I was wondering if anyone felt 12 patients was a bit much for a new grad? I love caring for my patients, but after two weeks of orientation, the 3 days I have been on my own we’re not so great.
I had 5 long term care patients and 7 skilled nursing patients. (2 with Q4hr neb treatments, all had a dressing changes, 2 with tube feedings). I am not complaining by any means, but I did feel very overwhelmed to the point of tears on the 15 min break I got. I worked from 7am-11pm at night to help out. (We work 8 hour shifts. I worked a double) I am new to this site and have seen ignorant comments on others topics. Please try and refrain from that if anyone decides to respond.
I'm not writing this to be a smart$$$, but is this provable? I know short orientations for new nurses is a bad thing, but does it (beyond anecdotal stories) result in patient/resident death?
I suppose it would be difficult to prove since there are multiple factors involved when any patient dies.
I certainly don’t doubt it, though. I don’t think it’s actions that “kill” most of the time, it’s usually inaction.
Yes, it is....when you don't teach a new RN the specifics of how to be safe in a particular healthcare setting, you are setting the stage for that patient to be harmed and yes, that can ultimately lead to their death.
So you don't think that a short orientation is nothing more than an inconvenience for the nurse and cannot possibly harm a patient? Wow.....just wow.
Your "wow" is pretty hyperbolic, and shows you're making assumptions (false) about the point I was making.
(The same hyperbolic tone used on your assertion about short orientation = death that I was asking for a bit of proof about.) Of course poor orientations- especially for new grads- can't be a factor for good care. Claiming it results in patient deaths needs data backing it up, especially if the situation is ever going to be changed...
Your "wow" is pretty hyperbolic, and shows you're making assumptions (false) about the point I was making.
(The same hyperbolic tone used on your assertion about short orientation = death that I was asking for a bit of proof about.) Of course poor orientations- especially for new grads- can't be a factor for good care. Claiming it results in patient deaths needs data backing it up, especially if the situation is ever going to be changed...
So prove me wrong...show me where short orientations DON'T have any impact on patient outcomes.
I'll be listening to the crickets while you look for that.
So prove me wrong...show me where short orientations DON'T have any impact on patient outcomes.
I'll be listening to the crickets while you look for that.
You sound like you think that I'm a fan of short/inappropriate orientations. I'm not. If you want to advocate change, one of the things you need to do is provide objective data. That's the point I'm making.
You sound like you think that I'm a fan of short/inappropriate orientations. I'm not. If you want to advocate change, one of the things you need to do is provide objective data. That's the point I'm making.
This is where critical thinking comes in....do you need a study for everything? You actually don't. Some things fall under Captain Obvious.
You agree that short orientations for new grads result in poor care but you don't seem to believe that poor care can result in a patient death...we all know that isn't the case.
Take a nursing home for instance...new grad nurse, two weeks orientation, nobody dies during that time. New grad RN on her own goes into Mrs. Smith's room who has known COPD and is having Cheyne–Stokes breathing. She goes in and documents patient is sleeping and documents the respirations. Mrs Smith is not a DNR. So the patient just lays there and dies. That is inexperience. If she had longer than two weeks I guarantee, in a nursing home with two or three month orientation, she would have seen it at least once.
Same New Grad RN let's say...has never done any nursing besides acute care. Walks in and notices Mr. Jones toenails are long. She feels bad...she decides to cut them. She doesn't know it's a brittle diabetic and a couple of weeks later he has diabetic ulcers and a couple of months later, loses his foot. The immobility causes pneumonia and he dies.
A longer orientation...would have helped that patient.
So...let's not pretend short orientations are not a problem.
This is where critical thinking comes in....do you need a study for everything? You actually don't. Some things fall under Captain Obvious.
You agree that short orientations for new grads result in poor care but you don't seem to believe that poor care can result in a patient death...we all know that isn't the case.
Take a nursing home for instance...new grad nurse, two weeks orientation, nobody dies during that time. New grad RN on her own goes into Mrs. Smith's room who has known COPD and is having Cheyne–Stokes breathing. She goes in and documents patient is sleeping and documents the respirations. Mrs Smith is not a DNR. So the patient just lays there and dies. That is inexperience. If she had longer than two weeks I guarantee, in a nursing home with two or three month orientation, she would have seen it at least once.
Same New Grad RN let's say...has never done any nursing besides acute care. Walks in and notices Mr. Jones toenails are long. She feels bad...she decides to cut them. She doesn't know it's a brittle diabetic and a couple of weeks later he has diabetic ulcers and a couple of months later, loses his foot. The immobility causes pneumonia and he dies.
A longer orientation...would have helped that patient.
So...let's not pretend short orientations are not a problem.
ARRRGH! I am not saying that short orientations aren't a problem. I realize that poor nursing has consequences and sometimes these consequences lead to a downhill slope that results in increased morbidity and mortality.
I'm saying that if you want to forcefully and successfully advocate for better conditions, you need to provide data driven proof. (Not that even having it always results in change, given other factors affecting healthcare economics.)
And that's Colonel Obvious to you, thank you very much... ?
