Really, is this real?!?!

[FlossyRN]

Hi, I am a new nurse who graduated in May. I graduated with honors (this was not easy, I had to work for it) and did well in clinicals. I have been working day shift on a cardiac step down unit since July. I truly love nursing...I am just not sure I love where I am at. I feel like I am being run over but when I mention something casually to other nurses all I hear is "this is day shift" or "it is what it is" or my favorite "Management doesn't care". I also fear some of these feelings may be because I went to school and did clinicals in a large city with a very up to date hospital who treated their employees excellent. It was a CHI and magnet facility. Now, I know most may say well, go somewhere else, however, I live in a rural area with only two hospitals where everyone knows everyone so word of mouth travels faster than the speed of light around here. I am just unsure if this is what nursing is really about, will it get easier, or am I being taken advantage of as a new nurse???

I started working in July with a preceptor. First issue, I was told I would get 12 weeks of training. Immediately, management started balking until I went to higher management and demanded my full training. This didn't set well with me. Second issue, I was told I would have one dedicated preceptor...the forth day of having someone different I balked again and demanded what I was told. Another flag. From there things did seem to improve but were always hectic. However, I must mention that the hospital says they are a cardiac step down unit but will not make that official because they do not want to lower nurse to patient ratios. We also are a catch all floor as well. Basically, everyone on our floor is not sick enough for the unit but too sick for a med surg floor. It is standard, every day, without fail, I have at least 6 patients if not 8!! WHAT!?!?! This is insane. I had one patient the other day on Cdiff precautions, had a rectal tube, chest tube, stage four pressure ulcer, suprapubic catheter, peg tube, tube feeding, as well as non speaking and confused, who went to dialysis 3 days a week, plus 6 other patients just as complicated. It is nothing for each patient to have 10 to 20 meds due at nine am, 3x a day dressing changes, etc. We as nurses here are also responsible for getting our on blood sugars and passing those food trays!!! EVERYONE is a blood sugar check!!! These are all scheduled for 11 am...but they will schedule my lunch at 11 am and then get mad because I'm late going to my scheduled lunch. It is not uncommon for them to give me four patients who know they are being discharged at 6am and then give me 4 direct admits back to back who all have to have UA's, IV's, Cultures, etc and all of their information enter!! Again, when I complain I am told to "buck up" or "this is the big leagues" or some other smart comment that just completely defeats me. At this point I am ready to quit! This is so overwhelming to me. I get to work early, write down my meds, my labs, etc and none of this helps with me with my time management. I try to delegate to my CNA's but there is absolutely no team work. They are always busy or will ask you very rudely, "Wasn't you just in there, why didn't you do it!" And telling management is a joke. For instance the other day I had a patient who didn't receive her 11 oclock tray because I had an emergency in another room. With 7 other nurses and four techs and two secretaries not one person took her the food tray! When I asked two hours later why this patient wasn't taken a tray, I was told "she's not our patient!" Financially, I can't quit, I have to work but I hate this..I dread work every time I'm scheduled. Because I know it's going to be hell. Hoping for some insight.

[calivianya, BSN, RN]

Your unit sounds like a nightmare. At the places I have worked, stepdown was 1:3 or 1:4. I have seen stepdown nurses take five in extreme staffing emergencies, but never 6-8. Never. That is very unsafe.

It is very unfortunate that you can't move. I would advise you to change departments ASAP. You'd likely be safer in any department than yours.

[Anna Flaxis, BSN, RN]

I've had a lot of jobs and worked in a lot of crappy facilities - 6-8 patients with that amount of lines and tubes hasn't been acceptable in even the crappiest of them.

Again, you're fortunate. ;-)

[Everline]

Ah, day shift. How I do not miss you. And with that acuity, those patient ratios and no team work? And you're a new grad? Not today, son. Not today or any day.

My advice? Think hard about what your long term goal is and whether enduring this hell is going to help you get there. Then decide how you will proceed accordingly. Plan an exit strategy whether it will be next week or in a year then focus on your goal. I realize you feel you have limited options, but sometimes we can find a solution if we expand our thinking about what we will or will not do. I hope you find an answer.

[Hoosier_RN, MSN]

Your unit sounds like a nightmare. At the places I have worked, stepdown was 1:3 or 1:4. I have seen stepdown nurses take five in extreme staffing emergencies, but never 6-8. Never. That is very unsafe.

It is very unfortunate that you can't move. I would advise you to change departments ASAP. You'd likely be safer in any department than yours.

