New grad......did I make a mistake?

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I graduated in May of this year and started a job on a covid unit in a nursing home about three weeks ago. I trained for a about a week and a half and I was put out on my own. I hate it. I hate my job. I cry when thinking about going in. I make a lot of mistakes, thankfully none that result in patient harm, but mistakes none the less. I wanted a hospital job so bad but I couldn’t get into any residency programs. Everyday I go to work and everyday I wonder if I even really want to be a nurse. I enjoy the nursing aspect but the workload and the lack of training for a new grad like me makes me feel like maybe I’m not cut out to be a nurse. I spent four years working towards my degree and I’m already ready to tap out one month in. I want to quit so bad. But I know that’s not professional. And I have bills to pay.

Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 8/13/2020 at 7:29 AM, RN-to- BSN said:

What?

Have you successfully used this strategy?

My thought- no employer would ever allow this, unless they are my mom.

Yes, actually I have. Look if the standard is that I should be able to see 6 patients and drive no more than 75 miles in a day and I’m getting 7 patients and driving 90 miles in the day, it is no reasonable to believe that I will spend extra time getting charting done when they over booked me. Now do I know that’s what they WANT us to do and twist it into some mockery of accountability to get us to do it on our time? Sure. But you can flat out refuse to give them more of your time. I will always make sure my patients are cared for, but if they want to be able to bill for all that care they had better give me the time to chart. On their time, not mine.

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Specializes in SCRN.
8 hours ago, KalipsoRed21 said:

Yes, actually I have. Look if the standard is that I should be able to see 6 patients and drive no more than 75 miles in a day and I’m getting 7 patients and driving 90 miles in the day, it is no reasonable to believe that I will spend extra time getting charting done when they over booked me. Now do I know that’s what they WANT us to do and twist it into some mockery of accountability to get us to do it on our time? Sure. But you can flat out refuse to give them more of your time. I will always make sure my patients are cared for, but if they want to be able to bill for all that care they had better give me the time to chart. On their time, not mine.

Thanks for your POV. We are talking LTC here, no employer will let you come in, take no patients, and chart. Usually catch up charting is done after report was given to oncoming nurse. Even then one risks being reprimanded for chronic overtime.

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Specializes in Surgical Specialty Clinic - Ambulatory Care.
1 hour ago, RN-to- BSN said:

Thanks for your POV. We are talking LTC here, no employer will let you come in, take no patients, and chart. Usually catch up charting is done after report was given to oncoming nurse. Even then one risks being reprimanded for chronic overtime.

Look, at any facility, if you have proven you are a responsible dedicated employee for a year or so, I can guarantee you that they WILL work something out for you. I do this with homecare now, but don’t think for a second that I didn’t do it when I worked the floor. Of course they are going to TELL you that it is impossible to do this. They are also going to try to face slap you with some perceived notion that if you aren’t willing to continue to work over on your time that you are being derelict in your DUTY as a nurse. I know exactly how they act when you stand your ground and tell them you aren’t working more than the time that you agreed to, no matter what charting is done. I very explicitly let them know if they didn’t assign me appropriate duties and patient loads that every chart I was unable to complete DURING MY SHIFT I would be putting in a note that stated, “Chart incomplete by this RN due to employer inappropriately staffed department and RN not given appropriate time to complete this care task. As patient care comes first this RN chose to spend the time available caring for patient need. This RN will not work outside of agreed upon hours of employment to catch up documentation for employer and employer is unwilling to give this RN time during work hours to catch up charting.”
You bet your bottom dollar that if you let your manager know that you are about to start putting that in all of your incomplete charts and, barring an actual life and death related patient issue, you are going to arrive on time for work and leave on time when work hours are over....they will start working with you. The key is that you have to prove you are worth it with about a year of servitude and then you have to gradually over 2-3 weeks become very LOUD about your time and the unacceptable work conditions that require you to do to much. If your employer isn’t willing to budge I would say high tail it out of there. We are not slaves to our employer or our patients. Don’t confuse a duty to do right by people as a duty to do poorly to your self.

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Specializes in Emergency Department, Pediatrics, Home Health.

