Unit change r/t STRESS?

smile123 · Aug 31, 2007

Hi yall. One month in as a new grad. Thinking about a unit change and want to hear what you think. Here's the situation:
Feel overwelmed by the acuity of my pt's (solid tumor onc @ busy teaching hospital) and that I just run from one task to another and am totally unable to have time for the big picture. Today and everyday by 10am there are long lists of new orders on everyone. I haven't had a day without one pt going down and needing ny undivided attention and stat PCXR, EKG, and so on! When I am with them, everything else scheduled for others goes to pot. Our unit staff is predominatly nice with a very few brisk people on staff & very nice managers. It is not the staff, it is the STRESS. When I am in the shower, lots of hair literally falls out. I have lost weight too.
Today I got home and realized I did not chart one of my pt's assesment! Spent the day titrating his O2, drawing stat labs, starting vanc dealing w/ pain and it is not written down. Called the charge and talked to her. Will late entry tomorrow. I was first in my class, a real type "A" and screwed up nursing 101!
Move downstairs to radiation. They are inhouse and do radiation onc for both in and outpatients and are looking for some new nurses as the facility is expanding. Main tasks involve pt and family education, some basic IV fluid rehydration, nursing assesments, and more office style nursing. I worked outpation onc as a student and loved it. Love the pace and continuem of care; seeing pt's and families over time. I am going to shadow for 2 days. Talked to my nurse recruiter (they're awesome!) and they said that past new grads felt that they "lost skills" not being bedside RN's. I am still interested. Thoughts anyone?

Hold it! What happened to your preceptor who's supposed to show you the ropes? I hope they didn't just let you drown by yourself in the stressful environment. The preceptor should show you ways to handle all those patients in an expeditious manner. If for some strange reason you didn't have a preceptor, you need to go to your unit manager and ask for one. You also need to ask for a lighter patient load because as a new grad, you will be slower and it will take you longer to assess, chart, hang IVs, change dressings, decipher orders, and handle needy patients and families. One month is still a litttle soon to make a change especially if you haven't been trained to handle the patient load properly.

You do bring up another unit in your decision. I applaud you for asking to shadow a RN for a couple of days. Perhaps that will give you a better idea whether you would enjoy working there. You can still catch up on "lost bedside skills" if you want. I would also investigate whether the pay rate is the same in that clinic setting. It may be less; does that matter to you?

In the end, your health is the most important. Stress can age you very quickly, so follow your intuition on this one. Good luck!

RNchemo · Sep 1, 2007

Thank you for your post smile123!

Technically I do have a preceptor for the first 3 months, but I am really on my own. Each nurse has 5 patients, which sounded great when I interviewed, but I did not understand the acuity. Community hospitals send us difficult cases, and many people who have been failed by their treatmen come. Anyhow, my "preceptor" gives me three patients and she takes two. Then unless I hunt her down that's pretty much it. A few times throught the day she will say "how are things going?" except she is irritated unless I say things are fine. She sometimes shows me technical things like D/C ing the PCA but is very hands off. Yesterday was my first big dressing change and even though I asked her to come with me, she was busy and said that I could do it. I was in there pulling silver dressing stuff out of a crater going down to the bone, and re-packing it for 45 min.

I'll just see how the shadowing goes and check on the pay issues that you brought up. Thanks again.

smile123 · Sep 3, 2007

Thank you for your post smile123!
Technically I do have a preceptor for the first 3 months, but I am really on my own. Each nurse has 5 patients, which sounded great when I interviewed, but I did not understand the acuity. Community hospitals send us difficult cases, and many people who have been failed by their treatmen come. Anyhow, my "preceptor" gives me three patients and she takes two. Then unless I hunt her down that's pretty much it. A few times throught the day she will say "how are things going?" except she is irritated unless I say things are fine. She sometimes shows me technical things like D/C ing the PCA but is very hands off. Yesterday was my first big dressing change and even though I asked her to come with me, she was busy and said that I could do it. I was in there pulling silver dressing stuff out of a crater going down to the bone, and re-packing it for 45 min.
I'll just see how the shadowing goes and check on the pay issues that you brought up. Thanks again.

Sounds like your preceptor is making you swim a little too quickly. Perhaps you can talk to the unit manager and ask if you can have a new preceptor or if you can see how she manages with 5 patients with you as a shadow, not as the primary RN. Otherwise, you are going to have to be more assertive and ask those hard questions. Remember, this is your orientation time. They need to teach you how to handle a full patient load; if it you don't receive the proper training, you could be very stressed out and overwhelmed (which I gather you are feeling already). Is there a resource nurse you can go to? Or is the charge nurse willing to help you? You need some technical skill support and a caring staff person who will help you through this! Let me know what happens. We care about your well being!