overwhelmed by patient turnover

[ay23]

Hello fellow nurses,

I have been a LPN in LTC for years and now I am a RN working in a stepdown unit that is very busy. I am still on orientation day shift. I feel overwhelmed and I am not sure I will ever get the hang of this place. When I worked in LTC 7p -7a I would have two halls by myself and two aides with a total of 60 residents to pass an extreme amount meds to, get/ take off orders along with various other tasks and I did it well with little thanks.

Now I am here, because I wanted to increase my skills and knowledge base, but I am so busy here I don't have time to think. I usually start off well getting my assessments in and am meds for 5 patients, but then everything gets insane with tests, discharges, admits, transfers, caths, OR patients and keeping up with new orders, careplans, computer charting, ADL's, tele strips, meals VS and consents. my example : start 5 pt then I transfer a pt out to another floor which takes time to do the computer screen and call report by the time thats done it is time to get a pt from the cath lab and get report and set up room, then get that pt while I am sending another to OR AHHHH! Its time to pass meds again to the other patients. UH oh! cath lab patient is going out to another hospital for heart surgery! plus vs q 1 hr, Now I am told to discharge another of my patients plus reconiliation of meds and teaching needs to be done as well as discharge computer screen and iv taken out. Tele strips are due to put in computer but that will wait because transfer team has arrived for cath pt. Meds are due for other patients and I must transfer another of my patients to another floor to open up beds, because I am getting an ER admit with chest pain. Then I get a call that my OR pt is coming back too. Then I am told I am also getting a transfer from ICU that is a trainwreck!( trach pt, vent, large, the whole nine yards and contact iso to boot). Meanwhile my ER patient ( admits take time, lots computer screens to do and paper work and wants tylenol and a consent for stress test needs to be signed) and OR patient (vs needs to be done and wants pain meds) arrive at the same time! bEgged Icu to keep pt until I could get her done! Old retired nurse who is the hospital's bed checker said icu pt needed to be moved now! Icu needs the bed for a pt that has been in the ER all nite! Its 5pm now! Pt comes. I Try to catch up on meds and computer charting, tried to get new admits assessment in computer and meds but I don't think I did the computer screen just right, it's time to give report to on coming shift that asks a lot of questions that I can't really answer yet and I haven't had time to look at the very thick chart. At this point I feel I barely know anything. My preceptor did help with the cath patient and helped with the vs and passed some meds on the OR pt. This my 3rd week on the floor they tell me that the charge nurse is so busy her self that you have to do everything yourself. By the way last week was worse. I wanted to be a nurse because I wanted to care for people in their time of need but all be dang! if this ain't too many needy. I am suppose to go to nite shift where I belong very soon, I hope it gets better and safer for me and my patients.

[RNLisa]

Hi, your post made me very tired just reading it. I feel for you. I hope it gets better for you!! Hang in there. When do you move to nights?

[ay23]

Thanks for your reply, Yes I am extremely exausted by the time I get home and worried I forgot something or did something wrong that I didn't catch. I am suppose go to night's in 3 weeks but my manager said, it may change and she would give me my last 3 weeks of orientation on night's. The nurses say I am doing fine and I am catching on quick, I don't feel that way. I just don't know how any one nurse can do it all. If it were not for my preceptor helping some I don't know how I would have made it.

[youngatheart]

ay, I am going to night shift next week, 7p-7a cannot wait I hope it eases up a little bit for me too. Your story sounds like mine. Good luck

[Daytonite, BSN, RN]

ay23. . .I try very hard not to be negative in my posts, particularly with students and new grads. However, I worked on a stepdown unit for 5 1/2 years and I know the nature of the beast. It sounds like you are working with people who are supportive of you. That's a plus. Other than that, if I had known you were considering this job a few weeks ago I would have tried to talk you out of it. Stepdown is not for new grads. It is a highly stressful and intensive area and riddled with surprises. One good thing is that you won't have the intensity of discharges and admissions during the night. . .but, you probably will have to deal with quick transfers of patients in and/or out of ICU to make room for patients from ER or coming out of ICU. There will often be scrambling for telemetry as well during the night.

My advice for you as you go to the night shift is that you make first rounds as soon as you get out of report and assess for anyone who might be on the brink of going bad. Make sure all your IV's are patent. You haven't mentioned having IV problems, but nothing is worse than having 3 or 4 IV's that all need re-starting in the middle of your shift.

I wish you well. Survive stepdown and you'll be able to work anywhere. You are still very early in your new job. It's not too late to consider changing employment if there are other hospitals in the area where you live. Only you know how much stress you can handle.