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.
My point is that it's not that I am fortunate, more that you are very unfortunate - because that is not normal, even in arguably bad facilities. Your characterization that this type of staffing/acuity mix is normal is off base, IMO.
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.
(1) What you're describing isn't normal.
(2) Nursing sucks. It is not a good career if you're expecting to be consistently treated as a respected professional. I focus on the good aspects - good income for relatively little education, lots of off-time, etc.
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.
Don't interpret my stating that this is not abnormal or uncommon as synonymous with it being okay or acceptable. I'm simply attempting to convey that right or wrong, this is the reality for many, many nurses - and that you are simply seeing the writing on the wall.
Whether you decide to accept the situation as it is and make the best of it and take what good you can from the experience, or be indignant about how wrong it is and dig in your heels and demand to be treated differently (and see how far that gets you) is completely up to you.
Alternatively, many hospitals have practice counsels and staffing committees. It can be a real eye opener to participate in these types of committees. Sometimes you can effect some change for the better, and sometimes you're just spinning your wheels, but it could be worth investigating.
But seriously, I don't doubt what you say your experience is, but that doesn't change that for many other nurses, this type of scenario is real. Just because you personally haven't encountered such a working environment in all of your many rodeos doesn't mean it doesn't exist.
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.
The acuity, ratios, ridiculous workload, unfair assignments, and uncooperative disrespectful CNAs make this a recipe for disaster.Your instincts are correct. You are being abused.
Find another position. Based on what you have described, I would not bother giving two weeks notice.
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.
Earlier it sounded like your matrix was to take up to an 8 patient load, do you actually have 8 patients at once or are you counting the total number of patient you might have had during a shift counting all discharges and admits? What's the typical number of patients you might have at once? Does your floor take CP rule outs or pre/post cath patients?
I simply cannot imagine a world in which one nurse taking care of 6-8 stepdown-level patients (and honestly it sounds like some of your "stepdown" patients would really be in ICU in some other facilities) is something that is tolerated. There are really that many of you guys that have seen/worked in these conditions and lived to tell about it? That just seems insane to me.
I used to work on a vascular surgical floor with an attached stepdown unit, and as a new nurse I was kept hopping with 3-4 patients. And that's with an amazing group of coworkers who really rocked their teamwork. That is the worst nurse/patient ratio I've ever heard of and I would be calling the news, my state nursing organization, my Congressman/woman, and anyone else who would listen about the piss poor working conditions you're describing to try to cast light on the issue and change it somehow. Otherwise I would just run.
For the record I would like to state. I am kind, courteous, and generally well mannered. I have only mentioned my previous hospital experience to anyone that has asked (honestly, I think three people)...it was not volunteered. When it comes to small chat or walking to the car everyone is nice to me. I am not hated because of my attitude or being some fancy city slicker who only talks about where she used to work. I grew up in "hillbilly hell" as I chose to call it...just a different one, so I know about hometown pride etc...Never once have I compared a nurse's competency to someone else's abilities. I am just shocked at the difference in facilities...and even said this may be part of my hesitation with my current facility. And as far as "demanding" one certain preceptor and training...I only did so because I was TOLD so. I mean, if you tell someone something then you follow through with your word. Having different preceptors I was getting conflicting information as to how things were done. When I asked my charge nurse the correct way she tried to turn in into a whole who did this or who did it that way moment, which I quickly averted to avoid drama. Therefore, I went to my director and requested my original preceptor. And FYI, she apologized for this not being done originally and had no problem arranging it. She stated that there was a miscommunication and that was all that it took to straighten it out. For the most part I have no problem with the people so much as I do with their inability to help me or lack of concern for patient safety and my safety. I am certain much of this is due to their demanding schedule as well. Now, I have been there since July and have already pegged a few that could have one patient, who is waiting on discharge and still refuse to help you. I chose not to be that person, nor do I chose to be ugly, lofty, or frankly rude as many of you have assumed I am. I am hard working, I want to do right and frankly I hate failure...so this is why this is such a huge issue to me. I hate to be behind, I hate to struggle to keep up..I want to get it. I feel that taring someone down is childish and, frankly, a lack of professionalism. I honestly think this place is full of over worked run-down nurses who are all being taken advantage of and their attitudes are put up with because management looks the other way because they are unwilling to hire the appropriate amount of staff or reduce the nurse to patient ratio. So there this complete huge vicious cycle. This is what I see but as a new nurse I wanted to be sure this is what I am seeing and not just being unrealistic. I feel that many of you are in this same type of situation and have chosen to tolerated it so this feasible for you. Not wanting to sound crass or childish....I simply will not turn out to be some hateful soul, half-assing health care in order to have a job (and I am not insinuating anyone who has posted does this or is this). I became a nurse to better peoples lives and mine...Sorry, if this is hard for some of you to understand.
We can have up to 8..I have never seen anyone have more than that. I have never had less than 6 meaning at one time...not I have three and discharge 3. Usually, if I have six I have two empty rooms who usually get filled giving me 8 or if I am able to keep 6 it is because we were graciously given a float nurse. We do take CP rule outs and pre/post cath patients as well.
VANurse2010
1,526 Posts
My point is that it's not that I am fortunate, more that you are very unfortunate - because that is not normal, even in arguably bad facilities. Your characterization that this type of staffing/acuity mix is normal is off base, IMO.