Spotting a bad unit......before you take the job.

[Sugarcoma, RN]

OK fellow RN's. I need some advice on how to spot a bad unit BEFORE I actually work on that unit. The things I have been doing are not working obviously because I have found myself on TWO bad units. (Have only had 2 nursing jobs lol) so apparently I need some help in this respect.

Probably the most frustrating thing about my experience has been that NO one will tell you BEFORE you actually take the job. In both instances once I signed on and started to realize something wasn't right......people came out of the woodwork to tell me how crappy the unit is. Would have been very nice had they shared that tidbit BEFORE I took the job!!

My info: RN licensed in 2009. First job: a severely short-staffed med-surg unit with very high acuity (functioned as a trauma/sicu step down unit.) and very high ratios.

I spent a long time researching before I left. I ruled out units with multiple openings posted all the time. When I interviewed I ruled out any unit staffed with all new RNS or RNs who had only been their for a short time. I talked to RN's who worked for the system and asked current employees when I shadowed about their job satisfaction.

I have been on this current unit for 9 months. I have given it my best shot. Normally I would NEVER consider leaving before 2 years but in this instance....well let's just say I do not need 2 years to know I am in a crappy situation.

The issues I have: Hired for full time at one rate of pay only to find I am actually part-time and receiving a lower rate of pay. My signed offer letter included the little tidbit that this offer is not binding and can be changed at any time, so I have no recourse. So they are getting the benefit of a part-time employee who works full time hours and I am paying much more for my benefits.

I was hired new to the ICU and told I would not have to take open hearts until I had at least 6 months experience and went through another orientation........I routinely have to fight with charge RN's about not taking fresh open hearts and many times am told too bad so sad. I am NOT comfortable with this!!! I never received an open heart pt. on orientation. Was only shown a SWAN so I knew what it looked like, received no info about the various readings and what they meant. I have taken steps to train myself but do not feel this is ideal.

Lastly my co-workers (most not all) are very non supportive and routinely try to sabotage each other. Oh and of course no lunch breaks makes for the icing on the cake.

What I would like for my next job: Rate of pay and status I am promised. A reasonable ratio if med-surg (less than 9) and ideally a lunch break! I have resigned myself to the fact that I am never going to receive an adequate orientation and that I am going to have to spend a lot of my off time teaching myself things...I am ok with that, as long as I have at least a couple coworkers that will let me run things by them when needed.

Also I do not have a lot of RN friends, so I am unable to find people who actually work on the unit prior to accepting a job and in both instances when I asked current employees outside of management's ear shot was told "this is a wonderful place to work"

[ckh23, BSN, RN]

Ask about staff turnover. High turnover usually translates into poor satisfaction. Also find out about the experience on the unit. Are there a lot of new nurses and new grads? If that is the case it is usually a sign that experienced nurses won't work on that unit. Just my opinion.

[Double-Helix, BSN, RN]

Remember that the interview process is a two way street. You can ask questions as well. Don't be afraid to ask detailed questions about the orientation process. Ask about the ratios. Ask to speak to one or two of the nurses, if possible, privately and ask them the same thing. If there are any recent hires or new graduates on the unit, ask to speak to them about their orientation and whether it was accurately represented.

Multiple job openings can mean there is a high turnover. It can also mean that the unit is growing and attempting to fill staffing needs in order to improve their ratios. I'd ask how many employees have left in the past 3-6 months. It's possible that employees haven't actually left.

Ask for a tour of the unit. Observe the nurses while you're there. How to they look? Stressed? Frazzled? Is the unit disorganized? Do staff speak politely to each other? Is there any joking or light hearted speech? If you can see the assignment board, try to notice how many patients are assigned to each RN. This can give you some clues about the ratio's and morale on the unit.

[Been there,done that, ASN, RN]

You can get a feel for the unit just be observation.

How fast is everybody running?

Are the alarms going off and being ignored?

How do the unit clerk and assistants talk to the nurses? (hopefully there is a shred of respect)

I agree you need to move on.

Taking care of open heart patients with a Swan-Ganz without thorough training is not fair to you OR the patient.

Make sure you drop this little tidbit off to the surgeons(as you are going out the door of course).

Watch things change then!

Good luck keep us posted.

.

[Thunda]

Heh, where do you live? I'll take and eat anything I have to in order to get that golden "1 year experience required" in an acute setting

[That Guy, BSN, RN, EMT-B]

I always said that me leaving wasnt the worst thing the hospital had to worry about. It was me saying how bad the conditions were where I worked and telling people not to work there. Im very candid and would tell people exactly what I thought when they asked if they should apply for the unit. I want people to be happy and enjoy what they do. the least they deserve is some honesty.

[OnlybyHisgraceRN, ASN, RN]

Others gave great advice. I agree when you are new and you see that there is a high turnover then you know its' a bad place. Same as multiple positions being open.

So far as the open hearts. You have the right to refuse any assignment you feel is unsafe. If you don't feel comfortable tell someone.

Next time you go to work, do not get report. Go straight to the charge nurse and tell her that you will not be taking care of open hearts until you have received proper training and feel comfortable. Ask her is she plans on assigning this patient anyway and if she does you walk out of there.

If something goes wrong the judge won't care that you were new or not comfortable, you will be held accountable. I have refused an assignment before and will certainly do it again if I have too.

[TakeTwoAspirin, MSN, RN, APRN]

I would never take another hospital job without asking to shadow first. If they decline that will tell you a lot. If you let shadow, don't bother asking the nurses (they may or may not tell you the truth). Talk to the patients on the unit. Look at the patients on the unit. Do they look comfortable, frustrated, are they clean, are they behaving "appropriate" to the unit they are in, do the linens look clean, bathrooms clean, etc? Ask how many agency nurses work on the unit vs. staff nurses? That alone will tell you a lot.

[MN-Nurse, ASN, RN]

OK fellow RN's. I need some advice on how to spot a bad unit BEFORE I actually work on that unit.

In this economy, the unit with job openings is the bad unit.

[Good Morning, Gil]

haha, pretty much what PP said. While I love my job, my unit does have openings occasionally, so many people do not find it to be their cup of tea, and it's by no means the "cake walk dream job" that many people want (like postpartum or outpatient surgery). That has more to do with our patient population than anything. I don't think people realize that ICU nurses do have to deal with withdrawal patients at times, many patients are morbidly obese, and we do total care, and when you have a patient go bad, you will be very busy, and need to work quickly, not to mention the emotional aspect of it. I don't mind this in the least, and I love my job, but some people come to ICU expecting that 2 patients means they will chill all shift, I guess, not sure what they think.

Anyway, there will be some red flags. Like, how many open positions are posted at any given time? (if a lot, not good lol).

Do a shadowing day to see what it's really like this next time around since you've had some bad luck. (ask when they offer you the job if you could shadow before accepting to ensure it's the "right fit" lol).

Find someone you know, if possible, tell you what that unit's like.

And, if both of these units you mention are in the same hospital, maybe you should apply to another hospital lol.

[nurse2033, MSN, RN]

Before you accept ask for a shadow shift. This will help you see in the inner workings and talk to people. Good luck.

[Ruby Vee, BSN]

the one common thread between the two jobs is the op. obviously, i don't know the op and don't know anything about her or her practice. it couldn't hurt to take a good, long look at herself and her interactions with others, though. it may help.