need advice badly please help

Virgo_RN, BSN, RN · Nov 10, 2007

I didn't read your entire post, as I don't have the attention span today, but I get the basic idea of what you're saying. I, too, used to dread going to work. The ritual of changing into my scrubs, gathering my supplies, making my lunch, and going out the door all felt like each step was one step closer to my own execution; I felt like "Dead Nurse Walking".

I think the basic problem that faces new nurses is that the reality of acute care nursing does NOT match our expectations. Nursing school does not prepare us for this reality. My solution to this has been to accept the situation as it is instead of expecting it to be what I want it to be, and to do the best I can with what I have.

I am always going to have too many patients and not enough time to do everything I am supposed to do. I am always going to feel that when I am at the bedside I should be charting and when I am charting I should be at the bedside. I am always going to have to pass meds late or put something off just to get my dinner break. I am never going to know enough about my patients to feel like I really know what is going on with them. I am always going to feel like I am not doing enough for my patients, and that I am doing all I can just to keep my head above water. This is the reality of acute care nursing today, and better to accept it and embrace it and do the best I can despite it, than to keep expecting it to be different from that.

And maybe this is silly, but I've also thought about finding a way to get involved in efforts to change these things, so that conditions will be better not only for me, but for future nurses as well.

Mommy TeleRN, RN · Nov 11, 2007

NursHeather - I feel just like you do. I have also been told I spend too much time with my patients and that I have to get faster. I struggle to get everything done on time. I hate having to be so impersonal to patients. I've had such good experiences like when I was an intern and could spend more time and have gotten so much good feedback from patients and families. I LOVE teaching patients. Maybe one day I can be some sort of hospital educator.

But for now I feel like NancyNurse - she summed up exactly what it's really like. That is the perfect phrase "when I'm at the bedside I feel like I should be charting and when I'm charting I feel like I should be at the bedside" it's that tugging that I need to be doing 82 things at one time. I try not to be task driven but rather to be patient driven and constantly critically thinking. On our floor the patient condition can change so quick..they are so sick. I worry all the time I'm going to miss something that is staring right at me because I have to rush in and out of the room and I don't have the time to look at all the labs and read the progress notes and stuff. I'm just recently off orientation so I hope with more experience I can get through the routine stuff quicker and have more time to actually manage the pt care instead of passing meds and putting out fires all shift long..but for now I'm having to learn to be more realistic of my expectations.

Daytonite, BSN, RN · Nov 11, 2007

Being a new grad is a very stressful time. At 3 months you are in no way the experienced and confident nurse that you envisioned you would be. It takes at least 6 months and more like a year or more to get to that point. The biggest challenge for new grads is learning to become organized and get all the tasks of the shift accomplished. I've spent my entire career perfecting organization of my work shifts.

The reason it is good to be on a med/surg type of unit is because of the stability and routine of these units. You may not agree with that statement, but I guarantee that things are more chaotic in units like ICU and ER. As a new nurse you need that regular routine to fall back on as you struggle to become organized and perfect nursing skills that you only touched on in nursing school.

Please realize that this is still a critical learning time in your career sans your nursing instructors. With a year or two of experience under your belt you will be able to start turning your attention to those ideals that were important to you in nursing school. You will learn to make time for patients. I struggled with organization for a few years. But once I mastered this skill I was on my way. I found ways to sit with patients and listen to them talk. I found ways to be caring and kind. I found ways to make things personal with patients. I sat at bedsides of patients who were restrained and charted. I almost never sat at the nurses station but was always in the hallway and in and out of my patient's rooms checking on them. And, I didn't care what the other nurses had to say in critique (that's what confidence will do for you). Misery loves company and I was happy and determined not to get sucked into their misery over their jobs. I was working hard and loving it. I knew I was doing what was right.

You need to know that there is a movement afoot to improve the nurse/patient ratios. It started here in California with the passage of the Nurse Staff Ratio Law. Several other states have similar proposals before their legislative bodies. Some places are just voluntarily reducing nursing patient loads as they see that high patient loads are driving nurses out of the profession. Medicare is also putting pressure on facilities to improve nursing workloads. So, hang in there. Things are going to change.

Michelle123 · Nov 12, 2007

Daytonight, you always give the best advice!!

charie · Nov 12, 2007

im no RN, but allow me to tell you that you can do it if you just believe and trust yourself!

Hellllllo Nurse, BSN, RN · Nov 12, 2007

Daytonite does give great advice, but the realities of nursing are daunting.

