Fifth day and very disillusioned. Please help.

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Reply Thu 13 Jul, 2006 03:32 am
Fifth day and very disillusioned. Please help.
Okay, so I started at a great hospital end of June, a month after graduation. I am working on a Progressive Critical Care floor for which the orientation is six months. I had only my fifth clinical day with a preceptor yesterday. She had 3 patients on Cardizem drips, and the fourth was high acuity as well. I took one of the patients on the drip. She had NO time to teach me a thing. I was left pretty much on my own. I worked 12 hours with one half hour break the day before and this day was going to be no different. My patient took ALL my time and without the critical care course, I felt extremely inadequate to be taking care of her at all. After I got home, I realized that I forgot things. My preceptor was almost crying all day, and I know if I wasn't there she would NOT have been able to get her work done at all. We turned over our four patient's to one nurse at 3pm and that nurse rec'd ANOTHER patient as well, along with a new admission. Ratio is supposed to be 4:1, but this scared the crap out of me. How, on earth, do nurses get this stuff done and work with no breaks every day? You are told you MUST take your break, should NOT work OT, but you get more work than you can handle. I am NOT supposed to be over my Honeymoon stage yet, am I? Any help on this at all?
Susan Turner
Reply Thu 13 Jul, 2006 07:43 pm
Well I am from Tuscaloosa, Alabama. I am currently in school to get my BSN, I have worked as a RN for 11 years. The reason why I am on here is because my assignment ask for us to talk with a nursing college about a issue that we are experiencing in a practicum setting. Mine is staffing. I am doing my practicum at the local health department and of coiurse the state will not hire very many people, not that staffing isn't a issue all over this state as well as others. Can anyone respond to my email about their issue their facing is means of staffing? Where arer you from? WHere do you practice? What is your name? We have to have these details. Also what is your facility doing about the staffing issues, and are they working?
Susan Turner
Reply Fri 14 Jul, 2006 01:07 pm
Everything you are going through is normal, do not let anyone tell you , any different. Being a new nurse is probably the most stressful time in ones career. It's important to let your supervisor know how difficult the situation is-it is not that you are not competent. You are as competent as you need to be at this point. When nurses are not proactive, the situation gets worse. You may not want to continue working where you are-at least give it six months, though, and know that there are other positions you may like better. Hospital nursing is HARD. It is a JOB. It is not your life. Treat yourself well, get rest, exercise, massages, whatever it takes for you to get through the day. Very Happy
Reply Fri 14 Jul, 2006 06:07 pm
Thanks for taking the time to answer. I am under a lot of stress this week cuz tomorrow is the big one, too...hahahaha I'll stick with everything, but WILL let my supervisor know of the issues.
Reply Sun 16 Jul, 2006 10:02 am
Hi Susan,

I am also from Alabama (Gardendale), although I live in Florida now. I have several friends who graduated from U of A! Roll Tide!) I work pool at an HMO now, but when I graduated from school I went straight to an ICU. At the time the pt/rn ratio was 1:1, at most 2 pts. That is THE main reason I went to that unit. We were a catch all unit, we had trauma, med/surg and some overflow neuro and cardiac pts. At the time, I thought two critical care patients was more than I would EVER be able to handle. I can't imagine 3 or 4 at a time. I worked nights (like I had a choice as a new grad) but I felt I learned more and in a more quiet setting. However, we had 6 weeks of orientation on days and I cried every morning before went to work. I stuck it out and after a year or so I felt like I knew what I was doing.

I feel like my CC experience helped prepare me for the job I do now. When I was working in the hospital setting I didn't see office nurses as "real" nurses, boy was I wrong! I learned to multitask in the hospital which is now ALL I do.

