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?
Ok we are now on the beginning of week 4 as an RN.
I had a decent week, in aspect of the I didnt have more than 8 patients at any given time. Although they tried to give me 4 post op's within 2 hours of each other which luckily there was an extra RN, so they I cant possibly take another person at this point of having 7, worked. Only because there was a so called "Extra" nurse that came in early.
I would like to comment on everybody saying that we as nurses and new grauduates need to stand up and get something accomplished. Also I can see that their have already been instances of people losing their jobs.
I can see in the short time of being here at my hospital and on my floor, that a lot of the nurses do see as having a high number of patients as being the norm. I even kinda get some negative aura from some of the older nurses that I am even saying anything due to the same reasoning that I just mentioned. This is nursing, get used to it, or we all do this everyday. Well my reply that I am thinking is that hey I see the care that They are receiving also.
Which another point and purpose. I dont know how other hospital are with care plans. But I can say this HAHAHAHAHAHA, a care plan, that is the biggest joke at my place of employment Its like right something down on the paper thats what its like. They are unimportant, never looked at, never reviewed, It is marked that they are updated and reviewed but yeah its a joke. There are many things that are overlooked and its very very sad.
Also again like many people have said on this post, this is how it is, and nobody is doing anything about it.
I am in the state of Pennsylvania, We do not have a union at my place of employment, and our hospital is part of a larger system.
I will give you a little run down of this day. I started with 6 patients, which isnt Horrible, but I know that there is no possible way to deliver great care with that load to begin with but I go with it. Get report from 3 different nurses, because I am split on 2 sides of our 3 sided unit. I have to use 2 different med rooms, because we have a PYXIS med machine. So I have to go to 2 differnt places to get my mars and my rooms. I most likely walked 20miles today wouldnt suprise me. I had 3 patients that were going for tests, extensive invasive tests that when they returned needed some close monitoring, which I wasent able to provide as close as need be because of the time restraint. ( at this time is when they were bringing trying to call report on the fresh OR from PACU) Also my afternoon meds I was still trying to catch up on. Two pateints were fall risks and skin breakdown risk due to inactivity and becasue of trying to crawl out of the bed/wheelchairs so Im running back and forth trying to keep an eye on them. I have 4 IVS running, one went bad, calling IV team. Drs. needing called to give them test/lab results. Thats if I can find the chart. Drs. come in write new orders and maybe maybe not the charge nurse will come find me to tell me if its important enough. People not happy about lunch trays having to call dietary, because we have to make the patient happy, so they are fussy at me on the phone becuase they are short staffed and im bothering them. My aides I was working with were primarly with other nurses meaning that they have more patients of the other nurses, so I was kinda hard hit of seeing them most of the day. I felt like a glorified med passer today I had so many to do IV pushes your routine pills, pain medication (4 of the 6 were needing to be medicated on a routine basis)
AGAIN I will state I know im not perfect I must work on my prioritizing and organizational skills, I am new it comes with time BUT, did my people get washed up today... haha thats funny if night shift or the aides got to it today which I dont know I didnt see them most of the day, I sure as crap didnt have time which is sad. Rooms are trashed with old food the patietns try to keep off their trays old juices and beverages, on my one side the aide was so busy she didnt pass new water until almost 3pm which wasent her fault she was busy too and that wasent the priority but the poor patietns have the same water for most likely 16 hours or so this isnt right!
Call lights go off for approximantly 5-10minuts to get answered maybe, which makes it really bad is that I know a call light is going off and I can not possibly go answer it because it maybe something that an aide can handle that If I get caught in the middle of my already late 8-9:00 meds will be given at noon instead of already being given after 10 even 11am this morning. I am trying I am working as fast as I can, Oh and again if theres anything new that I may not be familiar with well I might have two seconds to look it up..... but again that just throws my day off more... since I have so much still to do..... I am trying people I am trying! And when they said there calling report from PACU on my second post op I looked at the charge nurse and said I can not possibly take another patient I'm up to 7, and still behind. My charting is less then to be desired mostly because I dont have time, and I really try really hard to do the best job you can do but when your running around ready to rip your hair out on the inside ready to scream, and your barley holding it together, just taking things one at a time, its kinda of difficult to remeber everything and chart the most awesome chart ever its not going to happen, Of course Im not giving the entire picture of my day for again fear of HIPPA, but thats the surface of it.
