SunnyRose

This is unacceptable...absolutely dreadful. Feel just awful for you, the pts, and other caring staff. We still have a long way to go in so many places in treating mental health and med-surg pts with equal resources and compassion...

Thanks for the validation, everyone. Makes me feel not so alone in the world :) My State Nursing Board rules allow a VERY wide range of managerial discretion in deciding ratios. Since we are so short-staffed, my unit has 1 nurse at a time, so 18 total pts on the peds unit w/ 2-3 techs. An adult acute unit is across the hall, so I can "borrow" their 1 nurse or a tech if I have a crisis, but they are always short-handed too. Several upper-level managers have rounded my unit recently, hiding in the nurse station as though the patients were going to jump them if they came out on the floor, and never asking a nurse how things are going. No union in my facility...the only resort I have is the "nuclear option" of Joint Commission...no other way my voice can be heard within the corporation. Really love working with kids but am reaching the end of my rope...seems like $$$ is the bottom line, period.

I work in a peds acute inpatient unit (ages 5-17). Management decided to up our nurse to patient ratio to 1:18. We do all our own discharges and admissions (Admissions take 2 1/2 hours per pt. Usually 1-2 admits a day shift and 3-5 a night shift). The kids are usually pretty acute: lots of active little fellers running around bugging the teens; sad future borderlines trying to cut themselves or bang their heads; psychotic teens having their first break, kids who come to us in shackles from juvie lockup and have to be watched so they don't jump another pt. Typical inpatient psych. Boys and girls and littles are supposed to be separate, but I usually have just 2-3 techs, so it is just plain hard to keep everyone separate and keep eyes on constant observation pts. Conflicts arise among the pts because of this. The unit is sooooo busy-with treatment teams, constant phone calls, helping calm pts through a crisis to avoid holds and seclusions, passing meds, calming somatic tummies, confirming orders, just listening to a kid vent, doing medical nursing tasks etc,. I usually have to stay late--sometimes very, very late-- to chart and finish an admission. I have 1 1/2 years experience. I wanted to stay inpatient, but I am wearing out. I love working with kids and try so hard to make a difference in these kid's lives. Sometimes there is even a breakthrough-insight gained, behavior modified, a depressed teen sees they have a reason to live--but I still usually leave every 12+ hour shift feeling rushed, inadequate, and defeated. Every nurse and tech has complained about the load. The whole hospital is short staffed every shift. We all feel it isn't safe. We all work well together, but there are not enough nurses or techs. Critical thinking is a luxury--I feel like I am putting out fires while running on a treadmill. Management listens sympathetically, but the end message is always, "Deal with it. It's going to get worse before it gets better. This is what healthcare is like." So...is 18 patients the new normal? Is this what I have to look forward to for the rest of my career-14 hour days and never feeling like I've done enough? Any comments are welcome. Thanks for listening.

Bras are ok as long as they don't have underwires; they can keep them if pt allows us to remove the underwires.

Up to 16 acute kid patients (ranging from age 4-17) per nurse. 3 techs for 24 pts. Unit has 30 beds. Sometimes have a dedicated unit secretary, and do our own admissions and discharges. Admits have so much paperwork and are so time-consuming, and we have 2-4 every day. I end up staying very late to finish paperwork, get orders, and do charting. Wish I had fewer pts, because I love working with the kids, but feel so swamped. Very frustrating for a newbie 3 months on the job. I only get into the milieu for assessments, meds, and crisis situations. I got into nursing to work in mental health, but I am so stressed and exhausted right now. Hope it gets better as I gain experience because I really do love my job and my coworkers.

Well said! I'm graduating in May-this will be my third major career change (and I hope last!). You described my med-surg preceptorship to a T! I was a zombie after 2 twelve hour shifts in a row, and that was just as a student who was assigned 2 pts, and helping my preceptor with the other 4 we had. I want to start in med-surg, but getting a little nervous about being thrown to the wolves.

Thank you to all of you for the advice and good wishes, I appreciate It!

I passed NCLEX-PN in July. I just gave notice and left my first post-grad job after only a month. It was at the largest SNF in the region, and each nurse has 24-30 pts on days/evenings. Trachs, dementia pts that need one-on-one, tube feedings, quadrapeligics, breathing Tx's, you name it, mixed on each floor. 90% of pts on any floor needed their meds crushed or fed to them one at a time. I had 9 days of training w/ 4 different nurses, then floated on evenings. When I was training, the nurses kept telling me that I would get my "own system", and "do as I say, not as I do". I found this was code for not doing 90% of the Tx's on any shift (but still signing off on them because you get in trouble if you don't sign), passing all the shift's meds at the same time, not giving nose sprays or eye drops, and never spending more time with a pt than needed to shove pills in their mouth. I tried to do it right, confirming each med with each pt's MAR, doing all the sprays and drops, and assessments and Tx's, but I was too slow and ended up finishing the 17:00 pass at 20:00 or 21:00, then staying over for 2-3 hours to chart, and not taking a lunch (although they made me sign a card every time saying I "forgot to punch out"). My friend (another new grad) got written up there for getting behind on their med pass, so I knew it was just a matter of time before I got written up, too. I couldn't take the feeling of providing inadequate, and possibly unsafe, care any longer, so I gave notice. So now, I am job hunting again, and running into the "no-experience" Catch-22. Should I put the one month of experience on my resume, since I have no healthcare experience other than student nurse clinicals? Should I continue to keep the nursing school clinicals on my resume? I should add that I liked the pt interaction, and hands-on skills. I got complements on my good attitude from pts and their families, and staff. I left the facility on good terms, and got along well with all the staff, so I think I can maybe be a good nurse someday, but I am discouraged. Am I just a big sissy? Or did I just get a bad break for a first job?