My advice is to research the job before you take it. If you can find someone who works where you plan to, talk to them, pick their brain. I remember how staffing was the single most important thing to nurses, while the almighty dollar is the most important to the hospital (and I bet that hasn't changed). The job that offers that big bonus may sound wonderful on paper but it may not always be best for you.
peaches 1
Reply Sun 23 Jul, 2006 09:58 pm
PCC Nurse.
Hey, PCC Nurse, welcome to nursing. The REAL world of nursing, that is. I have never worked at any hospital where I actually got to take a lunch break, or any break at all. Nobody relieves you, trust me. You have already been thru nursing school, so why do you expect another nurse to tell you how to manage your patient? Pick up your books, look up cardizem (and atrial-fib, rapid heart rates, etc.) and learn about them. Learn your cardiac drugs, rhythms, etc., and you will not need to depend on anyone else. Knowledge is power. If you are not willing to put in the effort it will take to be a real nurse, you can always change units to something less intimidating. I am not trying to be mean, but this is your learning experience and you need to take advantage of it. I never got any orientation anywhere I have worked; you are usually thrown out there to sink or swim. You are very lucky to have six months.
Reply Tue 25 Jul, 2006 12:24 pm
nurses not taking breaks all day? "ridiculous" Maybe they need to work on their organization. I certainly don't want a nurse to take care of me if they can't find the time to take a break. Maybe you need a new precptor.
peaches 1
Reply Thu 17 Aug, 2006 01:27 pm
breaks- answer to malenurseusa.
The problem is not organization. The problem is that there is nobody to relieve you so you can go to the cafeteria or breakroom to eat. I will have 7 or 8 patients, and they are all very busy. If I take a lunch break, who is watching my patients? We also have a lot of telemetry patients on our floor, and an RN has to watch the monitors in addition to her own load of 7 or 8 patients. We don't have a monitor tech, and none of the secretaries they hire can ever read a monitor. If I leave the floor, there is nobody to take my place. I usually work ICU, and it is the same scenario-- it will be JUST ME, by myself, with two or three ICU patients. Usually at least two will be on a vent. No secretary, no nursing assistant. Just me. And there is no one to come to the unit to stay while I take a break. Organization skills don't help here! I have been a nurse for many years, and can do my job blindfolded, but if there is no one to watch my patients for me, I can't leave the floor or unit, period.
Reply Fri 18 Aug, 2006 05:52 am
Get out the policy and procedure book. You know, the 6 inch thick book collecting dust, the one nobody ever reads, Educate yourself on exactly what the policies are regarding lunches and breaks. Make copies of the ones pertaining to your situation and show them to your head nurse, charge nurse, supervisor, or hospital administator. That shouldn't be tolerated.
Reply Tue 19 Sep, 2006 08:38 pm
As a preceptor myself I see many things wrong with what you said. The biggest issue being that if you are truly in an orientation setting that is what you need to be doing, orientating, not flying by the seat of your pants. Your preceptor should have taken charge of the situation and realized that it was more than you can handle. This alone could have made you whole preception of nursing different. It is sad that the charge nurse of nurse manager of your floor lets this kinda thing happen you have the next 50 years to bust you butt and be overwhelmed, but every nurse should get the opportunity to learn in a low to moderate stress level situation. It makes me realize how lucky that I am to work where i work....................Quinn
SharpknifeRN 1
Reply Sat 23 Sep, 2006 10:29 am
Hi, I too don't see anything unusual here. As I remmember it, I was flying by the seat of my pants too by day 5. Don't let cardizem flip you out. As cardiac drips go it is the easiest one to work with. It is for new onset afib and mostly for rapid heart rates. Biggest thing is maintaing a working IV site. Beyond that
you are watching to see the heart rate does not go below 60. Most doc"s have it weened at HR below 90 and switch to oral meds. Your monitor tech should call you and let you know when you have someting to worry about, or you could watch it your self. In seven years I have never seen cardizem drop anyone suddenly in HR. I don't think it happens. After the first IV boulus I never heard of anyone having another bolus. Just maintain the drip. It is not chemo. It does not mess up vains. People don't go blind. You can't poison your self by handling the bag. It is not light sensitive. Every pt I have ever seen with it reacted slowly, you are going to have a long lead time to realize that you might need to turn it off. Ods are someone else is going to make that decision for you like the doctor. The weaning process is easy. If the rate is 10
