I graduated from nursing school in May and have been working as a med-surg nurse since September. I just hit my six month mark and am brinking on seven. I love being a nurse. I love my coworkers and my patients. However, I can't shake the sense that my job is unsafe and I need to get out of there.
Our staffing is horrendous (which I know is like most places), but when I say horrendous, I mean that two days ago I had eleven patients on PM shift. I was "protected" for the first six months of this job cuz the newbies are only allowed six patients at a time. Now that I suddenly broke my six month mark, though, suddenly I found myself being one of two nurses for twenty-two patients. I couldn't keep track of anybody and I did not feel safe on the unit. The average runs at about eight or nine patients, but I have seen nurses at ten or eleven patients often enough in the past who were still expected to take admissions.
A week or two ago, I had an admission who died (but not on my shift thankfully) and it was a patient with whom I had a good rapport. Finding out that patient didn't make it felt awful because he died of some minute thing. All I could think about when I had eleven patients is how I was praying no one else coded because I would never have known. It just feels like I'm gambling with people's lives and it's not worth it. I didn't have time to catch the little things and, as we all know, the little things can be so important. My coworkers tell me that "you have to make room for human error," which I get, but I want out.
I'd been planning on handing in my two weeks notice tomorrow, but now I'm second-guessing myself. I don't have another job lined up and I pay approximately $1000 a month for my nursing loans. However, that uncertainty seems minute when compared to playing with the safety of someone's parent, grandparent, sibling, or child. Am I crazy for quitting without another job lined up?
If you can not transfer to another unit, (and I would be looking at the internal job opportunities now) then you have no choice but to stick it out until such time as you have another job in place. And I would further suggest you keep your job for at least a year in order to better prepare you for another position, as most would like at least a year of experience.
I would, however, let your union know (if you are union) about the ratios, do a risk managment report, as pp have suggested. As a complete aside, I would also start now by contacting your student loan carrier and see if it is feasible to make some extra payments on the prinicpal of your loan. (Even if it is $100) Some will allow you to do that, others will not. While you are actively working.
And finally, use your resources. If you have CNA's, they are a huge part of your team. If you can stick it out, do so. Look at internal openings, or contact the nurse manager of wherever you would like to be and have conversation regarding what you need to do to get where you want to be. The last thing you want to do I am sure is to quit only to find out that 4-5 more months would have meant you could have gotten another position. And then default on your loan--which makes like difficult from here on out.
Most of the time I don't post any responses if I don't have anything nice to say. However, this time I will bite because it strikes me as being part of the pervasive nursing culture problem, that instead of being outraged and indignant over the unsafe practice of institutions burdening nurses with unrealistic patient loads, posters here are regaling their own tales of institutional nurse abuse with the implication that "I did it, so why can't you?".
For in-patient hospitalizations, a one nurse to 10-12 patient load is wrong. Period. Just because a nurse makes it through a shift without any major mistakes doesn't make it right. Eventually a mistake WILL be made and the nurse will be hung out to dry as if his/her nursing skills are the problem instead of the unrealistic and inappropriate expectations placed upon the nurse.
This is one of the areas of nursing that I hate so much. The "suck it up" mentality, doesn't work for me. But hey, of course that just my opinion. We all have one.
Wakeuptothesun86, do what you have to do that makes sense to you. Personally, I wouldn't work there, but I have no idea what your situation is currently.
I was a new grad over 18 years ago working a Med/Surg unit. We did direct admits and post-ops continuously. At the time, we averaged 18-21 patients for every RN. Each RN had a nurses' aide and would occasionally have the help of an LPN who would pass medications (but LPNs were not touching IVs back then also). The acuity was high, so it wasn't like we had more patients that were in more stable shape. Many days it was a good day if you left your shift and everyone was still breathing. Not to scare you, what you really need is encouragement and confidence right now. I pretty much had to sink or swim back then. Oh and we didn't have the help of that new thing called the internet back then. It didn't exist, nor did YouTube for the awesome nursing educational videos you can find on there now. Keep your chin up. Pat yourself on the back for the things you feel confident in doing right now. It will take some time before you really feel like you know what you're doing. If you really feel afraid to work there, go somewhere else. Although it's still best to stay on your first job for two years. I've been a nurse administrator and I can tell you if I had a resume of a nurse who only stayed on her first job less than a year, I would have concerns. Stick it out. Look for ways you can make things safer. Your leaving won't help the patients. Good luck!
