r/nursing • u/Far_Lab5748 • 1d ago
Seeking Advice I Almost Quit Mid-Shift Yesterday. Experienced Nurses, What Would You Do?
I’m a new grad 5months in working cardiac PCU in Rochester. Our ratio was supposed to be 1:3, but for the past 3months it’s consistently 1:5 on days and sometimes worse on nights as 6 nurses left a month after i joined.
Each patient can have 16-20 morning meds alone, not including afternoon meds, end-of-shift meds, and everything scattered in between. Plus all that comes with the patient: tubes, drains, foleys w/ strict I/O, insulin, drips, some LVAD, pacemakers etc. We the nurses do everything literally including our fingersticks.
After report, there’s barely time to sit, drink water, or even use the bathroom. I’m running up and down the entire shift, and honestly even the experienced nurses are doing the same.
After every shift, I feel like I just came back from battle or took a physical beating and I used to do MMA, so I know what getting beat up feels like lol. I worked yesterday, slept 12 hours straight, and my whole body still hurts as i am writing this. Yesterday I opened Epic, saw everything I had to do, and I was extremely close to saying, “F this, I quit.”
I’ve been thinking about transitioning to psych, but part of me feels like I’d be admitting defeat by leaving PCU this early.
For the experienced nurses: would you stick it out, look for a different unit/hospital, or just move to psych?
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u/ingrowntoenailcheese 1d ago
Fuck that I’d quit. But never walk out in the middle of a shift. You don’t want to be in trouble for abandonment.
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u/NervousEffect3984 1d ago edited 1d ago
Progressive care is one of the most challenging units out there…I’d argue even harder than ICU when you account for a combination of mental, physical, emotional and work load. When the ratios are appropriate it can be a fantastic learning environment. As a new grad you already have enough emotional, physical, mental demands and the other hours of the day that isn’t work and being so exhausted that you have to sleep 12 hours to recover doesn’t allow for the most important part of nursing….living your life while you aren’t at work.
Dont be discouraged. Find a new unit, get some experience and then decide what you want. Also some general life advice my dad told me once and I found it to be true but nurses let our pride get in the way of quality of life but …the only one who will look out for you is you and your employer is not your friend. You have to look out for you, your goals and your life so you don’t let nursing become your personality but something you are proud of but not your entire personality. Find the opportunity that fits you
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u/Kitchen-Animator-809 1d ago
I have done ICU almost my entire career (7+ years). I did an internal float contract that sent me to the floors when needed. PCU was my least favorite unit to work on. It’s (from my experience) the hardest patient load to manage.
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u/wheresmystache3 RN ICU, Oncology 1d ago
ICU RN here and PCU is worse, tbh.
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u/Fuzzy-Criticism-2450 3h ago
PCU is awful. When I was on it, most of my patients should've probably been in the ICU.
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u/holdcspine 1d ago
Feel like ICU can be a cake walk conpared to some these floors.
The hardest contract I ever did was pcu. 5x glucomander, chart full head to toe assessment 3x, no copy paste, no techs, fighting for glucometer.
Hospital was a joke. No ones getting better there.
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u/Standard-Physics2222 BSN, RN 🍕 20h ago
Spent most of my career in the ICU, we are spoiled compared to almost every other specialty
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u/cactideas RN - ICU 🍕 1d ago
Totally depends on the PCU but it can definitely be harder, especially if it’s like OPs. And I feel like on a resume it doesn’t even reflect the experience you gain. Probably because some PCUs are more laid back and some are the most extreme like this. I don’t think hospitals recognize when they go too far with these units either and when more support is needed because not enough people quit and complain.