EVeryone keeps telling me it will get better, Im new, it will pass, it will be ok, so I start thinking that its ok to have 7-8-9 patients and I am suppose to be able to handle it, I am fortunate enough to have nurses that do care enough to tell me words of encouragment, but I do believe that they have been brain washed and they think that it is ok. I dont think Im unreasonibly stating that a ANY RN should not have more than 6 patients. Also If an experiecned RN happens to have 6 patients, and gets their charting done on time, has time to converse a little with the patients they say their bored, because there so used to it being rediculously chaotic and doing the bare minumum necessary for that shift, they say their bored!!!! That is why nothing ever gets done in the nursing field Am I not right? Also the much encouragment that It will get better makes me thing im being hasty, even my unit manager aggrees that it is busy and hectic and just tells me to take my time and do the best that I can do. Once I master this floor I can do anything.
Also one more statement, someone commented on there is no time to critical think when you have 4 patient, I SO AGREE, critical thinking I have pretty much forgot what critical thinking is. BAsically I get through my day by starting in my head a list of things that must be done, and praying that I choose the correct order to not get myself in a bind, and cause harm to any of my patients. I keep feeling like Im incompetent, and Im a bad nurse because I cant care for my patient assignement, when I know in the back of my mind that I am not wrong, and what is occuring isnt right, and needs to change. BUT WHY DO I FEEL THAT WAY? Not to mention, here are my things that i definitly feel, The nursing process, haha, Assessment is less to be desired, Implimentation whatever has to be done to get through your day, Diagnosis - care plans mean little to nothing. Planning, plan what? only what social services plan to do to get them home. Setting goals, yeah, everbody gets through the day in one piece thats the goals, Evaluation, people are breathing and their origial problem is half taken care of and away they go out the door.
I don't know... I just continue to feel frustrated. Is there a place that actually cares for the whole patient, physically and emotionally, the nurses actually work with the doctors and know whats going on with the patient, works together as a collective team with all departments and Families work together to get the patient to their optimal health, not just fix their admitting diagnosis. Where is this place?
I'm also a new grad, I had 3 weeks of orientation (which I thought was way too short, but that was another thread...) and usually get 4-5 patients each shift. My aides are often MIA and when I get one that's not, I'm so thankful I almost want to cry. I read your posts and I just cringe. It's absolutely impossible to safely care for the patients you're describing. You can't possibly thoroughly monitor the ones that need it and take a fresh post-op and pass meds and meet all the other needs you're required to meet by yourself... you just can't.
So who suffers? The patient, when he starts to crash. And you, when everyone turns on you and wants to know why you didn't catch his altered LOC, decreased BP etc... you didn't catch it because you hadn't been in his room for 90 minutes. Because you were racing around putting out fires everywhere else.
I wanted to laugh when I read someone's post about DOCUMENT EVERYTHING. Great in theory. But 1) you have to have the time to do it and 2) you can't possibly document everything if you never get the time to assess and reassess everything... And on top of all this YOU'RE NEW! You don't know everything, you have to stop and figure something out, stop and look something up, stop and ask someone something.
And then people tell you how you have to take your breaks... well yes, taking breaks is extremely important I get that. But when you have a patient that needs reassessed for the possible development of complications and another who needs an IVP for pain and another who's IV pump is alarming and another who's threatening to go AMA if you don't get his Ativan now, and new orders to note and... well you get the idea. Who can sit down and take a break then?! And that's what the whole shift is like sometimes.
I hear you girlfriend. We are going to burn out and we are going to burn out big. I would honestly take less money an hour if it meant a saner patient load. I really would. Blasphemy around here I know, but there it is.
I'm still in the process of trying to figure it all out. I can already see why management and staff become polarized. I've been an RN on my own for a month and already dislike the suits who tell me I have to perfectly and safely care for X amount of people. And that I have to do it with only 3 weeks of orientation. Excuse me?! Grab a stethoscope Sir and show me how it's done.
All I can say is I'm darn thankful I don't work with any nurses who get off on eating their young. I would be gone if that were the case. There would literally be no choice. Their support is what saves me.
