Hi, I'm a 36 y/o new nurse. Graduated 12/2008. I work for a major hospital in St. Louis on the telemetry floor. I've been working there since March 09. I am not happy with my job as this is not what I thought nursing to be. I was taught in school to listen to my patients concerns, cultural concerns, and treating the patient as a whole, including mind, body, and spiritual needs. Well, on my floor, it's always so busy that I barely have time to say more than 2 extra sentences to the patient. It's so stressful. They equip us with a cordless phone that is with us everywhere we go. So, either the phones is ringing with doctors, family, or techs on the phone or the patients are on the call lights. There is so much monitoring and I am constantly getting admissions and discharges. Admissions really take a long time. Plus, I am more behind than anyone else because I'm always have so many questions. I feel as if I'm constantly being pulled in 50 different directions and even if I get to work early to get prepared for my patients, I still end up leaving late. Which results me working in 14 hr. shifts, instead of 12. I am always so exhausted and even on off days, I cannot enjoy my off days because it takes me several days to feel energized again. Since I've been working, Ive been so stressed out and I just don't feel like myself anymore. I'm always crabby and never feel like going out and doing anything. I feel so bad because I can tell that my patients need a little extra attention and loving care and I only have time to push meds, change dressings, and run out the room. This is not the way I thought nursing to be. I worked so hard to get through nursing school with the motivation that I would have a job that I love doing. But, I hate it. I feel nauseated every morning when I wake up and get ready to go to work. I want a job that I'm busy, but, not crazy busy, and where I still have time for my patients. I know I can't sit in the patient's room all day and lolly gag, but I wanna at least be in touch with their feelings and needs. I don't want a lazy job, either, where I'm not using many of my skills. A lot of friends of mine suggested working at a nursing home may be better, but, some people say it's the same or worse. Do you think I feel the way about my job because I'm still a new nurse and still trying to find my way...such as time management, and etc. or can you suggest a position that you would think is better suited for me? I welcome your opinion. Thank you.:heartbeat
I feel for ya, I really do. I bet I could guess what hospital you work for, but I won't do that in a public forum. In any case, a few suggestions:
1. Is there a really GOOD nurse on your floor who could mentor you? I'm not talking about going back to orientation, just to show you how she or he does it all, take you through their routine, etc. You could bounce things off them, learn some shortcuts, etc. I had a couple of good nurses who really helped me out when I was new and now I try to help the new ones as well. That's part of professionalism.
2. Make a really good report sheet and use it. We had canned report sheets at one of the ICUs I worked at, but some nurses made their own that worked for them. That way, when you're getting report, you have triggers right there that if the offgoing nurse doesn't tell you something, you can ask.
3. Are you working days? Do you have to? Even though you usually have more patients at night and it's still busy, you usually don't have to put up with as many visitors and phone calls and pretty much all the doctors and ancillary staff have made their rounds for the day. There's nothing like walking in the room three times to do a dressing change only to find PT getting them up, the dietitian doing a diet instruction, or the RT doing a re-assessment. Or multiple ancillary staff and physicians hunting you down to ask you questions and taking you off task.
4. Make a priority list. Take care of therapeutic communication while you're assessing, passing meds, doing a dressing change or treatment, etc. Some things you really can't talk through, so don't distract yourself, and some people need more of the touchy-feely stuff than others. I personally HATED all the touchy-feely crap when I was in the hospital having my babies, but everyone is different. The confused little old lady may just need you to sit down and pay attention to her for 5 minutes, then she'll get off the call bell!
5. Delegate! In nursing school clinicals, we did EVERYTHING for the patient. When you're the RN, you generally don't have time. If you have a free charge nurse, that's who should be rounding with the physicians. You can certainly ask Dr. So & So if he has any questions, answer them and then go about your business. They are not really supposed to give verbal orders anymore, so the physician should be writing orders in the chart or entering them in the computer and you can review them after he or she leaves. You don't have to stand at attention while he or she is there. Whatever the PCAs/PCTs/whatever your hospital calls them can do, they should do. Period.
6. Don't answer your phone while you're in the patient's room. That's so rude. If the expectation is for you to do that, point out that cannot be good for patient satisfaction scores. I would leave the phone on the med cart or computer cart. Do you have voicemail? That would be a good option...those phones can go to voicemail and whoever is calling can leave a message. That's how my work cell phone works, and my boss would never want us to answer the phone while we're in with a patient.
