Recently interviewed: I said: "No, no, no, no...."

Nurses Job Hunt

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I recently interviewed with a Nurse Manager of a medical-surgical floor combined with Telemetry. From what I gathered, these patients would be admitted with an acute/chronic condition related to the heart, in addition to another medical/surgical issue. I am fairly new nurse with one year's experience, and I am eventually wanting to work in one of the critical care areas (ICU, CCU.) I was willing to give this job two years, to gain telemetry experience with less critical patients.

A) Job description presented" "No experience is required, but 2 years is preferred."

B) What are you looking for in a candidate? "Someone who has integrity/honesty, Someone who will be here everyday, on time. Someone who wants 'to do' the job."

(Code: Warm-body) These are nice traits of a hard worker, but will this ensure someone's success?

C) NM: "You will be given a 8 to 12 weeks orientation. You will work with the same preceptor throughout your orientation, unless they are absent. Then, you will be placed with another Nurse for that day." (Why would they not show up for work?)

D) NM: "During your 8 to 12 weeks, you will complete the telemetry class. Upon completion of the class, you will have an examination. If you do not pass the telemetry examination the first time, We will help you to pass it the second time." (a...a.. do what?):nono:

E) NM: "I will not lie to you, this is a fast-paced floor." (what medical floors are not fast-paced.) Majority of the "day-shift" Nurses are having difficulty getting their medications passed on time." (Oh, that's bad!) :uhoh3:

F) NM: "Nursing culture around here can present one with a challenge." "Night-shift nurses seem to assist each other, and support each other." "Day-shift nurses seem to not help each other out, and stick to completing their own work." (Great, new guy on the floor with no co-worker support.)

G) For an entry-level person what acuity level should I expect, less critical?.

NM: "Oh no, you would have the same patient acuity level as the experienced nurses." "And, we get several admits during the day." 4 to 5 patient ratio. Total of 3 nurses on the floor. (Nice!) :uhoh3:

H) What is the Nurse retention rate for this floor?

NM: "Actually, it is low. Approximately, 26%. :eek:

I) What heart dysrhythmias are Nurses presented with on this floor?

(Are we talking afib?) NM: Oh, no... V-tach, heart blocks, anything, and we run "Codes" too! (Three Nurses on the floor, and 'we' run codes, with the combined Nursing year's experience around 10 fingers.) :eek:

J) NM: The Nurses do narrative charting at the present, but a computer system is on

the way..to do Electronic Charting- Maybe by June." (Critical patients, and the Nurses are still doing narrative charting...no wonder the Nurses are unable to complete their Med- pass on time.)

K) The unit also has 16 rooms with double beds. Total census is kept around 16. This enables the patients to have a "private" room. That is nice, but the work ergonomics is destroyed. The nurse is forced to walk a great distance between the 4-5 assigned patients, not congruent with time management. Then, if another patient is admitted to an occupied room, the nurse has to deal with the fall out of a disgruntled patient ." I WANT A PRIVATE ROOM!"

NM: "Would you be interested in this position?" ME: I think I will pass... where is the elevator, I am really distraught right now. Where is my truck, I got to get out of here!

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Wow! No job is perfect, and there are going to be some draw backs in healthcare, but it is good that you realized what you are not comfortable working with and sticking to your guns, thats a good way to prevent errors and mistakes from taking on too much of a job.

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Be sure to ask the manager if you can volunteer to take all the patients on the unit if the other 2 nurses want to go home early. lol - that place sounds like a cruel joke!

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Specializes in Emergency & Trauma/Adult ICU.

I'm sure you made the right choice for you.

I'm also sure that someone else will take the position and thrive, with a manager who appears to be a straight shooter, and an orientation program in place that appears fairly generous in length, and utilizes what I believe to be the single biggest help to a new nurse -- working with one dedicated preceptor.

Good luck to you.

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I was given good info about my new coworkers when I was hired at a job long ago; I found the warning to be spot on and helpful to me. I commend the manager for giving you a birds eye view of the shift cultures. She sounds like the type of supervisor I would like to work for.

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I'm sure you made the right choice for you.

I'm also sure that someone else will take the position and thrive, with a manager who appears to be a straight shooter, and an orientation program in place that appears fairly generous in length, and utilizes what I believe to be the single biggest help to a new nurse -- working with one dedicated preceptor.

Good luck to you.

Yes. I'm kind of confused. To me that sounded like a really good, honest interview, great orientation set up, and overall, a pretty decent place to work.

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Specializes in ICU.

We are expected to take 8 patients on our combined telemetry/med-surg floor. Plus we have LPN's, so the RN's must do the things the LPN's can't do here, like blood products, pain med pushes, etc. Good luck finding the perfect job.

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Im not quite sure what to think. I do think that the NM ought to be commended for being a straight shooter, honest and upfront.

However, that 26% retention rate spoke volumes to me and can not be ignored in addition to the non-team environment on the day shift when thrust hand in hand with a high level of acuity for new nurses.

Having dedicated preceptor is excellent especially when you can' t accept help from the day nurses.

I think at the very least, I would have asked for 2-3 days to consider the offer, do some more research and then respond. However, you know yourself better than most here so I'm assuming that is why you gave a swift decline.

