Need some advice please...

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Well, first solid week on the unit that I have been requested to work... still supposed to be on orientation, yet I had two shifts by myself this week alone... and I am quickly finding that this unit and I are not a good fit for each other... How do I approach the unit manager and DON and tell them that I don't believe this is the best fit for me or the unit? I never wanted to be a psych nurse and there is too much psych on this unit... which is not a typical LTC or SNF unit, but a "dementia" unit... some dx are psychosis, dementia, alzheimers, schizophrenia, bipolar, depressive not otherwise classified, etc. I knew in clinicals I never wanted to be a psych nurse, that field just isnt for me... I thought I could handle this unit, I thought I would be able to fit in well with the diagnoses and be a good nurse, but I am afraid that I am going to burn out quickly on this type of unit and put a bad taste of nursing in my mouth. I am a new grad, and 49+ psych residents is just too much for one new grad nurse and 3-4 CNAs to handle in my opinion... especially when 99% of these people are HUGE fall risks... I just cannot be everywhere at once and neither can my CNAs. there was an incident this morning that proved this. If I am at the other end of the hall passing meds and my CNAs are in rooms trying to get residents changed and up so that first shift doesn't have to do so many residents, we cannot answer call lights in a timely manner and we cannot always hear a resident shouting out for help as one resident does. if I am doing meds on a resident who has a PEG tube, its going to take a me a few minutes, but if I hear a resident yelling for someone, am I supposed to drop what I am doing with the resident I am with (checking placement, residual, flushing PEG, administer meds, flush, med, flush, and so on) and run down the hall to that resident shouting out, who either needs a pain pill or to use the urinal? and that is if I even hear that resident... if the door is partially closed and a tv is on in the resident's room, me hearing the resident decrease greatly when I am at a completely other part of the hall more than several rooms away. I am overwhelmed, feel I haven't gotten great orientation and sure as heck shouldn't be left on my own, but most of all... psych isn't for me and I just don't know how much more on this unit I can take...

I know that psych is a part of nursing, however, one or two or even 4 patients with a psych dx with acuity is different than 49 psych dx and acuity for one nurse to babysit, do treatments on and pass meds on.

So, how do I professionally handle this? I plan on talking to my unit manager on Tuesday, and being straight up and honest with her that I do not think I am a good fit for the unit and that I believe I need to be on a different unit. Since I am still technically supposed to be on orientation and havent got my 90 days in yet, I do not know if I will be fired on the spot for doing this or not, but honestly, if that is what happens, so be it. That to me is better than driving myself crazy or a resident being hurt because of a fall when I couldn't be right there to babysit them because I was tending to another resident. I do not get my 15 minute breaks, I don't get a lunch, and I got mandated to work over 4 hours (after being on my own all night long because they simply didn't schedule anyone to precept me or couldn't find anyone who was willing to work the shift, so I was it) because they are so short staffed. I know breaks in nursing is a luxury, but when dealing with 49 psych residents, one needs to be able to step back and take a breath, especially a new grad who is trying to learn so much and do the best she can, despite less than stellar working conditions. They expect treatments to be completed and dressings changed, but finding the supplies is extremely difficult, especially when I cannot leave the floor to go in search of them on other units, not that the other units have any supplies or dressings either...

sorry to sound like I am complaining, I started out liking the job when I was on the other two units, one being rehab and ltc, and the other just ltc, and when I orientated on different shifts to the unit I am on now, it didn't seem so bad... but after 5 straight days of working it, I know now I cannot handle it.

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Sounds like you have a no win situation. I feel that you understand your surroundings and the deck of cards you have been dealt. It doesn't hurt to discuss your situation with management. You will probably feel like the only professional in the room, but that's OK. Can you do OK without working for a while? Have all this thought out so that when you talk to them you no for sure your decisions for each possible scenario.

Leaving a new nurse alone seems to be very common from what I read here and have heard through the grapevine. If you feel intuitive danger warning bells going off, you need to heed them.

Remember places like this only work in this way because it is always going to be your problem if there is a problem with a patient. The buck stops with the nurse. Everyone should remember this. You are licensed to provide nursing care, and the moment you accept that patient load, it's all on you. If there is a problem everyone including your employer seems to want to wash hands of any responsibility and put the entire weight of the matter on your shoulders. That's the hardest thing to swallow with bedside care. When new nurses were well trained, and facilities actually cared somewhat about their patients, nursing was doable. I seriously wonder if it makes sense to do bedside unless you can get a job at one of the few legitimate workplaces in this country.

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Hi,

First of all it sounds like you need to take a deep breath, every nurse is a psych nurse (like it or not).

That being said, it is EXTREMELY common for residents in LTC to have oodles of psych dx, its all in various degrees as to how serius the dx is. Federal & State law requires these dx for certain medications. :rolleyes:

I would definately talk to your unit manager, DON & the staff developer & get more training.

It is truely a different kind of nursing. You may not have a job after, but you have to ultimatley protect the licence you worked so hard for. Follow your gut & balance that with not rushing to make a decision.

Good luck!

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Follow your gut..be honest with your supervisor and see what, if anything, they are willing to do. I know a lot of people on here will tell you to hang in for a few months,etc. however I think there are times, and this sounds like one of those, that time won't make a difference and hanging in there is only going to stress you out more. If they aren't willing to relocate you then you have the choice to hang in until you find another job, quit or stay. Regardless, going to your supervisor on Tues. sounds like the best place to begin. Good luck.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

I hope you have a good manager, although his/her decision to cut short your orientation doesn't support the concept of "good manager".

