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.
I guess it just depends. I have had CP patients that were on nitro drips with constant titration, post cath lab patients with femoral sheaths and coming off doses of reopro that had q 15 groin checks and ultimately pulling the femoral sheaths and applying the femstops, all labor and monitoring interval intensive. And a "fresh CABG," obviously not straight from the OR could still be really hairy, especially if you had 3 of them!
I wouldn't do it. But I live in a major metropolitan area with a lot more options than the OP.
Every once in a while a CP rule out might require a NTG gtt, but it's certainly not the majority of them, and I don't find them all that time consuming when they do.
I'd hazard a guess the OP isn't pulling sheaths on post-cath patients.
OP- I think you have gotten the gist of things. Your job sucks. Your company could give a rats azz about you, and probably " promised " you things just to get you in the door. The people you work with sound a lot like some of mine, and your situation is rather similar. My ratios arent as bad as yours but they are still 1:6 for "stepdown" We used to be 1:4. Until the suits said sorry, no more. and added 2 more patients to the floor census.
I'm sorry all your hardwork had to culminate to this. I hope someday you find something better. We're having a "mass exodus" of experienced nurses as they won't put up with that BS.Many of those nurses have been lucky to find better work.. I hope to go someday too.
Good luck to you if you have to stick it out for a period of time.
One forgets sometimes when things suck like this , that this is not "who we are" . You are a hard worker, or an honest person, or had high honors. When the job wears on you lie this , you forget these things.
Unfortunately it is real. What you describe, however, is about as bad as I've seen.
I've witnessed new nurses get dumped on time and time again. It mostly has been very conscientious, perfectionistic types who have a tendency to verbalize their stress (mostly in the form of "venting" when they are in a shared work area like the med room). Management and co-workers don't appreciate them verbalizing their discontent and tend to dump on them more. I don't know if the dumping is a means of punishment or just a way to push them to their breaking point so that they will quit and things will remain status quo.
New grad nurses aren't given help and are given some of the toughest assignments so that they can "learn time management". I am all for learning time management but there is a tipping point when the amount of work is no longer conducive to managing in any kind of timely manner by one mere mortal. This is when a new nurse needs his/her co-workers to step in and help out without it being held against him/her. But this does not happen. Then they either quit b/c they feel something is wrong with them or they are let go for "not being a good fit".
I remember once offering to help a very good new grad w/ an admission b/c I was caught up and sitting there twiddling my thumbs. I was pulled aside by the charge nurse and told not to help b/c "he's having trouble w/ time management and needs to do it by himself". That's all well and good and I guess there could be some merit to that. However, people don't learn in a bubble. I could have used some of my free time to watch him do the admission and give him pointers on where he could save time. By himself, trying to learn those time savers could take months. A few weeks later I noticed he was gone.
Another newby lost to "poor fit" issues. He was a very good nurse
Every once in a while a CP rule out might require a NTG gtt, but it's certainly not the majority of them, and I don't find them all that time consuming when they do.
I'd hazard a guess the OP isn't pulling sheaths on post-cath patients.
Obviously I'm seeing this from my own lens from back in the day when I worked critical care (I floated between units). In stepdown, we had a lot of titrated drips. Maybe not a huge hassle for one patient, but if I had drips and 5-7 other patients of step down acuity, absolutely NOT SAFE. In fact, at our hospital, anyone on a titrated drip had to be in one of the critical care units, never on the floor. And our stepdown always had patients with arterial sheaths from the cath lab, which was a very busy unit. They either went to stepdown or CCU. The OP's stepdown may certainly not be like the stepdown at my facility, but it still sounds as though their nurse to patient ratio is nevertheless ridiculously unsafe. Especially given the fact that she is a new nurse getting piled on. I found the 1:3 ratio in our unit to be very challenging. I just cannot imagine working in the OP's unit in those conditions.
Obviously I'm seeing this from my own lens from back in the day when I worked critical care (I floated between units). In stepdown, we had a lot of titrated drips. Maybe not a huge hassle for one patient, but if I had drips and 5-7 other patients of step down acuity, absolutely NOT SAFE. In fact, at our hospital, anyone on a titrated drip had to be in one of the critical care units, never on the floor. And our stepdown always had patients with arterial sheaths from the cath lab, which was a very busy unit. They either went to stepdown or CCU. The OP's stepdown may certainly not be like the stepdown at my facility, but it still sounds as though their nurse to patient ratio is nevertheless ridiculously unsafe. Especially given the fact that she is a new nurse getting piled on. I found the 1:3 ratio in our unit to be very challenging. I just cannot imagine working in the OP's unit in those conditions.
For true stepdown patients I sometimes find 3 patients to be too much, and often I'd rather have 3 ICU patients than 3 stepdown patients. What the OP is describing is not stepdown, at least in the way you and I are used to seeing it used. Uncomplicated CP rule out and pre/post cath are definitely not stepdown acuity. Having those patients mixed into some heavier patients like non-fresh open hearts (extubated, art line out, etc) isn't all that horrible. It's not nearly as cushy as when I worked in a major urban teaching hospital, but it's doable at 6:1, I would agree 8:1 if that actually is the case is excessive, although even then it varies widely depending on how much support you get (CNA/Techs, PT/OT, etc).
