Is this truly the reality of nursing?

[Reneeann25]

I am so incredibly frustrated with my job! I was told plenty while in school that nursing is NOT easy. I was told when we were learning proper procedures for skills, that you'd often hear nurses say "but that's not how we do it in the real world", but to never listen to them, and to always follow protocol. They crammed our heads with "prioritize, prioritize, prioritize!" but I didn't anticipate I would be forced to completely neglect certain nursing duties in order to prioritize and tackle the most important.

I am responsible for 39 patients. At any given time, roughly 3-6 of those require Medicare A / Skilled nursing care, 3-6 of them are skilled nursing care but only have Medicaid coverage. Four of them are hospice - in varying stages of the dying process - requiring lots of care. At least half of them have mental health issues, also requiring a lot of my time. Four of them are peg tubes, with 2 different times each on my shift requiring peg flushes, meds and formula. Two colostomies, and 5 of them with skin issues requiring dressing changes/wound treatments. One woman requiring lymphedema wraps which take about 45 minutes to wrap every other day. I have to prep approximately 15 lab reports each day, schedule appointments, manage consultations, deal with angry family members, as well as family members with concerns each day. I have to spend an hour in the dining room at lunch time verifying that patients are being served the proper diet, and monitor the dining area to ensure there is no choking, and watch for signs of dysphagia. I have to monitor and record dietary and fluid intake daily. I have around 15 people I have to apply some sort of cream or ointment to, and monitor skin daily for signs of breakdown. I am responsible for calling our medical director each day to report changes in condition and report lab results to - then writing and pulling orders, which involves calling each patients family members to educate them on the orders.

In addition, I am in charge of 2 bath aids, 4 CNA's, a CMT, and a restorative aid. It is my duty to ensure they are properly carrying our their duties. Two of those four CNA's are constantly rotating. We haven't had consistant staff or proper continuity of care in the year I have been a nurse and been employed there.

Furthermore, I am on my 4th day of training our new hire nurse ie - my new relief on second shift. The first two days I trained her on my shift, and the last two days, I have worked a double shift so that I may train her on the shift she will be working. I can see she is no where near being left alone yet. While I was there this evening, I spoke with the doctor for her, wrote and pulled all the orders, did her charting, performed many of her assessments, answered call lights and passed pain meds, and she STILL struggled to complete her duties. This is, I think, the fifth nurse I have trained for this shift, and it's exhausting work to train, only to see that it's quite possible she won't work out. But is the problem really with her? or with the expectations and demand our higher ups are placing on us as charge nurses? She was frazzled, and I found several times that she was leaving the nurses cart outside of patient rooms - unlocked, MAR wide open, and the narcotic drawer keys right on top - all unattended.

An example of what 15 minutes can look like at any given time is: I'm at the med cart outside of a patients room preparing meds to administer via peg tube - one patient wheels up to my cart requesting pain meds. I stop what I'm doing to get them out of the drawer - sign them out of the narc book, and sign them off on the PRN sheet. Before I'm finished, a CNA approaches me to let me know that patient in room 521 is lethargic, and difficult to arrouse. I put my half prepared peg tube meds in my cart so that I may go assess patient 521, and I pass 3 call lights blaring on the way. After assessing and leaving room 521, I realize I'm nearly out of compliance in administering the peg meds and rush back to finish. While I finish prepping them, I hear my name being paged for a call on lines 1 and 3 - one of them being the lab - surely calling to report a critical lab value that must be phoned to the Dr. The other is pharmacy calling wanting me to check the dosage on a newly ordered med, which I must look up. Another patient rolls up wanting pain meds. I now have only 15 minutes before lunch starts to check blood sugars and administer insulins. Sometime between now and then I need to fill out an SBAR communication form to alert the dr of patient 521's status change.

Ahhhh!!!

CNA's neglect carrying out nurses orders on answering lights in a timely manner, vital signs get turned in late, patients aren't being toileted and repositioned as frequently as they should. I get onto them when I know they are just slacking, but for the most part - they're feeling the same strain I am. It's hard for me to be angry with them, when I see they're working their butts off and just can't keep up with the demands d/t patient overload. They see me as the 'bad guy', but I know it's just the corporation. No one will listen to us that it's just too much. I think they're just waiting for something horrible to happen to see - or even then - will they see? And can I keep working in these conditions? Part of me feels like I continue on out of a sense of obligation. I love these people - I love their families - I love many of my co-workers, and they need me. I just wish the working conditions were better. I wish I had more time to use my knowledge to assess patients and communicate with them and their families. I wish I had more time to complete my duties in a thorough and careful manner. I wish I could shake the corporate big wigs and get them to see that quality care is being compromised so that their buck may be maximized.

