Should I take this med/surg job? Is it unsafe?

[RiaRN]

Ok I will try to make this brief. I was offered a job in med surg in a city hospital in NY. I am a new grad RN. The unit is a stepdown and hospice unit. They told me that while their ideal nurse to patient ratio is 6 to 1 this is hardly ever the case. The nurse is responsible for total care of 12 patients with the help of only 1 nurses aid or 1 LPN. Orientation is 8 weeks.

It sounds intimidating to me especially having no experience. Can anyone give me some advice? Any help would be appreciated. Thanks! ~Ria

[Daytonite, BSN, RN]

I worked on a stepdown for a number of years where each RN and LPN had 10 patients. It worked well. At the time the LPNs could not do IVs or give medications. The LPNs basically did bedside nursing care. However, they were able to do the head to toe assessment, suction and do a lot of the turning and repositioning of our comatose patients. That meant that us RNs were basically involved in doing the IVs, meds, telemetry and doctors orders. This was on the night shift. I have to tell you that some of the LPNs felt that they did all the work because the RNs were sometimes tied up on the phones getting orders or reporting things to the doctors or tied up with one patient who was going sour. Made for some bad attitudes. The day shift RNs had only 6 or 8 patients and an LPN to help them. Things are much more hectic on the day and afternoon shifts with patients being admitted and transferred to and from the ICUs ALL DAY LONG. There were generally little spats among the doctors as to which of their patients they would allow to transfer out so another doctor's patient could get a telemetry bed on the stepdown! We also were the first choice to float to the ICU when ICU was short-staffed. Even the ICU nurses absolutely hated having to float to stepdown.

I don't usually recommend that new grads go into stepdown units as a first job because the stress is just too high and the routine is too topsy turvy. There are too many skills that have to be learned and mastered quickly. If you do decide to do this, make sure you have a backup plan in case things go wrong and fall apart. Be aware that not all nurse recruiters are honorable and trustworthy. Some are only interested in filling empty positions and not the least bit interested in YOUR needs as a new graduate. If you even get an inkling of that kind of feeling from these people, bow out now. I would also suggest that you read through some of the older posts on stepdown job problems of new grads in the First Year in Nursing Forum. You might have to do a manual search since the search function is not working correctly since allnurses made it's new software changeover.

[RiaRN]

Thanks so much for all the info. I am definetly thinking twice about taking this job. I am just having a hard time finding something right now...I am so confused and intimidated by it all. I find talking to people that have gone through it gives me the best insight into it all. Thanks for taking the time to reply. I appreciate it more than you know. :0) ~Ria