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 think 6-8 on a step down unit is simply unsafe and unreasonable, but what do you plan to do about it? I would be looking for another job, otherwise I don't see how things will get better. Rural hospitals are under pressure financially and some of them have been closing. That is the reality, but still the ratio's should be 3-5 max! Without a union or a national or state staffing ratio law the hospital can staff anyway they like!
As for being a team member a couple of your comments don't make sense. Your honors degree has nothing to do with being a team player and if I went around telling my coworkers that or I was on the dean's list it wouldn't improve my popularity, probably the opposite. Your honors degree is good for your self esteem and perhaps for getting hired, that is all. I wouldn't even mention it at work!
As for the judgmental comment that you won't work half assed or whatever you said due to the high ratio's, my question to you is what are you going to do about it? Are you going to quit or how are you going to be the self righteous perfect nurse with these high ratios while disdaining your coworkers for not having your perfection attitude? Many nurses start out with high ideals and perfectionist attitudes but the reality of nursing in many places doesn't allow for such a lofty goal. Not to mention those high standards will burn you out in the real world! The important thing is keeping your patients safe as you can while doing no harm. Personally I would look for another job because the ratios are simply too much and unsafe!
I'm sure it's been said before, but I'll risk saying it again. Nursing school is over. I got out of nursing school with all kinds of idealism, too, about how I was going to be the world's greatest nurse and only give 100% every single time. I lost that notion fast. It's not always a matter of compromising quality--it's frequently a matter of prioritization and experience in time-saving measures. I mean, I wanted to be Supernurse, too, but you eventually learn that sometimes you just have to save the cape for special occasions.
I'm happy that your student nurse experience was so positive. However, please keep in mind that your perceptions of nursing at your university's teaching hospital were based on your experience as a student; life as a staff nurse may have involved all kinds of headaches you knew nothing about.
Finally, at the risk of sounding like a bit of a *****, you frequently come across in your posts as quite defensive, even a tad self-righteous. Sometimes, the wrong attitude makes a bad situation worse. I agree that it sounds like you are being stretched too thin. However, you're not getting the sympathy I think you expected--from anywhere--because the nurses you work with are actually being honest: this is just how it is. I honestly don't know any nurses in acute care settings who ever feel they have too little to do--any day when you aren't running, or at least speed-walking, to get all your work done is a freak occurrence to be savored but never expected. If you can't handle the acute care pace, you'll have to go elsewhere; however, from doctors' offices to nursing homes, home health to day surgery, nurses are valuable but expensive assets who must be utilized at close-to-maximum capacity in order to maintain the bottom line. The only place I've worked where I didn't ever feel overstretched (and, over a 25-year career that included peds, PICU, pedi- and adult sub-acute, nursing homes, in-patient psych, prison, and agency work in multiple settings) was in inpatient hospice. The only place.
This is the most moronic, anti nurse comment that I have read on this site. How dare you
suggest that nurses should martyr themselves and compromise patient care to protect the profit margin.
It angers me that this new nurse has been characterized as self righteous and defensive by persons who have not worked in years and couldnt hack it if they did.
Anyone who claims that nurses should be running or speed
walking at all times is not a nurse. IF you ever really were a bedside
nurse, just because you
are used to being abused doesnt make it the norm everywhere and does not make it right.
Anyone who advocates stretching nurses to the limit to maintain the bottom line deserves to be a patient in the cardiac stepdown in these ridiculous conditions. This is why the physicians and management officials refuse to go anywhere but an ICU. They know that the staff elswhere are
You know, while on the subject of team work, I notice part of our problem is that those who get everything done and are sitting around, while others are running their behinds off and not even getting a break. Usually due to ACUITY. or ridiculously needy patients that you seriously spend most of the shift with ( high falls, not unstable enough for icu, but time consuming, etc. ) And you know what they say to their buddies? " I'm not going to do my job AND YOURS. So they don't help. Not even answering bed alarms etc.
I don't know about the being picked on part as true or not. I had a charge nurse (telemetry unit) about 20 years ago who gave me 14 patients! I was one year out of school but only 3 days off my 1 WEEK of orientation there. I had been FLOATED to her floor.
Her reasoning? You have to learn some time! Oh, and 8 are going home today. I had 8 of the 10 diabetics. We had 2 glucose machines. Both with the other nurses...who refused to share "until mine are done." They both had 11 patients each & a nurse orienting with them both; those nurses had worked there before AND were in their 3rd week orientation (well seasoned too).
