i need support with my bad experience as a new nurse...

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I am a new grad; I graduated in November 08 and started orientation for my new job in January. I just came off my 8 week orientation period with my preceptor on a cardiac/telemetry floor. I have had two days on my own so far. Last night I had the worst experience in my nursing career (which i do realize is quite limited--just school and these few months). I started the night with 4 patients--which I can handle. By the end of the night I was assigned two new admits so I ended up with 6 patients by the end of the night. Between one really sick patient, another non-compliant patient, and various other complications that just sort of throw my still-developing routine, I had a meltdown starting about 4 hours before the end of my shift. I know this is probably normal for a new nurse, but I can't help but feel like there could have been better planning on my charge nurse's part. I guess I need to know if anyone else with more experience can tell me if this was an unfair experience...or if new nurses are just thrown to the wolves often and I should just get use to it! I feel so discouraged. I was told that my floor is a 4:1 ratio and 6:1 critical ratio. There were other nurses that had fewer patients than me, although I'm not sure of their acuity and I am feeling cheated out of having a good attitude about my new career. Any thoughts? Feel free to be blunt...my feelings won't get hurt!

Specializes in Gerontology.

First - I'm sorry you had a bad night.

But leaping to the 'the charge nurse was mean to me' route, you should consider a few things.

1. - What were the other nurses' assingments like? Were they busy too?

2. How many admissions came in. if you got the only 2, then you may a legit complaint. But if several came in, maybe she had no choice but to give you two. I had someone complain once when i gave them a second admission. What they didn't realize was that everyone else had already had 2,and my choice was to give her a 2nd one or someone else a 3rd one.

3. Did you ask for help? If you don't ask, don't complain that you don't receive. I find it hard with new nurses - if I jump in and help, and I get accussed of not trusting them and thinking that they are incapable of their job. If I don't help, I get accussed of 'throwing them to the wolves". If I make suggestions of what to do better, then I'm "eating my young".

Finally - don't assume that the charge nurse knows you are having problems unless you speak up. She is probably so busy being charge, taking care of her own pts and dealing with other responsiblities that being in charge brings, she may not see you floundering.

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Specializes in Cardiac Telemetry, ED.
In my experience, this is simply the reality of acute care hospital nursing. It's not really an abberrance, which is not to say that it shouldn't be. But it's all part of the scene. In time, you will handle a night like this better, but in the meantime, try to remember that every nurse you work with is experiencing this, perhaps not as the same time as you, but experiencing it none the less. It sucks. Believe me, I know. I also know it won't change.

This would definitely be an aberrance where I work. Our staffing matrix is four to one. Being cardiac tele, we're considered critical care. The medical patients we take when the medical floor has no beds are five to one, so if you have medical patients, you might have five, but the charge nurses are great about keeping it four to one across the board.

We have 7-9 tele patients. No it is not safe. On days when census is low and we only have four or five patients, (which is terribly rare) I cannot believe how much "easier" my job is.

My. God. Are these medical tele, or cardiac? On days, they try to keep it three to one when they have the staffing, but usually they get four. I don't understand how a nurse can know a thing about their patient and get all their work done with that many patients. Something has to give, and you'll either be giving drugs to patients you don't really know, or knowing your patients really well but passing on a lot of work to the next shift.

First - I'm sorry you had a bad night.

But leaping to the 'the charge nurse was mean to me' route, you should consider a few things.

1. - What were the other nurses' assingments like? Were they busy too?

2. How many admissions came in. if you got the only 2, then you may a legit complaint. But if several came in, maybe she had no choice but to give you two. I had someone complain once when i gave them a second admission. What they didn't realize was that everyone else had already had 2,and my choice was to give her a 2nd one or someone else a 3rd one.

3. Did you ask for help? If you don't ask, don't complain that you don't receive. I find it hard with new nurses - if I jump in and help, and I get accussed of not trusting them and thinking that they are incapable of their job. If I don't help, I get accussed of 'throwing them to the wolves". If I make suggestions of what to do better, then I'm "eating my young".

Finally - don't assume that the charge nurse knows you are having problems unless you speak up. She is probably so busy being charge, taking care of her own pts and dealing with other responsiblities that being in charge brings, she may not see you floundering.

