Med-Surg sentence

[ThePrincessBride, MSN, RN, NP]

I am a little hesitant posting this thread but here it goes...

I have been working on a busy Med-Surg unit for a few months now. I have been off orientation for a month and while I enjoy learning new things, I feel like I am stuck in med-surg hell.

Today I almost snapped at the day shift nurse who had the nerve to complain about having seven patients knowing I had seven patients, no unit clerk and only two techs for the entire unit (but she had three more techs, a unit clerk). I was also forced to sit with a suicide patient for nearly two hours while call lights went off (did I mention there were two cases?) while the day shift nurses weren't expected to waste nursing time by acting as a sitter.

One of my patients complained she had waited over an hour for someone to help her off the bedside commode. I was furious. I was stuck sitting with a patient and no one bothered to answer the call light. When I am not sitting, I am answering call lights and helping with beeping IVs and ADLs but there are some nurses who will walk past a beeping IV or a patient in need of toileting assistance if it isn't their patient.

There are some nurses and techs who take smoke breaks which forces me to cover their patients as well as mine. That isn't fair to me or the other patients, nor is it safe.

I know all the seasoned nurses are probably going to say "suck it up, Buttercup" for a year but to be honest, I am just so disgusted. I want to be proud of the care I give, but I can't give good care to seven patients while being forced to sit for two hours at a time or having coworkers and techs leave for smoke breaks and leaving me and one other nurse and tech to cover the unit while acting as the unit clerk.

I am currently in the nurse residency program. The coordinator knows the unsafe working conditions but doesn't seem to get it. When told about the nurse to patient ratios, she asked why didn't I just say no and refuse to take on a patient? I don't have the option...I have to take it.

As a new grad, I have no clout. If I go to the manager, I might screw myself over and put a target on my back. Everyone seems complacent and they seem to have accepted poor working conditions, sub-par care and embarrassingly low patient satisfaction scores.

As a new grad, I don't have the power to make any changes, nor do I have a choice. So I have a few options:

1. Quit

2. Ask the coordinator about transferring at six months- which may not be possible as a new grad in the residency program

3. Put my neck out there and try to come up with new strategies to improve patient care

4. Ask to be moved to day shift where there is better staffing and more support.

I will be meeting up with my manager soon regarding my progress...should I even bring up my concerns? She has been manager for quite for sometime so I am sure she is aware of the issues of the unit.

I am sorry about the long post, but I don't know what to do. I am leaning towards trying to transfer at six months or requesting day shift.

[icuRNmaggie, BSN, RN]

You can only go up from here and you will. Do not quit. At this point it is all about building your skills and your professional reputation. Keep it positive even though your night shift coworkers sound like jerks.

Ask for dayshift now. At one year you can apply for a transfer. You might like telemetry or the progressive care unit or even PACU or an outpatient area like endo or a clinic. You are half way there and the time will fly. Keep your chin up.

[TriciaJ, RN]

You're responsible for seven patients and you have to play sitter? That is ridiculous. And other nurses just walk by, oblivious to call lights and IV pumps going off? Sounds like they've all gone into "every nurse for herself" mode. I take it there is no union. That's a major bummer.

When you talk to your manager, talk specifics. Tell her how stressful it was to play sitter and watch your other patient needs go unmet. (Don't they worry about Press-Ganey?) Employ a spirit of problem-solving when you talk to her: "So how can I better meet my patients' needs under the circumstances?" She won't have an answer, but it will be a way of tipping her off about the problems without coming across as a whiner.

Beyond that, start looking for a graceful exit. If you can transfer or change shifts without burning a bridge - wonderful. And please have Liability Insurance. It's worth its weight in gold.

Good luck to you.

[ThePrincessBride, MSN, RN, NP]

You can only go up from here and you will. Do not quit. At this point it is all about building your skills and your professional reputation. Keep it positive even though your night shift coworkers sound like jerks.

Ask for dayshift now. At one year you can apply for a transfer. You might like telemetry or the progressive care unit or even PACU or an outpatient area like endo or a clinic. You are half way there and the time will fly. Keep your chin up.

I agree about not quitting as that would be the worst possible decision to make. Although, on nights like these past few shifts, I have been tempted.

My floor has telemetry. My goal is to work in NICU with the babies. If not NICU, I think I would really love cardiac ICU. I enjoyed my EKG course, and cardiac was my favorite system to learn in nursing school.

How should I go about requesting day shift? This upcoming schedule will put me at over five months into my job. Should I wait until October?

Thanks!

[ThePrincessBride, MSN, RN, NP]

You're responsible for seven patients and you have to play sitter? That is ridiculous. And other nurses just walk by, oblivious to call lights and IV pumps going off? Sounds like they've all gone into "every nurse for herself" mode. I take it there is no union. That's a major bummer.

When you talk to your manager, talk specifics. Tell her how stressful it was to play sitter and watch your other patient needs go unmet. (Don't they worry about Press-Ganey?) Employ a spirit of problem-solving when you talk to her: "So how can I better meet my patients' needs under the circumstances?" She won't have an answer, but it will be a way of tipping her off about the problems without coming across as a whiner.

Beyond that, start looking for a graceful exit. If you can transfer or change shifts without burning a bridge - wonderful. And please have liability insurance. It's worth its weight in gold.

Good luck to you.

