Yep, new grad vent about new job, orientation & staffing. :)

[Nenja]

I graduated in May and got an RN job at an LTACH where I had been working as an aide for just over a year. Thrilled about it, no, but it was the only offer I had and I knew the facility, patients and coworkers. It has always been explained to me as much like an ICU (a lot of the patients are s/p MVA with multiple injuries, respiratory failure with trachs and vents, wound vacs, dialysis...I gather few have a single fully functioning organ in their body).

So here I am exactly 4 weeks into orientation and the DON was ready to put me on my own starting tomorrow. I talked to her about the fact that I haven't had much experience interacting with doctors because my shift is 7p-7a and asked if I could get a few shifts on days with the charge nurse for that, which she agreed to and buys me just one more week of orientation.

My patient load has been 7ish throughout my orientation and for the most part I LOVE my coworkers. These are the same I worked with as an aide and they have been very supportive and helpful. I thought that 7 was a bit much for these types of patients and then I go in this weekend and have 10! Granted, we do have LPNs and they are awesome and do so much...but I cannot just walk into a room and know that something is going wrong with the patient and needs attended to NOW like an experienced nurse because I've never SEEN anything go wrong. They aren't ALL on vents and brain injuries, but I still feel like it is a lot of unstable patients to be responsible for.

The RNs I have been orienting with are great but they know how the unit REALLY works and at this point have pretty much left me on my own and they are for backup because they don't want me to sink my first day on my own. So with our census of 19 this weekend there were 2 RNs actually working the floor plus the RN orienting me. The other RN was agency and didn't know how to do orders so I had to do the entire unit's worth of orders as the NP stayed well past midnight continuing to write them to cover the weekend. Unless they were getting an IV med or their vent alarm went off, I honestly did not see a patient after their assessment at the beginning of the shift.

I then gave report for all 10 patients to a new grad agency RN who has never set foot in an LTACH, touched a PICC, trach, vent, wound vac...day shift had a charge nurse to help, but they had their own work to do too. I just don't understand how they are thinking this is at all safe or acceptable??