I'm also a new grad, I had 3 weeks of orientation (which I thought was way too short, but that was another thread...) and usually get 4-5 patients each shift. My aides are often MIA and when I get one that's not, I'm so thankful I almost want to cry. I read your posts and I just cringe. It's absolutely impossible to safely care for the patients you're describing. You can't possibly thoroughly monitor the ones that need it and take a fresh post-op and pass meds and meet all the other needs you're required to meet by yourself... you just can't.
So who suffers? The patient, when he starts to crash. And you, when everyone turns on you and wants to know why you didn't catch his altered LOC, decreased BP etc... you didn't catch it because you hadn't been in his room for 90 minutes. Because you were racing around putting out fires everywhere else.
I wanted to laugh when I read someone's post about DOCUMENT EVERYTHING. Great in theory. But 1) you have to have the time to do it and 2) you can't possibly document everything if you never get the time to assess and reassess everything... And on top of all this YOU'RE NEW! You don't know everything, you have to stop and figure something out, stop and look something up, stop and ask someone something.
And then people tell you how you have to take your breaks... well yes, taking breaks is extremely important I get that. But when you have a patient that needs reassessed for the possible development of complications and another who needs an IVP for pain and another who's IV pump is alarming and another who's threatening to go AMA if you don't get his Ativan now, and new orders to note and... well you get the idea. Who can sit down and take a break then?! And that's what the whole shift is like sometimes.
I hear you girlfriend. We are going to burn out and we are going to burn out big. I would honestly take less money an hour if it meant a saner patient load. I really would. Blasphemy around here I know, but there it is.
I'm still in the process of trying to figure it all out. I can already see why management and staff become polarized. I've been an RN on my own for a month and already dislike the suits who tell me I have to perfectly and safely care for X amount of people. And that I have to do it with only 3 weeks of orientation. Excuse me?! Grab a stethoscope Sir and show me how it's done.
All I can say is I'm darn thankful I don't work with any nurses who get off on eating their young. I would be gone if that were the case. There would literally be no choice. Their support is what saves me.
here's something that really makes me mad - is the floor nurse who has the same "concerns" as we do and they go to the management position and ok - for the first few days the "try" to keep going with thie r"concerns" but then quickly turn tail and all of a sudden the "concerns" are needless "complaints" and they are no better than the upper management - it turns my stomach.
exactly what I'm going through right now and exactly why I'm looking for another place ( not that another place will be any different but i have noted that for about a yr maybe less at some places you are usually kissed butt to try to keep you until they are sure you wont or cant leave and then they dump on you. sigh.
I just put in my first three weeks as new nurse on a psyche floor. Training was three days--scary! I am supposed to be learning to be charge while running up and down the halls doing meds for 20 or more patients in varying stages of psychosis, confusion, depression, or agitation. On top of that any special feeds--anything on the Cardex, I do. Then I have a pile of nursing assessments and notes to write. Notes that you know that no one reads. I was interested in the concept of the therapeutic milieu and nurse's therapeutic role. I was told by my boss,"You don't have time to talk to the patients. That's the way nursing is these days. " Meanwhile patients are shot with drugs just to shut them up because they won't staff the place enough to help these confused people. But I really love these patients and that is why I am going back tomorrow. In the meantime--why are nurses putting up with this? We have the power.
Ok we are now on the beginning of week 4 as an RN....
I don't know... I just continue to feel frustrated. Is there a place that actually cares for the whole patient, physically and emotionally, the nurses actually work with the doctors and know whats going on with the patient, works together as a collective team with all departments and Families work together to get the patient to their optimal health, not just fix their admitting diagnosis. Where is this place?
This is the gist in a nutshell. A friend emailed me yesterday, "Welcome to the world of capitalist medicine where it is all about greed, greed greed."
I would like to give my input as to not scare EVERYONE.......
I went to school in Atlanta and graduated 1 year ago. While in school I NEVER spoke with a med/surg nurse that had the pt loads that are stated here. M/S ratios at most were 5 to 1 in the day...... ICU 2 to 1 sometimes even 1 to 1....