I never used the flashcards I bought, mainly because the text and pictures were too small. Flashcards can tend to take things out of context and I like to be able to see the "big picture." Before you do anything, look at your A&P textbook to see if the publisher has a code to access online resources. Many publishers will put the full text of their books online-including tables and diagrams-that you can print out and mark up. There will usually be some interactive labeling and quiz material online, too. I found this to be the best way for me to study, because I was using the same book I was reading from and that my instructor was drawing from for the tests. Also, you might want to consider a digital recorder. (ask the instructor's permission first.) A&P lectures go by VERY fast, and just listening to the lecture again later on and filling in gaps in your notes is very helpful. You'll want to review the previous lecture's notes the next day to really solidify the info in your mind. You can google "A&P" + whatever you are studing to get results for diagrams, pics of models, etc. Here is a very helpful link I used: http://www.colorado.edu/intphys/iphy3415/models/index.html Good luck with your studies!

Like ZiggsGal said, look at job postings for your area to see who is hiring LPNs. Also, don't discount LTC. Patients are far more acute now than in previous times, and if you are on a skilled floor, you will get a good opportunity, as an LPN, to do assessments, dressing changes, IVs, tube feedings, and sticks (depending on state and facility), along with dealing with dementia/psych issues-All kinds of interesting "nursed up" stuff. CNA work is very rewarding, but backbreaking work. Your pay as a CNA will be considerably less than an LPN, your scope of practice is very limited, and there is much less chance for advancement. I am a recent LPN grad, and my fellow classmates currently working as CNAs until they pass the NCLEX cannot WAIT until they pass it and get to be nurses. LPN school is one year of your life. An extremely intense, frustrating, tiring, but rewarding and life-changing year. You can earn a good living as an LPN if you choose the right facility. If you are already accepted to LPN school, and already prepared to deal with a year of reduced income (working full time is very difficult), go for it, and don't listen to the nay-sayers in your life. When I announced that I was starting LPN school, I found people tended to project their insecurities onto me. I stayed the course, graduated valedictorian, and have an NCLEX date next month. Good luck, whatever path you choose!

Demographic and previous career details: how long have you been a nurse? LPN student about to graduate. Age? 45 gender? Female. What was your previous career? Web/graphic designer and technical writer. Did you receive a college degree in that specialty? Yes. How long did you work in your previous career? 14 years. What was the hardest part about changing careers? Going to back to school. Having homework instead of a life! What was your motivation in changing from your previous career? Tired of getting stuck in 1-2 person departments with nowhere to advance career. REALLY tired of working in a cube with computers instead of people! did you make more or less money in your previous career compared to nursing? I will make less money initially, but will even out in about 3-4 years. What qualities do you possess (if any) from your previous career that help you in the nursing field? I am very detail-oriented (OK, a perfectionist). I am good with people, I am good at prioritizing, and I like to be challenged and use my brain and skills. Was your first career in the healthcare field? No. Retail. Is there anything you would change, in regards to your career choices if you could go back in time? Every career I have had (healthcare is major change #5) has contributed to who I am, so, no. What prevented you from becoming a nurse earlier? Lack of knowledge in the career options available once I became a nurse (not just hospitals/Dr.'s offices). Lack of confidence in my ability to do well in school. On being a nursing student: Did you have another job while in nursing school? A grateful "No." What obstacles do you/did you face being a student? Time, time, time-never enough of it. Personal life is almost zero. Haven't had the grandkid overnight in 6 months. Which class is most important for student nurses? Tie between Skills and Med-Surg. Skills: hands-on is where you start to feel like a real nurse. Med-Surg: you have to have an idea about what you are looking at. Which is the least? We have a pretty lean curriculum at our LPN school. Everything is necessary. However, I am baffled by the Speech Class requirement that all the local RN schools have here in E. Tenn. What other classes do you feel student nurses should be required to take? I took all but one RN pre-req before starting LPN school (as has 1/2 my class). I would not have been able to do this without college A&P, because the LPN A&P is so fast and general, yet you need the knowledge for med-surg.

Congratulations!!! I am looking forward to posting my own "Yippeee, I'm done!" on April 22. I know how hard you've worked. Best of luck on boards!

Just finished my first day at Tennessee Technology. We have a class of 50-whew! The instructors seem very good. We have our first test in Success in Practical Nursing on Thursday, and the first A&P test on Monday, then 1 or 2 tests per week after that. The A&P is much more of an overview than the RN prerequisite A&P 1 and 2 I just finished (thank heavens!) and the other class looks pretty interesting.

So glad I found this thread! I just got "the letter" on Friday while out of town. My cousin (a retired RN) was dog sitting, and I told her to call if it arrived-we both squealed!!! Orientation is April 23, start is May 4th--TTC. Now I'm slightly terrified, and very excited! I plan on bridging to RN, so I have everything but Micro out of the way, and I am SO glad I took A&P 1 and almost done with A&P 2, 'cause my study skills were NOT up to par last year when I started. I sure hope I can do this!