New Nurse-So many ?? So little time

[BigMama3]

Hi all,

I'd like to start out by saying I got my license in September whoooo hoooo!

So here's my problem. I live in MA where there isn't a nursing shortage but you really need a BSN and I have an ADN, with no nursing experience so the job choices are limited

I got a job in a nursing home (40 patients) they gave me 5 days total of training (3 were administrative NOT skills or floor work) then they put me on the floor. There was no nursing supervisor just myself and one other nurse (fresh out of school too). Needless to say I felt unsafe and that I could potentially lose my license so I quit.

I got another job in another facility rehab/nursing home. I am supposed to be on orientation BUT have had 18-24 patients by myself. These patients have had IV's, on hospice, wound care, etc. They run the gamut.

The problem is I don't really assess or care for them because I don't have the time.

In fact, one of my patients I saw for 5 minutes total at the end of the shift and that was only to take a set of vitals and give her her BP meds.

I realize I have to pay my dues but am very anxious and stressed every time I walk in the door. There is little to no support there as well. The attitude is don't worry about it...but I do.

So, I really need some advice here. I know a few office jobs that are available but I don't want to lose my skills. But I also don't want to jeopardize my license.

I'd also like to add that I've been working in healthcare (hospitals, rehabs) for 15 years.

I knew nursing was hard work but I just don't know what to do or if this type of nursing is for me.

Is this the norm? Eighteen patients (dialysis, hospice, IV, dementia,) or is it me?

Thanks for any advice!

Fitz

[firstinfamily, RN]

Hey Fitz: This is what I refer to as "reality shock"!! Usually, the patient load is heavier in LTC, however, in sub-acute you really should not have more than 7 patients total. It sounds like management is trying to save costs by keeping staffing at a minimum. That is usually the law of the land. I find it very difficult for anyone to expect a nurse to complete care for pts when their load is 18 or above. By the time you get around to passing out medications there most likely is not time for anything else. Have you asked your unit manager how to get the expected tasks done? How many nurse aides do you have? Maybe you can delegate some of the easier tasks to them. Does your facility use med techs? They can pass out routine medications. If you are the only RN for the floor on your shift, that means you are the most responsible/held accountable for everything. That can be a very over-whelming sensation. If you feel you need more orientation on some things you should ask your manager for that time. Ask her/him how you are to prioritize your work etc. They are there to support and teach you, however, if you do not let them know you are having problems, they cannot help. It is not a negative aspect to admit when you need help and it is better to do this than wait until something awful happens. You need a little confidence and you will get that with experience. Focus on what is important, learn how to prioritize your work, not everything has to be done on day shift. Don't be afraid to approach others for help. Something else you might be able to try is to search staffing levels for sub-acute rehab and see what the normal is nationwide and present this to your manager. The next thing you could do would be very time consuming which would be to rate the number of nursing hours you spend doing certain tasks---ie: suctioning trachs, doing dressing changes, and present this to your manager. We use to do this in the hospitals to get staffing levels improved, sometimes it helped, sometimes it did not as it took too much time. Good Luck, sometimes you have to be the one to initiate change!!!

[Esme12, ASN, BSN, RN]

thread moved for best response