I've been anurse for 15 years, RN for seven.

There is no nursing shortage; There are more than enough licensed RNs in the US right now to fill every job opening with thousands of nurses left over. (Stats and links have been posted on allnurses a number of times).

Then why the so-called "shortage"?

Because work loads are so overwhelming, nurses are not able to give their pts the care they deserve, or even adequate care in some situations. We go home feeling discouraged, drained, and unhappy that we were not able to provide the kind of care we want to, and always thought we would when we were students.

Because of this, nurses continue to leave the bedside. Stats show that new nurses are leaving faster than in any past generation. Some think things will improve with more men becoming nurses, but they leave even faster than women do.

These are the realities of nursing.

"Recent graduates of the nation's nursing schools are leaving the profession more quickly than their predecessors, with male nurses bolting at almost twice the rate of their female counterparts, according to a new study. ....

http://www.cbsnews.com/stories/2002/09/06/health/main521057.shtml

http://findarticles.com/p/articles/mi_m0843/is_6_28/ai_94590407

04.07.2007

"RESEARCH has found nurses aren't leaving their profession because they don't want to do their job any more- many leave because they feel workloads don't allow them to do their job properly."

http://www.dailymercury.com.au/localnews/storydisplay.cfm?storyid=3740306&thesection=localnews&thesubsection=&thesecondsubsection=

ltmja · Nov 17, 2007

I am a new grad, past my boards on october 6th :). I have finished my 9th day on the floor and OMG!!!! I became a nurse because I want to make a difference. Nobody likes to be at the hospital but if I could be there to showed I cared and was able to make the time to listen to their story:( My preceptor had a little talk with me about how i am not a student anymore and I can't be spending as much time in my patients rooms as I have been. I had two patients in the same room and the first patient I handed meds out to was new. I explained all her meds she was talking and answered her concerns. The next patient I had had so many meds. Both were pretty needed of my time but that's what I am there for. To make them as comfortable as i can....right!!! When I left their rooms my preceptor said I was in there for 40 minutes and I can't do that. Sometimes I have to call the CNA or LPN and tell them I will be with them when I can. I still spent some time with one of those patient who I found out she was admitted on her birthday, poor thing! She gave me a rose for being so nice to her. I hate not being told I can't do some things for my patient's because I don't have the time! It will take some time for me to learn how to manage my time, get meds and charting done on time and still have time for the patients. I think that comes with time.

marie-francoise · Nov 18, 2007

Those patient-to-nurse ratios are just insane. The "nursing shortage" I think is in essence a strike - just without picketing or demands; nurses just giving up on the bedside because they don't want to put up with those conditions any longer.

Hellllllo Nurse, BSN, RN · Nov 18, 2007

A strike- a silent strike- you're so right.

Dierdre · Nov 18, 2007

I have a huge amount of sympathy for you, but no real answers other than to vote with your feet that hospital nursing is a burnout career and try something different. Hospice and Homecare are areas where you are expected to spend about an hour per patient, and you might really like those. The areas you were talking about--NICU, ICU--these places report even higher percentages of burnout than your average med-surg floor. The patients really appreciate a bedside nurse, but believe me, the managers don't.

When I worked LTC I had four nursing assistants, a med aide, and myself to take care of forty patients. Yeah, they were medically stable enough to not need to be in the hospital, but believe me that did not mean that they were medically stable. The patients in the nursing homes and hospitals continue to get sicker and sicker, and the people on the med-surg units in the hospitals now would have been in ICU 15 years ago.

I added up the amount of time I needed to comprehensively perform my duties at one point. For an eight-hour day, I had approximately 22 hours worth of work. I took it to my boss, she was astounded, but nothing changed. Why should it? It wasn't negatively impacting anyone except the patients, and they couldn't remember to complain anyway.

I was literally so sick, angry, and depressed when I left that job that when one of the corporate nurses asked me in the hall why I was leaving, I shouted the reasons at her without regard to who might here. They didn't try to get me to stay anymore after that, which was a bonus, I was tired of the begging and the empty promises of how much better it was going to get.

Will it get better? Well, it's better in California. If you really want to work in a hospital, my advice is to relocate to a state with a strong nurses union that forces the hospital to do the right thing. Otherwise, go to work somewhere besides the hospital and keep your sanity intact. Be able to love what you do.

Mulan · Nov 18, 2007

the conditions are not going to change, you'll be able to handle it better with more experience