New nurse staying way past 9:30 pm on day shift

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Hello everyone,

I am a new nurse and this past week was my first on my own and also my first 4/4. I work at a very busy med surg floor and needless to say I feel very stressed/overwhelmed being on my own.

I am so scared of making a big mistake. I usually end up giving some meds late like very late :((. Even though I try really hard it is very difficult with 9 patients. I had two patients with PEG tubes so those really made me late for meds for all the other patients. On top of that, doctors want me to round with them, management, new orders, critical lab value reports ughh just remembering it all makes me hypertensive lol. I have stayed very late until 10 pm or worsee 12 am (that day was crazy).

I absolutely LOVE my job and my patients, but it is too much. I usually end up thinking of little things that I should have documented but didnt. I stay up late documenting but even then I feel like my documentation is not very good. I am scared those four days I was on my own I made a mistake I didnt catch.

There are a lot of things I could have done better for my patients but could not since I was very busy. I don't know if I should talk to my director and ask her.

Time management with meds and documenting is my big issue. Anyone have any tips to keep up with documentation/passing meds on time/ provider notification? I also give meds one by one so I take out the mediction for one patient and then go give it, then I return to the med room take out medications for next pt. and give them. I dot he same for insulins but I am beginning to see not everyone does that. How do you all pass meds? one by one too?

Any tips/advice/suggestions are welcomed,

Sincerely,

A stressed out new nurse.

Thank you for your response nalie2. My patients also have their own cubbie in the med room and also uses the electronic scanning system. I will keep drawing insulins individually. How many patients do you have in California?

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We are short staffed right now, and my manager says by October there will be four more nurses in my floor. So we would each get 6-7 patients.

Did you ask about the ratio when hired? Also, a lot can go wrong between now and October..is it worth it?

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Some people feel good about themselves by looking at these as "trial-by-fire" situations that are a challenge to master - - - but what about the patients??? If I could be convinced that you could succeed (and feel good about it) without cutting major/critical corners, I might have some practical advice. Instead, this just seems like a sad situation to think of a new grad striving and being so eager here because experience would suggest this won't end well, either in emotional health ways or in more tangible ways.

I'm sorry. TBH, for the sake of your health and your career I will only advise putting out other apps ASAP.

Thank you for your response, it was difficult to read but everything you said is true. However, it is not realistic for me to leave so soon though. This is my very first job and did sign an agreement for a year. This is a major hospital branch and leaving before 6 months could make me unhirable. Management tells me we will get more nurses so I would have less than 9 patients by October but until then it seems like I will have 7-9 patients

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My floor has cut back recently RN's/CNA's alike, we now go up to 6 pts each and that is not safe in my opinion. Like it or not, corners will be cut to get everything done...some people may not admit it.

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You can only survive and keep your patients alive by cutting corners in a very big way. Anyone leaving anywhere close to on time is doing just that.

Asking for help is not a good solution when the other nurses have nine patients, too.

Get out as soon as you can. You'll need to retrain yourself to do things the right way when you find a more reasonable job.

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I have had no word for your manager: agency. That fact that management would prefer to staff unsafely than to pay some extra bucks to bring in some agency nurses tells me all I need to know.

The manager could increase the number of aides on the floor to help too. While adding more aides would still be an untenable situation, it would help some.

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Specializes in Urgent Care, Oncology.
I have had no word for your manager: agency. That fact that management would prefer to staff unsafely than to pay some extra bucks to bring in some agency nurses tells me all I need to know.

The manager could increase the number of aides on the floor to help too. While adding more aides would still be an untenable situation, it would help some.

This person hit the nail on the head.

I quit after 6 months working nights on an Ortho floor with 7 patients with no tech. I honestly cannot fathom how you or your co-workers can do it. How long have the senior nurses been working there?

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Specializes in LTC, Rehab.

I work at a 'transitional rehab', where the acuity varies quite a bit, but I'll have anywhere from 5-12 or 13 patients, and yeah, 9 for med-surg sounds like too many. I doubt that you're bad at time management - you just have a ton to do. But I often - especially when I was starting out, but even now - think about ways to gain little bits of time. I probably don't document enough, but I try to. In our facility it's 6-6 shifts, but a few days ago I was there 'til 8:30, which is equivalent to you being there 'til 9:30. I had a new admit, multiple new orders, lots of wound care, and more.

It goes without saying, but IF there's anything you can pass on to the next shift that makes sense, try to. Like if I get a new admit very late in my shift, I have to pass on some of everything associated to the next shift.

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Specializes in NICU.

You staying because you "already got the bonus?" What you spent it ?Give it back..This sounds really dangerous,I realize we all become a little anal trying to do perfect charting and making everyone

happy,but who is looking out for you?Make a mistake and watch the wolves come out for blood...

Why wait for a promise of more staff the need is now,right now.Are you taking your meal breaks,or just working for free?Does anyone help you? who covers you for meals,and breaks?

This will eventually be showing signs in you physically,emotionally...put them on notice ,that if you find something you are going to leave, then wait awhile ,keep applying for jobs,and hand in your resignation.

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What a lousy way to start out. You're going to have to stay over... it's unavoidable.

The last time I had 9 patients, I had 20+ years of experience. I had all I could do to keep up.

I knew which corners I could cut, you cannot know this yet.

Focus on IV's, meds, and new orders that are stat. Turf all hands on care to the assistants. Do an eyeball assessment while passing meds. Most facilities require you to only pull one patient's meds at a time... for (haha) safety reasons.

Best wishes.. it's a jungle in there.

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Specializes in PACU, pre/postoperative, ortho.

I would venture to say that your next floor position will be a piece of cake after enduring that level of hell!

Keep charting brief & on the essentials only : head-toe assessment, dressings, IV, drains. Do it immediately at the bedside; it takes like 2 minutes (unless you're charting narratives; in which case STOP it, except if there is an unusual occurrence that needs detailed info). My facility has oodles & gobs of education interventions & miscellaneous BS to chart each shift. Leave that kind of stuff for last when you have a moment to breathe; personally I would just let it go if it was a crap shift.

With that many pts, everything would revolve around giving the meds. Bundle as much care as feasible into that one med pass so you don't have to go back to the pt's room again right away.

How anal is your facility about meds being passed early/late? Mine isn't at all, so I always start passing meds right away when I see that it will be a crazy busy shift (1st pt's 0900 meds will be given about 0745 or so); this is for daily type meds, nothing time sensitive.

Believe it or not, you will get faster over time, but you will burn out quickly if you stay there. Good luck.

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Specializes in Community Health, Med/Surg, ICU Stepdown.

I agree 9 patients on a busy, high acuity Med/Surg floor is too much and unsafe for patients and nurses. I had the same experience in my first nursing job (6 to 7 high acuity patients on days and usually 9 on nights). I honestly can't imagine having 9 on day shift... horrible. I signed an 18 month contract that required repaying the facility the cost of my training if I left early. After 7 months I was exhausted and depressed and had to resign. It feels terrible to work SO hard and still feel like your patients are receiving bad care. I really wish you the best and I hope you can find a job with more reasonable ratios. I found it difficult to learn much other than time management during that job because any time there was a chance to learn or practice a new skill I didn't have time to take the opportunity as it would put me even further behind. NOT a good experience but it does make me super grateful for my current job. You sounds like a wonderful and conscientious nurse who is trying super hard to do a good job in a really difficult environment

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