Still Not Sure If I Can Cut It

Sheri257 · Aug 5, 2005

I would consider trying another hospital that might be more supportive, even if it means having to pay the tuition back, which usually is an option under most tuition reimbursement contracts.

At my hospital, they sometimes orient new grads for as long as six months if they need it. It is expensive but, it seems like you've run into the problem where not all nurses are interested in orienting new grads, even though management tells them to do it.

Sometimes you have to float around to different RNs until you find the one who is most helpful and the best fit for you. But that takes more time, and it sounds like this hospital is putting a lot of pressure on you to be on your own, whether you're ready or not.

Yes, orientation is expensive, but that's not your fault. Other hospitals have come up with solutions to this problem. What my hospital did was start hiring students as externs several months before graduation, so they could train them and give them more time to function as nurses at half the salary and expense they would pay new grads.

That way the students aren't rushed to learn everything, and the hospital isn't paying as much to orient the student. Meanwhile, it gives you more time to work with and find the RN's who will help you most.

If you could find a hospital that's come up with solutions like this, and is more supportive, it might be worth buying out your contract. Because it doesn't sound like this hospital is supportive at all.

:coollook:

grinnurse, RN · Aug 5, 2005

Kim,

All I can say is that I know where you are coming from with the orientation. I also got thrown from the frying pan into the fire after 5 weeks orientation on a MS floor in a small hospital.

This past weekend was a nightmare. I had 7 pts (day shift) on my own and one came, it seems, directly from the state mental hospital!! Went home crying, directly to my room, b/f seeing family. Went back on Wednesday, had 8 pts. , and had another doozy of a day in which I also cryed all the way home in my car. I try to keep telling myself, that in a year, that "magic" year, that I will look back on this and laugh and see how far I have come. I have come to look at it like that first orientation in NS and how scared and frightened and stupid I was b/c of lack of knowledge, experience, etc. All through NS I thought I would never get through it, but I did. I have those same feelings now and am praying to God that I survive this too. NS was a walk in the park compared to where we are at now. Just as prereqs were to NS. I am determined to be a good nurse who still puts the pt first but will not jeapordize my license for the unsafe working conditions of the hospital.

All I can say to you and others that are in our position is to keep taking it one day at a time, put one foot in front of the other, remember to breathe and be good to ourselves when we are off. We are one person doing the best that we can with the knowledge and experience that we have so far. Just as we made it through NS and passed boards, we will survive this too and be so proud of ourselves when we notice the day that we didn't have to ask a question but relied on our own judgement from the confidence we gained from our own previous experience. I know there will never be a time when we don't learn something but when we can have the confidence to rely on our own judgement we will know we survived the hardest year!!

Good luck to all of us "newby nurses"

ShayRN · Aug 5, 2005

I feel so bad for you. The way that your employers are treating you is just another example of the disrespect we receive in our profession. They seem to think that just because one is an "RN" or an "LPN" that we can function independently wherever they put us. They would NEVER ask a cardiologist to deliver a baby, or a general surgeon to clean teeth, but don't seem to think twice about pulling us out of our specialty areas and EXPECT us to function and provide safe patient care.

My advice to you would be to go to your manager's boss. Tell her/him what you just told us. This is why nurses burn out, quite frankly dear, your orientation was HORRENDOUS. Our preceptors must take a class given by the hospital. New grads are given NO LESS than 12 weeks orientation, even if they ask to be taken off we as managers cannot allow it. On our Telemetry unit they are also given 12 full 8 hour days of classes. These include monitor reading, ABG reading and more. They are given folders when they get to their units and are assigned no more than two nurse preceptors. (One who is the primary and another in case that one is on vacation or something.) They have a checklist of things that must be done prior to coming off orientation and a list of things they must be proficient in by the end of their orientation. If the preceptor signs the paper saying that the person has done this or is proficient at something, then they are responsible for that decision.

Yes, it is costly to orient new people. It costs my institution 25,000 to orient a new grad RN, but if I give a good orientation and they STAY, the cost is minimal in the long run. Your manager and preceptor should be ashamed of themselves for putting you in this situation. If you can't leave the hospital, I would demand a transfer to a new floor. One that cares more about YOU and not just having a "body" to cover the numbers. Good luck and keep us updated.

Tweety, BSN, RN · Aug 5, 2005

I know what you mean.

Actually, you need to give yourself a break. Running your butt of is no indication that you can't cut it or have what it takes. It only shows you're busy and working hard. Take stock of the situation because it sounds to me like you are doing a good job.

We had a manager that kept putting a new grad on orientation everytime she had a busy day. I finally sat the manager down and explained that new grads are often busy and overwhelmed long after orientation. They need support on the floor, safe ratios, etc. but don't necessarily need to be put back on orientation, because after 12 weeks another day or two of orientation isn't going to help.

Granted 4 weeks is not enough orientation for you and if you feel you need more oreintation and the manager isn't going to give it to you, then you might have to think of other options for unemployment.