I wish I could be happy in my career choice and employment. Is this truly the reality of nursing? or am I just at an awful place?

[mazy]

You are at an awful place. However difficult it is to be a nurse -- and it is very difficult -- the situation you are describing sounds extreme and out of control. I'm sorry you are going though this.

I think you should start looking for another job. Next place you go to you will at least have some knowlege and experience behind you to ask the right questions and pick up cues on what you will be dealing with.

For the moment, the only area for wiggle room that I see is to not worry too much about what is going on in the dining room and let your aides keep you aprised of what is going on there.

Best of luck and hang in there.

[tyvin, BSN, RN]

https://allnurses.com/general-nursing-discussion/dont-know-if-630149.html

You are not alone.

[canoehead, BSN, RN]

Finish what you've started unless someone needs to be coded. Tell the patient who wants pain meds that you'll get right to him once you've finished Mr G's meds. Tell the CNA you'll just finished what you've started if they'll grab some vitals. If you leave too many pieces of tasks you'll feel twice as out of control, even though you've been working steady.

If you must be ready for choking in the dining room what is close by that you can do at the same time? Do your quick assessment survey of how everyone is eating, then do some of your paperwork within yelling distance. I suppose giving pills while they are eating is a violation of someone's rule some where.

[Reneeann25]

Tyvin - how funny I had just happened to see that post. It sounds nearly identical to my situation, as if I had written it myself. I, too, started out in the rehab/express recovery unit. I graduated and passed my RN boards in July of 2010. I fell into the hype of the 'nursing shortage', only to see upon graduation and being thrusted into the job market, that the demand wasn't quite what I was lead to believe. Nursing graduates are being pumped out by the hundreds to thousands in our area - every semester. There are many jobs posted for RN's in acute hospitals, but they seem to be hiring those applicants with the most experience.

I accepted this position at a SNF/LTC facility to keep from becoming a "stale RN grad", but now I'm wondering if I would have been better off unemployed before landing my dream job in a hospital. When I apply now, I still don't get return calls, or any leads. Someone told me that I may be seen as "damaged goods" now that I have spent the entirety of my new career in LTC. I don't necessarily qualify as a new grad anymore, but my experience thus far doesn't seem to be counting.

When I voice my concerns with our facility to my LPN unit partners, they make remarks that I'm chasing "unicorns and rainbows" in thinking I could find anything better. Yet at the same time, I get razzed about being the RN in LTC working as a charge nurse.

I haven't put myself out there in a while regarding applying elsewhere, I guess because it's so discouraging to apply, apply, apply and get my hopes up, only to never receive any calls or leads.

[tyvin, BSN, RN]

You're beaten up and always working that's why you haven't put yourself out there. I know what you are going through. I kept putting myself out there and low and behold I finally got my "dream job" ... as far as being seen as damaged goods the damage is done. Why not go for home health or home health hospice? I think with your experience you would get hired quickly in home health. I did home health for awhile and you are autonomous with your schedule in most instances. It's a whole other ball game.

[classicdame, MSN, EdD]

too much for one person. Not every place is like that.

[BuckyBadgerRN, ASN, RN]

I am so incredibly frustrated with my job! I was told plenty while in school that nursing is NOT easy. I was told when we were learning proper procedures for skills, that you'd often hear nurses say "but that's not how we do it in the real world", but to never listen to them, and to always follow protocol. They crammed our heads with "prioritize, prioritize, prioritize!" but I didn't anticipate I would be forced to completely neglect certain nursing duties in order to prioritize and tackle the most important.

I am responsible for 39 patients. At any given time, roughly 3-6 of those require Medicare A / Skilled nursing care, 3-6 of them are skilled nursing care but only have Medicaid coverage. Four of them are hospice - in varying stages of the dying process - requiring lots of care. At least half of them have mental health issues, also requiring a lot of my time. Four of them are peg tubes, with 2 different times each on my shift requiring peg flushes, meds and formula. Two colostomies, and 5 of them with skin issues requiring dressing changes/wound treatments. One woman requiring lymphedema wraps which take about 45 minutes to wrap every other day. I have to prep approximately 15 lab reports each day, schedule appointments, manage consultations, deal with angry family members, as well as family members with concerns each day. I have to spend an hour in the dining room at lunch time verifying that patients are being served the proper diet, and monitor the dining area to ensure there is no choking, and watch for signs of dysphagia. I have to monitor and record dietary and fluid intake daily. I have around 15 people I have to apply some sort of cream or ointment to, and monitor skin daily for signs of breakdown. I am responsible for calling our medical director each day to report changes in condition and report lab results to - then writing and pulling orders, which involves calling each patients family members to educate them on the orders.