In rural locations, it's often like this (as others have pointed out). Many other departments may be staffed accordingly as well. The other area hospital may be the same or worse. OP may also have a time commitment before eligibility to transfer in that facility, other may not be hiring, or hiring without more experience. It's why I stay away from the hospitals in my area. They are all Magnet, but have similar practices to this. No thanks...

[icuRNmaggie, BSN, RN]

Flossy it's not you, it's them. I have seen exactly what you have described in community hospitals on the East coast and it is appalling.

The Ortho unit is a clean unit and usually has better staffing and well trained CNAs. Ortho PACU ICU or the 23 hr observation unit or a Chest Pain unit would be my choice if I had no choice but to

work in that facility.

In the meantime, work on building your resume. Take ACLS PALS at this hospital. Do the online NIHSS course.

Try to stay positive. It can be very political. Being liked is more important than being competent in these places.

[w3ndiscott]

I have been a nurse for 6 years and have hated both jobs. I don't hate being a nurse, just the companies I've worked for. They made it impossible to be a nurse with all of their demands that wasted time in my day and took me away from my patients. I started my career as an LVN. In my area the only places that will hire LVN's are nursing homes. I worked with a lot of skilled patients, which means they had something going on. Either sick, just had surgery or wounds. Not just babysitting the elderly. The nurse to patient ratio is ridiculous in nursing homes. I rarely had less than 20 patients and up to 30 at times. It is impossible to give the patients the time they deserve at this ratio. Even if they were not sick. And I worked days so there were 2 meal times that the nurses were expected to oversee. So on top of all the admissions and discharges, dealing with family members, 3 hours out of your day for meal times, trying to please management with their impossible requests, scheduling and arranging transport for follow up appointments, doctors orders, labs, med passes, trying to manage staff, answering call lights and so on and so on, oh and charting! Everything you do is expected to be charted on. That is lots and lots of charting. Plus medicare/skilled patients all have to be charted on every shift, every day. God forbid there be an emergency and you have to send someone out or spend a lot of time with them because you are worried you might have to. Management never takes anything like that into consideration. There is no one to help. I had to get all of my own vitals, do all of my own treatments, check all my own blood sugars, do all of my own breathing treatments all while management is breathing down my neck telling me everything they still want me to do that they think should be the nurses responsibility. I've even been blamed for meal times running late. That left very little time to be an actual nurse. Through all of this I bridged and got my RN, I tried to stay because I loved my patients. But it was killing me. It was affecting me physically, mentally and emotionally. I never got a break, I would go all day without eating anything. They allowed no overtime yet you would get called into the office and chewed out if you didn't finish something. All of this is to say that it could be worse. My advice to you is to stick it out until you have enough experience to go elsewhere. You also might consider specializing in a certain field. Floor nurses are expected to know everything about everything and everyone. That in and of itself is very stressful.

[icuRNmaggie, BSN, RN]

If you do opt to do per diem at the other hospital in your area do not do Med Surg.

Ortho or another specialty area would likely have better management and staffing.

[LadyFree28, BSN, LPN, RN]

I have been a nurse for 6 years and have hated both jobs. I don't hate being a nurse, just the companies I've worked for. They made it impossible to be a nurse with all of their demands that wasted time in my day and took me away from my patients. I started my career as an LVN. In my area the only places that will hire LVN's are nursing homes. I worked with a lot of skilled patients, which means they had something going on. Either sick, just had surgery or wounds. Not just babysitting the elderly. The nurse to patient ratio is ridiculous in nursing homes. I rarely had less than 20 patients and up to 30 at times. It is impossible to give the patients the time they deserve at this ratio. Even if they were not sick. And I worked days so there were 2 meal times that the nurses were expected to oversee. So on top of all the admissions and discharges, dealing with family members, 3 hours out of your day for meal times, trying to please management with their impossible requests, scheduling and arranging transport for follow up appointments, doctors orders, labs, med passes, trying to manage staff, answering call lights and so on and so on, oh and charting! Everything you do is expected to be charted on. That is lots and lots of charting. Plus medicare/skilled patients all have to be charted on every shift, every day. God forbid there be an emergency and you have to send someone out or spend a lot of time with them because you are worried you might have to. Management never takes anything like that into consideration. There is no one to help. I had to get all of my own vitals, do all of my own treatments, check all my own blood sugars, do all of my own breathing treatments all while management is breathing down my neck telling me everything they still want me to do that they think should be the nurses responsibility. I've even been blamed for meal times running late. That left very little time to be an actual nurse. Through all of this I bridged and got my RN, I tried to stay because I loved my patients. But it was killing me. It was affecting me physically, mentally and emotionally. I never got a break, I would go all day without eating anything. They allowed no overtime yet you would get called into the office and chewed out if you didn't finish something. All of this is to say that it could be worse. My advice to you is to stick it out until you have enough experience to go elsewhere. You also might consider specializing in a certain field. Floor nurses are expected to know everything about everything and everyone. That in and of itself is very stressful.

