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.
Specializes in Med/Surg/Infection Control/Geriatrics.
A good bit of this involves staying calm, prioritizing, and taking control - which does get easier with experience, but you can still consciously practice these things. Considering "what should I do first" is, in itself, a measure that helps work against panic and helps combat the tendency to spin in circles according to signals from too many different sources, when what is needed is for the nurse to stand in the middle of it all and decide what is going to happen.
In your hellish scenario: The two patients who feel like vomiting can be medicated by the off-going nurses, if appropriate. As can the person who needs pain medication. Put the oxygen back on the person who doesn't have it on and instruct a few deep breaths/make sure that issue is resolved. Forget the 170/90 b/p for the moment and you're left with the remaining significant problem: the hypotensive patient. So, I would say that within 5-15 minutes you should be able to attend to the two highest priority patients.
It's counter-intuitive, but you probably need to slow down a little, mentally. Try not to let your mind get into a frenzy. Prioritize according to what you were taught and go from there. Be kind, but don't be afraid to make requests: [To off-going nurse] "I have a hypoxic patient and a hypotensive patient that I need to attend to right away. Would you be willing to medicate Pain Man before you leave so I can focus on them?"
Also, envision yourself not becoming incapacitated by emotional reactions to what others are or aren't doing (such as a less-than-helpful charge nurse). This is super difficult - but it's a worthy goal. If you can mentally get to the point of systematically putting one foot in front of the other to handle the situation you've been given, you will be ahead of the pack. MUCH time can be wasted on emotional responses to others' actions.
Lastly - In your "spare time" remember to cultivate relationships with your coworkers. Usually there is someone who is willing to step up and be a mentor and resource.
I'm not a cheerleader for the idea that new nurses should "tough out" situations where they aren't getting appropriate help. These are professionally risky because in unsupportive environments one may be faulted regardless of choices made. Only you can decide what to do in this situation, but always be willing to learn what you can whether you're staying or going...
Best wishes ~
Very good advice. I might only add that if your blood sugar has a tendency to take a dive, have some healthy snacks in your pocket..nuts, cheese stick? If you have to wear a fanny pack with some small juices in it, do it! (Just don't wear it in Isolation.) :)
And if I may add, based on what you have shared, it wouldn't hurt to share your concerns with your manager. She may have some better assignment ideas going forward while you are still getting your feet wet in nursing. And well done to you for passing your tests!!
WOW! OP here. I have enjoyed reading everyone's comments and looking at the poll. I appreciate all of the experienced advice that has been given to me so far. There are several things I could have done looking back on that night to make it better. First of all I don't think I should have went into work feeling as bad as I did. It did not help with anything. Although we are only allowed to miss a certain amount of days a year, when you're sick you're sick and should go home if you can't take the workload. I also wish I had addressed the pt with no o2 on then the low BP pt first versus all the IV pain med/nausea callers. At 2234, I should have just asked my charge if she would pass a few meds for me so they wouldn't be late. I instead said "I'm just about to start my meds because I had several situations going on". Others have said she puts the worst patients off on others and not herself but I should have flat out asked for help. That way if it was a no at least I asked. Not all my nights are like this (although there is a trend). I will end up eventually switching in the future to day shift but I am going to stay on nights on my floor for now.
I agree. But it's the charge and two other nurses. If we have 10 totals on the floor, I also do not think it's fair for one nurse to have 5 then the other to have 5 and for the charge to not really help out.
Have Nurse, ADN, RN
3 Articles; 719 Posts
Very good advice. I might only add that if your blood sugar has a tendency to take a dive, have some healthy snacks in your pocket..nuts, cheese stick? If you have to wear a fanny pack with some small juices in it, do it! (Just don't wear it in Isolation.) :)
And if I may add, based on what you have shared, it wouldn't hurt to share your concerns with your manager. She may have some better assignment ideas going forward while you are still getting your feet wet in nursing. And well done to you for passing your tests!!