Charge did their discharges but not mine. They never got their beds filled again, but all 8 of mine were before housekeeping was done cleaning!
I called management & it took 3 nurses to do my assignment! One did my admits and another helped me do discharges, meds, assessments. We were busy until 3 am & were supposed to leave at 11 pm.
Lesson? Check ALL assignments before you accept yours. My charge SHOULD'VE helped me & not left my patients at risk. Someone talked to her. She never did it again while I worked there
This is all about corporate America - people who sit at desks from 9 to 5 and take hour long lunch breaks, and earn 3-4-5 times what any nurse earns and make decisions about staffing based on their "numbers". They do not care about the human toll or the care and they certainly do not care about nurses. They go home at 5 o'clock on Friday to enjoy their "much deserved" weekend.
First of all, after reading the entire thread, I can say with some confidence that you are being hazed. From what I understand this is relatively common in nursing (it is where the nurses eat their young stereotype comes from) and it is unacceptable. It happened to me as a new grad on a tele floor (six patients max, usually five, until mandatory ratios kicked in), it happened to me when I was new on a stepdown unit (three patients max) and it happened to me when I was new in ICU (two patients max). I mention the ratios so you understand that you are not only dealing with being hazed as a new nurse, but an untenable workload exists for all the nurses on your unit. This is part of the reason they are bullying you. It is called oppressed group syndrome.
Having said that, I wanted to address something nobody else has brought up:
No, I didn't sign a contract however due to child care and my husband's job I am not able to work night shift.
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.
You state that your husband's job precludes a night shift position. Why? Are you being expected to care for your children while he is at work? And he cannot care for them while you work because of his work? Why is your job and career on the back burner here?
Secondly, why did you move to be closer to your husband's family? What about your family? What about your career? If they are so close why can they not chip in and take care of the kids while you are working or sleeping? If they are not going to help you why do you need to be close to them? Move to where the good work is. Five hours is not that long of a commute for holidays and the occasional family gathering.
Basically I feel there is more to this story that is causing you undue stress as you embark on a new career. You stated that your husband supported you through nursing school. Well, good for him. You don't owe him anything for that. Now he can support you in your career. That support should not disappear because you graduated. Nursing school is a significant investment and so is nursing. Unless he is making $100K/year at his job he needs to support you 110% and rearrange his schedule as necessary. He should also be willing to move to where the good nursing jobs are. You previously said you moved a lot for his job, well, now it's his turn to move for your career.
I am not mentioning this kind of dedication on your husband's part is necessary out of feminist indignation (although there is that too) but because if you are going to make a career out of this you will have to go back to school. Over and over again. You will be at conferences, in other states, lasting from anywhere from a few days to a week. You will be changing jobs. The initial time and money investment that you both took on when you started nursing school does not evaporate. It is a continual process. Your career needs to come first. Period. That is how you make manager, director, CNO, etc. Your perfectionism means that this is where you are going. Anything less would leave you unsatisfied.
You need to come first. You cannot do your job unless you are the priority.
First of all, after reading the entire thread, I can say with some confidence that you are being hazed. From what I understand this is relatively common in nursing (it is where the nurses eat their young stereotype comes from) and it is unacceptable. It happened to me as a new grad on a tele floor (six patients max, usually five, until mandatory ratios kicked in), it happened to me when I was new on a stepdown unit (three patients max) and it happened to me when I was new in ICU (two patients max). I mention the ratios so you understand that you are not only dealing with being hazed as a new nurse, but an untenable workload exists for all the nurses on your unit. This is part of the reason they are bullying you. It is called oppressed group syndrome.
Having said that, I wanted to address something nobody else has brought up:
You state that your husband's job precludes a night shift position. Why? Are you being expected to care for your children while he is at work? And he cannot care for them while you work because of his work? Why is your job and career on the back burner here?
Secondly, why did you move to be closer to your husband's family? What about your family? What about your career? If they are so close why can they not chip in and take care of the kids while you are working or sleeping? If they are not going to help you why do you need to be close to them? Move to where the good work is. Five hours is not that long of a commute for holidays and the occasional family gathering.
Basically I feel there is more to this story that is causing you undue stress as you embark on a new career. You stated that your husband supported you through nursing school. Well, good for him. You don't owe him anything for that. Now he can support you in your career. That support should not disappear because you graduated. Nursing school is a significant investment and so is nursing. Unless he is making $100K/year at his job he needs to support you 110% and rearrange his schedule as necessary. He should also be willing to move to where the good nursing jobs are. You previously said you moved a lot for his job, well, now it's his turn to move for your career.