26% RATE IS HORRIBLE AND ANYONE WHO THINKS OTHERWISE IS DELUDING THEMSELVES

I'm in the business world and with that rate, the manager would have been fired or reassigned- management is not doing something right if retention rate is that low.

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I agree that the preceptor bit sounded good and the length of orientation. I also thought the fact that she said we will help you to pass the EKG class if you fail is great also. Better than someone who says if you fail you are fired. Hopefully, that would transfer over to other things like if you make a mistake, we will help you grow not fire you (like so many recent threads). Also the fact that the manager is honest and aware of the culture on days and nights and staff retention rates means maybe there are going to be action plans put in place to improve that.

I guess all in all I didn't really think any of your arguments sounded all that bad.

The paper charting sucks but that is not really the units problem just the organization is a bit behind technology.

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Specializes in Pediatric Cardiology.

c) nm: "you will be given a 8 to 12 weeks orientation. you will work with the same preceptor throughout your orientation, unless they are absent. then, you will be placed with another nurse for that day." (why would they not show up for work?)

i don't think the problem is them "not showing up" but maybe if they are sick (that does happen, even to us nurses), get called off for low census, or a number of other things. just because someone is a preceptor doesn't mean their life outside work stops.

d) nm: "during your 8 to 12 weeks, you will complete the telemetry class. upon completion of the class, you will have an examination. if you do not pass the telemetry examination the first time, we will help you to pass it the second time." (a...a.. do what?):nono:

i take this as they will work with you to make sure you have the skills to pass on the second time. would you rather them just fire you?

h) what is the nurse retention rate for this floor?

nm: "actually, it is low. approximately, 26%. :eek:

okay, i admit that isn't great..

i) what heart dysrhythmias are nurses presented with on this floor?

(are we talking afib?) nm: oh, no... v-tach, heart blocks, anything, and we run "codes" too! (three nurses on the floor, and 'we' run codes, with the combined nursing year's experience around 10 fingers.) :eek:

it is a cardiac floor, of course you will see vtach and heart blocks. also, i am pretty sure you would have help from doctors during these codes. maybe a code team?

j) nm: the nurses do narrative charting at the present, but a computer system is on

the way..to do electronic charting- maybe by june." (critical patients, and the nurses are still doing narrative charting...no wonder the nurses are unable to complete their med- pass on time.)

a lot of hospitals still have narrative charting. it takes time and money but it sounds like they are working on getting electronic charting. the floors at my hospital have electronic charting but the icus are still paper, acuity doesn't seem to matter.

k) the unit also has 16 rooms with double beds. total census is kept around 16. this enables the patients to have a "private" room. that is nice, but the work ergonomics is destroyed. the nurse is forced to walk a great distance between the 4-5 assigned patients, not congruent with time management. then, if another patient is admitted to an occupied room, the nurse has to deal with the fall out of a disgruntled patient ." i want a private room!"

i hardly ever have patients in the same room and we do double people up. i think it's nice that your hospital even has that option.

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Specializes in Emergency, Telemetry, Transplant.

If a nurse manager read the OP, the might think "well, I should blow smoke up their *** and I'd be more likely to hire staff." I know I have had the "blow smoke" interview with a NM...and I much prefer the honest NM like the one you describe above. Just a few comments on your points (I find it a little difficult with your use of quotation marks to determine the NM's quotes...are the exact quotes?):

C. This sounds like a real orientation, and it is great to just have one preceptor--take it from someone who had many during one orientation. P.S. they might be absent because the are ill, have a family emegency, etc....that stuff does happen.

D. It sounds like they are trying are going to be helpful about it...not sure what the scolding finger is about.

G. This is pretty much the way it is everywhere. Yes, your first day on your own, I would expect lower acuity...beyond that, it does not really matter most places.

H. I agree, that one it a bit disturbing.

I. I'm not sure what your shock is on this one. Ask her to define "run." On any floor, the nurse is expected to start a code until the code team shows up. I worked on a telemetry floor. Many times a shock before the code team gets there is all it takes to solve the immediate problem. For a new nurse this can seem overwhelming, but this is how it goes. P.S. also ask about ACLS for staff.

J. I work on a 100% electronic system and I do a ton of narrative charting...the way I look at it, it is impossible to write a thorough assessment without a narrative. Granted, it goes more quickly on an electronic system than with pen and paper, but I still do plenty of narratives and not just point and click.

K. This situation is not unique to this unit.

It is good that you know what you want. However, many of the things you discussed are common on telemetry units. I hope you are able to find that for which you are looking.

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Specializes in Med/Surg, Academics.

Like others have said, the NM is to be commended for being so honest about her floor.

The orientation sounds fantastic! I got 12 weeks as a new grad.

The only thing that out of that list which would concern me is the 26% retention rate. Did you ask a follow up question as to why she thinks that is happening? She sounds like an observant NM who is honest in order to give prospective employees a clear picture of the floor--and thereby reduce turnover. I also infer from her honesty that she's trying to do something about it.

As for the day nurses doing their own stuff, it could be that they don't have time to help out others, rather than not wanting to help others. Did you ask for clarification?

4:1 is the absolute lowest ratio I've seen on a medsurg/tele floor during days.

On cardiac floors, you do get every type of heart rhythm, not just a-fib. Not sure what you were expecting.

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