New Nurse In a Step Down Unit and I hate it

[Aurora0941]

So I'm a new RN grad I've been working in a general ICU step down telemetry floor for 4 months now. I'm not new to healthcare I've been a nursing assistant and monitor tech for the past 4 years so I knew what I was getting myself into. However, I'm pretty miserable right now. I get out of work (night shift) feeling defeated. I have 4-5 patients who some nights are on the border of being ICU appropriate due to hypotension, tachycardia Afib decreased oxygen sats, out of whack lab values, neuro changes, etc.......we do cardizem drips and all that and continuous bipap and trachs and stuff. I feel like so much is expected of me and these peoples lives are in my hands and its just too much on my mental health. There are so many tasks at hand while also trying to monitor these people and deal with new admissions and transfers. Often my patients are completes, incontinent, super needy, crying out for pain meds, dealing with upset family, dealing with vital sign changes.. Does anyone else feel like this? I cant talk to other nurses on my unit because I don't want people knowing i'm unhappy with my job and it to get to management or anything.

[babychickens]

On 2/8/2019 at 7:42 PM, Aurora0941 said:

Thanks for responding. My patients do not have femoral catheters in place and the only drips we really only usually titrate are amio cardizem and heparin. I've heard on rare occasions they will prescribe different drips but typically in our hospital they would have to be in the ICU. What causes me stress is dealing with patients whos O2 sats are constantly dropping, and who have low blood pressure or out of control heart rates that I am trying to closely monitor. While dealing with this I will get an admission from the ER, or have patients demanding their narcotics within the minute. I feel like I do not enjoy critical care, it makes me too nervous dealing with the instability as well as the number of patients. Not that all 4 of my patients are unstable, but having to closely monitoring 1 or 2 of them with 2 others is too much (not forget all the stupid charting). DO you have any opinions on if nurses are happy in mother baby, LTC or maybe a docs office? Trying to seek sanity and happiness here. thanks,

I feel like I can hear my mentors (in my head) saying "well some of them will just have to wait" or "are they symptomatic?" re: the pain meds and HRs respectively. Btw, I've done my share of freaking out over the same stuff. I've been told that comes with the territory as a new grad. Old pros see a wacked out HR and pt who LOOKS like they're fine and they walk away. I'm still standing there staring at the monitor, then back at their chest like...OMG, are they about to code? Lord knows they probably live in that wacky ventricular rhythm, ya' know? And during the time I stood there watching them NOT DIE I could have passed those pain meds! Easier said than done, but I would reach out to your fellow experienced RNs, as suggested because they can remind you of those things on the daily.

[LibraSunCNM, BSN, MSN, CNM]

That sounds awful. My first job as a nurse was on a heavy surgical floor that had 8 step-down beds, with patients about as sick as the ones you're describing. We never had more than 4, and the goal was to not have more than 3. You're dealing with double stress---the normal stress of being a new grad as well as the stress of being understaffed. You are human, and can only handle and accomplish so much. Hugs, deep breaths. I agree with the advice to delegate whatever possible and SPEAK UP when you need help. Even if no one else can, it's important to assert your needs. You are not crazy or deficient in some way for struggling to take good care of that many sick patients. Try to squeak it out to the 1 year mark, if you can do that you'll 1.) have a set of skills that will be marketable ANYWHERE, and should be able to find another job, and 2.) be able to look back on this experience for the rest of your life and say, "That sucked but I survived!"