In addition, I am in charge of 2 bath aids, 4 CNA's, a CMT, and a restorative aid. It is my duty to ensure they are properly carrying our their duties. Two of those four CNA's are constantly rotating. We haven't had consistant staff or proper continuity of care in the year I have been a nurse and been employed there.

Furthermore, I am on my 4th day of training our new hire nurse ie - my new relief on second shift. The first two days I trained her on my shift, and the last two days, I have worked a double shift so that I may train her on the shift she will be working. I can see she is no where near being left alone yet. While I was there this evening, I spoke with the doctor for her, wrote and pulled all the orders, did her charting, performed many of her assessments, answered call lights and passed pain meds, and she STILL struggled to complete her duties. This is, I think, the fifth nurse I have trained for this shift, and it's exhausting work to train, only to see that it's quite possible she won't work out. But is the problem really with her? or with the expectations and demand our higher ups are placing on us as charge nurses? She was frazzled, and I found several times that she was leaving the nurses cart outside of patient rooms - unlocked, MAR wide open, and the narcotic drawer keys right on top - all unattended.

An example of what 15 minutes can look like at any given time is: I'm at the med cart outside of a patients room preparing meds to administer via peg tube - one patient wheels up to my cart requesting pain meds. I stop what I'm doing to get them out of the drawer - sign them out of the narc book, and sign them off on the PRN sheet. Before I'm finished, a CNA approaches me to let me know that patient in room 521 is lethargic, and difficult to arrouse. I put my half prepared peg tube meds in my cart so that I may go assess patient 521, and I pass 3 call lights blaring on the way. After assessing and leaving room 521, I realize I'm nearly out of compliance in administering the peg meds and rush back to finish. While I finish prepping them, I hear my name being paged for a call on lines 1 and 3 - one of them being the lab - surely calling to report a critical lab value that must be phoned to the Dr. The other is pharmacy calling wanting me to check the dosage on a newly ordered med, which I must look up. Another patient rolls up wanting pain meds. I now have only 15 minutes before lunch starts to check blood sugars and administer insulins. Sometime between now and then I need to fill out an SBAR communication form to alert the dr of patient 521's status change.

Ahhhh!!!

CNA's neglect carrying out nurses orders on answering lights in a timely manner, vital signs get turned in late, patients aren't being toileted and repositioned as frequently as they should. I get onto them when I know they are just slacking, but for the most part - they're feeling the same strain I am. It's hard for me to be angry with them, when I see they're working their butts off and just can't keep up with the demands d/t patient overload. They see me as the 'bad guy', but I know it's just the corporation. No one will listen to us that it's just too much. I think they're just waiting for something horrible to happen to see - or even then - will they see? And can I keep working in these conditions? Part of me feels like I continue on out of a sense of obligation. I love these people - I love their families - I love many of my co-workers, and they need me. I just wish the working conditions were better. I wish I had more time to use my knowledge to assess patients and communicate with them and their families. I wish I had more time to complete my duties in a thorough and careful manner. I wish I could shake the corporate big wigs and get them to see that quality care is being compromised so that their buck may be maximized.

I wish I could be happy in my career choice and employment. Is this truly the reality of nursing? or am I just at an awful place?

IMO? You're in an awful place!! Management needs to take a serious look at the workload they've placed on the RN's....

[Ruthfarmer]

This is a dangerous assignment. It is completely unreasonable and unacceptable. Each day that you accept thjs assignment you are risking your license. I would take my license and run.

[imintrouble, BSN, RN]

After the night I had, I can't be objective in response to this thread.

It was awful. :cry:Twelve hours later I'm still teetering toward tears.

Proceed without me while I go blubber on the dog's neck.

[NocturneNrse]

I understand.. I understand!! And after all that.. it STILL isn't good enough.

Honey hang in there. Damn.. we've got to take a stand!!!

[sweetnurse63, BSN, RN]

Remember nursing is 24 hrs so don't feel bad if you can't complete everything all the time and you must always prioritize. There are times when i have to tell the cna to wait until i am finished doing my current task. Unless it is an emergency, i try my best to stay on course because time will fly away before you know it. I would look for more employment if things do not get better to save your own sanity.