For true stepdown patients I sometimes find 3 patients to be too much, and often I'd rather have 3 ICU patients than 3 stepdown patients. What the OP is describing is not stepdown, at least in the way you and I are used to seeing it used. Uncomplicated CP rule out and pre/post cath are definitely not stepdown acuity. Having those patients mixed into some heavier patients like non-fresh open hearts (extubated, art line out, etc) isn't all that horrible. It's not nearly as cushy as when I worked in a major urban teaching hospital, but it's doable at 6:1, I would agree 8:1 if that actually is the case is excessive, although even then it varies widely depending on how much support you get (CNA/Techs, PT/OT, etc).
1:6 is doable but at the patients expense. I work a step down unit, day shift is 1:4 max and night shift 1:5. We are also a stroke certified unit, however we do not do TPA. Our census consists of post op CABG, some are still on a pulse generator, valve repairs, strokes (both ischemic and hemorrhagic), DKA/HHS on insulin gtts, we take cardiac gtts but do not do titration, cath patients that require pulling lines, CP, CHF, ESRD, fem-pops, COPD, etc.
Not all of our patients are critical, but they require much attention. We have also had a huge turnover of staff and the newer nurses are struggling. Unfortunately there are only a handful of experienced nurses on my unit.
The problem is Leadership, more so than management. It's all about thar bottom dollar. What they don't seem to understand is that happier nurses=better patient experience and thus higher patient satisfaction scores.
Well...im on a Cardiac step-down in a large urban hospital and its quite frequent for staffing to be 6:1....our ideal is 4:1...but due to extreme short staffing we frequently are stuck 6:1. Our unit doesnt tend to get any random patient though...unless literally every other floor in the entire hospital is full then we may get an odd trauma or neuro pt but they are moved asap...a 6:1 ratio leaves much to be desired and some weeks our acuity is very very high, other weeks its not...like you may have a few post cath/ablation/starting tikosyn/prep for OHS or hanging out indefinetly for a heart tx...so we dont get post surgical or pt with a whole ton of lines...we do get a lot of Cardiac drips which require a great deal of monitoring and labs (heparin gtt anyone?!?) and those darn post caths can be incredibly time consuming... esp if you have a pt with a cough or who insists on getting up every 5 minutes...
Personally I prefer to do day shift as there is more support...which leads me too...whats most worrisome about what the OP writes is lack of suport...TEAM WORK is absolutely essential in the hospital. Everyones patient is everyones patient. If im charting at the front desk and hear a red alarm behind me and see a co-workers PT tele showing VT I will immediately run in and chekc on them and if need me get care started....WE ALL MUST TAKE CARE OF EACH OTHER AND OUR PATIENTS....
I did work previously as an APCT on a diff floor and dont wonder if your experiencing a bit of hazing...the floor I worked on first as an APCT while in school for Nursing was VERY cliquish and anyone new was basically hazed...mentally, verbally, physically...from being treated rudely to be gossiped about to even being undermined...once you passed this apparently "trial by fire" you were "IN" with evveryone and suddently there was team work and help. It was an aweful environment though which is why I didnt want to work there as an RN. The floor im on now...there is a LOT more teamwork and less of the "hazing/new person" mentality...and our unit director makes a point of not allowing it.
id say keep the job but START APPLYING EVERY PLACE YOU CAN!
I don't agree with what some posters mentioned about your attitude...As if they expect you to kiss those nurses' asses....I believe they are like those nurse you work with...What Im trying to say you should demand their cooperation and help...Well lm like this....Remember always always hold your head up...Maintain you compoture even if when you are behind your assignment...And be rspectful....One more thing never get close with you coworker...
Specializes in critical care, PCU, PACU, LTC, HHC, AFC.
You had a lot of points I wanted to address but I wanted to respond to a few.
I think you have a right to how you feel and even though this is the 'norm at some facilities' not all but majority operate at this ratio.
Your doing the best you can and it sounds like you stand up for what's right. Patients need a good advocate.
With that being said I know your frustrated with your co-workers chances are they are in the same boat.
You could try and reach out to them and offer them turns, see if they need help with anything when you ask for help. I utilize this tool a lot when I work at multiple facility's. If I ask someone for help, turn, etc and when they are done helping me I ask in return if they need anything. I know its busy! But most of the time even if they don't need anything people appreciate knowing you would help.
Communicate with your CNAs. Say something like when you go into so and so's room again grab me and can you help me with etc and etc.
Do you have a charge nurse? a supervisor? Let them know how your doing? If you can't go to lunch at 11am go another time you feel would work for you.
Six to eight patients is a big team, but you are the leader of your team. Treat this as a learning experience.
MunoRN, RN
8,058 Posts
Every once in a while a CP rule out might require a NTG gtt, but it's certainly not the majority of them, and I don't find them all that time consuming when they do.
I'd hazard a guess the OP isn't pulling sheaths on post-cath patients.