My first few days, as a new RN

[starryx2]

Here I am, it has been 6 days, since I have been off of orienation, I am disgusted. I took boards yesterday, keeping fingers crossed, but actually I'm a little worried about having the RN title, because that means more things that I have to do. Which that would be no problem, besides the fact that today alone I had a 9 patient assignement! Come on 9 patients? A experienced seasoned nurse shouldnt be taking care of 9 patients. I am a new graduate with 6 days under my belt, by myself. We are on a med-surge unit specializing in orthopedics and gynecology, due to the recent close of our OB/Gyne floor that is our newest addtion. My head is spinning, I cant keep up, I am trying like heck to get everythign that needs to be done, but I am not even coming close, I do not feel that it is my inability to do things quickly, I am moving at a very quick pace but, here is the question i pose, Why is it that a new graduate nurse or any nurse for that matter should have to take care of 9 patients on a daylight shift? Why do we allow these things to happen. I am curious to know from the California RN's how the patient:staff ratio is working out, does it work to have mandatory Ratios? Make no mistake it was not an easy patient assignent load either, I had 2 patients on complete bed rest, which were complet cares, I had 4 post ops, which besides PCA's, Foleys, dressing changes, and routine meds, have to be down for Physical Therapy twice a day. Also you have all your routine meds, pain management for the other patients, I was lucky if I say 2-3 of my patients once in the 9 1/2 hours I was there, and that was to give them there medications and give them a very brief once over, which is complety inadeuquate, but what are you to do... I was still passing medications at noon, of course no breaks, no lunch, and the 2 RNs, and Myself along with the LPN whom which all carried the same load today were sinking. We have a charge nurse who was taking off orders ect, and another RN that got mandted due to not having a unit secretary. Another RN came out at 11 to take over for the mandated night shift nurse. Why are these things happening, I feel fortunate enough that I am able to keep my cool and keep moving and doing the best job I can do. I feel that this is such a joke, and such an inadequate way to do nursing, THIS IS NOT WHAT THIS PROfESsion is about , I feel like im doing TURBO nursing. You walk in the room, and are trying to keep moving you cant talk to the pateitns, your in their for only 5-10minutes at the most, how are the pateints getting good care, why is our patients not getting excellent care! Why are we not able to do what we are taught a nurse is suppose to do? Doctors are coming in and out writing orders that you come and find or are told about 2-3 hours later. You simply dont have time, I did not sit down today, until 4pm 1/2 hour after I should be on my way home, I sit down to chart, and try to look at my hands my papers, and sort through and see who had what going, and what I need to chart, I finish that after about 45minutes, and I am not satisfied with it, but hey its 5:15, I am exausted my feet ache. One of my co-workers come to me and says, do you have heart burn yet? Dont worry you'll get it, and turns to our other co-worker and asks what do you take, prilosec or protonix? I sit and wonder to myself, they are serious aren't they? This is so sad. I love this profession, I love what a nurse is suppose to do, I want to help people and I want to go to work everyday and do the best job I can possibly do but this is rediculous, I am managing for the moment but I do not know how long this will last, until it catches up to me. I knew this was a tough profession, and that is one of the reasons I got into it becuase I wanted a challanging profession, BUT i didnt want a unsafe, tiresome, work yourself into the ground, barley remember your patients names at the end of the day. On account of HIPPA, I can not paint a complete picture of my patient assignment, but believe me when I say, It was definitly not an assignment anyone should have. My manager and charge nurse, knew it was bad they were trying to help, I can't complain about my co-workers, they try as hard as they can to help you, but they have 9 patients a piece, and their own problems to worry about, I cant blame them for not being a little annoyed, but again why is this happening?

I know this is not new, I know this is not a new concept, I also know this is happening all over the US. I just am very disgusted. My question to all of you out there is, WHat can we do to change this? Or has anyone encountered this at their hospital or facility and took a stand and decided to do something about it? I know that my co-workers want these things to change, but nobody knows what to even do about it. We dont even have time to think about it, we cant even stop for a moment to think, wereway to busy trying to give our patients 1/10th of the care that they deserve. Were doing our best, I am doing my best. I just cant keep asking myself WHY, and What can I do to make a change?

[weetziebat]

I think your post should be required reading for everyone who is so intent on going into the nursing profession. They need to read it slowly, let it sink in, and realize you paint a totally realistic picture of day-to-day nursing in the U.S.A. in 2006.

I wish I had an answer. The only thing I do know is that nothing will change unless we, the nurses who are routinely being assigned ridiculous patient loads, that are truly dangerous to the patients, do something about it. Administation cares only about the almighty dollar, despite whatever lies they tell, and will do nothing to lighten our burden.

Unless patients start dying off like flies in the winter, and it could be proven beyond a shadow of a doubt that it was not a nursing fault, but instead it is the fault of the greedy system, we are on our own. And being good little caregivers, they know we're not likely to all get together and walk out at once, till decent nurse/patient ratios are established.

I will be interested to see what other posters think. There should be something we can do, IF we can manage to get us all to stick together. I'm actually amazed that more patients don't die of neglect. Goes to show what a bunch of great nurses we have! But no nurse can stick around any length of time working in these conditions, and no matter how many new nurses they graduate, that won't increase the number of working nurses if things don't improve.

O.K. I've ranted on long enough. I'll step down off my soapbox and hope for some good ideas from others.