I got dumped on with 40-80 residents immediately after graduating at the SNF that hired me. 12 is doable...hang tough! Don't be afraid to ask for help when needed! ?
If you don’t mind me asking, what was you’re strategy? That is so amazing being able to survive that. Well, coming from me I guess where I think 12 is a lot.
You’re in a SNF. This is actually a very light load for a SNF and you are lucky. For you to have less patients means some other nurse has to take some of your work and add it to theirs. New grad or otherwise, the facility will not be able to change the patient load.
Youre going to feel overwhelmed for at keast the first few months to a year. Just power through and you’ll be ok.
The floor I work on is long term care, but they have the front of the floor designed for skilled rehab. It is a total of 12 beds available. No one wants that assignment. They are very short staffed so i am taking patients that other people would have had added. But, maybe in the long run it’s more work on them because I’ll ask for help. (Which I don’t bother asking as they will get snippy anyways). Thank you for the reply and I hope you’re right I will be okay ?
It's disturbing that this is considered a "light" assignment. Honestly, say you're working a truly 8 hr shift. Twelve patients with dsg changes, 2 TF, 2 with nebs, and we all know about the plethora of meds you're passing. Not to mention all the toileting, ADLs and incidentals that come up as well. Yes, this number might be light relative to obscenely bad ratios, but it's still not good. Not if you're providing decent care.
I've come to despise the term "Skilled Nursing Facility" because it's exactly that service that is in such short supply in so many places. Not because of nurses's skills, but because of how much average time they can (in reality) spend with their patients.
You’re exactly right. I have heard many people say quality over quantity. I don’t have an aid that wants to help so it makes it all so much more. If I ask for help it’s like pulling teeth, so I just do it all. I don’t want to come across as complaining as it is not that by any means. My main focus is making sure the patients are safe. In the computer it is ordered(and should be done regardless) to do pre and post neb vitals and documenting which lung sounds the patient had. The patients told me I’m the only one that does them, so what do other nurses document if they don’t actually do any of the vitals? What a nurse actually lie on documenting? I appreciate you’re reply. Thank you ?
If you don’t mind me asking, what was you’re strategy? That is so amazing being able to survive that. Well, coming from me I guess where I think 16 is a lot.
I "tarnished" my reputation/resume in this tiny little community I work in, and I left that crummy facility with its 40-80 patients after about 4 months.
I would have 1-4 aides on overnights, but half the time they'd either pull a disappearing act or be forced to float. I never went to the bathroom, ate, or took a break. I came close to having a nervous breakdown.
I'd come in, get report, round on the patients with the off-going nurse (as I never wanted to accept responsibility for that large a census without laying eyes on them with an additional nurse present, plus we had to both verify the placement of patches), and then do count.
From there, a quick review of the MAR and treatment sheets. Dole out the creams into little cups, pull the 12 AM meds, get the VS equipment on top of my cart for anyone who needed temps (on antibiotics, recently ill, etc), and then start hustling.
11pm-2am and then 4am-7am (technically 7:30am, by the time 7-3 took their sweet time coming to the floor) were the busiest times.
2-4 am was dedicated to nightly 24 hour chart checks, summaries (that I really had no business doing because I didn't know the patients), edits and then changeover at the end of the month (used to kill me because there we SO many mistakes), Medicare documentation, PRN medications and followup assessments/documentation, glucometer checks, medication destruction, refrigerator checks, setting up the aide assignments for 7-3, etc. It wasn't a case of the individual tasks being onerous, but if something went wrong (a resident fell, became ill, had behaviors, had to be sent out, etc) it could set your entire night off kilter because of all the mandatory, "tasky" busy-work left to the overnight shift.
My supervisor was of absolutely no help, and actually came close to harming a patient simply because she didn't want to help me (and it wasn't over a "stupid" question that I, as a new grad, should have just researched better; it was a situation where I needed access to supplies that only she had the keys for and she refused to give the keys to me/wake up from her nap and walk down to get the supplies for me).
I hated every minute of it, but it was a good wake up call about what to be mindful of in evaluating potential jobs in the future...
The themes of "that's a lot better than what I endured" are troubling, especially since problems of substandard care in LTCs/SNFs are well-known and well-documented.
The idea of "if you can't handle the work someone else will have to do it" - is illegitimate outside of a clear assurance that the workload is appropriate to begin with.
If you want to say, "My situation of 40 patients was not safe, but twelve is actually doable and should the be standard everywhere" - well that is something different and gives everyone a better idea how the OP should process this.
I hope that's what a lot of these previous posts meant to say.
OP, I would highly suggest not working doubles right now. The goal is not to get into to others' good graces by appeasing them - the goal is to learn how to safely provide care and then to actually provide excellent care. My observations have been that trying to appease others by any means necessary appears to be a dangerous road to travel overall - so I hope you will spare yourself some agony by not going down that road. ?
Sour Lemon
5,016 Posts
I suppose it would be difficult to prove since there are multiple factors involved when any patient dies.
I certainly don’t doubt it, though. I don’t think it’s actions that “kill” most of the time, it’s usually inaction.