Stuck on an unsafe floor (Vent, long)

[monkeyadale]

I counted myself very lucky when I was able to land a job 2 months before graduating because so many new grads are having such a hard time finding work. My new job that I was so excited about has become a nightmare. My husband is currently out of work and I am breadwinner for us and our children right now. I feel the floor I am on is extremely unsafe and putting patients at risk as well as my own newly earned license. I want to get off of it but my recruiter says I have to stay at least six months before they will transfer me. I have applied to every hospital in a 50 mile radius but mine is the only one currently hiring. I really don't know what to do. I feel a huge ethical dilemna here, do I want to eat or do I want to do whats right?

I am on a surgical floor, we get heavy patients, most of which should be in SICU. Many of whom just transferred from sicu and they have mulitple issues which require diligent observation. I am on midnights and my load is usually 7-9. I almost always have at least 3 GSW patients, MVAS, Cardiac, etc. On easy nights I may get thyroidectomy, lap choles, small bowel resects etc. I can handle those pretty well because for the most part they are relatively stable. It is the GSW, MVA, PE's new onset cardiac, etcs, that scare me because of all the complicatons, and there are ALWAYS complications! New onset arrythmias, critical lab values, blood, shock, etc. I have basic telemetry skills, no acls, but here I am with tele pts every night, I can barely start IV's and if one goes bad your option is to poke them until you get something or pray one of the other nurses can help you out and actually get it (never happens their too busy). Or if you can't then you have to leave said patient with no iv access until am when IV team comes in.

All of our nurses are new, the most senior nurse on nights has 6 months experience. They put me on my own before I even had my license with the other RN's to pass my meds for me. I have already been asked to be charge nurse twice!?!? and it is just a matter of time before they will ask me to precept. (my preceptor graduated 2 months before I did) I showed up for my shift last night and it was just me and one other RN who is 1 week out of orientation and just out of school for 14 patients. She had a patient who needed blood (I have hung blood a total of 3 times) and she had never done it. So not only did I have to watch my patients (1 I had to call RR for and it turned out he was having an anterior MI) but I had to help her hang her blood. I am so frazzled right now my nerves are literally raw. We get no breaks on this unit because 2 RNs have to be on unit at all times. Even if we could take a break its not like you would ever have time to, and to make it all worse, they just changed our matrix and now we will always have at least 7 on nights.

I cannot do this. It is too much and too hard. I have never had one night where I did not have at least one patient have a major complication. Trying to balance 2 or more patients going bad is very difficult and if you do call RR you are expected to remain in there with the patient during the RR, which makes sense to me but what do you do with your other people? They need attention to and they may not be critical but they need orders fast to relieve their issues or else they will need a RR.

I am interested ultimately in critical care. I wanted to start out in medsurg to build skills (especially assessment skills) before moving into ICU but at this point I would rather just be in ICU. My recruiter tells me to hang in there, that I am on a fast track to any ICU i want when I finish my six months, but I am not sure I can finish six months without losing my mind. (3 months left) I do value the education I am getting on this floor. We do everything except vents. I can now handle Chest tubes, wound vacs, pca's, epidurals, drop NGS without any problems. I have seen patients go into shock, bleed out from DIC, CIWA, have MI's etc. I am getting nothing but praise from my manager (but I think it is just because she will do anything to retain people) and my recruiter but I just don't know how long my nerves will last. It is starting to affect my personal life. I do nothing but sleep on my days off. My schedule this week is brutal 4 12s, and I am seriously contemplating calling off one of those nights.

Shouldn't a unit be staffed with at least one RN with more than 6 months of experience? Shouldn't we be allowed to leave the unit for at least a few minutes for a break? Who do you complain to about these things outside of the hospital because everyone I have complained to in the hospital knows and doesn't care.

[PAERRN20]

That unit sounds like a nightmare. I would document, document, document. Refuse to take report if the assignment is too heavy. Go up the change of command. Do you have a shift supervisor that you can talk to? Have you looked for jobs in LTC, offices, schools, dialysis, etc? You said your goal was critical care but perhaps taking a detour away from this hospital would serve you well.

