Staff being floated, leaving only 2 on the floor? (long vent)

[trudlebug]

I am a new nurse (Graduated in May, been working 2 months, had 3 weeks orientation) and I work nights (11-7). Our unit has 15 monitored beds, and we have 3 staff on our shift (RNs and LVNs only, no Aides or Clerks) While this is usually sufficient, lately they have been understaffing our unit (9-10 pts) so they can take one of the nurses and float them to another floor. (We staff on numbers only, acuity is not considered).

Anyway, that leaves just 2 people on the floor all night. There is no way we can leave for a break UNLESS we are able to get another nurse to "float" back to cover for the time we are off the floor. Also, many times we are unable to assist our patients when they need it (moving in bed, getting to the bathroom, etc. for those who are not ambulatory). This is due to the fact that many times the other nurse is busy with their own patients, and having to wait until they are finished so we have 2 people. (Not to mention the time we had a 400+ lb woman slide down a chair onto the floor, and couldn't get her up without at least 4 people).

I just feel so unsafe! Of course everyone says "you're doing fine, don't worry" etc. But I don't feel that way. I feel like there is so much they didn't tell me, (orientation consists of one day following a charge nurse, then taking on gradually larger assignements during the first 3 weeks) And the popular phrase is "If you're not sure, just ask!" .

Well, the problem is, I sometimes don't know what to ask! For example, the other night a patient was supposed to get 2 doses of a med before a procedure, but the order was not written that way, not timed during my shift on the MAR, and I was not even aware until 7am that he was going down....(usually they don't take patients off the floor until later, after I leave, so no I had no experience about that either:o ) So the daytime Unit Clerk had a fit about that, since transportation was on the way up, so she kept asking why he hadn't had it. (sidenote: if she would have just left it alone, I could have given it and been done in the time she kept griping!!) That, coupled with being tired and hungry, (again, only 2 on shift due to low census) I about lost it, and even threatened to quit because I felt I was not providing safe care (Charge nurse was so stressed out anyway, that I don't think she saw how bad it got for me so fast).

My nurse manager just happened to be on the floor as this goes down, and was asking me what she could do to help, but I was too emotionally drained to think of anything to say, and even turned down some time on day shift to reorient (That was really dumb!) She is great and wants to help, but I don't know what to do. I guess I would appreciate any advice, or any ideas about how we could improve this. I would like to be able to offer suggestions to improve how to do things, not just complain.

Thanks for "listening",

Sharon

[meownsmile, BSN, RN]

You know you can only do what you can do with what you are given. Dont beat yourself up. Everyone has to let things go for the next shift and it doesnt sound like this was your fault anyway. Be forward enough to ask for help when you need it. If you feel yourself starting to sink,, ask for help. If they refuse, write up an incident report to CYA if there is a problem like this again. You did the right thing if someone failed to follow through with their job the day before by writing the med as it should have been given. Send the ball back to them and forget it. Anesthesia should be able compensate for the lack of premedication. It was most likely a anti-anxiety agent anyway. If the patient was ok and not climbing the walls from fear then all is well.

When i would start feeling myself getting overwhelmed i would take 2 minutes go to the bathroom, breath a min and regroup, then go back out with the idea that you can only do what you can and take one step at a time. Try not to let yourself get frazzled (for lack of a better word), the more frazzled you get the worse the situation becomes. One thing at a time,its ok to keep a minds eye on what your next task is and keep a mental note of what you need to accomplish. Just dont let yourself get ahead of where you are. When you let your mind get 3-4 steps ahead of where you are is when you lose it.

If someone asks if you need help take it. Have them gather your I&O's, put MAR's on the chart, give your AM insulins, answer a call light for you, give a pain med. Little things go a long way, and if you dont have something for them to help with,, they quit asking.

[Tweety, BSN, RN]

You're new and you're learning, it's entirely normal to be going through what your going through. The best of us could have done what you've done. But they certainly aren't going to give you three profressionals for 9 to 10 patients (don't I wish!!!), but even with three people it's still would have been tough coming off orientation, it always is. It's a stressful time and I hope it passes soon. Hang in there and good luck.