Well said...to add throw in Hospice, Dialysis pts and if you are the supervisor of the floor, or it no supervisor for the floor, making assignments on top of all that.

Lasted at that job about seven months, went on to a more acute facility where one night I precepted and had to run the respiratory cart and my own cart due to short staffing-I started planning to work away from this facility after that incident and one incident with me being the only nurse in the building-still something I'm never comfortable doing; and I have been in that position a few times-I can still count it on one hand thank goodness, not right but that is the reality of the healthcare business of today. I navigated that minefield strangely enough; some days I wonder how I made it through-it sounds cliché, but I learned through those days of 30 pts or most times 60 pts (being a supervisor with an inept manager that made me do everything) and make things happen timely.

I work in a ED-there is unstable sick kids and unexpected sick kids and traumas that can roll in back to back and I mange to document and provide error free good care and get to do hand holding, teaching and using resources in the most complex of situations. The best thing amongst the chaos is my ratio is at the most 4 pts in general ER, 2-3 in the trauma bay and urgent care 7; and I do a LOT of advocating if that pt needs to be triaged higher or their acuity changes.

I say this as to infer that a lot of us have our own stories of being in positions where the acuity doesn't match up with the ratios; and while it's real, one has to be their biggest advocates in deciding how they want to practice if and when those settings do not mesh with how we want to practice; most make the choice to vote with their feet and thrive elsewhere; others make the most of it and survive, even thrive; I haven't worked in a community hospital as a nurse; and what you describe is a situation that certainly needs an action plan. I have worked inside and outside the hospital setting,having two different specialties to keep myself from burnout-I did private duty home health and worked at an acute rehabilitation hospital; both out of hospital but provided the freedom for me to establish what type of nurse I wanted to be.

I agree for the OP once they are established enough-perhaps a year?-to be able to have a perdiem position if possible in another specialty and to test out another organization that may be manageable (fingers crossed and hugs to you) and provide a much better experience

[Beatlefan, BSN]

Had to check to see if you work with me! If you solve the attitude/teamwork problem, please let the rest of us know how you did it.

Taking all this high-acuity, high-stress and working independently negativity and turning into a positive by applying somewhere else and pointing out that you are capable of performing under these conditions may be a way of taking something bad and making it better.

I'm over ten years in health care, and will always be perplexed at the fact that management hesitates to allocate more money into more staff which equals safer, better care for the customer/patients. But adding more staff without team mentalities will only get you more of the same. Looking forward to other nurses' responses here!

[hppygr8ful, ASN, RN, EMT-I]

I wish..it was an amazing facility..however, it is five hours away. We moved to be closer to my husband's family which also happens to be a town over from Hillbilly Hell and Good Ol' Boy junction it appears.

While I agree your current situation sounds awful I am still not sure if it's really as bad as you say or if it is more of a perception issue. It's clear you came from a metropolitan area and don't like the fact that you had to move. It's one thing to know you rights and make that known but it's another thing to be obnoxious about it. I sure hope you are not making comments like the one above to your co-workers. I come from a small rural town and as a rule we are very protective of our way of life. Also in smaller rural hospitals it's not uncommon to combine units. I would try to tone down your aggravation. One thing you said that I caught on to was that you were expected to take your own blood sugars and vitals. I personally would not want someone to do this for me if the results were meant to guide my care......ie insulin dose, HTN meds etc..... I work in a very busy LTC and care for and pass meds for up to 20 patients at a time. While I know comparing LTC to acute care is like apples and oranges as a new grad you are quite frankly lucky to have a job. PS nobody likes a complainer - it brings down morale. My advice is to "pull up your big girl panties, roll up your sleeves, dig in and instead of focusing on all that's wrong with the job, just focus on doing the job.

Hppy

[FlossyRN]

I appreciate all the responses. This situation I have found myself in has me regretting going to school to be a nurse. Let me say, I am not a fresh faced 20 year old (no, I'm not old as dirt either) I am a 33 year old working wife and mother who was given an opportunity to go back to school and find a career so my family could stop traveling for work. I have put a lot on the line for the last four years to get this degree. Not only have I, but so has my husband who supported our family those four years while I completed this goal. I am also currently pursuing my BSN to continue to further my education. So, I'm not just going to throw in the towel but this is NOT what I expected. Frankly, my nursing school did a great job at preparing us and I have had some medical experience before so I wasn't completely new to health care but have never felt this overwhelmed. I know there are good and bad facilities. I also know that numerous of you have had a crappy experience like me and I am sorry but I'm not sure I can handle the stress and pressure or do I feel that I should just accept it as normal.

