(kind of) new grad with a dilemma

[muddmz11]

Hi everyone. I'm a graduate of an associate's program from May 2010. I got my very first job doing flu shots (yippee) in October that year. Luckily, I was recruited by an acquaintance for a job at an outpatient surgical center in February 2011. People told me it's a great opportunity, you're lucky to get that kind of job... etc. It started out great, but over the past year we've had management issues like crazy. We lost a bunch of nurses due to either staff cuts or RNs leaving on their own terms. We've gone up and down with our staffing because management tried to cut costs, but then realizes sometimes it is unsafely low. And there is other petty office type drama to deal with. I do enjoy the actual JOB I do, but that environment felt like a circus at times.

So that being said, I decided to put some applications in to hospitals just in case anyone would call me for a job - not expecting anything as all us new grads know you "need experience" to get jobs! I was picked up for a job on a "stepdown"/PCU floor at a smallish local hospital, with a not-so-hot reputation. I was pretty enthused and I changed my status at the surgery center to per diem to begin working at the hospital.

What a nightmare. I don't know how to gauge my feelings, so I want to speak with other experienced nurses here. First off, our patient ratio would be 1:6 patients. Some patients are unstable; some are stable but are required to stay on the floor till cardiology clears them (all patients are on tele). I felt "okay" after a few weeks of working with my preceptor and going up in my patient load, but in honesty I felt like the job we had would not be feasible without BOTH of us being there. Between your patients who are constantly getting up (and being refused a watch) to the unexpected rapid-responses, to calling the physicians 8,000 times to clarify orders/get new orders/find the COVERING dr for the one you are trying to reach.... I don't know how it's done! I try not to base my opinion off of others, but EVERY nurse was unsatisfied with work. Some wanted to stay on the unit and transfer out after getting experience, but the writeups seem liberal there and you can't transfer within 6 months of a writeup, or something of that nature. In addition, I had 4 different preceptors in a few weeks, and the main one I was designated to follow ended up quitting. The management seems to be involved in petty BS rather than actually listening to nurses.

I'm pretty devastated that this is my first "hospital" experience. I told my clinical educator that the particular floor was not in my heart and I really, really did not enjoy it. I never wanted to go into med surg anyway and this felt like it to me. I think the expectations are unrealistic, not to mention there is ONE aide for all patients (up to 36), and if anyone needs to be on a watch, they pull your aide!! That experience put BEAMS of light on the surgery center. I told them how things are going, so thankfully I am picking up some hours there in the mean time. I am meeting with HR at the hospital next week to discuss the possibility of switching floors, but I don't really know what to do. I'm concerned that all work environments might be as bad and I am a firm believer in ENJOYING your job and feeling COMFORTABLE with your management. I cannot just muddle through a job - it takes too much of a toll on me, because it is a part of your every day life and the stress is just miserable. I may be young, but I'm an adult, and a professional - and I deserve to be treated as such. I would appreciate any input from experienced, or even new, nurses on this subject.

[Five&Two Will Do]

That sounds like a complete nightmare. I will say that I am so grateful that I initially worked on a tele floor where we routinely had 6-8 pts during the day and up to 10-12 on evening or night shift. It is frustrating when you do not feel like you are able to spend adequate time with your patients due to the sheer number of tasks there are to compleet. It taught me great time management, prioritization, and the ability to look at what is really important to each patient. Though it was stressful, I believe that working hard in that environment and overcoming the difficulties with it ultimately made me stand out in my interview for the ICU.

[Asystole RN]

holy wall of text batman! guess you didn’t have to write too many essays that required paragraphs in nursing school, joke. seriously though,paragraphs make reading your posts much easier to comprehend.

first of all, congratulations on landing a surgical center job and a hospital job. you really need to consider yourself extremely lucky. i know rns who went 6 months to a year before finding their first job (took me 4months) and even then were only landing ltc jobs, pushing a cart for 30 some patients.

chaos in hospitals, and in all health related fields, is to be expected right now. we are in the midst of one of the greatest transformations in health care in the past 60 years. reimbursement, or the lack thereof, is causing management to seek novel approaches to trim variable costs in order to compensate for lower reimbursement. last january my facility terminated 11% of the nurses, we are in negotiations currently to stave off another cull of 10% of nurses (this does not count all the other departments and other forms of cut backs by the way). by the year 2014 we expect 40-45% of all the sub-acute facilities in arizona to close down. chaos is somewhat the norm nowadays and somewhat expected. as the professional nurse leader and professional change agent you are, you need to understand the necessity forchange and help facilitate the change that is ongoing.