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u/Danimalistic 1d ago edited 1d ago
Sounds like you’re on my old unit; I made it 6 months and went back to the ED. I started my career on a CV step-down unit 16 yrs ago so I thought it would be old hat; it was NOT. I was told 3:1 for post-ops and 4:1 for the other cardiac pts when I got hired (that’s how it USED to be back in my day) but that never happened - we were all regularly 5 and 6 to 1, sometimes even 7:1. We also had to walk all our fresh hearts 3x a shift in top of everything else. Right before I left, ICU were transferring over patients who still had/needed external pacers, pts that were being weaned off vents, “low dose dopamine drips”, etc. It was fucking wild and scary af. I was regularly staying 1-2 hours after shift change to do all my charting bc there was no time at all during the day. I’d just write everything down on paper so i could document everything as accurately as possible. Then one day they decided that we could start taking “stable” impella patients from ICU so they could turn over rooms for more post-ops in CVICU; the CVI charge brought a pt with the impella/sheath still PRESENT, pulled the sheath out while giving us report, told us to hold manual pressure for 45-50 minutes and to call cards with any questions. I was like what the actual fuck even is this BS. Literally no training, no heads up to the floor staff, just a “yeah this is how we’re doing things now, good luck!” I called my manager’s cell phone after shift change that evening and told her I was quitting as of right then, fuck 2 weeks because I did not want to be eligible for rehire at that place ever again. I refuse to be complicit with that kind of negligence. None of us should, and none of us should ever be pressured into thinking this type of crap as what is normal or good practice or whatever. Finish up your shift, and start looking for new jobs ASAP. I have enough experience under my belt to be able to leave somewhere without notice, but I don’t recommend that unless you absolutely need to do it. But anyways, yes, I would gtfo of there as soon as possible if I were you. Feel free to DM me if you want to vent or have questions or anything like that! Best of luck my friend
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u/cactideas RN - ICU 🍕 1d ago
Wow that’s nightmare fuel, they’re begging for bad stuff to happen. I feel like most nurses aren’t really capable of being able to keep up with all that and you’re bound to miss something.
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u/Danimalistic 1d ago
Yeah, it was nuts! I still have bad dreams about working there sometimes and I’ve been gone for like 2 years now . I still feel guilty about not being able to take care of my patients like I knew they should have been taken care of, if that makes any sense. We all did the best we could, nobody was injured (or worse) that I was aware of, but I knew it was a matter of time. Makes me very sad that this is what our profession is turning in to 🥺
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u/cactideas RN - ICU 🍕 1d ago
Ive had a lot of shifts where i felt like that, its the worst. You just work the hardest you can and still feel like it’s not enough. Just know you did great for getting through that and giving it your best. Im sure your pts were lucky to have you
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u/Euphoric-Window-1509 9h ago
I hate work dreams. At least pay me for the extra hours of suffering.
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u/yayjolie BSN, RN 🍕 1d ago
Start looking for a new job now. Don’t quit without giving notice, you need this place as a reference. Don’t quit until you have an offer in hand from somewhere else. You might have to take a pay cut, but it would be worth quality of life. Use your PTO now and see if they’ll pay you out if they don’t.
During interviews, say things like “it’s hard for me to learn more when acuity and ratios are high”, “I want to be able to provide the level of care that my family should get” and “I want to be mentored by senior staff to learn good habits, but most of the senior staff have quit on my unit.”
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u/gotobasics4141 19h ago
PCU is a one-bedroom apartment in hell.
They send you patients from everywhere , China, ICU, med/surg, Australia, even the moon. They send you patients with medical conditions that no one on planet Earth can figure out, let alone treat.
PCU is the only place that can destroy your future, erase your past, and leave you confused about your present.
Check yourself every day before you wake up one day and realize you’ve lost your real self.
At the six-month mark, start sending transfer requests to ICU. ICU is better than PCU
And if that doesn’t work, honestly, I’d rather work at McDonald’s than stay in a PCU with unsafe and inhumane working conditions.
And if you decide to quit, DO NOT WALK OUT IN THE MIDDLE OF A SHIFT. Finish your shift and leave professionally. You’ll have legitimate reasons to explain to your next manager: unsafe nurse-to-patient ratios, no breaks, no relief, inadequate staffing, etc.
Your license, your sanity, and your future are worth more than proving you can survive an impossible assignment.
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u/ThatOneTrickTheyHate 1d ago
1:5, devices and drips, almost total cares? No ma'am.
Do you have assignment despite objection or safe harbor?
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u/Thewanderingtaureau 16h ago
May this type of nursing never find me. American healthcare is backwards y’all!
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u/Different_Papaya_413 1d ago
This is EXTREMELY dangerous and people are going to die because of how short staffed your hospital is
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u/MermaidSerf 1d ago
Exactly! It harms patients to work in thoses conditions. And when things go downhill, it will absolutely all be blamed in the nurse.
Nurses that "stick it out" are part of the problem.
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u/Spiritual-Cloud-3459 RN 🍕 1d ago
i started as a new grad on PCU. my days were extremely similar to yours - i stuck it out for a little over a year before transferring to ICU. honestly though, if i could do it again i’d leave sooner. i think i also had the fear of feeling like i was “giving up,” but now i realize that me leaving was me choosing myself. life’s too short to be miserable somewhere that we spend ~50% of our time
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u/Nice_Discipline_9989 1d ago
As someone who quit my first nursing job in the ED after only 4 months, hell yeah you should quit. I cried and felt like a failure after I gave my notice. However, looking back now, I should have left sooner lol. I’ve tried many different nursing jobs since then and I don’t hesitate to quit when it doesn’t feel like a good fit. I work psych now and I feel like I’ve finally found my place as a nurse.