[PAERRN20]

Also, you can alert your state board of nursing. They may listen, or they may not, but at least you have filed a complaint. Send a letter and keep a copy for your own records.

[Virgo_RN, BSN, RN]

It seems to me your options are:

1) Quit. Yesterday.

2) Look for work elsewhere then quit when you find another job.

3) Stick it out for 3 more months, then put in for a transfer.

[HappyBunnyNurse]

Find out how things really are in this hospital's ICUs are before you make a decision to stay. You don't want to tough out 3 months risking your licence and going crazy only to find the ICU to be just as unsafe. Also find out how good they are at keeping promises. At the end of your 6 months will they really let you go? What have others experienced?

[LLLLiiiFFEsaveer]

WoW!

If you're asking? Get out of that place fast! That place sounds very very unsafe, and all wrong! I don't work the floor, so somebody else please tell me the situation described above is not normal? If it is? How did we ever let it progress to this? Nobody should ever have to put up with what was just previously described. Shady shameful practices going on some places.

[canoehead, BSN, RN]

It would have been way, way too much for me as a new grad. You are undoubtedly having patients get sicker because there aren't enough nurses to watch them, then you pull them back from the brink just in time. If you've already finished 3 months line up that transfer so you can move on the MINUTE your 6 months is up. Be aware that managers of floors that have staffing issues have used delaying tactics in the past to prevent transfers, and let everyone know it's over in 6 months.

Another thought, though...can you speak to the ICU manager and see if she would be willing to hire you as an outside candidate? If you put in your notice and resign she can hire you back the day you leave. That will cause some uncertainty for you, but it sounds better than the situation you're in.

[bellcollector]

Ask yourself if it is really worth risking your license and career and or possibly another persons life just to tough it out another 3 months. When you accept an assignment you are saying you believe it to be a safe assignment and one that you believe yourself capable of handling competently. Should an issue arise you will be held accountable. I understand that times are tough right now but believe me they can get much tougher if you should lose your license or face disciplinary action as a result of the poor staffing situation.

[wonderbee, BSN, RN]

Obviously there is a problem that this unit can't retain nurses. Low minimum staffing levels? Yeah, I'd think about getting out. Your recruiter isn't looking out for you. Maybe you should start doing some leg work on your own and start taking a walk on critical care units. They'd love to have you.

As for the no break issue, you should complain to the labor board for your state. I'm sure the hospital is taking credit for giving your breaks. By law, you are entitled to a break. If you're not getting it, the facility is breaking the law and can be sanctioned. In my state, nurses have joined together to file a class action lawsuit against a big facility to recover $$ for breaks charged but never received.

[HouTx, BSN, MSN, EdD]

So sorry that you are caught in this situation ((((((hugs)))))))). It's easy to for us to say "quit" -- not so easy if you are the sole source of income for your family right now. Quitting may result in a huge impact on your marriage and personal life as jobs are not so easy to come by right now. My advice is to take every action needed to protect yourself FIRST as well as your patients.

I realize that you may have already done this - just didn't mention it - but have you already utilized your 'chain of command'? Have you clearly expressed your concerns to your immediate supervisor? Your department manager/director? Your CNO? If not, you need to do so, using whatever formal processes your organization has in place. It is important to take these formal steps. If anything (heaven forbid) were to happen, a record of your complaints/grievances will be very important. Keep a record of all of your communications. As you go 'up the line', make a real effort to actually talk to these people. I have never met a CNO who would ignore a situation like the one you describe.

You did not indicate what state you are in. Here in TX, we seem to have a lot more protections - including prohibition of assigning a 'charge' role to new grads. I am sure your BON will be able to advise you.

Remember, you've got a huge support system here at A N.

[MiAprilsky73]

I think I work on the same floor. I could have written that post myself. I feel for you.