My first few days, as a new RN

Nurses General Nursing

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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?

:madface:

Slu06, can't they call someone in? Or is that not a realstic option?

The problem is getting someone to come in. Right now we're struggling with out patients. Our acuity is incredibly high, and work can be a very depressing place to be so who wants to exhaust themselves working an extra shift?

I say leave the hospitals. That's my 2 cents. Then maybe the "powers-that-be" will take note.

I would love to leave the hospital. I just don't know where else to go. Working in a MD office just doesn't really sound any better.

Corporate America is the same way. The last two marketing positions there was always the woman who wanted to be the super star. She would take on more work than she could handle. Kiss up to the boss. She would work nights and weekends. The PTB would talk about how wonderful she was. Well, both of those women I am thinking of look like old hags now due to working all those hours and they are only in their late 30's. They look like they are 60. It is not worth it! I am into holistic healing and taking care of myself. I and my kids come first. To bad if people do not like that. It is what it is. If I get fired, so be it.

lol, I love your attitude!!!!:roll

This sounds like the place I used to volunteer at! (They were constantly short-staffed.) 9 patients on ANY unit is more than one nurse should be asked to handle. Starryx2, I wish you well & I hope you can find a better position soon.

Some others mentioned the general attitude of corporate management. I once had a boss like that at a company where I worked. His attitude was "sell your soul to the company and you will be rewarded". (I never sold mine.) I heard after I left that the company was bought out. While he was on vacation, they shoved his desk & everything else out in the hallway. Someone new was in his office when he got back from vacation. Boy, he sure got his "reward"! Right where you would get a colonoscopy!

How do they even let you off orientation without even having your license yet? At my job they are counting my orientation from the time I got my license, which is about 1 1/2 months. They are in no rush to push me out either.

I would refuse 9 pts, esp as a new nurse. I know I can barely handle 4 as it is! I try to do everything on my own, but I go to my preceptor if I feel like I'm drowning and she helps me w/ my pts and gives me direction.

I would find a new place to work!

Starry that's insane!! No one can or should be expected to provide care to that many pts. Regarding the staffing in CA, I think it depends on where you work and how they interpret the law. I'm in SoCal, and at the hospital that I work things were GREAT right after the ratios were put in effect. The unit I work on is called a medical specialty unit, almost all pts. are tele/step down, s/p heart cath, fresh MI, etc, most have multiple system issus such as renal failure/CHF/copd, etc etc. Intitially the change took our ratios to 1:4, with an aid for about every 15 pts. (31 bed floor,all open at that time, part of it closed at present, that's a whole 'nother story, currently working with 20 beds) That was really good, very manageble most days. Then admin decided we no longer qualified as a step down unit, just a plain tele unit(which is crap to say the least) so they took our ratio to 1:5 and then on top of that there is only one aide for 20 pts. (if we fall to 19 no aide they send 'em home). Before ratios we could at times go 1:6 for rn but had an aide for every 10 pts. There is no language in the law regarding unlicensed workers (nurse aides) and so it falls to individual hospitals to decide when and if they will use them. I know of a couple hospitals that have gotten rid of aides altogether. I'm sure when the ratios change again in 2008 (straight tele units will go 1:4) they'll probably take away our aides altogether too. Now, I can see that my situation is nowhere near as bad as yours, but it still sucks. I haven't worked outside of CA so I have no comparison, but from my experience the mandated ratios haven't been a cure-all. I'm interested to see how other CA nurses feel.

Hey Everyone thanks for all the support!!!

Just as an update to some of the questions that were asked

Yes, I am off of orientation, today was my eighth shift being off of orientation.

Yes, I just graduated June 2006, and I just passed boards as of 2 days ago!

I had 5 1/2 weeks of orientation which they offer 6 on that unit. Now do not get me wrong, If I would be handed 4-6 patients I do feel as though I could somewhat manage in a decent safe manner, busy but safe at least. Which is why I was cut a little short, and before yesterday, I did have the poor souls, that I was working with had to cover me while I was still a "graduate nurse"

I have one problem in regards to quiting or leaving, I went through the hospital and they paid for my school and I owe them 3 years. I really really really dont want to pay them back almost 20,000 dollars plus my student loans that I took out just to live for the 22 months in which at the time I thought was hell, wow was I wrong. That is one of the nagging things in the back part of my head, as I go through each day.

The second question I have to pose to everybody is Is it actually legal to not accept the patient assignment given to you, can you actually say no I am not taking that, because I was told that if you do so then you are neglecting your duties and your patients and can be held liable for that. That is why I pose how is the best way to handle that.

I do believe that my next step is to speak to my manager, she is for the most part a reasonalbe person, I do believe she is managing the best way she can minus, the fact that she is not fighting for her staff to the "powers that be"

Also to add the last 2 days have not been any better I didnt have 9 patients but I did have 7 yesterday and 8 today!!!

I dont know I am just very disgusted, and it is definitly unsafe, I just guess Im still in shock that this occurs. Of course only the patients suffer and maybe my bladder!

Specializes in OR Internship starting in Jan!!.

Wow. That was very sobering to read as a hopeful nursing student.

I am soooo freaking out reading this post! I am a new nurse (LPN) and I start my new job in a few weeks. I was told I get 4 weeks of orientation. I asked if I would be granted more time if I needed it, but was told that they have only had to extend orientation 3 other times in the last several years. I kind of got the feeling that they really didn't want to extend orientation either. I'm scared I'm going to be eaten alive at my first nursing job. This is just so harsh....are hospitals really like this? What a nightmare!

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