So I’ve been on my own for a month now. A few things I’ve come to realize:
1. I love my job.
2. Yes there is a nursing shortage.
3. I have great organizational skills and time management skills.
4. I need to say no.
Let me explain.
1. I really do love my job. Being able to teach people, talk to them, change a dressing or two, it’s great. My paychecks are wonderful! Better than I had planned. I love only working 3 days a week. I really do love it.
2. Let’s skip this, I’ll hit this one on number 4.
3. I’ve always been this way. One of my first jobs was a waitress at Shari’s, which is like an IHOP. We would have 7-12 table sections, do our own drinks, taking orders, salads, service, etc, and even bussing/cleaning our own table, and many times seating our own guests. I was really good at it. I’ve worked as a server and a bartender for many years and am really good at it! As a manager, I’d be able to to the money count, inventory count, or whatever much faster than others, because I was more organized. Now that has carried over to my Nursing job, which is really helpful when you have 15 patients. Sigh, number 4.
4. Most of our hospital is team nursing, meaning 1 RN, 1 LPN, and 1 PCT (CNA) take care of a group of 10 (sometimes 15) patients. It works ok, if you have a good and helpful team, and if the other team is also helpful. One floor does primary nursing, which during the day time they have 5 RNs and 1 LPNs (making 5 patients each) and a charge nurse, and at night it’s 4 RNs, 1 LPN, (6 patients each)and a charge. The charge nurse opens the charts for the LPNs. Meaning, they do the assessment and documentation for the first of the shift. Any other thing that needs to be documented can be done by the LPN. Of course ER and ICU are all their own entities, so I’m including those units here.
In the last month we have lost our travel nurses. I believe there is one left on the cardiac unit. The hospital spent so much money on them, they decided not to renew their contracts. One bad thing about them, is that most of them live within an hour or two drive and still get paid travel nurse wages. Well, being in a rural area, most of our nurses travel to get to work anyhow. So many of them have signed up with travel companies, and we have lost nurses.
So one night, I was put on the primary care unit, and made charge nurse. Ok, fine. But due to a shortage of nurses, staffing pieced a staff together. Which meant there were 2 LPNs, 1 experienced RN, and 2 new RNs (one of which graduated with me). Ok, fine. So I had to chart on 12 patients, plus deal with any other issues. Ok, fine. But I had to do it all by 11 P.M. when I would be moved to the oncology floor. Ok, fine. I managed to chart on 11, helping a newer LPN with some skills she hadn’t done yet, calling the doctor for the new grad, among other things. At 11, I went upstairs and received 15 new patients. The nurse leaving had charted on 5 of them. One room was empty, and two patients were new and needed to be admitted. That left 7 patients to see. This is where I began to think it’s crazy. Thankfully, another nurse (the 3pm to 11pm charge) stayed until 2 am admitting the two new patients. I had another who was really ill, and had to have his bed changed every 30-45 minutes (not to mention he was in isolation), and be given three units of platelets and some chemo. Thankfully I did not have any blood to give. I ended up seeing my last patient at 6am, right before shift change. Crazy! I also had to draw the morning lab and get two patients ready for surgery. Thankfully I had a good LPN and PCT, who were experienced and knew how to get a job done.
Good ol’ hindsight says I should’ve said no. It’s my license to protect. My job line. My family’s income. I am not superwoman, and I need to say no.
Oh, the week before the night above, I worked on the senior behavioral health unit. I’ve worked there many times and a PCT, but never a RN. The paper work is COMPLETELY different, including the three times more paper admission packet. So two weeks out of orientation, I was sent to the pysch unit. No problemo. Except that I had three new admits. UGH. Now in this unit, there are 14 patients, 1 RN, 1 LPN, and 2 PCTs. Great. So the day RN stayed and did one admission, leaving me two. I managed to get them 90% complete. Again, thankfully my team was experieced and worked on that unit, so I didn’t have to follow up on them very much. The day after the charge nurse/oncology floor experience, I was put back on the psych unit (no, not as a patient), again, with 3 admits.
This past week, I worked on the pysch unit (again). Except, now they opened 4 more beds. 18 patients, TWO RNs, ONE LPN, and 2 PCTs. IMO, still not enough staff. These patients have schizoprenic disorders, depression, combative agression, dementia, etc, etc, etc. So after a rough start, and somewhat quiet middle, around 4 am, the most ambulatory patient on the unit fell and broke her hip. Of course she was my patient. Nice. I had to call doctors, the house supervisor, get her transferred to the med/surg floor. What a mess. Now, I’m not saying that wouldn’t happen with more nurses, but I do think that once again, I should have said no. NO, NO, NO!
I’m learning, I do love it, we’ll see what the next three nights have in store for me!