I will reinforce what others have said. Talk to your manager. If they are trying to build a stable workforce, they should understand that this is not a good fit for you AND unless they listen and act upon your concerns they will very likely be looking to replace your hours after you find a better job.

So, talk to management. Think about what you might like to do in that facility. Speak in a fashion that reinforces the concept that you are a very good, dependable, and caring nurse who WANTS to work with them.

If they are not interested working to help you be successful in this role, you should probably start looking for a new job.

I hate when management cheaps out of proper orientation for new staff, especially new grads.

Good luck.

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Sounds like a privately owned facility.

There is no way you can safely do this job. You have a new license that you worked hard for. Don't let this greedy, unprofessional facility jeopardize it.

This has little to do with the diagnoses of the residents. Stop blaming yourself.

I would quit on the spot, doubt if it would show on your work record.

These people wouldn't recognize professionalism if it bit them in the tookas, they are USING you.

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Specializes in Icu, Corrections, CICU.

the factors that will help you with this is to learn priorties and time management. As a nurse you cannot be everywhere all the time. Sometimes people have to wait and that is just the way it is doesn't mean they like but that is the way it is. If you want to talk to your manager hopefully they will understand. This is the way I see it you do what you can and no matter what everyone is not going to be happy anyway so don't beet yourself up about it.

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Specializes in Geriatrics, Ambulatory Care.

If you know psych nursing is not for you have every right to sat so within your first 90 days. There is no reason to feel bad about that. There are so many specialties in nursing even within LTC. You said you enjoyed rehab and the other LTC units. It is okay to know your limitations

Also I would have concern about working a unit that has both dementia and true psych. There is a difference. Dementia behaviors are handled differently than true psych (major depression, schizophrenia, bipolar). These people should not be on the same unit. Dementia units should not have more that 20-25 residents on a unit. More residents means more simulation and more behaviors.

Is there an opening on the other units? Good luck to you -- I hope you find the right fit.

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I understand that in some way, all nurses are psych nurses, however, there is a difference between working on a psych unit and working med/surg with a few patients who have psych issues... in the situation I am in right now, its more psych than anything else - and lots of it... psych and pressure ulcers it seems like. When you have one resident going through the paperwork and destroying your mar books and going through the 24 hour log books because they "think they run the place" and if you try to redirect they get upset and take the loose papers and walk away from you... its very trying and I just don't have the ability to handle this every night by myself because they wont hire more help. Also, when you have more than one resident like this, its nearly impossible to make sure they are all ok while they wander the halls at night. If any of them go into the dining room, I lose an aide off the floor because no resident can be in the dining room alone -its a no win situation, and dangerous for the residents and my license as I physically CANNOT keep every resident safe, especially if I am trying to keep tabs on one fall risk wandering the hallway with confidential paperwork.

The preceptor I have been with on midnights, has not really left from behind the desk... paperwork has gotten done and she leaves the desk when the AM med pass time comes... I have worked with patients who had med/surg and psych issues, and I can handle those, but 49 TRUE psych patients is too much for me to handle... I have spent one week of nights on this unit and I already feel depressed, overwhelmed and exhausted. There is no physical way I can work on this unit - I am not cut out for it. There are too many other areas of nursing that I would rather do to burn myself out on this unit, in my opinion.

I am going to talk to the unit manager and the DON on tuesday, tell them exactly how I feel about the unit and myself, and I hope they allow me to go to another unit, but if not, then that may be best if they let me go so that I can protect my license and find a job that I do like. Before I got put on this unit, I liked the facility and the job. I worked 5 days on first, and 5 days on second, mostly on the other LTC and rehab unit, and loved it. If they will not place me on that unit, I will have to seek employment elsewhere... if I continue to work this unit, it's going to be me who is going to need Ativan given to me scheduled and prn...

Oh, brings up another point, is it common practice to "sedate" or "dope" these types of patients up with ativan that is scheduled and prn given at the same time, just to help keep them quiet and from escalating?? it is utter chaos on the unit during the day, from people in wheelchairs cluttering the halls to residents yelling at other residents to residents walking into other residents' rooms and taking their clothes or placing things in the room - it's insanely chaotic. There are so many wanderers that just go where ever and there is not enough staff to stop them and keep tabs on them. Elopement risk people get on the elevators and other staff from other units bring them back up to the floor - there is not enough staff to watch over 2-3+ elopement risk residents and all the other residents in the hallway that are having behaviors and such... feels like the idea on this unit is keep them as doped up as you legally can... I don't necessarily agree with that either - how about you bring on more staff or cut down on the number of residents you take on because your amount of hired staff cant safely handle the number - neither of which I know is going to happen, but dang... I understand why 2 aides and another new grad have quit in the last week alone... I am almost right there with them....

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I was honest with the unit manager TWICE and got nowhere both times. I got "You will fit in in time" and "you just aren't seasoned yet." and "every new nurse feels overwhelmed and like they can't handle it. I requested you for this unit." at one point she even quit looking/listening to me to start talking to someone else that walked up. This is part of the reason that I went on an interview I got called for and quit this facility after being offered a job at the new 5 star facility... If my unit manager cannot spend 5 minutes to listen to my concerns about feeling unsafe on the unit, I cannot expect ANY support should something more serious happen that I need to discuss with her...

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This sounds like a poorly run facility. You should have another nurse on the floor when you have so many residents who have behavioral issues.

You have to be careful in LTC that you are not "doping up" your residents. You can't do this to accommodate staff.

This is a bad situation that you might want to leave!

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That is the biggest reason I left. Some staff had the attitude of give them their prn Med, and I do not agree with shoving meds at someone like that. Redirection for more than 3-4 is almost impossible when they feed off each other and are agitated. I want no part of involuntary chemical restraints...

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