My first few days, as a new RN

aquarius11 · Sep 21, 2006

I have just come off of orientation and already I am considering going back to school to purue a new career. They have started team nursing on my unit, in which there is a team leader who is supposed to hang all IV meds and fluids, discharge and admit all patients for a team of 16 patients. In addition they are also expected to transcribe all new orders, scan them to pharmacy, write down all pt. labs and call doctors if any are out of range. The whole team consists of 3 nurses, the team leader, and 2 nurses, or a nurse and an LPN. This means that each nurse is getting 8 patients. If the team leader were able to actually do everything like hang the IV meds and all admits and discharges this system would work wonderfully, but often there are two admits at once and possibly many discharges at the same time. In addition the team leader needs to be trusted to inform the other two nurses of any abnormal labs. What is happening is that the team leader is doing things here and there which help, but it boils down to each nursing taking atleast 8 patients and looking up labs and speaking with doctors (we were told 16 would be the max but as you guessed they did not stick to what they said and sometimes we are getting 18 or 19 patients to a group, giving each nurse 8-9 patients. It's crazy. I have been getting out of work so late! This truly is back breaking work! I feel that if I continue to work in nursing I will be aged beyond my years from mental and physical stress.

farry · Sep 22, 2006

Hi,

Welcome to nursing. In the Bahamas this is a normal thing for the staff. Be encourage and just talk it over with your manager for something to be done.

Keep the faith. :nurse:

lindy777 · Sep 23, 2006

Starry,

I graduate in May, 2007 and I am scared to death. I don't know what the rules and regulations are in North Carolina (where I live). I know how little we really know when we graduate and I am scared to death that I will harm or kill a patient because of that lack of experience.

I know you feel really trapped because of the payback clause on your loans. I thought even from the beginning that allowing them to pay for my education would amount to me becoming their slave. Your story really confirms that suspision.

All I can say is that I will say a prayer for you & hope that things will get better. Nursing is a calling and I pray that you won't get burned so badly that you leave the profession. Best wishes.

swanganz · Sep 23, 2006

That is definitely not safe and everybody has the same suggestions. Take these issues to management and don't stop going up the chain until you are heard. Until we demand better and safer care for our patients we will always have this problem and will always be an obstacle to why nursing is often viewed as a "job" and not a profession

yupyup5 · Sep 23, 2006

This is a very scarry, but real scenario for nurses. I am sad and distressed that many are experiencing the same thing. As nurses we need to do something and it has to be more than just complaining. I would be very careful to 'assume' that CA has figured it out. As the saying goes, "be careful what you wish for". In my units, if the we had the same staffing ratio as CA, the nurses would have more patients than they do now, without a nursing assistant on their team!

My suggestion is that you arm yourself with real facts, ideas, literature to support your concerns..and provide your manager/administration with a "solution". Many nurses have complaints but don't have the foggiest idea how to fix the problem. So they walk around frustrated, upset, etc and become disfunctional. And this demeanor translate to the patients.

I suggest you read the information on the American Nurses Association web site. Go to http://www.nursingworld.org. In the "core initiative" section read the information related to safe staffing, etc. This information will give you a basis of knowledge to begin to determine what is best for your setting. Meet with your manager, supervisor or nursing director. Begin the discussion about what is best for your patients. When you focus on the patient, patient outcomes, patient satisfaction, etc there are not too many that can argue. BUT you must be prepared. Educate yourself and others.

Do you have shared governance in your organization? If you are not aware of what this is and what it entails you can read about that topic too. Complete a search on the web page I mentioned earlier.

If you feel like this is too big of a task for you then, talk to other nurses, find support for your ideas. Most importantly, become informed to become effective.

Good luck and keep caring!

rktele · Sep 24, 2006

I started out at a ECF and it was like that for me too. I was made an LPN charge nurse on a 38 bed unit after being an LPN for 1 month- all the meds, daytime skin treatments, all the orders, and the phones- all by myself. The day after I took my RN boards, "congratulations, now you get to be a RN charge on our medicare floor." It was also on the evening shift, and I was the only RN in the building, which made me house supervisor by default. And I had just taken my boards. I was hating nursing, my job, my life. And every day that I worked I was in fear for my license, because I was spread so thin no matter how hard I tried, I knew that a mistake was going to happen if given enough time.

GET OUT NOW BEFORE YOU BURN OUT!!!! It sounds like the culture of the place is to overload the nurses. You're tap-dancing on a license you've just earned.

