New Rn Grad. Sub/acute, overwhelmed and sad. Thoughts please???

[xanderfan]

Hi everyone, I just got a job at a subacute facility. I work the 3p to 11P shift. I'm on my 8th day of orientation which will end in about 2 more days. I am feeling crazed, overwhelmed, scared and I'm starting to feel as if this is not for me. It feels like an impossible task. The patients need close monitoring but I never have time to do more than the minimal look over for them, basically a set of vitals. Most of my time i've been just passing medications and it's insane. I was given 10 patients of my own on friday and 1 admission. A nurse was supposed to help me but she disappeared most of the shift (probably doing orders or something) and I literally had no time to look for her. It was insane. The meds were missing or in another cart, pts. that were complaining, family members that wanted something, Aides that kept disappearing. It was hell.

Yesterday I was with another nurse and he told me that I need more time management skills which okay I get but I noticed he skipped a lot of things (like treatments) and he told me if I wasted time getting caught up on the minutia I would be there until 3 am everyday. I feel like that is horrible, why is it like this? It seems everyone knows it's impossible. Everyone knows about these stupid 'shortcuts' everyone is taking so why is still like this. Why is nothing being done? Am i supposed to start developing these shortcuts as well like everyone else? I don't want to but I see no other way from what I can tell of the other nurses. It's scary and ridiculous. I hate it. I feel like I'm going to tear my hair out and the rub is I only had 10 patients and 1 admission and the other nurse was doing my orders for me. They've told me it gets as bad as 20 patients and 2 admissions at times. This is insane, how does anyone expect this job to be possible.

I don't know what to do. I really really hate this feeling. I can't sleep and I feel horrible and just want to cry. I don't like that feeling. I'm really afraid i'll make a mistake, It's a frightening feeling. Maybe bedside nursing is not for me. I don't want to give up, please anyone let me know what you think? what do you think I can do to manage my time better? should I stick to it and hopefully eventually i'll get it?

Emotionally wrung out,

Sammie

[CryssyD]

I worked for years in sub-acute, and this situation sounds kind of nuts; are you just out of school, or have you had some med-surg experience? Because you're right, 10 patients and 1 admission for a nurse still in orientation sounds really unsafe.

Sub-acute means different things to different people, but I'm accustomed to these patients being ventilated, tube-fed, on tele, on IVs, with Foleys, central lines, wounds, recent surgeries/CVAs, altered mental status, impaired mobility, stuff like that: 10 patients like that are a real workout unless you have superb CNAs and RTs--and even then it can be rough. And on 3-11, when you have families around--yikes.

Now, your co-worker may have a point about time management, because clustering care and being very astute about prioritization are very important skills in this particular specialty. But if everyone seems to be resorting to "shortcuts" like leaving necessary things undone, the patient loads are too high.

If you are brand new at nursing, though, 10 days' orientation is just not enough. Maybe you should have a candid talk with your manager? It's OK to say you're feeling a little overwhelmed and unsure you can provide safe care for so many patients at this point. Always focus on what is safe for the patients--those are magic words: no one wants to put the patients at risk--or, at least, no one should.

If you do have that talk, and get told to suck it up, this is how it is and 10 days is all you're going to get, maybe you should look into a friendlier place for newbies. Brand new nurses need to be fully oriented, not thrown in at the deep end.

Good luck.

[TheCommuter, BSN, RN]

With the ratios the OP mentioned, I suspect this is subacute at a SNF or the Medicare rehab wing of a nursing home. In that setting, it is normal to have anywhere from 10 to 25 patients, a.k.a. residents.

Time management is king in this setting. You must hurry up, vitalize the patient, medicate them, change any dressings, and move onto the next person. Spend no more than 10 minutes with each patient because you have a mountain of charting to do.

In addition, get off the 3-11 shift ASAP. It is a horrible shift for new grads due to the volume of new admits and family interruptions.

[xanderfan]

It's been still a crazy experience. As you mentioned the load is not unusual for this setting, it's not quite acute nor is it long term but it's still dealing with patients with high acuity, enough to give me chills and palpitations. I've been feeling overwhelmed yes and frightened and that hasn't changed and I've realized from speaking to other workers that it's just the job. They say theres a very high turnover rate, people just don't stay. I spoke to my DON and she gave me 2 more days of orientation, 2 that's it. At this point, i'll give it a month. If it doesn't become at least bearable or even doable i'll quit. I really wanted a job any job so that I could be marketable/hireable as a nurse and that's all i got, other than home care. I don't want to say i'll give up nursing but bedside caring so far especially in that setting is not something i like at all. I can see myself become a very different person if I deal with that stress for long. I've already become short tempered and easily anger and it's only been a few days, imagine doing this for months if not years. I just can't. I'll give it a month and I will try my best, do it the right way, the safe way. If it doesn't work out, I'm going for something else. I'll try another freaking career before I take those scary shortcuts. The loans will wait for me as I learn something else.

Sorry I think I'm seriously depressed and sad and in a funk, don't know how to come out of it. Trying to stay positive but i'm already in the negatives for that battle. I don't mean to be whiner just needed to vent a little and it's best someplace where someone can relate.