Hello all. I would love some advice for what I should do. I really want to find another job but I do not know how to go about it. I work on a night shift 7p-7a on a cariac med surg floor.I graduated in December of last year with my bachelors in Nursing. I accepted a job in January (which I was working as a PCT longer than that on a different floor). I took my NCLEX in February and failed. I had to wait 50 days and then passed my second time in the end of March. For this one position I've technically worked for 9 months here. And in that time I have learned a lot of things.
In a summary the other night I worked so hard that I almost fainted in the hallway because I did not have enough time to eat and I've been fighting a sinus infection. I started working at 7 and had not even sat down until 0139 to eat because I felt my blood sugar was low. (I still needed to run and do other stuff but I knew I needed food.) I had 7 patients. When I came onto the floor 2 were screaming out about to throw up. One had a RR of 35 with SOB (prev nurse left his o2 off). One was a chronic pain med requester and it was time for their meds. One had a BP of 90s/50s and one had a bp of 170s/90s. I started my med pass for 2200 meds at 2230. I told charge I was just about to start my med pass with all my meds on the computer and she just looked at her watch. (The other two nurses had finished their pass at 1000 on the dot). I felt like I was thrown at with the hardest patients. At 0100 I finished my twelves then had to call ER for report on my 7th pt. Then the seeing stars happened and I had to eat. Then at 0530 my patient with low BP had to be transferred to ICU because it was decreasing. Another one of my patients I also almost had a rapid for absence seizure at shift change. I charted until 1000 into day shift. I wanted to cry. I know I only had a bad night because of the lack of help I got from the charge and it does not help there was only 3 of us. I know with the other charge it wouldn't have been so bad.
Other cons:
-Half the time there are 3 nurses with 21 pt beds and we get assigned 7 patients for the night. (If the floor is empty like 16 pts on our floor we will literally get 5 admissions in one night.)
-When certain charge nurses work you will not get any help. Even when you're drowning.
-The er sends you patients no matter if they've given you report on the patient AND if you don't answer after their first call they just send them up. (and you get admissions any time at work and we always only have a unit clerk that leaves as 11pm or none at all)
-With 21 pts we will usually have only 2 techs and on some nights one.
-Nurses get pulled practically every night. We are the most staffed floor and yet get our nurses and techs pulled the most often.
-We receive the sickest patients than all the others floors. We also are the only ones who can run cardiac drips (but we cannot titrate).
I am looking at other positions and will probably submit applications tomorrow. I am nervous because my dream job is within the same hospital which means, I believe my manager will be contacted if I submit one. I wanted to tell them about my night but I was so sick feeling and frustrated that I felt explaining what happened when I am calmer would the best. Anyone felt this way? I am tired of being the new nurse who gets dumped on with hardest patient load and then I look like I did nothing for day shift when all I did was try my hardest.
Alternately, think of it as being as important as pooping. Lest's say you are super busy, and have to poop. Would you just do it in your scrubs, and continue working, or would just realizing that pooping is one of life's necessities, and go drop the kids off at the pool? Eating and drinking is just as important.
I don't think this was the "dumped on" to which the OP was referring.
This place sounds like most of the places I've worked. I don't know what to tell you except to take care of your health. If you pass out patients will still be sent to your floor. I am fortunate enough to work in case management. I just can't deal with the bedside anymore. I have changed some of my goals due to that fact.
Your license is at risk--Start applying elsewhere! You can always find another job but you can't get another license. You've worked too hard to risk losing it. In future interviews...ask about pt. load, staffing, turnover etc. Best of luck! And keep us posted. :)
I think you had a really bad night, seven patients is too much for a step down unit, the dementia patients will follow you wherever you go but I'm not convinced you're being dumped on. Also I doubt a nurse didn't put oxygen on, most likely the patient pulled it off. I work a step down unit and we are constantly getting ICU patients because they are short ICU nurses as they can't keep staff so I know how you feel and can empathize. Then unfortunately a patient codes and finally goes to ICU where they should have been in the first place. It is very frustrating!
I would suggest looking for another job, not step down, less acute, where they can't get away with admitting ICU level patients on the floor. I would probably look at another hospital system that has better working conditions and staffing ratios. I doubt any other floor or hospital in that system will be much better.
I wouldn't bring up the night to your manager. I doubt you will receive support and instead only be seen as a weak new grad nurse. Just my opinion. Does the charge nurse have an assignment? Where I work charge has a full assignment of their own patients so they are not free to help everybody else.
I think you had a really bad night, seven patients is too much for a step down unit
I don't love 7:1 staffing ratio for med-surg. But the OP said she works cardiac med-surg, not step-down. Running non-titrated drips doesn't make a unit step- down in acuity level.
The OP is new and seemingly has not yet come to terms with how difficult nursing in general and acute care specifically can be. I wouldn't be too quick to reinforce her perception that her unit or assignment is much out of the ordinary for most parts of the country.