Now I am a nurse in Louisville I have worked TCU for one year ratios were 3 to 1 but were changed to 4 to 1 and we thought we had it bad....
I now work ICU and it is 2 to 1 sometimes 1 to 1.....
Lesson:
Cali is not the only state that cares. You need to look for TEACHING hospitals with plenty of resources and research dollars
The theory behind nurse/ patient ratios is great, but the practical application doesn't always work out as planned. My hospital is staffing the floors as close to the bone as possible. Each shift staffs for the following shift using the current house census. This means that there is no plan/ leeway for floor admissions. So, if at the beginning of the shift, a nurse already has her maximum ratio - what do you think happens when I try to start sending up my admits from the ER? Yes, we force M/S and Tele to go out of ratio. Because what else am I going to do when there is literally no bed or chair in the ER to put a patient in. And this is terrible - but sometimes I can only get an ICU bed if somebody dies! It is VERY rare that the ER or the floors don't go out of ratio each shift. What's the solution? More nurses -OF COURSE !!! Will we get them? Probably not.
I work in the UK on a respiratory ward and qualified about 2 months ago, the usual ratio of nurses: patients is 1:15! Being a medical ward it is a bit different to a surgical ward, but I have been on placement on a surgical where the nurses have 12 patients. It is very stressful and I do not get to do the basic nursing that I love and I do not get a chance to have a chat to my patients and see how they are really doing, it is very frustrating. however my days do go very quickly! The US system does seem very different to the UK, but the UK government is saying that we do not need anymore nurses, but really the NHS just can't aford to employ anymore! They have even stopping foreign nurses from applying anymore, but then at least it will mean that there are more nurses in developing countries.
It is very frustrating that one knows that one can do a good job if only we had the time and more funding. But then again I have worked in Africa and their situation is even worse, even less nurses as they all move to the developed world, and the minimum amount of money, so we can call ouselves lucky in some ways even though it does not feel like it when you get home after a horrific shift.
I hope that this thread does not put off any budding nurses, nursing is a great job.
starryx2
33 Posts
Hello Everbody once again
Ok we are now on the beginning of week 4 as an RN.
I had a decent week, in aspect of the I didnt have more than 8 patients at any given time. Although they tried to give me 4 post op's within 2 hours of each other which luckily there was an extra RN, so they I cant possibly take another person at this point of having 7, worked. Only because there was a so called "Extra" nurse that came in early.
I would like to comment on everybody saying that we as nurses and new grauduates need to stand up and get something accomplished. Also I can see that their have already been instances of people losing their jobs.
I can see in the short time of being here at my hospital and on my floor, that a lot of the nurses do see as having a high number of patients as being the norm. I even kinda get some negative aura from some of the older nurses that I am even saying anything due to the same reasoning that I just mentioned. This is nursing, get used to it, or we all do this everyday. Well my reply that I am thinking is that hey I see the care that They are receiving also.
Which another point and purpose. I dont know how other hospital are with care plans. But I can say this HAHAHAHAHAHA, a care plan, that is the biggest joke at my place of employment Its like right something down on the paper thats what its like. They are unimportant, never looked at, never reviewed, It is marked that they are updated and reviewed but yeah its a joke. There are many things that are overlooked and its very very sad.
Also again like many people have said on this post, this is how it is, and nobody is doing anything about it.
I am in the state of Pennsylvania, We do not have a union at my place of employment, and our hospital is part of a larger system.
