BBQvegan

Our charge nurses have the same patient load as any other nurse, day or night. That's 5 or 6 patients each. Yes, when necessary (not often), we may have to go to ICU to give chemo, even with our own patient load. Just last weekend, our charge nurse on the day shift had her own patient load, but was away at ICU doing complex chemo for a patient. Meanwhile, at change of shift (1855), they were calling a code blue on our unit. She had to try to finish up the chemo quickly and run back to our floor to help out with the code. The patient did not make it. And the day shift nurses were there til 2100 + finishing charting.

Where I work, we have 16 beds on an our Oncology Med-Surg unit. I have been a nurse for almost three years and have seen our staffing go down down down as the patients get sicker and sicker. I am at the end of my rope. I am ready to go work as a waitress! I have had enough! I cannot effectively take care of patients as they deserve. We are assigned 5 or 6 patients per RN and we almost never have a tech on the floor. We are doing everything at all times. We are lucky if we get a tech. The day shift is usually no better. Sunday night two weeks ago, I had an unbelievable patient assignment. I had 5 patients, no CNA. Our charge nurse had 6 patients. Just three nurses were the only staff on our 16 bed unit. I gave 4 chemo drugs to two patients, three units of blood to one of them, multiple IV antibiotics, one was neutropenic. I had a patient receiving tube feedings where all meds were crushed. I had another very confused 90 year old patient with a broken hip. Three of 5 patients were high fall risk. I was so angry when I left work in the morning. It was the last straw. The next night, our charge nurse was so busy (we had 3 admits coming all at once at change of shift), she had not seen most of her patients yet at 9:30 pm when our shift started at 7 pm! Well, we heard a loud thump way in the back corner room where a patient fell on the floor. She was naked and had not been seen for hours. We had no tech to help answer call lights. The patient's bed alarm was not working! I was so angry then, too! This job is making me completely frustrated and depressed. I cannot believe I worked so hard to become a nurse for this!!

Yeah, we give it SQ, too. Of course, the MD has to order the route of administration.

I am just nearing the end of my first year as a nurse. This is a tough job, and we have to keep our priorities in order. Like another poster said, "ABCs, my dear"! The situation = the patient cannot breathe well. Were O2 sats dropping? Was there a change in breath sounds? Did you try other things first, such as increasing O2 per nasal cannula? When that wasn't working, did you try a venti mask? Did the patient have a prn respiratory treatment? Do you have respiratory therapists on hand that you can call? If these interventions are not successful, you MUST call the MD, or initiate a rapid response. I can't imagine that it would be essential you get approval from a charge nurse to call an MD. It is YOUR patient, and YOUR responsibility to keep that patient safe.

Good for you!!!! I am a new grad (May 2009) and have been working at the bedside since then. I am burnt out already! I would love to have the job that you might get offered! Congrats! Take it! And don't look back!

Well, no, but it sounds like a good idea! I think I went home covered in urine and blood clots one day. None in my eyes though! Maybe a gown is a good idea?

Berquj, It is very frustrating in the role of new grad. I had 12 wks orientation and I felt that was just the right amount of time. Everyone said I could have stopped orientation long ago, but I am glad I had the time I did. I work nights, and we are so busy. There is nothing "laid back" about it. During orientation, I always felt like I was behind, and I often stayed late to finish charting and getting everything done. I have been off orientation for just one week, but it was a great week. I don't know if it was the patient assignment or if I just finally am getting the hang of nursing. One very simple, but excellent tip that was shared by an experienced nurse is this: Just stop and think. When you are in the middle of something, and someone calls you to do something, just stop, think, and say, "I'll be there in a moment." Finish what you were doing, then focus on the new task. Interruptions are the biggest problem that interferes with our time management. Unless something is an immediate emergency, it can wait until you finish what you were doing. Also, if a patient calls you to the room, try to combine tasks with your trip in there. If you have some meds, go ahead and bring them along. If you need to recheck a BP or assess urine output, or inform the pt about a test tomorrow or whatever it is, combine as much as you can into that visit. It may make your visit longer than you expected to spend, but it prevents you from needing to go back and forth several times. Just stop and think. Ok, I have to see Mr. X. Here is what I need for Mr. X..... Keep yourself organized with checklists. I created a wonderful tool that I would be happy to email to anyone who needs it. I use a new one for each pt for each day. I check off when I have given and charted meds, I write down the patient's diet, VS, time to give meds, accuchecks, I&Os, IV site and gauge, and any other reminders necessary. They get crossed off as the shift goes on, and before I go to report at 7 am, I make sure all was done. Those are just my tricks I have learned in the past few months. And I must say it is all so much easier when I am on my own, instead of with a preceptor. Good luck to you!