Good luck.

twotrees2 · Sep 25, 2006

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?

welcome to the world of nursing - i tired to make a change - all it got me was a change of jobs and not by my doing. sigh - well - we can only do the best we can. hang in there kiddo.

twotrees2 · Sep 25, 2006

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.

when i went to state ( of course thier investiagtion showed adequate staffing as they can run those numbers quite well to cover thier butts regardless of the staffing ) i THOUGHT i had the backing of EVERYNE and when push came to shove i toolk the fall alone - even by what i thought was my best friend - no longer even an aquaintance thats for sure.

anne74 · Sep 25, 2006

The only leverage we have as nurses is the nursing shortage - and this is huge leverage - use it! Simply don't work at a place that uses you like that! It's terrible to put you in that position - it's unfair, and it's unsafe to you and the patients.

I don't understand why anyone continues to work in an environment like that - by doing that, you're basically saying it's acceptable practice and it's OK to be exploited and put patients in danger.

If you quit and go somewhere else (which with nursing is easy to do) then these places will be forced to make policy changes. They simply can't function without us.

I was working on a specialty med/surg unit with a 4:1 ratio, which was decently safe, but still didn't allow time for critcial thinking, care plans, and psychosocial interventions with patients. Even with only 4 patients, I couldn't stand the conditions - no lunch, no bathroom breaks, major stress, backaches, sleepless nights, no life outside of work. I put up with that for 7 months, but tomorrow I'm starting a new job in pre-op/PACU. No more than 2 patients, consistent schedule, you get to eat, pee, etc. Interestingly enough, this unit has no problem getting nurses to work there, and they're always properly staffed - imagine that! Even more, the patients get great care.

It's as simple as supply and demand - hospitals have a demand for us, and we supply our services. When we stop supplying our services to bad environments, hospitals are forced to compete and offer us what we need. They will have no choice!

If you continue to work in an unsafe place you're not only hurting yourself, you're hurting the nursing profession and most of all, the patients!

Maybe not all states can band together like California did, but there are statements you can make on the individual level. Refuse to "enable" these places and go where it's safe.

twotrees2 · Sep 25, 2006

Jenni - you said it all. Because they put up with it is the correct answer. If we banded together and stood up against unsafe assignments things would change very quickly. Unfortunately nurses just will not band together, and will not be assertive enough to help their patients in the long term.
Harsh words? Yep. You all know that it is true though. The only ones who can make them change is the nurses. I would love to see the day that we hung together and all refused unsafe assignments.

tell you what- i wil stand beside the nurses and in the end i will be there with them but i wil never ever ever again take it in my own hands thinking i got them beside ME cause been there done that and i know they aren't.

not only that - the places can run the numbers till they are sickeningly wrapped around us and make us look like fools. sad but very very true.

twotrees2 · Sep 25, 2006

Wow. All this is terrible and makes me wonder if I want to be a nurse. This post has certainly opened my eyes. I am supposed to start nursing school in Jan.
I know it may be difficult to find, but I hear that there are many opportunities in nursing. Why not try a docs. office? Get invovoled with research?? Be an educator?? Being a floor nurse is not the end all. I for one, am not planning on working in a hospital when I get out of nursing school. I may start there to get my feet a little wet, but I will not stay. I have already determined this. My hat goes off to those who do it, but I do not see myself here. I have heard it's difficult to find jobs out of hospitals, but I am sure they are there. You have to look very hard. I am prepared to do that.
Hope things get better for you and you find your niche!! Hang in there!! Epona :monkeydance:

i can tell you it is no different in LTC.

twotrees2 · Sep 25, 2006

Wow. All this is terrible and makes me wonder if I want to be a nurse. This post has certainly opened my eyes. I am supposed to start nursing school in Jan.
I know it may be difficult to find, but I hear that there are many opportunities in nursing. Why not try a docs. office? Get invovoled with research?? Be an educator?? Being a floor nurse is not the end all. I for one, am not planning on working in a hospital when I get out of nursing school. I may start there to get my feet a little wet, but I will not stay. I have already determined this. My hat goes off to those who do it, but I do not see myself here. I have heard it's difficult to find jobs out of hospitals, but I am sure they are there. You have to look very hard. I am prepared to do that.
Hope things get better for you and you find your niche!! Hang in there!! Epona :monkeydance:

also - if your in a small town and are going to be an RN you can usually forget the docs office - they aint buying that price usually - home health is great but in a small town area not a good idea if you need a full time job as there arent a lot of home health issues around. no research in the small towns. just FYI in case anyone is in a small town - need to look at bigger cities.