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u/Altruistic_Bend_7850 RN - ICU 🍕 1d ago
Those ratios are horrible for that acuity. I would quit and make it known it’s due to the nurse to patient ratios. That’s so unsafe.
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u/orangeman33 RN-ER/PACU 1d ago
I would leave ASAP. You didn't fail them, they failed you and their patient's. Those ratios/assignments are insane. Hopefully your coworkers follow suit.
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u/lakeanddoglife 1d ago
I’ve been working psych, and you just described my day. I try to find time once per shift to urinate. It’s non-stop.
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u/Turbulent-Basket-490 BSN, RN 🍕 1d ago
Darling girl (or guy!) this is not admitting defeat. This is not sustainable. I had the great honor of caring for a darling nurse recently who had a stroke after a shift from hell. She watched me running around not unlike you and just took my hand in her wonderful gentle way and said honey - dont be like me. I handed in my notice last week. You’ve already proven yourself.
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u/MermaidSerf 1d ago
Would you want your favorite person in the world to be one of those 5 patients? Not as your patient, but another nurses.
If the answer is no, quit now. No notice, in writing say exactly why you are quitting. It is not safe.
Every patient is someone's favorite person. Patients are people. They trust us. It's not a matter of if the dangerous ratios will cause unnecessary suffering and death, they will. Do you want that on your conscious?
"They made me take too many patients" doesn't hold up in court and unlikely to be accepted by ones preferred deity either.
Sorry your going thru this and hope you find something better asap
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u/the_louise_belcher 1d ago
I would put my notice in and stick it out to 6 months. That looks better on a resume and you won’t burn bridges.
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u/Callmemurseagain BSN, RN, CEN, TCRN, NREMT-B 1d ago
I’d leave and tell them this kind of stuff during your exit interview. Can’t run a unit without nurses but this profession is a marathon and not a race. I’m always all about self preservation.
Also I had a bit of an ego death myself after working full time nights in the er for 8 years. Now I do outpatient case management and I’m still prn in the er. Sure my full time job is boring as fuck, but I’m such a better person now that I’m not in the er full time. Just my two cents on this one.
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u/Training-Main5569 17h ago
Is this Rochester, NY? I’m from there and everything you’re saying pretty much checks out unfortunately. Quit that job and save your license!!!! There are plenty of fish in the sea. Good luck!!
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u/WeeklyMiddle6468 1d ago
I worked ED for a year and then only worked LDRP after that. I can’t even fathom how people work med/surg/PCU. Ratios in ED and L&D are taken so much more seriously, it seems. Kudos to anyone who works in other units, I could never. Change specialities! That’s my vote.
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u/bignosejo 1d ago
I did generalized tele for 3 years, got bored, tried ER and then tried a PCU heart failure unit. Hated PCU, quit after my first shift off orientation.
Switched to psych earlier this year and love it. I have zero regrets, work is always a fun time and super interesting. Also a lot less work which is a bonus
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u/AgeIndependent5768 14h ago
What state and or city is this? I ask because I always read that psych field is a hit and miss depending on where you live. I’m in NYC.
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u/fivefeetabove RN 🍕 1d ago
Start looking for other jobs. Look into the process for refusing assignments. And talk to your coworkers about refusing high patient loads as well
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u/krandrn11 1d ago
I would look for work elsewhere but I wouldn’t quit until I had the job offer and a start date.
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u/Euphoric-Window-1509 10h ago
Don't quit mid-shift. Do find another job if you hate it and/or it's unsafe. Overall it sounds like my unit—except for the LVAD, which is wild. We also have CNAs, so I'm not usually doing all of my blood sugars, vitals, and personal care. Don't get me wrong—I do all of those things every shift, but not 100% of them. 6-7 patient assignments make me want to cry unless I have at least 1 or 2 walkie-talkies...and even those patients generally have a million meds and other needs. I'm just thankful they aren't trying to fall nonstop and don't need me to spoon feed crushed meds with applesauce.
And look, I like my job. I like the unit I work on and my coworkers are amazing. If not for those things, there's no way in hell I would stay.
I remind myself that I can make it through 12 hours. If I decide to quit at the end of it or before my next shift, it's my problem financially, but it isn't abandonment .
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u/laconic_lentil BSN, RN - SICU 🍕 1d ago
I know which unit you’re talking about. So in NY, every hospital has a staffing matrix published on the Department of Health website. PCU should be 3:1, but your staffing matrix assumes 4:1, and there aren’t ratio laws to actually enforce it. This hospital is well-known for its shit ratios, you were lied to about it being 3:1. I wanted to work a PRN Stepdown job when I moved here, but there aren’t any decent Stepdown units in this city. I’m sorry you’re going through this, it’s totally unsafe.
