Not sure I like this...long

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I have only been working as an RN fro 5 1/2 months on a busy musculoskeletal/vascular floor at a free standing rehab facility. I am on days, and my patient load usually consists of 6 patients some s/p joint replacement, amputees, vascular, SCI, burns, and some stroke. I work days, so we are working around the patients 3 hour therapy schedule. Before 0800, the nurses are expected to get report, check orders, get vital signs (NA's are too busy to do them, but we're not???) and administer insulin before breakfast. Then we have to make sure all of our patients with severe mobility issues are up, toileted, washed (we often are assigned ADLs for at least 1 patient) before their first therapy at either 9 or 10. At some time while the patients are on the floor, we have IV meds, wound vacs, PICC dressings, incisional dressings, burn dressings, duoderms,etc (my assignment has all of the above-days are expected to do all the dressings). Pain meds are administered to most patients every 3-4 hours. Patients have to eat and use the bathroom at some point. Call lights are going off like crazy. I overheard a patients family member ask another nurse "so, you're not really a nurse, but one of those maids, right?" He was totally serious because half our day we are wiping butt and fetching things for patients. Then we have to document everything and take off orders, collect specimens and call the pharmacy every 10 minutes because we don't have the meds we need. If I don't leave on time or take my breaks on time for their full duration, I will be spoken to. If I do a half assed job and don't document well, I am spoken to and feel like a lousy nurse. Can't win. Today I made my first med error because I was interrupted while getting my medications ready (to toilet someone because they were yelling and no one was around) and forgot to go back to get a med I didn't get out the first time. I realized this at the end of my shift and could give the med late although not ideal (oral hypoglycemic agent) but I still had to do an incident report on myself.

It is impossible to get everything done and do it well. I am stressed out and exausted. I want to persue my education so I can teach eventually, but I have absolutely not one ounce of energy left after work. The general consensus I have gotten is that it is like this everywhere. Is it? If it is, I'm not sure I am cut out for nursing. I am really upset because this is a second carreer for me and something I really thought I wanted. I am just having a really hard time handling the constant chaos and stress that goes with it.:o

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Specializes in NICU.

Try ICU. It is still stressful and busy but not as many patients.

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Specializes in Home Health, Primary Care.

I agree with mybabies. The most patients you should have in ICU are 2.

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Jane,

This sounds pretty typical and is the type of situation many of us are dealing with.

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Specializes in SICU, ER, MEDICAL.

I work a step down ICU in which I never have more than 3 patients. However I still feel the same. I am praying things will get better.

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Specializes in Women's Health, Oncology.

Sleepyjane...I'm sorry that your experience has not been great so far. I've been an RN for over 10 years and I can honestly say I feel your pain.

The difference between a new nurse and an experienced nurse is not just the level of time managment skills in the field. I believe there is also a difference between being comfortable speaking up and feeling like you will make enemies if you "rock the boat" so to say.

Yes, sadly, some nurses do "eat their young" so to speak, but I've found that has more to do with older nurses being just as burnt out as new nurses. You have to remember, these experienced nurses have been through shortage times that have really run them down as well.

It's a vicious cycle with the shortage of RN's. Units offer huge sign on bonuses, which sound great...but in reality it's probably because the unit is understaffed already and having trouble recruiting. You will come to realize in time that "word get's around" and that the nursing community is much smaller then you think. I hear from other RN's all the time about problems at such and such a hospital and on so and so other units.

You have two options here.

1. You quit and find another job with more suitable nurse/patient ratios. Will this solve the problem? Maybe, but maybe not. The grass is not always greener.

2. Get involved with improving your situation. Ask your manager for help in workflow and see if you can rally your co-workers and come up with creative solutions to the problems. Look at the workflow and really try to figure out where the problems lie. If it's MA"s not being utilized properly, or if patient assignments can be better delegated. There are alot of reasons RN's are overworked, understaffing is one of them. Talk to your manager and don't be afraid to speak up.

However, make sure if you are going to address concerns with your mgr, have some solutions to the problems. Even if your ideas may not be implemented, still go in with your plans. Mgr's appreciate someone who wants to be part of the solution, not just vent about the problem.

Good luck and do not feel that because you are a new nurse that your concerns and ideas should not be taken seriously.

One thing all of us experienced nurses need to learn is that if our new nurses leave, the cycle of overwork, understaffing will continue. Unlike years gone by where there was an abundance of nurses and RN's were getting laid off, we are still in a huge shortage.

New grads are finding they don't need to stay at a job where they feel abused. Here is something from Nursing Spectrum. This should make you realize you're not alone.

  • 33% of RNs said they had enough staff to get the work done
  • 35% of RNs said the care they delivered was "excellent"
  • 23% of RNs were so frustrated that they planned to quit within a year

Hang in there!

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In the following thread, post #107 (under page 11) lists some of the reasons behind the problems you mention:

https://allnurses.com/forums/f8/would-you-recommend-nursing-your-daughter-213148.html

Anyway, you aren't alone in your feelings.

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I will tell you, I don't know a lot, but think you are a pretty demanding floor. We come in at 7 a.m., but are not expected to really start rounds and vitals until 8 a.m. It's a stroke unit, so no major muskuloskeletal issues like that. I feel I have a good hour to get my head on straight.

Perhaps try to find somethng away from all that ortho and rehab stuff. I am new, but I personally feel those types of floors have truly demanding pts and issues. I almost signed on at one, and am I glad I skipped it.

I know my floor is no picnic, but t's a dedicated stroke unit and we have very strong techs. I know it's not perfect, but our expectations are pretty routine. We do a lot of neuro stuff, but that's not hard. Lots of bathroom issues, at times, but many are on foleys, etc. and are in stable conditions.

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Specializes in rehab.

You're not alone! I work evening shift on a neuro/brain injury floor of a free standing rehab hospital. The census is usually 27-30. If we have more than 4 nurses on our shift it's like a vacation. I have not been spoken to about staying late to chart, but if it becomes a problem I will leave. I take care of my patients first, but I'm not comfortable about skimping on my charting either (many are).

7-8 patients on a rehab unit is not safe and leads to a very unhappy group of nurses/aides. The patients deserve better. It's actually very sad and very very dangerous.icon9.gif

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Specializes in Cardiac Telemetry, ED.

Six patients is a lot, especially on days. I typically have four, and still find myself in the situation of choosing between taking my required breaks and getting my charting done on time. It sounds like your unit needs more support staff if they're going to keep assigning you six patients apiece. Either that, or give the nurses fewer patients. Ideally, both. Does your facility have any continuous improvement committees or anything like that? A unit council? Perhaps becoming involved in making change might help you feel better!

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You have to do what you want; it sounds to me like you need a change of scenery, and that is one of the wonderful things about this field--you have flexibility. Have you ever considered management? :up:

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