I am a new LPN and graduate with my RN in december. I am in pediatrics and LOVE being a nurse. When the covid hit, our census was low, and I got put on per diem. So, I went into a LTC facility to get some hours and UGH - GIRL, I feeeeel you. It is just not for me and I absolutely hated it. This area may just not be for you! I met a lot of nurses in the LTC that became nurses to work in LTC. There are soooo many directions to go in nursing - don't give up on what you went to school for, for so long! You got this!

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I am also a new grad. I definitely understanding how stressful the first year can be. I however do not work on a COVID unit so I can only imagine that challenges brought forward there. You did not make a mistake. You are a great nurse. We are all our own worst critics. Making mistakes, especially this early in our careers, does not definite our quality as nurses. Nursing involves life-long learning and even experienced nurses make mistakes. If you really feel that that job position is not a good fit for you, then I would recommend seeing if they will transfer you to a non-Covid postion. I personally feel like working on a Covid unit is too much for a new grad nurse. I currently work in a hospital and our COVID units requires 1-2 years of nursing experience to be hired there. As your confidence grows you will feel more comfortable. This pandemic has truly put a strain of the nursing profession. It's sad because I see so many posts about burn-out and experienced nurses saying that they're leaving the profession soon. As a new grad nurse, this is saddening. However, I always keep my mind on why I decided to pursue nursing in the first place. With that thought in mind, I will not let the pandemic destroy my passion for nursing. In actuality, this pandemic has widened my interests and I plan to begin working in community/public health nursing in the next few years.

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Specializes in retired LTC.
14 hours ago, KalipsoRed21 said:

... “Chart incomplete by this RN due to employer inappropriately staffed department and RN not given appropriate time to complete this care task. As patient care comes first this RN chose to spend the time available caring for patient need. This RN will not work outside of agreed upon hours of employment to catch up documentation for employer and employer is unwilling to give this RN time during work hours to catch up charting.”

We are not slaves to our employer or our patients. Don’t confuse a duty to do right by people as a duty to do poorly to your self.

Kalipso - Are you SERIOUS ?!?! Have you ever, EVER really charted such an entry into any chart?????? I am dumbfounded because I seriously doubt any employer would tolerate that type of employee action.

Seriously, I see you being suspended and/or fired the first time Admin saw such an entry. (However TRUE it might be, and I agree with your sentiment!)

In the time it would take you to write that type of note, you could just document a brief, down & dirty entry.

Maybe it's just me, but I think that was BAD advice.

I do have to compliment you for your last sentence. Very true.

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Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 8/15/2020 at 1:57 PM, amoLucia said:

Kalipso - Are you SERIOUS ?!?! Have you ever, EVER really charted such an entry into any chart?????? I am dumbfounded because I seriously doubt any employer would tolerate that type of employee action.

Seriously, I see you being suspended and/or fired the first time Admin saw such an entry. (However TRUE it might be, and I agree with your sentiment!)

In the time it would take you to write that type of note, you could just document a brief, down & dirty entry.

Maybe it's just me, but I think that was BAD advice.

I do have to compliment you for your last sentence. Very true.

