poor staffing and new grad

Joe,RN · Jul 16, 1999

Get malpractice insurance, stick it out for one year! Are new grads being taught to refer to their patients as clients?

Houseful8 · Jul 17, 1999

Welcome to the real world. Anywhere you go there is a staffing problem. I have been a nurse for 20 years and have not found one place without understaffing problems. If you do your job to the best of your ability and use some common sense the legalalities will stay away. Give your hospital a chance and at least try it for 6 months. Use some stress management techniques like taking deep breaths and hot baths etc. Good luck.

mirn · Jul 23, 1999

Sorry to break it to you, but I have to agree with the last two posts. I am a fairly new ADN-RN grad who has LPN experience as well. And about every hospital in this nation is understaffed right now, it seems. The patients continually become more challenging, the staffing ratios decline, and it is soooo easy to get discouraged! However, you sound intelligent and dedicated. I am willing to bet that in a few months you will learn to acclimate. Organization and speed only come with experience...don't be too hard on yourself. Rely on your skills, education, and peers and the rest will come.

And at our hospital the average orientation is 4 weeks...6 for ICU/CCU, ER, and OB/LDRP. This includes brand new grads!

Best of luck.

MollyJ · Jul 23, 1999

Hi Anji, I have been interested to see the replies to your post because my thoughts upon first seeing your post is exactly what has been posted.

The essence of your question is "When do I just have to work a little harder vs when does this become too dangerous to do?" and we all struggle with this issue. I would urge you to focus on the facts. In your post you say that you "might" have to take care of up to 14 clients. You may be exacerbating your anxiety by worrying about things that are unlikely to happen and that is mostly hard on you. I notice that some posters reacted to the fact that your hospital gave you an orientation that was considered luxurious (it was certainly outside of anything in my experience) so this is one sign that your hospital is trying to doing "right" by its' new nurses.

Realize that it is very hard to be new on a unit that may have a bad or grumpy attitude ("they won't show us the staffing grid..." sounded adversarial to me) so try spreading a little sunshine in your own corner. Make an effort to be kind to your clients and to the staff you work with. Note and thank even the smallest show of team work. What I am urging you to do is to create some team work, do some team building in your corner of the world. Say positive things to your charge nurse and your head nurse, so that they don't just expect complaints from you. Realize that you are learning to manage lots of tasks and that is formidable. Don't expect perfection from others or yourself. Do nice things for yourself; have lunch with old nursing school buddies. Try to avoid extra shifts or limit them to avoid excessive fatigue to keep your perspective. Stay physically active. Dig in for one year.

Try to find a natural nurse mentor, an experienced nurse who you know from work or another setting (even an old instructor if they are nearby). Discuss the situations that you feel are risky. Ask them to play devil's advocate. How could you ameliorate your risk? Is this just simply an unsafe situation? Don't stop asking questions, but approach them with hope, as if their is an answer.

good luck.

CardiacRN · Jul 24, 1999

While the prior replays are "appropriate", it is the tragic reality to nursing. I STRONGLY encourage you to be an ADVOCATE for yourself! Get malpractice insurance. When you feel you have an inapproriate assignment, SAY SOMETHING, DOCUMENT IT, MAKE YOUR CHARGE TAKE NOTE, if you don't get anywhere TALK TO YOUR NRSG SUPER....As noted earlier, we often find ourselves questioning where we stand we safety and the acuity/census level. It is horrible to feel that your license is on the line every time you walk through the door d/t census, acuity, short-staffing, lack of orientation/education, etc. That is my best advice, advocate for yourself, your common sense/intuition is worth a lot, and lead with confidence. As an old instructor always told me...."document as if you had a lawyer on your shoulder....". Best of luck.

molly w. · Aug 8, 1999

The last and only 3 nursing jobs I had, I was promised a 2 week orientation each time (even as a new grad: I was scared to death) but was lucky to get 1 wk. I was the only RN on a floor with 29 patients. 2 LPN's and 2 Aides.

This was geriatric floor with mostly bedbound patients who all had to be turned.

You will become more confident as you began to depend only on yourself (not a preceptor who is always around). It is then that you start to really think things through and analyze. You will become more organized simply through "doing" and trial and error also, do not forget to always ask you supervisor if you really have perplexing situation.

good luck

anji · Aug 10, 1999

hi all. I thank everyone for their advice, yet I have seemed to go against most of the advice. I got a new job and put in my two week resignation at my present job. I am now working at a hospital in which i have 12 patients with myself, a LPN, and a aide. A place where I feel I can give patients the care they desire.