This is very true, and a lot of good points are raised here. I remember being new and feeling like when I was sinking, it was due to my own lack of time management skills. What I didn't know at the time was that in many of those situations, any nurse would have been sinking, including the veterans. Also, when the entire unit is being slammed with admit after admit, everyone might be experiencing the same thing. I've had back to back admits on many occasions, but what helped was knowing it wasn't just me. I remember one night we had 18 admits. It was crazy.

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Specializes in ICU, nutrition.

I've always found it is harder to admit than to start out with a full assignment. If I were you, I'd try to talk to the charge nurse...in a non-confrontational manner...and ask if there would have been a better way to do things. Do you know how many patients were admitted that night and how many each nurse took? We'd always let someone know if they would be the first to admit or if they were next up.

You may have a routine, but admits will throw a wrench in it, so you have to be prepared and know what shortcuts you can take and what can be delegated. One of the floors I used to work on had one PCA who came in an hour earlier than the rest. She started daily weights and getting patients up to chairs. This took the RNs out of having to help with these tasks with most of the patients.

Hang in there, it gets easier:p

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Specializes in Nursing Professional Development.

I strongly agree with those who suggest that you look at what was happening to everyone else during the shift before jumping to the conclusion that you were the only one who was over-loaded with work. It may have been that other people had an even larger workload and were also struggling. The Charge Nurse may have been going out of her way to help you by giving you the 2 admits that she gave you.

Also ... I suggest you take a few deep breaths and make a list of what you expect. Then review that list and evaluate it. Think in terms of "Is that realistic?" "How would I know if that were true?" etc. For example, it is NOT reasonable to expect that you will never feel overworked and stressed at work. Everyone in every type of job has some bad days. To expect life to always be non-stressful in just not realistic. However, every day should not be a bad day. You should have some good days mixed in there.

It is NOT realistic to think that you will never get an admission when your plate is already full. That happens. What you CAN reasonably expect is that it won't happen unless it is necessary -- unless your colleagues are being asked to take similar tough assignments.

Etc. etc. etc.

As you go through this exercise, you may begin to see some of your "complaints" in a different light. You may begin to start asking the questions that can lead you to better understand the situation. You might decide that you are being treating unfairly. Maybe they really ARE being mean and unfair to you. But you also might find that you are simply working in a grown-up job with grown-up problems -- in an envrionment that is difficult for everyone and that no one is treating you any more harshly than can be reasonably expected.

Until you go through that kind of analysis, no one -- not even you -- will know for sure.

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Specializes in Cardiac Telemetry, ED.

On the topic of routine- I have found it difficult to have an actual routine. My preference is to spend about thirty minutes at the start of my shift looking up information on each of my patients, then go in and assess each one and chart those assessments as I go, giving any meds that might come early in my shift, making sure heels are floated and patients are clean, dry, and warm, and prepare for the dinner hour when insulins are due. I go to dinner after giving insulins. After that comes the second set of vitals and an eight o clock med pass, then HS care and meds/HS insulins. Somewhere in there, I need to take some time to go through the paper chart and make sure I haven't missed anything, review any new orders, and tidy it up a bit, putting loose sheets under the appropriate tabs and posting my rhythm strips. By ten, I like to have everyone tucked in for the night, leaving me an hour for anything I didn't get to previously, and to dig deeper into my patients' backgrounds and medical situation so I can give a good report. I like this kind of nursing because it is thorough and organized, and I can see the big picture of what is going on with the patient and what we are doing for them, and this is when I learn more about pathophysiology, different types of labs that I don't see as often, drugs, etc. There is a lot of thought going on along with the tasks, and I feel comfortable with this.

It rarely works that way. Usually, the second I hit the floor, patient A needs PRBCs that were ordered hours ago, patient B is on a diltiazem drip and their rate has been high for the last four hours on day shift (usually they had the same nurse that didn't start the blood, so I'm also irritated), so now I have to go titrate it, meaning Q15 vitals for an hour (and typically the dynamap will crap out on me, so I have to scour the floor for another one), patient C is a fresh stent coming back from the cath lab with a sheath in their groin, and if I'm not right there the moment they get back to their room, the cath lab nurses will complain and we'll get another nastygram from our NM (and the patient's two dozen family members want to know when the doctor is coming), and patient D is a new admit and the ED wants to call report on them *right now*. Kinda hard to have a routine. On nights like that, I go into survival mode and do everything on the fly. I don't feel like I have time to be thorough, to see the big picture, or to know very much about my patients, because my focus is efficiency and getting tasks done. That's not the kind of nursing I am comfortable with, but at the same time it is forcing me to develop rapid assessment skills and efficiency. And, as others have mentioned, it's usually not just me who is having that kind of shift.

