new grad dissatisfied with first job. advice??

[gmorelle]

Hi all!

I am a new grad looking for a bit of advice from the experienced nurses out there. I have been working as a med/surg RN for just a little over 6 months now. The hospital I work at is a small community hospital that actually has a pretty decent reputation. Since I began, however, I've been really surprised by how disorganized the hospital is run. The stress of the nurses is high, the acuities of the patients are high- many of our med/surg patients are total care and really could be step-down patients somewhere else. We are, seriously, nearly always working short staffed. The ancillary staff (including RNs, I feel) are overworked and under appreciated. Our ratio is 1 nurse to 7 patients. Many are dissatisfied and express their desire to leave.

I am currently working on a unit with no charge nurse, no assistant nurse manager, no secretary. All of the other units have a clinical nurse specialist or educator and we do not have one of those either. We do have a manager but she is also the manager of another unit in the hospital and is physically present on the unit for maybe 10 minutes in the morning and then leaves to manage the other unit. I've been getting really frustrated at work... I feel as if we have no resources! Sometimes we aren't even stocked with supplies I need and I have to walk to another unit to get them. When I have a question, there is rarely another nurse I can go to. The days are really difficult, some days are great, but most days I don't love it. Not because I don't love what I do, but because I feel like our employer is not respecting us/giving us what we need to do our job. I don't think we should always feel like we are drowning- and we do! I also know this does not create an environment that contributes to patient safety.

I guess I want to know, is this normal?! Does anyone have any advice?? Or am I just being a huge baby? I vent to my nursing school friends I graduated with and they say they have issues with staffing (which is just a facet of healthcare), but they say it should not at all be this disorganized. I am hoping to leave after I hit my 1 year.

[Ruby Vee, BSN]

The first year of nursing is difficult -- so difficult that there's even a forum for it on AN. It's going to be difficult no matter where you work, and changing jobs only means you have to start all over as a newbie somewhere else. You're halfway through that first year now. Stick it out.

About questions -- surely you're not telling me you're the ONLY nurse on the unit. If there's another nurse there, you have someone with whom you can collaborate. I've been known to call the manager (even if she's on the other unit) with managerial-type questions (Mrs. A's family is photographing her, and I've read that this is against hospital policy. Can you talk to them?). Or call the nursing supervisor. Perhaps the nurses on the urology unit can answer your questions about that recalcitrant Foley or the neuro nurses can advise you about how to check Cranial Nerve II.

As for total care patients -- total care doesn't mean they belong in step-down. It's possible they belong in LTC. Stepdown and ICU are assigned because of acuity, not on the basis of whether or not they can toilet themselves. That said, seven patients is a lot.

Stick it out. You're halfway through the first year, and after you've completed it (and hopefully felt that "click" of things falling into place for you) you'll be in a better position to know what you want in a next job. You'll also be better qualified.

[gmorelle]

Thanks so much for your response & advice. I totally understand that "total care" doesn't mean someone belongs in an ICU! Many of our patients are on drips that most med/surg floors at other hospitals would not have. They require close monitoring and are often very sick.

I am definitely going to stick it out until I reach a year, but after 12 months I doubt I will stick around :/ I really want to go somewhere where nurses are treated better.

Even today, when I got to work I was trying to obtain consent, but our translator phone was broken. Then, I came to realize it was not the phone, but none of the phone jacks worked in the room I was in. I tried calling to get the issue resolved and they were unable to send a new phone. How on earth am I suppose to communicate with my patient?

We just never have resources. Later today we had no tele packs to transfer patients. Patients are held up for their procedures because we literally can't transfer them safely. I am so over the disorganization. I just wish I had the tools I needed to do my job.

(and yes, on days when we have no charge - which is most days - it is only me and one other nurse! the other nurse has a district of 7 patients, so often it's impossible to pull that nurse away if she's having a busy day too. If I have to hang blood, I need to call the supervisor and ask them to send me someone. so, no, I'm not kidding..)

[lavenderskies, BSN]

I'd have to say that none of what you say sounds good or safe.....but it's likely not uncommon. Try to do your best for a year and then move on.

[Nurse Beth, MSN]

The working conditions you describe are not OK and not the norm. Every facility has high acuity, occasional problems with supplies, lack of resources, but not everything, every day. And a ratio of 1:7 is untenable. When you get the opportunity to work in a facility with better conditions, you'll be amazed. Best wishes