I will give you a little run down of this day. I started with 6 patients, which isnt Horrible, but I know that there is no possible way to deliver great care with that load to begin with but I go with it. Get report from 3 different nurses, because I am split on 2 sides of our 3 sided unit. I have to use 2 different med rooms, because we have a PYXIS med machine. So I have to go to 2 differnt places to get my mars and my rooms. I most likely walked 20miles today wouldnt suprise me. I had 3 patients that were going for tests, extensive invasive tests that when they returned needed some close monitoring, which I wasent able to provide as close as need be because of the time restraint. ( at this time is when they were bringing trying to call report on the fresh OR from PACU) Also my afternoon meds I was still trying to catch up on. Two pateints were fall risks and skin breakdown risk due to inactivity and becasue of trying to crawl out of the bed/wheelchairs so Im running back and forth trying to keep an eye on them. I have 4 IVS running, one went bad, calling IV team. Drs. needing called to give them test/lab results. Thats if I can find the chart. Drs. come in write new orders and maybe maybe not the charge nurse will come find me to tell me if its important enough. People not happy about lunch trays having to call dietary, because we have to make the patient happy, so they are fussy at me on the phone becuase they are short staffed and im bothering them. My aides I was working with were primarly with other nurses meaning that they have more patients of the other nurses, so I was kinda hard hit of seeing them most of the day. I felt like a glorified med passer today I had so many to do IV pushes your routine pills, pain medication (4 of the 6 were needing to be medicated on a routine basis)
AGAIN I will state I know im not perfect I must work on my prioritizing and organizational skills, I am new it comes with time BUT, did my people get washed up today... haha thats funny if night shift or the aides got to it today which I dont know I didnt see them most of the day, I sure as crap didnt have time which is sad. Rooms are trashed with old food the patietns try to keep off their trays old juices and beverages, on my one side the aide was so busy she didnt pass new water until almost 3pm which wasent her fault she was busy too and that wasent the priority but the poor patietns have the same water for most likely 16 hours or so this isnt right!
Call lights go off for approximantly 5-10minuts to get answered maybe, which makes it really bad is that I know a call light is going off and I can not possibly go answer it because it maybe something that an aide can handle that If I get caught in the middle of my already late 8-9:00 meds will be given at noon instead of already being given after 10 even 11am this morning. I am trying I am working as fast as I can, Oh and again if theres anything new that I may not be familiar with well I might have two seconds to look it up..... but again that just throws my day off more... since I have so much still to do..... I am trying people I am trying! And when they said there calling report from PACU on my second post op I looked at the charge nurse and said I can not possibly take another patient I'm up to 7, and still behind. My charting is less then to be desired mostly because I dont have time, and I really try really hard to do the best job you can do but when your running around ready to rip your hair out on the inside ready to scream, and your barley holding it together, just taking things one at a time, its kinda of difficult to remeber everything and chart the most awesome chart ever its not going to happen, Of course Im not giving the entire picture of my day for again fear of HIPPA, but thats the surface of it.
EVeryone keeps telling me it will get better, Im new, it will pass, it will be ok, so I start thinking that its ok to have 7-8-9 patients and I am suppose to be able to handle it, I am fortunate enough to have nurses that do care enough to tell me words of encouragment, but I do believe that they have been brain washed and they think that it is ok. I dont think Im unreasonibly stating that a ANY RN should not have more than 6 patients. Also If an experiecned RN happens to have 6 patients, and gets their charting done on time, has time to converse a little with the patients they say their bored, because there so used to it being rediculously chaotic and doing the bare minumum necessary for that shift, they say their bored!!!! That is why nothing ever gets done in the nursing field Am I not right? Also the much encouragment that It will get better makes me thing im being hasty, even my unit manager aggrees that it is busy and hectic and just tells me to take my time and do the best that I can do. Once I master this floor I can do anything.
Also one more statement, someone commented on there is no time to critical think when you have 4 patient, I SO AGREE, critical thinking I have pretty much forgot what critical thinking is. BAsically I get through my day by starting in my head a list of things that must be done, and praying that I choose the correct order to not get myself in a bind, and cause harm to any of my patients. I keep feeling like Im incompetent, and Im a bad nurse because I cant care for my patient assignement, when I know in the back of my mind that I am not wrong, and what is occuring isnt right, and needs to change. BUT WHY DO I FEEL THAT WAY? Not to mention, here are my things that i definitly feel, The nursing process, haha, Assessment is less to be desired, Implimentation whatever has to be done to get through your day, Diagnosis - care plans mean little to nothing. Planning, plan what? only what social services plan to do to get them home. Setting goals, yeah, everbody gets through the day in one piece thats the goals, Evaluation, people are breathing and their origial problem is half taken care of and away they go out the door.
I don't know... I just continue to feel frustrated. Is there a place that actually cares for the whole patient, physically and emotionally, the nurses actually work with the doctors and know whats going on with the patient, works together as a collective team with all departments and Families work together to get the patient to their optimal health, not just fix their admitting diagnosis. Where is this place?