[smilin_gp]

9 patients as a new grad! Wow, I've only been off of orientation for a month, and I usually have 4-5, occasionally 6. Patients are typically telemetry, transplant and postop. I still feel that I am going at max speed to get things done, and I can't imagine doubling the load!

[max1x]

Lots of people ask me (perhaps because I'm a guy) if I like nursing, and if it is a good career. My standard reply "Well there is a REASON that there is alsways a nursing shortage". This is the reason why.

Everyone knows why there is always a nursinf shortage. It is beacause the salary and working conditions mean that few people would ever want to do this. Employers know there are 2 ways to solve the shortage:

1) improve the salaries and working conditions.

2) import lots of immigrant nurses from third world countries who will be more likely to tolerate the salary and working conditions just to escape crushing poverty in their home countries.

It is clear the heal care industry has chosen option #2

If it sucks where you work, then either speak up and complain, or find someplace else to work. However, it just may suck just as bad at another hospital. Choose carefully.

[RNHawaii34]

I feel your pain. I think you have a lot on your plate though. I am a new grad myself, but I have 12 weeks of orientation.I think I shouldn't complain :-)

[steelydanfan]

You asked about Calif. nurses, and if the laws mandating assignments work.

You bet they do! You would NEVER have had to take such an assignment in a Ca. hospital, or if you had been presented with such; would have been able to refuse it, and walk out with NO repercussions.

That's the law. NO one should have ever beeen asked, and particularly a new grad, to take such an assignment.

My dear, I had a team of 3 last evening, 1 MS and 2 tele, code browns all afternoon; SICK people, and I transferrred 1 out, got one in. A "MS" pt., who by the time I heard the ER report clearly was a bit more.

With all the JAHCO rules, it now takes almost 2 hours just to complete a proper admission. When the supervisor told me I had ANOTHER admit, I simply refused it. I had to deal with a renal pt. with a BP of 204/89 post dialysis,, a pt. with so many cardiac sequalae it would make your head spin, a hepatic pt. on the transplant list. and a new pt. who had just had

ben diagnosed with a UGIB; confused and hypoxic. If I with 30 years of experience cannot do PROPERLY what you are expected to do in 2 hours, there is a problem here.

I refused it, and my supervisor HAD to listen.

Sheila Kuhn is a star IMHO; she listened and did what was right for your elderly mother and mine.

It comes down to this: You know what is right and diligent, and what the Nurse Practice Act entails.

To allow others to bully you into deviations of these is to invite poor pt. outcomes and lawsuits.

[traumaRUs, MSN, APRN]

I guess my first question is where in the heck is your preceptor!!!

9 patients???!!!! Unreal and unsafe!

You are still on orientation correct????

[max1x]

I've been waiting for the Calif. staffing laws to spread to the rest of the country. As far as I know, no other state has adopted those (or similar) mandatory nurse-patient ratios. This is not surprising, since the healthcare industry has spent more money fighting this than it would likely cost them to just hire more nurses.

This worked in Calif because the nurses there organized as a group and demanded this. This is what we all need to do.

[Elisheva]

Welcome to nursing!

[juls02]

See, this is exactly why i am looking to never do floor nursing again. Did you all know that the national average for nurse to work as one in hospital is only 5 YEARS! it's a fact (as of several years ago)! I just finished 4 years and i am pretty much done! anyway, as far as your question goes I have one thing to say: WE, AS NURSES, HAVE THE RIGHT TO REFUSE ASSIGNMENTS!! PERIOD!! do not accept that many! your manager or supervisor cannot force you to accept assignment. and if they fire you for it, you can take that straight to the board of nursing and someone will help you with it! There is no reason for you to have to take 9 patients. don't get me wrong, you can refuse in a professional manner such as saying to a supervisor and/or even higher, "I do not feel it's in the patients best interest for me to try to properly manage and care for that many patients. I feel if I took that many assigned patients, it would be an incredibly unsafe practice." it is YOUR nursing license and if something bad happens to a patient, you could be asked in a legal setting, "why did you accept that many?". seriously!! if we ALL did this (refusing an unacceptable assignment, etc) then hospitals would be forced to take action. but if we accept the assignments and then complain about it, nothing will happen. it will be just another complaint to add to the list of many that supervisors and administration hear every single day. we have to force change by action! hope this helps.

[Elisheva]

juls02: I so agree with you. Changes in nursing will only come when nurses step up and STOP accepting large patient loads, etc. Sound great in theory, but how do we do it?

We are not unionized in the South, and I don't know how I feel about unions/nursing. But I do know that something has to change. Hospital administrators aren't going to wake up one morning and suddenly feel remorseful for the patients and our plight.

I've been out of the loop for a while. Where's the ANA? Why isn't someone screaming for better care for patients and nurses?

[jenni82104]

I don't work in healthcare yet, but to someone on the outside looking in, I do not understand why people take on more work then they can reasonably handle. Do people accept these unsafe assingments because if they don't they will be fired? Is it because if one nurse refuses, then another nurse feels that they have to accept a bigger load, and then everyone hates the one nurse that refused too many patients? I am really struggling to understand why a lot of people on this board seem to put up with not peeing or eating or drinking for a 12 hour shift, and running around like a crazy person stressed out all of the time, and it is acceptable to them. I am sorry if I sound condescening, I am not trying to. I really am trying to understand how such capable, intelligent adults like most of the people here continually put up with being treated like garbage.