You really are seriously doing a great job. There are days now my butt doesn't find a seat to sit down in. In fact for the first couple of years I didn't sit down, (But to chart and I ate while I charted). Just last Friday I stayed an extra hour finishing up after a 12 plus hour shift without relief.

Sometimes it just takes that one patient, like a patient recieving Golytely and blood to ruin it for you. Would any extra orientation make it any easier?

Good luck to you. Keep up the good work.

Tony35NYC · Aug 5, 2005

I'm sorry to hear this, but thank you for sharing it. It only proves what I've been saying all along to those who keep saying that all new grads should get their feet 'wet' on a med-surg floor...as if med-surg nursing is a cakewalk compared to any other type of nursing. It is not!

Of course you can 'cut it' there. You're already doing it! After you get some experience there it will be easier to get a better position somewhere else and pay off the remainder of the contract. I encourage you to stick it out for a while and see how things progress.

kimmcgill · Aug 6, 2005

Thanks for all of the replies. The insight is very helpful. Here is an update. The pt who was getting GOLytely and the blood transfusion at the same time....ended up in the ICU with fluid overload at the end of the shift that followed mine. She went into V-tach several times. She was doing well when I left my shift last night and reported off. The 11-7 nurse who had her gave her Lasix 40 mg IV in between units of PRBCs as ordered, then started the 2nd unit. That's when she started going south. This afternoon, while I was getting report, a code was called in the ICU and it was this pt. She went pulseless...they did CPR and got her back. They are thinking her electrolytes when nuts. I thought GOLytely was suppose to prevent that, but I suppose anything is possible.

As for my workload for tonight....what a joke! My charge nurse (ex-preceptor) told me we were working as teams tonight, so her and I were a team. She set us up like this: We started out with 14 patients. She said I could go ahead and start doing the 1600 assessments, fill out the flowsheets and then start passing meds. In the meantime, she would do the chart checks, take off any orders and take any admissions that came to our block of rooms. (Keep in mind, she is the charge nurse and makes the bed assignments for new admissions). She said she would do the 2000 assessments and then between the two of us we would get the 2200 med pass done. Luckily, 4 of our pts got discharged early in the shift, and 2 more at the end of the shift. Guess who did all of the discharges! Yeah, that would be me. I didn't get my 1600 assessments done until 1900. I ended up doing the 2200 med pass for the remaining 8 patients by myself, as the charge nurse did take 1 admission in our block. It was crazy. When do I get to sit on my butt and do paperwork all night instead of running my tired butt up and down the hallway all night long dealing with grumpy, needy pts and malfunctioning equipment? I am exhausted again tonight. Hope this first year goes fast. It's really tough because the charge nurse is a real nice person, and she is very friendly to me, but she is obviously very lazy and uses her position to get out of doing patient care. Sorry for whining. Thanks for listening.

Kim

BandEmom · Aug 6, 2005

This experience you had does not indicate that you can't cut it! My gosh, I am a new nurse only working m/s for 2 months,and I've never had six pt's - I'd die! I can't even imagine how you have been doing it. I don't get the impression that your employer is very supportive. I had my dream job in ob before I came to my current hospital and I was totally thrown to the wolves, then blamed for mistakes. I didn't fit in with the group and my boss did not like me. The docs were mostly weird, and I made a medication error - nothing fatal - I gave percoset instead of vicodin. I did the right thing and wrote it up and that was all my boss needed to fire me. I cried every day for a month, and wanted to quit nursing for good - I thought that all the negative opinions these guys had about me were right, but I found a job at a better hospital where I think I'm well-liked, and I know I'm well- suppported. I think that your licence is too important to play around in a place that is not supporting you and makes you feel unsafe if that's the case. Most of us pay tuition back any ways, and lots of hospitals have "new grad" bonuses that apply within one year of graduation.

You didn't get thru school for nothing you can do it!

MedSurgeMess · Aug 6, 2005

My manager was not at all receptive to this idea when the supervisor told her this, and stated "do you know how much that costs us?"

You should have asked her if she knows how much a lawsuit would cost the organization if something would go wrong and it could be proven that you were not properly oriented and had asked for further training? Document all requests and comments as far as this goes-I think this manager gives a new reason to CYA-good luck, you deserve better!

kimmcgill · Aug 7, 2005

You should have asked her if she knows how much a lawsuit would cost the organization if something would go wrong and it could be proven that you were not properly oriented and had asked for further training? Document all requests and comments as far as this goes-I think this manager gives a new reason to CYA-good luck, you deserve better!

This is indeed good advice. When I asked to be put back on orientation, I did it in writing and copied the chief nursing officer of the hospital. That was when I was put back on orientation for 7 more nights, then taken off again. I have bee off of orientation for a week now and working on my own. I think at this point, I should probably write another letter to my manager, and copy the CNO again, stating that I still feel that I was taken off of orientation too soon, but feel pressured to be on my own, telling them that if anything happens that the letter is to serve as written documentation that I did not yet feel safe to practice on my own yet. Thanks for the suggestion!