I just wanted people to know that poor staffing and poor patient care in nursing does not have to be a "tragic reality".

EMPOWERMENT!

peace and love, anji

ajf · Sep 3, 1999

Good for you Anji! As a new grad I was a little disapointed by some of the responses myself. I understand that as new nurses we have a lot to learn. However, it seems to me that you knew the situation was unsafe. Rather than supporting you, many of the responses where to suck it up. I hope you made clear to your former employer why you resigned. Nurses leaving does not always change things, but it does send a message to administration as to the state of the unit. Congratulations for taking care of you AND your patients. Good luck in your new job.

ecb · Sep 5, 1999

I am in my 3rd job in 16 months, and it is the best facility I have worked in in al of that time, BUT (you knew there was one) we have a fairly new DON {more new than I} and she is horrible for moral, she writes up people for calling out with a Drs note, and for being sent home for being ill. We have lost 3 licences nurses and more than 1/2 a dozen CNAs in the time she has been "cracking down" Needless to say i had a friday night where I was not covered for the next shift, the CNAs asked the supervisor how she could be so calm in that they had stuck HER like this, I had to explain she was not the one stuck. We all know she is not required to take on 2 assignments, but I am legally required to stay and care for the assignment until my relief arives, even if they are 8 hours late.

We also know that in most facileties that administration is "required" to cover shortages like this, but the DON just happened to forget her beeper when she left her home(she knew about the shortage before she left work) and the ADON had no one to watch her kids.

the supervisor did end up covering the house AND a floor, and another supervisor came in to take 2 sides to the skilled floor, and the sceduled nurse covered her regular floor, {this was a night with NO call outs}

pretty bad huh?

the kicker is without her there tightening the staffing ratio to 11:1 for CNAs up from 10:1, life there is doable, and the people she is driving out are the thorough, caring, compassionate ones who do not cut corners. It makes for real problems, and she ONLY sees the botom line, she tells others, that this is out of her control, but she has ^ our paperwork by 5 documents a shift/day, per patient.

Sorry to vent, but her way of doing things scares me. I have been in a facility reviewed by the state, and it is the extra documentation, double {triple} documentation that gets a facility in the most trouble.

no-one wants to put problems in writting, because the one nurse who went to corprate was fired within 3 days of the complaint (yes she was written up to justify it, and she is disputing it, but still)

I am not liking this situation, but as my sig says "patients above personaleties"

------------------

ecb . @}--->-->-

remember:

Patients above personalities

mirn · Sep 6, 1999

I must not have posted my response to Anji clearly enough. I never meant to imply that she should "suck it up" if she felt an assignment to be unsafe. I simply stated that in many areas this is the norm. And while I agree that nurses leaving a facility can be an effective message for administration, it is only a workable one if there is a place to go when you leave. In my community there is not. Some have to work where we can. So, since I do not feel that our staffing ratios are unsafe (the majority of the time!) I choose to stick it out and hope to make a change not only for my future, but for my patients, because at the end of a 13 hour shift, that is truly all that matters.

Thanks!

Mirn

MollyJ · Sep 6, 1999

This thread keeps getting more interesting. Anji, I am glad that you left what you considered an unsafe situation for one that is more safe. Ultimately, everyone on this board expects you to do that but do not expect to find a risk-free practice venue. GOOD (and they aren't all) agencies staff for average situations; they have to and all of us have worked shifts that weren't average. I will tell you that your description told me you were uncomfortable, but it didn't automatically describe an unsafe situation. Ultimately, you are the best judge of that. I am still hopeful that you will think about doing the same things many of us posted. Get malpractice, practice relaxation, have a life outside of nursing, be physically active, document concerns about unsafe situations with your supervisor/risk manager, have mentors/good nursing friends to bounce situations off of in a safe, confidential environment. I have been a nurse for 20+ years and nursing grows in how un-safe it feels to me. Too many things are beyond my control and yet I may be held accountable for them. I constantly think about accountability and practice and I constantly strive in these areas. But I never feel "safe" in my practice. I did not feel that any of the respondents here were callous, though that was repeatedly voiced by the "newer nurse" respondents, so clearly it is a matter of perspective. Keep striving. I fear that new nurses that expect complete safety in nursing will always be disasppointed and nursing will lose you. We very much need nurses that think about safety for the patient and themselves so we may, again, be losing our best and brightest. Hang in there.

[This message has been edited by MollyJ (edited September 06, 1999).]