I would immediately speak with the manager about cutting my hours back to part time while I looked for another job. Maybe you can do three 8 hour shifts until you find something better.
How will you pay your loans if you quit your job without another one lined up? You don't qualify for unemployment if you resign. Start applying for jobs NOW and stick it out at your current job until you find one.
Just wanted to comment on the student loan aspect of this...you should be able to adjust the payments so that they aren't so much. I remember when I took mine out there were several options (e.g., graduated payments which start out low and increase over time as your income increases) which resulted in different monthly payment amounts. $1,000/mo is a lot. Examples below: https://www2.ed.gov/offices/OSFAP/DirectLoan/RepayCalc/dlindex2.html
I have enough trouble keeping track of FIVE patients even after 2 years on the floor ('this patient has a a Foley ... wait, no they don't ...') ... 10 patients is obscene. I guess this is why so many nurses go into critical care, at least there the ratios don't get as outrageous as this!
Don't quit until you get another job, you will regret that. Live the job hunt on days off until you get out of there. Anything less than a year on a nursing job is a red flag for potential employers.
I have enough trouble keeping track of FIVE patients even after 2 years on the floor ('this patient has a a Foley ... wait, no they don't ...') ... 10 patients is obscene. I guess this is why so many nurses go into critical care, at least there the ratios don't get as outrageous as this!
Ahem, as a brief clarification, do not for one moment think that having one or two very critically ill patients is somehow easier than having 10 not-so-critical ones.
Most of the folks on AN know how much I hate the conceptual task-ification of nursing practice (the "I can do anything a nurse does, I just don't have the credential" way of looking at nursing practice as a sum of tasks alone) , but for this brief moment you have to give me a pass on that. If you added up allllllll the "things I had to do" on a patient load of ten and all the "things she had to do" for a patient load of two, I think you would find a lot more equivalence than you think. Perhaps less equivalence, as in, the ICU nurse has more things to monitor, evaluate, intervene, communicate, and flat-out "do" than you think. But at least no less equivalence.
If you are stuck there for a while, try to make the best of it. Work on your organizational skills. I usually work ICU, but have worked enough medical-surgical floors to know you have to prioritize. I carry a clipboard upon which is everything I need to know about my patients. I don't wonder "who has a foley" because it is right with me all the time. With time, you will develop assessment skills and be able to perform a head-to-toe fairly quickly, and a simple glance around the room as you are leaving should be all that is needed to make sure safety measures are intact (bed locked, rails up, floor clean, etc.). Someone here has printable flowsheets, report sheets, and such that you might use to get better organized. Whoever it is, please chime in! Anyway, my point is that you might as well make the best of it, until something better comes along. Good luck, dear.
Ahem, as a brief clarification, do not for one moment think that having one or two very critically ill patients is somehow easier than having 10 not-so-critical ones.
Most of the folks on AN know how much I hate the conceptual task-ification of nursing practice (the "I can do anything a nurse does, I just don't have the credential" way of looking at nursing practice as a sum of tasks alone) , but for this brief moment you have to give me a pass on that. If you added up allllllll the "things I had to do" on a patient load of ten and all the "things she had to do" for a patient load of two, I think you would find a lot more equivalence than you think. Perhaps less equivalence, as in, the ICU nurse has more things to monitor, evaluate, intervene, communicate, and flat-out "do" than you think. But at least no less equivalence.
I never said it was easier. I would rather work more focused and run around busy with 2 sicker patients than with 5 less sick ones. Keep your ahem. That is all.
toomuchbaloney
16,060 Posts
Some people certainly are in a position where they could manage quitting without having another job secured. YOU ARE NOT IN THAT GROUP!