I am not mentioning this kind of dedication on your husband's part is necessary out of feminist indignation (although there is that too) but because if you are going to make a career out of this you will have to go back to school. Over and over again. You will be at conferences, in other states, lasting from anywhere from a few days to a week. You will be changing jobs. The initial time and money investment that you both took on when you started nursing school does not evaporate. It is a continual process. Your career needs to come first. Period. That is how you make manager, director, CNO, etc. Your perfectionism means that this is where you are going. Anything less would leave you unsatisfied.
You need to come first. You cannot do your job unless you are the priority.
Your entire post reeks of judgment from someone who hasn't lived the life that the person you are responding to has. Let me describe it for you.
While I was in school, with two preschoolers, my husband had to find a schedule that worked entirely around mine. This meant working around my school hours, because God knows we couldn't afford a sitter. For the last 5 years (four of which, I was in school), he has worked second shift, meaning he doesn't see me or the kids for up to 20 days of every month. He hates it. It has been a huge strain on our family.
I functioned in the primary stay at home parent role when I could, but often times he found himself feeling like the kids and I became a second full time job for him. He dealt with my mandatory class schedules, my emotional outbursts when I crumpled under the pressure, and really crappy food when there wasn't time to eat better for weeks on end. He picked up all the to do lists when I couldn't get through them. This meant that even though he didn't see us, he did so much for us.
Now I'm working. He tried for first shift last year but didn't get it. This year, he tried again and he did get it. He'll be able to see us again. We've functioned in this structure of handing off the kids and to do lists for so long, I have absolutely no idea how to have normal daily family time. I have no idea what it's like to have dinner together every day. My kids have no idea what it's like to have both parents at home every night at bedtime. Literally they haven't had that since they were babies.
Now that he is changing to daylight, we may be losing our sitter. I could take a tone of indignation like you have in your post and say, "what about ME? What about MY schedule? What about what *I* want?!" Frankly, the last 5 years have been almost entirely about what I want, and where I want to be and what I want to do. I made major life decisions, and he supported them without question. No, I think it's my turn to not question what he wants, and what he will do. My babies want their daddy, and I want to see what real family life and time are like.
So, it may be that I move on from where I am now to get something more suited for our upcoming new schedule. We're negotiating with my sitter to make a last ditch effort with her to see if I can keep doing what I've been doing. I love my job more than words can describe. But, if we still can't keep her, well, I won't expect or ask him to make any changes. It's his turn now.
Your right...you got me...there is so much more to this story. But I'll start with saying my husband is my biggest fan and has never put me or any of my endeavors on the backburner. I didn't work for 4 years while he was our soul income to achieve this goal. As far as night shift not being an option. ..he makes twice my salary..so yeah, that trumps night shift! Second, my mother and father have passed away. I am not close to other to my other random family members. So five hours for my child to know his grand parents and aunts and uncles and be a part of their lives is a goal of mine...not a settlement. Thanks for trying to make this more than I woek at a crap facility.
brandy1017, ASN, RN
2,910 Posts
I think 6-8 on a step down unit is simply unsafe and unreasonable, but what do you plan to do about it? I would be looking for another job, otherwise I don't see how things will get better. Rural hospitals are under pressure financially and some of them have been closing. That is the reality, but still the ratio's should be 3-5 max! Without a union or a national or state staffing ratio law the hospital can staff anyway they like!
As for being a team member a couple of your comments don't make sense. Your honors degree has nothing to do with being a team player and if I went around telling my coworkers that or I was on the dean's list it wouldn't improve my popularity, probably the opposite. Your honors degree is good for your self esteem and perhaps for getting hired, that is all. I wouldn't even mention it at work!
As for the judgmental comment that you won't work half assed or whatever you said due to the high ratio's, my question to you is what are you going to do about it? Are you going to quit or how are you going to be the self righteous perfect nurse with these high ratios while disdaining your coworkers for not having your perfection attitude? Many nurses start out with high ideals and perfectionist attitudes but the reality of nursing in many places doesn't allow for such a lofty goal. Not to mention those high standards will burn you out in the real world! The important thing is keeping your patients safe as you can while doing no harm. Personally I would look for another job because the ratios are simply too much and unsafe!