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i work 7p-7a...i know that is a slower shift but it's still rough!

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Thanks for everyone's advice. I may go back and peek at that assignment sheet so i can have more insight as to why i may have received that assignment. I do understand that sometimes nurses just have bad nights...but i also feel like it wasn't safe for my patients especially considering my inexperience...which at this point in my career i feel that is still a valid and important consideration when giving large assignments. I do know that The charge nurse was changed in the middle of the shift due to staffing issues on other units, so maybe the new charge nurse didn't know i already had a new admit?? i did ask for help from some nurses that were there for support during an electronic charting change, everything was happening so fast at the end of my shift, my brain was like mush! wish me luck on my next shift friday night!!

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I had a very similar situation but I was still on orientation (at least technically). Even on orientation.. my preceptor would simply get report with me then leave me to do everything. My preceptor this one day was also the charge nurse.. so she knew EXACTLY what was going on. I was used to 4.. so I didn't mind that. One was a little difficult, but I could handle it. As the shift went on I got 2 new admits. I told her as soon as she mentioned the first one that I wasn't comfortable getting the new one and she said get used to it. It's not unusual to have upwards of 6 on a shift. BUT I WAS STILL ON ORIENTATION!! And she wasn't doing her job to be my support person. She was simply sitting at the desk, and giving out orders and assignments to everyone else. Anyway- I ended up with 6 by the end of the shift ... still on orientation, but doing EVERYTHING on my own. yeah, that was fun- so I know what you mean. been there, done that. BUT that doesn't make it right!!!! I told my clinical coordinator when she realized how stressed I was and she said it was NOT supposed to be like that. I'm with a preceptor so they can help and teach me things. Not make me do all the work and them sit around.

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that's not acceptable! i truely believe that some preceptors do the job solely for the perks...at my institution they earn points where they can exchange them for items. I was lucky with my preceptor...she was good but we just didn't happen to get to see all the things i needed to know. it really upsets me when preceptors use an orientee to have an easy night...i think we all know it happens and it's not fair.

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that's not acceptable! i truely believe that some preceptors do the job solely for the perks...at my institution they earn points where they can exchange them for items. I was lucky with my preceptor...she was good but we just didn't happen to get to see all the things i needed to know. it really upsets me when preceptors use an orientee to have an easy night...i think we all know it happens and it's not fair.

yeah, it definitely isn't right. Like I said, about 4 weeks into orientation all but one (I had numerous preceptors) would just let me take the patient load and that was it. I see it as .. this is my ONE time to work with someone else and learn as much as possible.. and learn to make judgment decisions with the help of someone else. They just figured I would keep the pts alive so they let me go. Thankfully everyone turned out okay, but still- they got paid extra for me to do all the work... hmmmm.. doesn't sound right huh

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It's a mixed tele. Many are medical, many are cardiac/ACS/USA and many are truly steps downs fresh out of the ICU.

You are right, I cannot and do not know my patients well at all when I have nine.

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Specializes in ER, ICU, Education.

Try not to be completely discouraged. This is quite normal, especially in the first year. You are still having to stop to look things up quite often (meds, unusual diagnoses, etc) and have not fully acclimated to the role yet. I noticed a big change about my 6th month of practice- I started knowing more about how the hospital worked, who to call if a certain thing went wrong, etc. Then again, at about the year mark, things became much easier. I had a great routine down for time management (didn't always work, but did help me stay organized), and felt very comfortable in my duties.

After 2 years, I noticed things that use to make me panic as a new nurse were "old hat", and after several more years, I noticed that things were even more relaxed in terms of my confidence. Stress never goes away in the hospital fully, and it won't as long as healthcare values money over patient safety. For a good read, you might try "Nursing Against the Odds."

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