is almost out of reach? If so any advice, I'm very much in love with new born nursing and every time I have an infant that would be seen in a transitional nursery or NICU it feeds my desire and re-affirms my passion for that type of nursing. I would greatly appreciate any advice any nurse could give me!

[Lev, MSN, RN, NP]

I think what you're feeling is totally normal. Unless the application for the NICU job has as screening question that asks "Do you have at least 1 year of nursing experience", I say go for it! You've been a nurse for 9 months. If you apply now, it may be at least a month til they get back to you. Then if you interview, it may be another month til you are offered the job and actually start working (hypothetically of course). By then you will have been at your current job for 11 months! One month shy of a year!

[Ellie-Mae]

Thanks for your advice Lev, the job description lists the minimum requirements which are: Job requires Graduate of an accredited nursing program and 1 year of nursing experience required. Pediatric experience preferred. Previous NICU, Critical Care, Emergency or ICU experience. That was taken directly from the job listing, I think where my hesitancy stems from is will I make a bad impression on the hospital by applying before I meet the minimum requirements and how do I tell me current employer I want to apply and use them as a reference without burning the bridge with them causing tension or an unfavorable environment if I apply and don't get the option to leave my current job. If any of that makes as sense at all.

[iPink, BSN, RN]

I work in postpartum and certainly don't take care of 12 patients. I however understand that you are taking the job because you needed income and it's a stepping stone to get to your passion as a NICU RN. Though, I think it's wise to wait till your year unless you know someone personally who could get you in at Vandy. If you apply now, you may be up against nurses who have the minimum requirement.

Hang in there and make sure you are in good standing with your nurse manager in case there are NICU openings at your current hospital. Again, waiting till you have a year in PP, speak to your nurse manager about your desire to transfer to NICU.

[Ellie-Mae]

Thanks for your advice Ipink, we do couplet care and I have had up to 6 high risk couplets some nights, we are a 30 bed unit so a max of 60 patients when you add in the babies, some nights we only have 3 or 4 nurses scheduled with one CNA. So on top of the 6 moms and 6 babies I have I then become responsible for all of my baby care including vitals, feedings, baths, ect. Which I would be fine with if I didn't have 12 patients. Sometimes I don't think patient safety is a first priority on our floor. We also have no manager so our floor is kind of running itself in that sense. I mentioned to my manager when she interviewed me that NICU was my passion and I eventually wanted to end up there, she seemed unfazed by this. Our NICU is not a place I would like to work, I would like to see more ECMO, vents, surgeries, premies, and birth defects. Our NICU consists of mostly drug withdrawal babies who can no longer stay on our floor and withdrawal on their own so we transfer them, they see the occasional respiratory distress, infection, or micro-premie but the majority of the infant's are there for withdrawals. I can only hope Vandy will have an opening in the fall, I feel like they don't open a NICU spot often

[iPink, BSN, RN]

I'm on a 35 bed unit and we usually try to staff between 11-12 nurses, but sometimes we are understaffed, but I completely empathize with you. Are all your moms vags or a mix of vags and c-sections? On the days I'm working as mom nurse, I have vag patients and due to the low acuity I take on more patients. But my nights are usually spent helping in the nursery to feed, bath, or doing PKUs for them because I have the time and they appreciate it. Not all the nurses on my unit volunteer in there because they are not fans of the nursery.

However, not all babies need to be bathed, and some babies are solely BR feeding. As new grads we struggle most with time management and prioritizing and we sometimes feel patient safety is being compromised. When I started in progressive care, I had 5 patients with 3-4 being total cares, thrown in the occasional 2-4 point restraint patient and all had some type of drip or IV meds running. Nurses, not techs, were responsible for taking q4 vitals on our patients. I worked day shift and had to round on each patient with doctors and consults. If 5 different docs, that means 5 times rounding (not including the consults). And then there was dealing with the patients' family. There were days I had no time to eat or use the bathroom. I sometimes stayed late for an extra hour after work just to chart. The travel nurses hated working on my unit and there had been times newly hired techs quit within a day or two. I too contemplated if this was normal. Within a year, I had gotten better and learned new words like "no" and "wait" without compromising patient safety and care.

If you feel you want to give it a shot at Vandy, then apply. I believe there's an option when you apply where you can click "currently employed" and they won't contact your manager. Also look for other NICUs since you're not interested in transferring to NICU at your hospital.

[Ellie-Mae]

We have mix, there is no less patients because the majority of them are c-sections. And we don't get a choice between being in the nursery or not, if your not in there someone has to be in there. Mostly our babies are breast and I can spend 45 minutes in a room assisting with that. I am required to round every 2 hours not including times when I am called into the room. I don't mind doing my baby stuff and I am usually up on my charting where I leave when the other nurses leave most of the time. But how is 12 patients needing to be in there room every 2 hours safe. I can do it if no one needs anything, I can't exactly so no I can't help your breastfeed or no I can't walk you to the bathroom. I usually can say I will be with you in a few minutes but sometimes that isn't true. I asked a charge nurse for help getting a new vag up because I was dealing with a CHT mom who's meds weren't working and her pressures were in the 200's over 100's 2 days after her section. The charge nurse simply said "are you serious" and wouldn't do it. So I had to deal with the Doc for Patient A, get patient B up and Patient C was being discharged at 10pm so I was doing her paperwork along with answering the pediatricians questions. No one wanted to help me and I don't think that situation was safe at all. We don't have even 11 to 12 nurses employed on nights, we have 25 on days and maybe 10 now on nights, majority of nights is part time so we don't have full staffing all week. On nights when we have 6 nurses its like a present. Most of our babies and moms are high risk so nothing is typical or easy going. Most of our babies should be in a transitional nursery or end up in the NICU by 48 hours. Sorry if anything sounds angry or directed towards you, its not I'm just upset with the position I'm in but I'm scared to leave for fear I won't find work else where or by applying I will burn a bridge with the current hospital I work for. Its hard to vent to people who don't understand nursing so its nice to have a forum where people do understand the frustrations we as nurses face.

[iPink, BSN, RN]

You were doing the right thing by focusing on your patient who was experiencing high BP levels. Since you aren't receiving the help that is needed, then start looking for other units at different hospitals. You may have to apply to med/surg or even PP again at Vandy just to get your foot in the door. I personally wouldn't leave until you have an offer unless you can afford to leave without a few paychecks. Good luck to you! Hang in there.