( I never saw one higher, might happen somewhere) cut it to 5. Let it run 2 hours at least. See what happens with the rate and rhythm. If all goes well and you want to do really good, then cut it to 2.5. Wait another 2 hours and shut it off. Flush your IV site. Keep watching the rate and rhythm. Make certain to give your oral cartizem as ordered on time. Usually first dose at least 2 hours prior to shutdown of the drip. Most people can just have it shut off at 5cc hr. Don't be supprised if they go back up in rate or back into afib. Record your strips. Don't be alarmed by anything under 100 in HR. Don't be alarmed at all. CALL THE DOCTOR WHEN YOU NEED TO. Don't worry about what they think of why you called that is not your job. No one is going to yell at you for calling the doctor. If they do their an idiot. Don't let anyone tell you that having a drip makes a pt high accuity. It can, mean they are high accuity but with in its self it is nothing. I am going to give you a little secret to time management. Just listen and put it away it will take you a long while to process what I am about to say, and some nurses never get it. It isn't zin but it pretty close. "The longer time you spend in a pt's room, the more time you are going to be in that pt's room. " This doesn't mean race, it means be ready and maintain an air of I have other pts and other things to do. It also means being ready to do everything u need too, having the things you need and looking like you know what you are doing even if you don't. Master this and you will do well. You will get your lunch time. And no, if you are doing your job, you won't get a lot of other breaks. Normal work load for me is 5-8 pt's. Every one does a little over time. Meaning like half hour 45 min. every day. If they tell you different, you need to find somewhere else to work. I have been doing this for years, I also come in 30 min early. Reguardless of weather I am in charge that day. No one has questioned it in 7 years. Now you go over that and they probably will, but the time is well spent. Make yourself a cover sheet. Little boxes or something with all your pt's names and med times, with rhythms and vitals on one peice of paper so you know where you need to be when, x off the meds as you give them so you know what you have done. You will be fine. Relax.
Reply Wed 27 Sep, 2006 07:30 am
Stand up!
Being on the floor only 5 days without a critical care course and having sole resposibility for a patient you really don't know how to take care of is ridiculous. It not only jeopardizes the license you worked so hard to get but the health and life of the patient you're taking care of! First, stand up for yourself because no one else will. Talk to the nurse manager and see what she can do about the situation. If she doesn't do anything chances are higher management won't either. You can report it to the Board of Nursing or the State Health Department or even JCHAHO if you think its bad enough. Be an advocate for your patients and yourself not a doormat.
SharpknifeRN 1
Reply Thu 28 Sep, 2006 02:30 pm
Hi again, I was wrong about the top rate on Cardizem, apparently it can go to 20. I have never seen it used that hi, but I guess the person I ask knows what they are talking about. Question Now a word of caution. Everyone I ever knew who called the board of nursing, JACHO, ACCA, or the fire marshall lost their job an is still unemployed as far as I know. You can get black balled for this if they guess or find out who did it. Don't believe it, ask around quietly that is the story as I saw it four times now in seven years, two differnt places. As for there being something wrong with placing people in Critical Care with out having taken the coure, sorry to burst your bubble, but it goes on all the time.
I am in a critical care course now with two people from where I work, neither has had it before and they have been working the unit for more than six months. Some of the nurses that have been there for years have never had it. Education is great, it is not the end all, it does not solve all problems, acctually I have seen it aggravate a few. As I said before a drip does not a critical care pt make, at least not that one. What else makes these pts so difficult? I have orientated lots of people and the weaning process generally does begin pretty early. How many pts did you think you should have recieved? If this person was a walkie, talkie, that just had a cardizem drip, she was really being mercyfull to you. If they had lots of other problems, then it is a different story. Some peple dump on trainees. They have a sink or swim mentality. I think this generally distroys new people. But, generally you could be expected to take half of the preceptors load in a short amount of time. Then all of it. After all, you will soon have to take them with out any real help or guidence on your own. Now is the time for them to find out if you are going to be able to do this, or if they are going to have to get someone else. Very few places, I have seen every acctually allowed someone to finish 6 months of orientation, under a preceptor. Generally this means that they orientate 6 weeks, if you are lucky, and allow you small mistakes for six months. Sad Learn all you can in this time they have given you. Mostly work on your time organizational skills. Remember what I said, the longer you are in a pts room, the longer you will be in that pts room. Idea Good luck.
Reply Wed 4 Oct, 2006 06:24 pm
malenurseusa wrote:
nurses not taking breaks all day? "ridiculous" Maybe they need to work on their organization. I certainly don't want a nurse to take care of me if they can't find the time to take a break. Maybe you need a new precptor.

I will agree with what the others have to say. Many times if you are working with less experienced nurses or if you are the only RN that shift the other nurses just are not able to watch your patients long enough for you to leave the floor for a few minutes. I have given up on having another person cover my patients. I always bring my lunch and take care of all my patient's needs before taking a quick lunch break. This way I always manage to get a good uninterrupted 20 minute lunch break. :wink:

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