A lot of this comes down to a need for collaboration between the nursing units and the instructors. I would love to have my students exposed to realistic conditions, but this can be difficult as the facility often limits the more difficult cases and will not allow the students to participate. For example, this last semester on L&D, the students were not allowed in on any fetal demise cases. This same facility also complains that students only have a rosy picture of what OB entails, that they think it's all sunshine and roses. Yet, if it's a difficult case the students are banned. It is quite difficult to portray reality when the list of "thou shalt nots" greatly outweighs the things the students are allowed by the facility to do.
Also compounding the issue is the fact that an ideal situation would involve a clinical precepting of students, allowing them to take an increasing case load as would a practicing nurse. But with an average of 10 students, if each took a full load, I am not able to properly oversee the care of 70-90 med-surg patients. Although the bedside nurse is ultimately responsible for the care of the patient, if a student were to cause harm, I can also be held liable.
I would love to see the state boards recognize a preceptorship as a viable alternative and allow more precepted hours. This would really benefit students in several ways- allowing them to have a full load and have as close as possible to an actual shift, to allow them to follow someone who works on that floor full time and has access to more resources, and to "try out" that type of nursing. The problem is most staff at hospitals are already overworked an underpaid.
One of the more inventive solutions I have seen is for the both the hospital and the school to pay the preceptor in a joint effort to teach the students. Just as staffing isn't adequate anywhere in nursing, it is also far from adequate in nursing education. If you can think of a way I can safely oversee the care of 10 students caring for 7 patients each, while not adding to a staff nurse's workload and ensuring that all care is safe and acceptable to the BON, I'm all ears.
Maybe you would like ICU?? Don't get me wrong, its still kinda crazy....I like to call it "controlled chaos". I have 1 or 2 patients at the most and I really do feel like I have time to do a good history- review labs, radiology/tests, H&P, and talk to the family- I feel like I do get to really know my patient and really think about the disease process. Don't give up completely- you've worked so hard to get to this point- try something new. That's the good thing about nursing.
Wow, I haven't heard one good thing about the telemetry floor. All I hear is it is chaotic all the time. Your post reinforces this. I work at a hospital and I was thinking with your experience and high stress level, think of switching floors if it gets really bad. Don't let it swallow you whole. There is a happy medium with nursing. Just gotta find it.
whipping girl in 07, RN
697 Posts
I feel for ya, I really do. I bet I could guess what hospital you work for, but I won't do that in a public forum. In any case, a few suggestions:
1. Is there a really GOOD nurse on your floor who could mentor you? I'm not talking about going back to orientation, just to show you how she or he does it all, take you through their routine, etc. You could bounce things off them, learn some shortcuts, etc. I had a couple of good nurses who really helped me out when I was new and now I try to help the new ones as well. That's part of professionalism.
2. Make a really good report sheet and use it. We had canned report sheets at one of the ICUs I worked at, but some nurses made their own that worked for them. That way, when you're getting report, you have triggers right there that if the offgoing nurse doesn't tell you something, you can ask.
3. Are you working days? Do you have to? Even though you usually have more patients at night and it's still busy, you usually don't have to put up with as many visitors and phone calls and pretty much all the doctors and ancillary staff have made their rounds for the day. There's nothing like walking in the room three times to do a dressing change only to find PT getting them up, the dietitian doing a diet instruction, or the RT doing a re-assessment. Or multiple ancillary staff and physicians hunting you down to ask you questions and taking you off task.
4. Make a priority list. Take care of therapeutic communication while you're assessing, passing meds, doing a dressing change or treatment, etc. Some things you really can't talk through, so don't distract yourself, and some people need more of the touchy-feely stuff than others. I personally HATED all the touchy-feely crap when I was in the hospital having my babies, but everyone is different. The confused little old lady may just need you to sit down and pay attention to her for 5 minutes, then she'll get off the call bell!
5. Delegate! In nursing school clinicals, we did EVERYTHING for the patient. When you're the RN, you generally don't have time. If you have a free charge nurse, that's who should be rounding with the physicians. You can certainly ask Dr. So & So if he has any questions, answer them and then go about your business. They are not really supposed to give verbal orders anymore, so the physician should be writing orders in the chart or entering them in the computer and you can review them after he or she leaves. You don't have to stand at attention while he or she is there. Whatever the PCAs/PCTs/whatever your hospital calls them can do, they should do. Period.
6. Don't answer your phone while you're in the patient's room. That's so rude. If the expectation is for you to do that, point out that cannot be good for patient satisfaction scores. I would leave the phone on the med cart or computer cart. Do you have voicemail? That would be a good option...those phones can go to voicemail and whoever is calling can leave a message. That's how my work cell phone works, and my boss would never want us to answer the phone while we're in with a patient.
Good luck to you.