Our floor handles vascular cardiac issues..such as CABG, AVR's, as well as AAA's, TTE's, DKA, and simply patient's who request our floor. It is nothing for me to have two or three fresh CABG patient's with chest tubes, wires in place, electronic pacers, with a Cardizem drip. Along with 4 or 5 others with numerous problems. Anyone just brought to our floor has frequent vitals and assessments q15 x4, q30x 2 and q1 x 4 that the RN must complete. As I mentioned in my original post we are also responsible for our own CBG's and tray passing!! (This is lunacy to me!) A few of our tech's are good. But unfortunately you never know when you're going to have that tech. But even then all they do is bath the patient's, change linens, and help with potty issues. This is am AMAZING luxury..don't get me wrong when I say "that's all they do". However, even then most of this isn't done the whole "delegation" really doesn't work well when you say "Hey, (insert CNA name here), do you mind doing etc for me?" And that flat out say No, I don't have time or why can't you do it. I spoke to my preceptor about this and was told "Yeah, that's just how she is!"...So, yeah, I feel like I can't win for loosing. And I definitely agree with the statement made about other nurses being treated the same way (sometimes)...yes, we are all in the same boat a majority of the time however, they are experienced and I am not. That is dangerous. For example last week, I had four discharges and three admits back to back giving me "the new nurse" 7 patient's and all of the experienced nurses had 5 and an empty room...yet they chose to give me all the admits!! This is unfair. So, yes, I will stay because I am a team player, and because I do have a family to support, but you bet your behind I am looking for something else. It shocks me to think so many of you think this is normal and treating people poorly is a common standard. I have morals and will not treat someone this way and will not allow myself to be treated that way. Thank you to all of you who sent kind words and encouragement.

[RNsRWe, ASN, RN]

Well, I was hoping by saying that I graduated with honors and did well at clinicals showed that I was a team player and worked hard toward my goals. I understand you are stating how you see it and only hearing my side. However, I would also like to state that my preceptor suggested I demand my 12 weeks of training and, frankly, I do not regret it or the fact that I demanded to have some consistency to my training. I am caring for peoples lives as well as putting my license on the lines! To be adequately trained should be a requirement not a request! And, Yes, I am blunt, I am straight to the point and I am forward! However, I am a team player, I am friendly, I love to chat and laugh, I pitch in when I can, I ask for learning opportunities, I ask why, I pull my weight! So, yeah, maybe they don't like that I complain that it appears I am being treated unfairly...tough. I mean, I would hope they would want to foster me and help make me great not shut me down. Even, if they are not the training type or standoffish that doesn't excuse not feeding a patient because it wasn't there's to handle. Sorry, if it seems I am defending myself harshly...I am not trying to do such. However, I was always taught to speak up, ask questions, and demand fair treatment.

okaaaay......well. Thing is, graduating with honors and doing well in clinicals does not equate with being a team player, or a valuable employee. They may very well go together, but...sometimes not. You believe you are a team player, and maybe you ARE! But....perception is the greater part of reality, and you might well be perceived to be NOT a team player.

As I said before, while we are only getting one side of this, the side you are showing indicates an unhappy workplace but does NOT prove that it's Hell Hospital. Or that your colleagues are horrible....maybe they are? But maybe...it's you.

I understand you disagree, for all the reasons you stated, but I wonder if you'd be shocked to find out that you're not experiencing a welcoming atmosphere in part due to the impression you are making.

You SHOULD stand up for yourself. But HOW you do it might well impact how you are perceived, received. Sure, you have a 'right' to 'demand' a single preceptor for the entire 12 weeks. But it might not endear you to those who are put out by this demand. You are not assigned patients in a vacuum, others are likely having their world rearranged to accommodate yours.

Look, I'm only offering some possible explanations for what you're experiencing (along with others who have essentially said the same thing). You can insist that there is absolutely no merit to them, and feel very secure that YOU are alone in being correct and everyone else is miserable. You may be right. But, as I said before, MOST of the time when this happens to a new grad/new nurse it's brought on by themselves.

I hope I'm wrong, and that once you leave (you will, eventually, leave) you don't have a repeat of the same situation. If you DO....you will then know it was you. If it's better elsewhere....it was them :)

Good luck!