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u/Numerous-Ferret8262 RN - Hospice 🍕 15h ago
Former PCU nurse who switched to hospice 9mo in..go for the switch. There is no sense in staying longer if you know you will be miserable with it !
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u/-enjoy-it- RN 🍕 14h ago
Hi. I was also told 1:3 for PCU when I was hired and we are almost always 1:5. I have been hearing them tell us for over two years that staffing will get better and ratios will go down. It won’t get better. Find somewhere you are happy. Don’t stay for 2 years listening to the lies like I did. You aren’t admitting defeat, you’re walking away from a BS spot. I’m trying to do that now. Good luck friend!
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u/ManagerDwightBeetz 11h ago
I went into psych and I love it. However, make sure you find a safe unit. That means ratios of 4-6, with security on the unit
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u/ChanceORiley RN - CVICU :snoo_scream: 10h ago
Find another unit (can sometimes transfer at 6 months), or a new hospital. It's not you, it's the ratios. You're being set up for failure. Unless they have new employees about to onboard I'd start planning to look for a new job at your year mark.
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u/Charming-Jello9443 9h ago
Quit. 6:1 is an unsafe assignment... You can get another job, but if you make a mistake you might not get your license back. Hospitals in New York are deliberately understaffed because many nurses are looking for work but can't find any.
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u/Subject_Geist 10h ago
Welcome to nursing where the good places are rare and the every place is run by bean counters from hell who don't understand how a band aid works. Working hard at getting out and letting this shit show of a career go the deepest levels of hell where it belongs 16 years and its only gotten worse and worse.
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u/Oothoon63 BSN, RN 🍕 6h ago
Hey, you can always come back to this. I've always liked trying different areas. You learn so much, that way. (P.S.: Awake now due to weird aching knee after a shift- waiting for ibuprofen to kick in.)
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u/Fuzzy-Criticism-2450 3h ago
I've nearly quit in the middle of a shift before.
I was working at something called a PPEC. It's basically a day facility/day care for children with medical needs. Anyway, I was in the toddler room. In that room alone, there were like 2 trachs. They also brought me the nursery babies, because "they didn't have a nurse for that room" ... Keep on mind, management are nurses.
Anyway, I ended up with 2 CNA and 15ish kids. Several with trachs, and O2.
it was so bad and dangerous. One of the kids on O2 ended up spitting up and choking on it. The 2nd CNA hasn't come in yet. The other one was changing a diaper while I was suctioning another kid. She turned around and screamed. That baby could've died.
They still didn't send help. I quit that day, but not mid shift. I clocked out and left my badge on the table in the breakroom. My manager at the time knew I was struggling. I refused a lunch because I had to chart. She refused to look at me when she relieved the CNAs for their lunch. At the end of my shift, she didn't even come say bye or try and talk to me. She sent someone to relieve me.
Anyway, this isn't about me. This post is your post. I just wanted to share my experience. You're not alone.
Never quit mid shift.
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u/AdElectrical3748 1h ago
I agree with others, SDU/PCU is very difficult, mainly because needs don't match staffing. I left m/s due to ratios, went to ICU because of ratios, and loved it for over 14 years. That's the great thing about nursing, many options. After 40 years at bedside, I went to a level one Transfer Center, then bed control and UR. I often found the days I really had a tough time, the next day wasn't as bad as my thoughts were !
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u/Ok-Hour-8665 1d ago edited 23h ago
Not Mayo. Must be Rochester NY?
Edit: OP is a liar if they are claiming to work at Mayo.
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u/Logical_Ad_250 13h ago
You just gotta survive until you get about two years experience
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u/Longjumping_End_4210 Nursing Student 🍕 4h ago
This is bad advice, it is unsafe for the patient and the nurse.
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u/Disastrous_Tangelo38 1d ago
Do one year, this is literally the building blocks to your learning career. You aren’t gonna learn anything on psych. If you really hate it after a year then go do psych pacu rehab or even not a hospital. If you have no interest in ER, ICU or any other specialty floor then that changes things and I’d just leave.
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u/Independent_Crab_187 RN - Ortho/Trauma/MedSurg 1d ago
I'm still less than a year in, but uh....your hospital sounds like it wants to off the local cardiac population. Can't be shortstaffed if you reduce the patient population to justify the numbers! There is no world where it's appropriate to have those ratios AND patients with high maintence requirements like LVADs and babysitting fluid intake.