I’m dead serious that I WOULD do this. And fortunately, NO, I have never had to do it. Like I said, if you have proven your-self a decent reliable employee ,as much as your employer will continue to attempt to bully you into doing more and try to make you feel like it is your responsibility AND duty to be overworked, if you put your foot down hard they will back off. What I discussed charting would be a last Hail Mary threat...and yes I’ve had to Hail Mary several times in the past...but it comes down to how high is the turn over and how much are they wanting to try to train someone new. Most employers desire the person to stay and while they will talk to you like you aren’t doing enough, that you aren’t meeting expectations by refusing to be overworked, and that charting is part of good patient care.....they will back down when you stand up. 1) I did take an oath to take good care of people. Charting, aside from vitals and an assessment, is not taking care of people. It does put my license at risk to not have a through documentation of the course of the day, but to me, no matter how much hard labor I put into getting my BSN, if organizations are going to bully me into taking more than I can handle and get the job done right, then I have no choice but to quit or stand up. I live in a rural area so jobs are limited, thus I must stand up for myself. Charting, more than it is care, is a means for your employer to bill for services and to ensure the liability is lower, thus if you threaten it with charting a statement that puts them at fault, they really hate that. Legally they cannot make you change your charting, they can only request that you do. 2) My responsibilities vs their profitability. I want my employer to be profitable. And I always work to help them in that goal, however, if when I got hired they state that I will have 8 post op ortho patients, no aid, no secretary in a 12 hour shift...then that is what I agreed to be able to handle in 12 hours. (You have to watch this because these managers purposely don’t have these things written down...it is part of your verbal interview.) I do write it down at the start of every job. And I will take a couple of hits and let them over book me by one or two people....but then their is the creep. Suddenly 80-90% of the time you are getting 9-10 people assigned to you. Then you bring actual numbers up to the manager. “So 7 of my last 10 shifts I have been over booked, please staff me appropriately.” And the great gaslighters they are they will probably say something like “It has been very busy lately, ratios are not a hard and fast rule.” And then I have to say, “I agreed to these conditions ________ upon hire. I am informing you that you are taking advantage of our hire on agreement and I need you to fix it by my next shift.” Then you come in the next shift and they give you 10 and you call the house supervisor and state you need to fill out an incident report for unsafe staffing. And then they get their feathers in a bunch, but stay calm and restate your initial complaint. “I understand the hospital is full tonight and you state you have attempted to get extra staff to no avail. I still need to fill out an incident report because this is an unsafe patient load.” And they will suddenly start asking your coworkers who also have 10 patients to go up by one more so they can take you down to 8. And you will feel like *** because those nurses should say no but because nurses are people pleasers and easily manipulated more likely than not your coworkers will be curing your name but they will do it. (And frankly that’s their stupid fault. What they SHOULD be doing is saying no and filling out incident reports with you.) But that is how they will by pass the incident reports for the first few times. But then they’ll get sneaky and start bringing up admits and placing them on you so now you still have 10. And THAT’s when you start charting what I posted in my previous post. Look, I’m all for being a part of a team and working my butt off. But you and I both know that the conditions that they talk upon hire are the doable conditions and then, for the name of the almighty dollar, they will try to manipulate you to doing more so they can have better numbers. And unfortunately what they pay you to stay over time to get this done is not enough of a deterrent....otherwise they wouldn’t do it. I manage my home budget so I don’t have to work more....I don’t want to work more...full time is enough. So the real question is, is that extra $20-60 bucks you are making that day worth the time you lost with your family/friends/community? If not, put your foot down and hard. Experienced nurses are in high demand. I have never been more than a week without a job...and I think that is where people get hung up, they work so long at one place that they forget their own value. Of course I’ve had to take a crappier job to get out of a decent job that abused my time. I didn’t say it was easy, but it is worth it and I would advise all other nurses to do the same. When we all aren’t bending over and taking it in the butt then that will no longer be the expectation.

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Specializes in retired LTC.

Kalipso - There is a BIG difference between what you REALLY did and what you WOULD do. I still hold that that kind of charting would net you serious backlash. Even the rest of your post blows me away - you must be way more a risk-taker than I.

While I agree with you in principle in some areas, I'm more skeptical than you.

I think our fundamental difference is that you believe employers will respond as you expect. I believe many won't care. You see yourself as valuable/ important to them. Sorry, but they've a full basket of potential new applicants just chomping at the bit for your job. You ARE replaceable. Regardless how good an employee you are and in reality good for the facility's operation, you push their buttons hard enough & often enough, they will respond not in the way I believe you think they will. You've the experience, confidence and moxie to speak up & negotiate for yourself.

But for OP, she needs her job. You feel comfortable enough to pick up your marbles & move on, but she is struggling. Her employer has no vested interest in her. Even though her motivation/interest is good and she has decent skills from school, and she's TRYING and she CARES, she is stuck. She can only try some of the suggestions offered here on how to work within the job limitations, or she can leave (not too great).

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On 8/12/2020 at 7:52 AM, RN-to- BSN said:

These are tough times to be a new nurse. Please, try to find healthy coping strategies.

2 weeks training in LTC is acceptable. The difference is they give you and your preceptor a normal patient load when you train, and when you are on your own, the short staffing happens. Been there: a new grad in LTC. Could not get into the hospital for a year and a half.

Keep applying, maybe consider doing part time at the LTC.