to work a step-down/pcu unit with a 1:6 ratio is not terrible. granted you have a very busy day and primary care is not fun but remember that you are there to work, not have fun. not to say that one cannot perform their duties without having fun but providing safe and prudent care is never easy and rarely fun. i can provide you with a bucket load of nurse experiences from those who have it about 10,000% worse. i have one dear friend that has on a minimum 18 patients and up to 25. every single one of these patients is on either a vent or has a trach. every single patient is either on hemodialysis or pd. about ¾ of them receive either nutrition via a feeding tube of some kind. now she has a work load, but, she loves it. she loves the challenge of the situation, she loves being able to put her assessment skills to the test, to hone her time management skills, to see just what kind of nurse she can be. she can spot sirs/sepsis/uti/pna like no one i have ever met. at the end of the day she is thankful to not have to work per diem home health anymore and actually work a full-time job.

you cited many problems with your hospital, your manager, your coworkers, and your work load but never once did you cite what interventions you attempted to improve your hospital, your manager, your coworkers, and your workload. you are now a professional, act like it. be the professional nurse leader that your manager needs. be the change agent that helps your hospital.

be the change that you wish to see.

[wooh, BSN, RN]

Honestly, that staffing sounds pretty typical for med/surg.

[muddmz11]

Thanks everyone for the replies.

Honestly, at the surgical center, all of the staff routinely voices our troubles. We really do work together well to make ends meet and make things smooth for our sometimes demanding surgeons. What does make it to staff meetings is seldom addressed, and though our manager(s) (we've switched) are very nice and nurse-friendly, they are often too accepting of the mighty surgeon's demands. Our surgeons own the practice so they dictate whatever change they want at the drop of the hat, often for $$ purposes. That is the unfortunate thing that we can't change.

As far as management in the hospital, I kind of got "red flags" because of simply observing how management dealt with the nurses. And surely if EVERYONE on the floor does not like what they are doing, well... that must be some kind of sign for sure. I firsthand saw an issue that involved a COPD patient being assessed for a watch - several nurses and our clinical educator agreed he needed to be on one for a severe fall risk (he KEPT getting up was already listed as high risk) along with a change in mental status that we were looking into. He was given ambien the night prior. One manager (she is apparently a head honcho of some sort) came and just eyed the patient, said that we would "have to see" about a watch, and left. Well the RN in charge of that patient got in trouble because they claimed she directly opposed that manager's orders to NOT use a watch, which DID NOT HAPPEN. The unit manager had allowed us to use a tray table as restraint. I explained the interaction exactly as I had seen to the unit manager, along with several other nurses, but the manager was quick to interrupt and state the "wrongdoings" of the nurse. That nurse was my preceptor... who later in my orientation, quit. And FYI, that patient ended up rapid responding on us later and being intubated in the ICU.

These types of incidents with no nurse advocacy are what worry me. And the sheer workload with no assistance is ridiculous. The patients require more care than can be safely given. I refuse to work in unsafe conditions where I feel like my license is jeopardized on a daily basis.

[DixieRedHead, ASN, RN]

It seems that some sort of drama, chaos, or dissatisfaction seems to follow you where ever you go. There are going to be problems everywhere. Nothing is going to be perfect.

"Seems that now that you have had a taste of hospital work, the light now shines back on the surgery center.

Do you think it will be different if you return full time? Don't count on it. Nursing is about caring, and seeing to the needs of others. I is also about being a job. Either you need one or you don't.

[muddmz11]

Honestly, the days I've been working there recently have been busy, but great. In comparison to the PCU job, it makes the management and hour issues look minimal. I think it's just very sad that as nurses we should "accept" such terrible work environments! In what other jobs do people make such sacrifices - especially when patients lives are involved - because "that's what we get"? I really think it is important to enjoy the place you work for and to feel like employees are valued... seems like a pipe dream in this field.

[Multicollinearity, BSN, RN]

I think it's just very sad that as nurses we should "accept" such terrible work environments! In what other jobs do people make such sacrifices - especially when patients lives are involved - because "that's what we get"? I really think it is important to enjoy the place you work for and to feel like employees are valued... seems like a pipe dream in this field.

Nursing is unlike any other job. We have direct responsibility for our patients' lives and we have to rise to the burden of shifting patient acuity and needs no matter how jammed we feel. I know you know this. That said, I can think of other jobs in healthcare that have it worse. How would you like to be a resident on 24 hour shifts and have your pager go off each time you think you may get an hour's worth of sleep after being up for a day?

I agree it is important to enjoy the place you work, but it probably won't happen early in your nursing career because the stress of adjusting to the role and responsibilities is too great for happiness. The first 6-12 months I worked as a nurse I frequently had a hard time sleeping, and I constantly worried about how I would respond to the next life-threatening emergency. It was only after about a year on the job that I could relax more and enjoy. That's because the technical skills I was doing became second nature and I had confidence in my decisions. From reading allnurses for years I know this is typical. You really cannot enjoy your job when you are learning so much combined with the stress of your new responsibilities.

I honestly think the first year in nursing stinks because the role transition is unpleasant and hard. It's up to you if you want to stick it out at the hospital knowing it will be a lot of unpleasantness. But I do imagine it would get better.

[MikeJones]

Hey fellow GN!

Stick it out for the 1st couple years and find some ways to de-stress like swimming or something. We are very fortunate!