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!

I'm still a student, but I know the cardiac step down/tele floor I was on ran codes......as in when a code was called one nurse from the unit went to the code as part of code team. As a student I got to go to a code with the nurse once. That is likely what is meant by run a code. And while that nurse was gone, there pts were watched by other staff.

Also, the only time I ever saw a nurse with less then 4 was when they had a discharge, and they were the first to get a new pt. 4-5 is the norm for tele.

Specializes in PCCN.

Being that I work on that type of floor, this manager was nice enough to be honest. Maybe she didnt want to sugar coat it, and have someone realize 3 weeks in that "this sucks" and have interview yet another person after you quit. I was given those ratios also, but in reality, if someone calls out- they usually dont have anyone to fill their place, and we're stuck picking up the slack- ie 6 or so heavy med- tele pts. Luckily , that doesnt happen too much , but still sucks.

As far as codes- there's enough nurses on my floor who "like that sort of thing" and they are usually first in line to help.

I'm sure the 26 percent retention rate is just being realistic. All floor Nursing Jobs suck, especially med/tele stepdown. It may not be a reflection of the manager. but a reflection of the type of sucky work that stepdown entails(and the high liability that goes with it-esp. hospital nursing) .Im' sure if you got some stats from other med/surg floors you'd get a very similar retention rate. Hospital nursing sucks in general.But thats anotherr thread for another day.

Good luck- hopefully you will be one of the lucky ones who will find a non- hospital nursing job.

Specializes in nursing education.

We had a lot of RN turnover until we started requiring that potential hires shadow at least half a day to see what we are really about. That is the most honest way. Our clinic can be a culture shock.

I agree with all of the above posters- no job is perfect, you have to find the right place for yourself, and hiring people who have been deluded into thinking that a place is something that it is not, is a sure way to have big turnover.

Workplace cultures can and do change over time. It really does sound like this NM, being aware of issues, is really working on changing the place for the better.

Specializes in Med Surg.

Good call. F and M would have run me off as well. Retention at 26%--why would anyone want to work there?? Obviously there's something seriously wrong with the floor and/or facility if it's that low. I really can't believe other posters are playing down this fact. Sorry, but I would only get involved in the whole new team building thing if I were desperate for a job. Otherwise, no way. If your prospective NM is warning you that there isn't teamwork among the day shifters, you can assume (at least I would) that she's playing down the severity of the issue. I would think it's much worse if she feels the need to tell you in the interview. Could be why retention's so low. I would have run away as well. It doesn't matter how great the orientation is, or the benefits, or whatever, those 2 issues would set anyone up to fail and/or be miserable. I've worked in atrocious environments. It's not worth it. Life's too short. There's another job out there.

Specializes in Oncology; medical specialty website.
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.

I thought it was just me.

While some of the responses raise some valid concerns, others just made me laugh. Why would your preceptor not be there? Day off, vacation days, personal illness, family emergency. What does "help you pass the class" mean? Perhaps they have some sort of remedial program for people who don't pass so they're successful on the second try.

No place is perfect, and if you are looking for nursing Shangri-La, please be sure to post its location and who to contact.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

I honestly don't get why this is such an :uhoh3:

Specializes in Oncology; medical specialty website.
Being that I work on that type of floor, this manager was nice enough to be honest. Maybe she didnt want to sugar coat it, and have someone realize 3 weeks in that "this sucks" and have interview yet another person after you quit. I was given those ratios also, but in reality, if someone calls out- they usually dont have anyone to fill their place, and we're stuck picking up the slack- ie 6 or so heavy med- tele pts. Luckily , that doesnt happen too much , but still sucks.

As far as codes- there's enough nurses on my floor who "like that sort of thing" and they are usually first in line to help.

I'm sure the 26 percent retention rate is just being realistic. All floor nursing jobs suck, especially med/tele stepdown. It may not be a reflection of the manager. but a reflection of the type of sucky work that stepdown entails(and the high liability that goes with it-esp. hospital nursing) .Im' sure if you got some stats from other med/surg floors you'd get a very similar retention rate. Hospital nursing sucks in general.But thats anotherr thread for another day.

Good luck- hopefully you will be one of the lucky ones who will find a non- hospital nursing job.

I wonder if people just use that floor as a jumping-off point to get into more critical-care areas like ICU/CCU. That could account for some of the retention problem.

Overall, I thought the manager gave pretty honest answers, and it sounded like a decent place to work.

Specializes in Gerontology.

I wonder if the 26% retention rate is related to something else.

Is this a new manager just brought in because of a low retention rate?

Or are people using this unit as a get your foot in the door type of job, and then going to their choice unit when an opening becomes available?

frankly, I think the orientation set up and the fact that they are willing to help you pass a required exam sounds great!

Specializes in Med/Surg, Academics.
I wonder if people just use that floor as a jumping-off point to get into more critical-care areas like ICU/CCU. That could account for some of the retention problem.

Good call. It sounds like the OP was planning to become part of that statistic, too.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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!

*** Sounds to me like you passed up a pretty good job. Only 4-5 patients on a busy tele floor? Wow those nurses are lucky. A strait shooter NM who tells you like it is? A rare find in my experince. v-tach & blocks? Bread and butter nowdays. Anything less and they likely wouldn't be in the hospital. 8-12 week orientation? Very generous if you ask me, you after all are not a new grad but an RN with a years experience. More than enough orientation I would think. The narative charting should be looked at as a blessing as it will likely be far, far less time consuming than whatever cheap computer charting system they buy.

Please post the hospital here, I am sure many nurses would like to work there. I would if I was a tele nurse. Especialy I like the idea of only having 4-5 patients rather than 6-8 as would be normal in lots of places.

Specializes in Telemetry, OB, NICU.

I am very curious as to see what you thought a Tele floor would be like? What did you expect? Welcome to real world. There is no perfect job. And this job sounds very much like a telemetry floor. I also wonder where you got your year experience? I am thinking a non-hospital job?

Thank you all for your comments thus far. I believe that everyone would agree that Nursing has become a lot more difficult than in the past. Many factors have come together to make it so. And, what is adding to the mess of things is most hospitals are attempting to save money. In one attempt, they are combining floors, in another they are reducing staff. Who in the end suffers the most? I believe the patient. Eight patients to one nurse that is plain unacceptable, and if you think that you are providing even the mininum standards of care, you are deceiving yourself.

Also, if a new nurse, or any nurse for that matter, is to be working on a tele floor, then they better know how to read strips. They better understand what dysrhymia is being presented, and have some grasp of why. I do not believe the telemetry requirement should be taken lightly. (We will help you- BS) These patients are being monitored for a reason, and they deserve the proper care, which includes monitoring. There should be no "codes" on a Medical-Surgical floor. If these patients are that critical, they deserve to be on an ICU or Cardiac floor. Gees!

I believe my post brings home a very good point specially for new grads. Do not take the first job offered. Look around and decide where you truly will feel comfortable. I have no doubt I would have been successful at this floor, but I would have been very frustrated in the process. I do not want to be frustrated, specially when I am just getting started, and learning how to be a successful nurse. And, to those who think I am passing up a great deal. So what. I doubt seriously you knew everything when you first started out, and I suspect you had plenty of support. You didn't get where you are at today, without a someone looking after you. You were not that good, Sorry! And, I know that working on that particular "day-shift" floor, I would not have had the proper support.

I also believe nurses have settled for less than ideal working conditions, which has enabled the upper management to continue their attempt new and improved ways to provide care, I mean save money: Combining more floors, and doing it with less staff is just two example of many. Ask yourself, would physical therapy put up with even half the crapola the nurses do? I think- NOT!

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