How on earth is that acceptable?

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Specializes in Surgical Specialty Clinic - Ambulatory Care.
52 minutes ago, amoLucia said:

Kalipso - There is a BIG difference between what you REALLY did and what you WOULD do. I still hold that that kind of charting would net you serious backlash. Even the rest of your post blows me away - you must be way more a risk-taker than I.

While I agree with you in principle in some areas, I'm more skeptical than you.

I think our fundamental difference is that you believe employers will respond as you expect. I believe many won't care. You see yourself as valuable/ important to them. Sorry, but they've a full basket of potential new applicants just chomping at the bit for your job. You ARE replaceable. Regardless how good an employee you are and in reality good for the facility's operation, you push their buttons hard enough & often enough, they will respond not in the way I believe you think they will. You've the experience, confidence and moxie to speak up & negotiate for yourself.

But for OP, she needs her job. You feel comfortable enough to pick up your marbles & move on, but she is struggling. Her employer has no vested interest in her. Even though her motivation/interest is good and she has decent skills from school, and she's TRYING and she CARES, she is stuck. She can only try some of the suggestions offered here on how to work within the job limitations, or she can leave (not too great).

amoLucia-

Yes the way I handle my employers has some risk to it, and I always have to be mindful that if I don’t get what is required from my employer then I will have to back up what I said. In regards to the OP, I think she is wise to stay a year, but the environment is burning her out to fast. In my view she HAS to force her employers to change or she is just going to jump ship as soon as she gets another job offer anyway....making her point about staying moot. Nurses often do not know their value to a company. This is an excerpt from an article from the Robert Wood Johnson Foundation “Nationwide, the cost of replacing a registered nurse ranges from about $22,000 to more than $64,000, a sum reflecting expenses associated with filling temporary vacancies and hiring and training new staff. The average replacement cost of full-time registered nurses at the 13 health care systems evaluated in the “Wisdom at Work: Retaining Experienced Nurses” study totaled $36,567. With estimated national annual turnover rates for RNs ranging from eight to 14 percent, this can add up to a significant financial burden on hospitals and health care systems.”

So I hope you see your value. Yes, there is a risk if you ruffle feathers to much the manager will decide to let you go....or will start doing the passive aggressive thing and right you up for nitpicky issues. But at the time you get your first write up you will know you need to start looking for a new position hardcore. I REALLY did stand my ground on my ratios in the way I described, I REALLY did make incident reports EVERY time they asked me to take more than what was discussed in my interview UNLESS something changed, like they added CNAs or other assistance, and I really did show my manager what I was going to start charting in everyone of my charts unless ratios were kept as promised MOST of the time. And every 4-4 months or so I’d have to start to pipe up again because they got lazy about it. I have NEVER been fired. I have been a nurse 12 years. I have worked at 5 institutions AND traveled to many more. Know your worth, believe in your worth and use it to get the life you NEED from your employer. As far as I see it, if you don’t your going to end up loosing your license anyway because an employer will give you unsafe ratios and when something bad happens it will be YOUR license they are going to offer up as a scapegoat.

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Specializes in retired LTC.

Kalipso - 'You're a braver man than me, Gunga Din', I believe is the quote.

I do admire your courage to speak up and advocate for your principles. However, I think you are most definitely in the minority.

One thing to remember here though is that OP is BRAND NEW and works NURSING HOME. Not the most opportune situation to be in to try & flex her muscles/worth like you propose.

I do have to say, though, I have enjoyed our discussion - different POVs, but interesting.

Good luck to OP.

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Specializes in Surgical Specialty Clinic - Ambulatory Care.
6 hours ago, amoLucia said:

Kalipso - 'You're a braver man than me, Gunga Din', I believe is the quote.

I do admire your courage to speak up and advocate for your principles. However, I think you are most definitely in the minority.

One thing to remember here though is that OP is BRAND NEW and works NURSING HOME. Not the most opportune situation to be in to try & flex her muscles/worth like you propose.

I do have to say, though, I have enjoyed our discussion - different POVs, but interesting.

Good luck to OP.

Same here. It’s not that I don’t see where you are coming from, I just feel different about it. I feel the OP has more leverage than s/he thinks.

Good luck to the OP for sure!

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