Yeah. It was ridiculous. Seven patients is crazy, but doable. But throw in no unit clerk to cover the desk and having to sit for 2+ hours, and it is impossible. It wouldn't be so bad if other nurses answered call lights and didn't walk past beeping IVs and patients in need.

If a patient calls out for meds and their nurse is busy, I will ask their nurse if they want me to give pain meds. If a pump is beeping, I won't hesitate to hang another bag, etc. And I am not above helping a patient to the toilet, etc.

By it is wearing me thin. Some nurses are great about helping but then there are some who are terrible and it makes for a miserable night.

Thanks for the advice.

[TriciaJ, RN]

Start asking for day shift now. Tell your manager you'd like to be considered for a day shift position as soon as one comes up. Tell her it would be a better fit for your obligations at home (better than telling her your current shift sucks). Meanwhile, handle everything as gracefully as you can under the circumstances. If you don't ask, you may not even know there is an opening until it's been filled by someone else. Hopefully, the manager takes a shine to you and you score one sooner rather than later. Keep us posted.

[TheCommuter, BSN, RN]

I'm going to go against the grain by advising you to stick with this job for one year before looking elsewhere. With one year of med/surg experience, many doors will open for you professionally.

Many nurse managers have a saying: "If you can handle med/surg nursing, you can probably hack it anywhere else."

[OCNRN63, RN]

As a former psych nurse, I'm horrified that a patient who attempted suicide was placed on a med-surg unit. You don't have time to sit and watch someone who is suicidal when you have other patients. Who was covering for you? What a terrible set up.

I would also vote for moving to day shift where there is more help. If you can somehow manage to stick with it till you get that year of experience, it should make you more marketable.

I wouldn't say anything to the manager. There's something called "willful blindness," and it sounds like that's your manager's way of dealing with everything going on on her unit.

[calivianya, BSN, RN]

Find out what the transfer policy is at your hospital before you even utter one whisper about transferring. I would dig through your hospital's P&P and not ask anyone.

I doubt you are going to be able to transfer to days. Anywhere I've worked, the waiting list was at least five people long. It took a year or longer to transfer, usually, and it went by seniority. I'd say that is probably especially true on your unit if the staffing conditions are that different on nights and days.

I would find out exactly when you're eligible to transfer and put in an application that day, but I would not draw attention to myself by asking beforehand.

[Emergent, RN]

It does sound like a prison sentence. It becomes a vicious cycle on a unit like this. Lousy working conditions drive away good nurses. The core staff deteriorates, and new nurses like you seek greener pastures as soon as they can.

Our hospital has been squeezing the life out of people, especially after being bought out by another company. The job market has improved, and people are leaving right and left, including me. The level of disorganization and apparent lack of commitment to anything but the bottom line has severely eroded morale, finally driving my beloved manager to resign. I got a job at my Per Diem facility the next day.

We have a new grad who recently got off of orientation. She told me that she was really nervous that experienced people were leaving and she wouldn't have enough guidance. She applied and obtained an OB position at a competing hospital. Big loss for us, she's a smart and lovely young woman.

Normally, I advise sticking it out a year. But, really, having to be a sitter for you own patient while you have 6 others? That is beyond absurd. Start planning your exit strategy, who knows, maybe you'll get lucky like my young coworker.

[stephalina6, BSN, RN]

I wish we could give each other a hug, lol! I'm also on nights. Everything started out great but I'm learning real fast that I cannot handle confused patients at all, mentally I can't handle them (new nurse off orientation for 3 months). They pull off oxygen, start touching foleys, peg tubes, IV lines, trying to get out of bed. The other night I had 6 patients and one that was confused with all the lines I mentioned. These 6 patients had lots of night meds and IV antibiotics. The confused one had Ativan but didn't phase him at all. I had to sit with him majority of the night because I didn't want him pulling anything out. While I had a little old lady crying because she's being bullied by docs about going to an ALF which would mean she would lose her house (she lived alone). All this is happening while a group of nurses are having social hour at the nurses station and it makes me so angry. I was able to a couple nurses to help watch over the one confused one while I attend to other patients for meds and the CNA watched him while I went to lunch and had him use my computer to chart so he wouldn't get behind on his duties. I'm really thinking about switching to days because there are many other distractions - 3 meals, PT/OT, procedures, doctors visiting, family or friends visiting, etc. but I have to admit I love the night differential pay - that's going to hurt to lose that if I switch to days but I was in tears last night talking to my husband about all this wondering if I made a massive mistake going back to school for nursing. Anyway, so I feel your pain. I'm hoping for 2 good shifts this weekend, hopefully I'll have time to talk to my fellow night nurses about switching to days. I do work with a good group of nurses at night, but lately I haven't been scheduled the same nights as them and we've been getting lots of floaters who aren't very helpful. If this weekend puts me in tears again due to the confused ones I'll be staying behind to talk to my manger Monday morning.

p.s. I'm on a tele unit

[Pangea Reunited, ASN, RN]

I think you're romanticizing day shift just a bit. I doubt they have it any better than you do- even with the increased staff. And while your co-workers may not be very helpful, I'm going to give them the benefit of the doubt and assume that their assignments are also unmanageable. I don't even fault the complaining day shift nurse. I would complain, too.

If I were required to sit with a patient for two hours, I would respectfully ask my charge nurse who would be covering for me and give that nurse report. It's not confrontational to remind them that you can't be in two places at one time.