Your license is at risk--Start applying elsewhere! You can always find another job but you can't get another license. You've worked too hard to risk losing it. In future interviews...ask about pt. load, staffing, turnover etc. Best of luck! And keep us posted. :)
No offense - But bluntly, this is not very good advice.
For one, the whole license-at-risk thing seems to be a widespread delusion instilled during nursing school. Marginal staffing levels don't put you at serious risk of losing your license. Drunk driving, diverting narcotics, and employers that ask nurses to work far outside their scope or commit fraud on their behalf do.
For another, unless the OP wants to relocate to another area entirely, the chances are that the grass is not any greener in another system in the area. What happens instead is the OP burns bridges by leaving so quickly and builds a resume that looks suspicious to future employers.
Its hard to lose your license. It's easy to make yourself less employable.
The OP should either put in her time on the unit she's in before trying another acute care position or else find a different branch of nursing entirely to try out if she finds an opportunity that really appeals to her.
But the problem in any case isnt that she is getting dumped on or that her unit is something way outside the norm. It's that she works a hard job and is still new to it.
For one, the whole license-at-risk thing seems to be a widespread delusion instilled during nursing school. Marginal staffing levels don't put you at serious risk of losing your license. Drunk driving, diverting narcotics, and employers that ask nurses to work far outside their scope or commit fraud on their behalf do.
Don't take this as disagreement of your general point which is that people are afraid of losing their licenses for a lot of things that are very unlikely to result in such.
However. Marginal staffing puts everyone (especially those learning the ropes) in a position to suffer other negative employment/professional effects; it's not as if all's well as long as you don't lose your license.
Poor or very marginal staffing does affect things like not wasting controlled substance "according to policy," such as a situation where you're running your A off and so is everyone else and the whole place is going up in flames. Although people may be too afraid of losing their licenses, no one really wants to be reported to the BON, either. Or fired. Or have to pick their poison after having been reported to the BON for diversion, yes, diversion - because something was not done according to policy. Or in general be treated like an axe-murdering criminal or a run-of-the-mill piece of crap.
If you think that in the current climate every single person reported for diversion actually diverted something (by traditional definition - not this new crap of "you didn't document it right so it was officially 'diverted'"), well....you just trust humanity a hell of a lot more than I do. :)
Don't take this as disagreement of your general point which is that people are afraid of losing their licenses for a lot of things that are very unlikely to result in such.
However. Marginal staffing puts everyone (especially those learning the ropes) in a position to suffer other negative employment/professional effects; it's not as if all's well as long as you don't lose your license.
Poor or very marginal staffing does affect things like not wasting controlled substance "according to policy," such as a situation where you're running your A off and so is everyone else and the whole place is going up in flames. Although people may be too afraid of losing their licenses, no one really wants to be reported to the BON, either. Or fired. Or have to pick their poison after having been reported to the BON for diversion, yes, diversion - because something was not done according to policy. Or in general be treated like an axe-murdering criminal or a run-of-the-mill piece of crap.
If you think that in the current climate every single person reported for diversion actually diverted something (by traditional definition - not this new crap of "you didn't document it right so it was officially 'diverted'"), well....you just trust humanity a hell of a lot more than I do. :)
Point well taken. I don't mean to support poor staffing ratios, and 7:1 isn't great (even though its not particularly uncommon either).
Likewise, I have seen firsthand coworkers acused wrongly of diverting and placed in that particular circle of hell, so I advise a great deal of caution in any nurse's treament of narcotics, which a low staffing level doesn't help, of course.
But my general point was that a lot of newer nurses put too much weight on protecting their license, and not enough weight on protecting their resume and employability... which I stand by.
Unfortunately no matter where you work, shifts like the one you described above are going to happen if you work on the in-pt side. There will always be that one charge nurse who you feel singles you out for the busiest patient assignment. Transfers to and from other departments happen on a regular basis and depending on what shift you work there can be several admissions. Nursing is hard work, and the patients we take care of now are more complex. A rapid response or code can knock your whole shift out of whack. After a particularly lousy shift, a casual chat with your nurse manager or clinical leader to discuss your shift may be helpful as many nurses in leadership roles were once in your shoes and can be supportive. As you get more experience, things will get better. If you're ultimate goal is within the same facility, I would stick it out.
I'm sorry you're going through this. I've been a nurse for 6 years now and have done the last two on a med-surg/tele/neuro until. We haven't the highest acuity second to the ICU because we also take trach/vent patients. 7:1 does seem like a lot, usually our max on nights is 6:1 and we generally get 4 or 5. My advice is get into work early to look up your patients and get a plan in place. Being over prepared helped me get through the first year without "drowning.:
I know on my unit if I'm behind I can usually ask my charge or co-workers to pass a med to help me with an IV if needed. Reach out and be willing to help when/if you have any down time to do so. I would say good luck and try to stick it out. Your first nursing job will always challenge you but you can push through it.
psu_213, BSN, RN
3,878 Posts
I don't think this was the "dumped on" to which the OP was referring.
Although it is a very good way to look at it.