OPINION: Would you accept this job offer as your first job?

Cuddleswithpuddles · Dec 1, 2011

Hello there,

Congratulations on the job offer!

I would be more concerned about aspects of the position that cannot be presented neatly in job description.

How were the staff interacting with each other? Was the place clean? Was there a general sense of organization or did it feel like chaos (well, more than the controlled chaos you would expect)? Were call lights on for long periods of time?

If you have any concerns, who can you turn to for help? As a new grad, looking at your support network is so crucial. The staff is comprised of 2 RNs. Will you always be paired with a more experienced staff member? Will you be expected to be the primary supervisor on your shift?

Pediatric Critical Care Columnist · Dec 1, 2011

Hi Sammie and welcome to allnurses.com.

I would be very reluctant to accept the job you've described above without asking a LOT of questions. The first one would be, "What happens if the other nurse calls in sick, or needs a personal day? Is that nurse replaced EVERY time?" Let's face it, we've all heard about units that never replace sick calls. Do you really want the responsibility of being the only RN on the floor with potentially 36 patients? Many of those patients will have dozens of meds and will require dressing changes, trach care or other nursing-specific interventions. If you're super-organized and able to prioritize you might be able to manage it all but it would be a daunting task.

Question Number 2 would be, "What's the protocol for managing acute changes in patients' condition? Cardiac patients in rehab *should* be stable, but I can tell you that my code team is called out fairly regularly for post-op cardiac patients who were "fine" an hour ago and now they're NOT! Stroke patients remain at high risk for recurrence for up to several years. Trached patients are notorious for plugging their airways at the worst possible time. With no in-house physician and only 2 RNs on the floor (on a good day) if there is an event how will it be handled? Is there a physician on call, or do you call the patient's personal physician? You need to know this, and you need to know how the physician is going to react if you call at 10:45 pm with a patient who just doesn't look right.

Question Number 3 is, "What other resources will be available to me on these evening shifts? What is the scope of practice for the aides? How involved are patients' families in their care?" If you have 30 patients on the floor and 15 of them are receiving tube feeds, the RN will be ultimately responsible for ensuring there are no aspiration events. Will you be expected to start all the feeds, or simply monitor them? Some stroke patients and spinal cord injury patients require intermittent catheterization. That's usually a nursing responsibility. How often will you be doing that? Do they ever have patients with IVs?

These are just some of the qualms I have about this job... for any nurse. Nurses with little experience to help them make choices and decisions will have a harder time keeping on top of their workload. I hope you take some of these things into consideration. Good luck with this very difficult decision.

Sammie_R_N · Dec 1, 2011

Thank you for your replies! Thanks to janfrn and Cuddleswithpuddles I now have better insight. From what I've seen, the organization is organized and clean. The amount of complaints against this place is fairly low to none and they did promise alot of support for a new RN. I will follow up with more questions to the nurse manager and continue to read anymore replies that may come up here. I will make my decision by next week. I hope it's a good one.

Thank you everyone

ProgressiveActivist, BSN, RN · Dec 1, 2011

no no no no. Impossible and unsafe nurse patient ratio. You might have 18 acute patients. It will all you can do to pass meds document and do treatments. Even with great CNAs and respiratory therapists, it is still highly unsafe.

LauraRN1 · Dec 1, 2011

No. That nurse/patient ratio is horrible.

sbostonRN · Dec 2, 2011

How acute are they? I work on a rehab floor and have 18-21 patients at a time. The patients are considered more rehab/subacute though so different staffing rules apply. It all depends on the environment (hospital, rehab hospital, LTAC, subacute/SNF) and the level of care each pt requires. Just seeing the diagnoses listed in a job description isn't enough to determine the acuity. Some trachs are well established and some cardiac patients are well managed with medications. So you'd have to hear more info about it to really decide.

Sammie_R_N · Dec 2, 2011

Thanks for more feed back! This is NON-Hospital, NON-LTAC. The patients have been discharged from a hospital and bought here to rehab. Some of them do have trachs and some do require wound dressing changes. Also, as I noted earlier, there are cardiac and stroke patients..... As I never have worked as an RN before, I cannot elaborate on how acute the patients will be. sbostonRN Do you like your job? Tell me more about it please! Do you have good support from your staff?

PsychNurseWannaBe, BSN, RN · Dec 2, 2011

Well.... these patients are going to be potentially very dependent on caregivers. Do they need assistance eating (post stroke), if so, who is going to feed them. You will be amazed on how 4 CNAs are suddenly gone because of cares. For example I am assuming some may be 2 assist people. It is hard to say because you are going to have your hands full with trachs, dressing changes, pain management issues, med pass, assessments, orders, etc. Are they going to be medicare because that charting is long and tedious to begin with.

PsychNurseWannaBe, BSN, RN · Dec 2, 2011

On a positive note, I like the orientation period.

sbostonRN · Dec 2, 2011

sbostonRN Do you like your job? Tell me more about it please! Do you have good support from your staff?

I usually do like my job. It's busy and hectic but I love being a nurse. There are some days when I feel totally overloaded but most are good. I work on a subacute floor in a nursing home. 95% of the patients are discharged home and 5% or so get admitted to a long-term unit. We have G-tubes, respiratory patients, tons of ortho, post-CABG or stent placement or s/p MI. I'll be honest I've never had a trach patient there, but I've only been working for 6 months. We deal with wound vacs, PICC lines, IV antibiotics, meds in all shapes and forms. We receive high ratings from our patient satisfaction surveys and from the state suerveyors, so I'm proud (most of the time) to say I work there. I like seeing a patient go from being bedridden to walking to going home...that's the best thing about working in Rehab. It's a ton of work but it's very rewarding.

OR-RN2011 · Dec 3, 2011

On this I agree with libbyliberal. I left a similar situation. You won't be able to provide your patients with good care because you will be spread to thin. trust your gut the fact you are asking all of us sounds like in your gut you know it is a bad situation. Maybe ask to shadow one of the RN's on the shift you are going to work and see exactly what you would be getting into. Try not to let the excitement of a job offer cloud your judgment. Also are you sure they are going to honor the training program?

Best of luck