My first cry

[RNby24]

I'm a new grad working on a med-surg floor. I had my last night of orientation and it was the worst night I ever had. I had 8 patient assignments. I had three post op patients who needed to be assessed q4 hours. One was nauseous all night-nothing I gave worked. One had a completely numb arm from an epidural that I had to call on. And the other was a complete angel and slept all night (thank you!!)

A severely autistic, non verbal, agitated patient who was flailing and jumping off his bed every hour (we had no staff to sit with him either). MRSA. PEG tube.

A crabby, sarcastic a&o x2 patient who was only here because his family couldn't pick him up the day before.

A spanish speaking patient, neuro checks q4 hours. Our translator system wasn't working. I couldn't understand her with even the basic spanish I knew.

May I add, EPIC was working in only 2 of the 8 of these patient's rooms.

A patient who was just plain old weird, wouldn't stop telling stories, of course had no time to listen to these stories even if I wanted to. Going to surgery in the morning. Contact for c diff. Patient develops new wrist pain, very swollen fingers, wrist is hot to touch, rated 7/10 pain, seemed like s/s of gout in hand. Updated surgeon as it was new onset pain even though it had nothing to do with the surgery that was scheduled in one hour. Surgeon proceeds to ream me out for calling him and saying this was a hospitalist issue. Sorry for letting you know :| Don't really care that he yelled at me but confidence -100 at this point for thinking that I was doing the right thing by calling and then to find out I wasn't...

A confused patient who was admitted for a bleed, change in mental status during the night, had ICU nurse come up and give a drug to treat her arrhythmia at one point. No beds available in the IMCU. Pt would be staying on the floor per hospitalist. Gave a unit of blood ( for the first time) Large amount of coffee ground emesis began right before shift change. NG placed. Transferred to ICU. Gave the worst report ever to the oncoming nurse about all my other patients who I felt like I hardly knew. Hospitalist actually came in to my report and gave me a hug and said don't worry you're doing great. Nearly burst out in tears.

Stayed an extra 2 hours to chart after my shift (I'm sure my charting wasn't even complete) and was holding my tears in until I got off the elevator and I was sobbing as soon as I closed my car door.

I know it could've been a lot worse but I was soo overwhelmed and stressed. I felt like if I was on my own I wouldn't have been able to handle it or know what to do. I have the feeling my preceptor wasn't impressed because I had to be given so much direction. I had so many things I hadn't experienced before. And this was my last night on orientation!! I honestly feel like I am in over my head. Will I ever be able to be up to speed and know what I'm doing...

[Dikid]

That is crazy!

8 pts is too many even for the most experienced nurses.

Was innaoropriate to give you that assignment. Make sure to submit something in writing, you want it documented how you are being put in dangerous situations.

[HouTx, BSN, MSN, EdD]

Congratulations! Despite daunting obstacles, you kept all your patients safe. Sometimes, that's the only realistic goal. This experience will serve as your frame of reference for years to come.... "heck, it's not as bad as that last night of orientation" . I have a few of those shifts in my memory bank also - along with the "best" shift, the "craziest" shift, etc.

You did great. You're stronger than you were before.

[RNbubu]

Wow and I complain of my 3-patient assignment... 8 patients is insane even more when some are not doing so well. I would have gone home crying too.

[rnnluvnit2006]

Think of it as a right of passage...your preceptor was preparing you for being thrown to the dogs...

I remember my first night off orientation, I started with 8 patients, discharged 3 and picked up 3 more...OMG!!!...I was on a 12 hour shift, hit the floor running and didn't see the nurses station until 11 hours later...it was awful, horrible, exhausting, and yet looking back it was probably one of the best things that ever happened to me. It was a learning experience that was invaluable.

As much as I was challenged, that first year I picked up every extra shift I could, because what I realized was the more I was there, the more efficient I became.

You WILL get it...

[asmallangrycermet]

What a horrible shift! It might be worthwhile keeping a nursing diary where you document all of these things. I'm not sure what your registration renewal is like but for mine we have to write reflections etc and this would be perfect. You survived. Well done.

[jennifer_gail]

FYI: A lot of patients with c diff get reactive arthritis which presents like gout. I only know this because it happened to me. Contracted c diff from a patient in HH who didn't think it was important that any clinician know about the dx so no contact precautions. Took almost a month before the severe pain in my joints subsided.

[NickiLaughs, ADN, BSN, RN]

Holy crap you need a new job. I would have had my middle finger up in the air on my way out the door after that shift. In California the ratio laws max nurses out at 5 patients on med sure floors....just saying.

[ladedah1, BSN, RN]

Eight patients!!!! ***!!! I can hardly imagine how an 8 patient assignment became acceptable! Oh, wait, yes I can. We are all supposed to be robots, set on a mechanical track which scoots us along to the next patient at the "appropriate" moment...

Do you realize that 8 patients equates to 7.5 minutes (7.5!!!!!!) per patient per hour... including charting, supply gathering, information gathering, assessing, med passing, set up, etc. I guess someone, somewhere along the way, decided that it was ok to simply cut "human" out of the equation. And you work with epic? As a new grad, I bet one complete assessment takes about a half hour to chart, too, (to say nothing of regular rounding) lol. Ridiculous! It's not a bad night, in my opinion, its a bad healthcare system which would think such a thing is reasonable.

[SuzyQ2011]

Eight patients in an acute care setting....that's insane. Is 1:8 the standard assignment for your floor?

Hang in there

[deejae76]

I left the hospital because my preceptor was to busy to teach this new nurse any thing and when I ask she would say you were a lvn you should know . well no I did not , because I worked long term care needless to say . I am so scared to go to a hospital now and I really wanted to.

[RNby24]

It's rare,but we can actually take up to 9 patients at night. But most nights it's 1:8

[barcode120x, RN, NP]

It's rare,but we can actually take up to 9 patients at night. But most nights it's 1:8

I've heard of that as well in other states. One of my close friends worked a regular MS floor in Arkansas with a 1:7 ratio. He told me the only way he would get through each night was prioritization and time management which he had to learn the hard like, most of us had I would assume. Glad that I work in Cali where the ratio stays at a max of 1:5 (if you are MS nurse, less if you are of another specialty).