All excellent suggestions! Also, tell your clinical instructor you are very interested in oncology, and ask if you could be assigned any cancer patients during clinicals. Good luck to you!

Yes, just do a search for "nurse externships" for a good start. Look at individual hospital websites. I was interested in oncology, so I found programs at MD Anderson in Houston, MSK in NYC.... Also, Mayo has a program on many different units -- not just oncology. I had a classmate do an externship in St. Louis at Barnes-Jewish. Just search far and wide. Good luck!

Wow, so basically the magnet designation means diddly-squat nowadays? What a waste. I assumed that ALL institutions would be making cuts, but wondered if the nurses at Magnet hospitals felt any less disgruntled than others. I guess there really is no difference?

You are usually eligible when you are entering your senior year of nursing school (when you have 1-2 semesters left). Most programs are for 10 weeks during the summer. Applications are often due anywhere between October and February before that summer. So, go ahead and start researching. When you apply, there will likely be specific questions about your status on a special application. My experience was at Mayo Clinic in Phoenix. Check out their website for more info. I know they have the program at their main Minnesota campus, as well. There are lots of programs around the country. Get to investigating!

Just a quick bit about prep and recovery. Most patients getting a colectomy will be "NPO" (nothing by mouth) for at least 8-12 hrs prior to surgery. If your bowels can empty sufficiently, you may get the Go-lytely bowel prep that people usually get before a colonscopy. Otherwise, they may do a tapwater enema to clean you out from the back. After surgery, you will have plenty of pain. You may be in the hospital for anywhere from 1-2 days to a week or more. It will depend on how well you do and what your pain levels are. At the beginning of recovery, you may be restricted to eating ice chips, then advance to a clear liquid diet. You might be on that clear liquid diet for several days. That gentle diet will allow internal incisions to heal. Your doc will be looking out for your first bowel movement after surgery. He wants to make sure your bowels are working before he advances you to a full liquids, or soft diet. In the meantime, if you are having a lot of pain, you may have a PCA pump in which you press a button to deliver pain medication as needed. I hope this helps. Just be sure you have plenty to read and keep from being bored while you are healing. Good luck to you!

I graduated in May and have been working as a new grad since June 1. I started applying back in January. Upon being hired, I was given a 12 week Orientation period in which I work with a preceptor. I am finishing up my 12th week now, and will be on my own next week. My title was "RNA" or RN Applicant until I passed the NCLEX. Then I became an RN, even though I am still in orientation. At the 90-day mark (next week), I will be evaluated. Hopefully my employment will continue. I am not eligible for a pay increase until one year from when I was hired. I like the suggestion from the above poster about trying to get an externship while you are still in school. It gives you experience which will make you a more attractive candidate when applying as a new grad. However, do not thing that it means you are guaranteed a job with that hospital. Even though a hospital offers an exciting summer program, does not mean they will have any jobs open after you graduate. So, get that externship anywhere, then apply for new grad jobs everywhere. Good luck!

Hi fellow nurses. I've been a new nurse for the last three months. I am in my last week of orientation, then am on my own. In these few months, I have seen my hospital cut out recruitment incentives/benefits, try to increase productivity, and eliminate nurses ability to work overtime. Three particular incentives including loan repayment, tuition reimbursement, and recruitment bonus were all discontinued. More and more nurses and CNAs are being canceled or cut early, leaving us short-staffed and taking on more patients with less assistance. Then, when I stay late to finish my charting, I get scolded. And no one gets the opportunity to work overtime, but I understand it was always allowed in the recent past. All these annoyances are stressing out the nurses and decreasing the morale. Employees are very irritated. I understand in these economic times cuts are happening around the country. But it makes me wonder what is going on at magnet hospitals. I truly feel my employer does not care about nurses' satisfaction at work, but a magnet hospital is meant to be a great places for nurses, right? So, if you work at a magnet hospital, please give us some insight into how they are making budget cuts, but keeping their employees smiling (or are they)? Thanks!!

Good luck to you. Last summer, I participated in a nurse externship, and it was a fantastic opportunity to get experience. As far as I know, externships are for students only, therefore I don't see how your chances are hurt because you are one. I was a student, on my summer break. When does this externship take place? During the semester? My application and resume included a lot of experience that most students might not have had because I had a previous degree and career. Make sure your essay is well-written. Have someone proofread it for you, and listen to their suggestions. I did have a phone interview, and it went very well. I showed them passion, compassion, a desire to learn, and a sensible head on my shoulders. I hope this helps.