Critical Admissions every night :(

Specialties Agency

Published

When I was a charge/staff person, it was unusual for me to give agency new unstable admits and generally avoided assigning critical patients to the agency staff altogether...choosing to give them the more stable group. I understood they didn't know the ins and outs, the docs, which docs like to manage their own vents, who partners with who, which ones want ABG's B4 ya call them about SOB, yada yada. All those little intricacies that come up with the unstable ones.

One facility is wearing me out...every night I have a problem patient AND the admit, while their staff sits. Their charge takes a full load and tends not to be helpful. I feel a passive aggressive component is at play. They only 'half answer' my specific questions, avoid me, don't offer assistance, then correct me later because something wasn't 'right' altho there is no written policy I could see..It is making me uncomfortable and pizzing me off...I'm feeling dumped on.

Anybody been here...if so how have you handled it? I am considering telling my agency to tell the unit director I will refuse ICU admissions from now on...but I realize it may sound like an ultimatum and I may get DNR'd (maybe I wouldn't mind...these dump-on-agency admits are really getting to me)

Any suggestions on how to handle this???

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Specializes in Interventional Pain Mgmt NP; Prior ICU and L/D RN.

sorry to hear that your assignment isn't going so well...I normally always enjoyed the travelers I've worked with. (to be honest..a few were not that good)..but overall they've been terrific. Have you tried to be direct and ask them? Although I know that that would probably turn into you don't want to work sorta "stuff". Maybe talk with the manager. When I was in charge on another floor I always attempted to "be nice" to the travelers when giving assignments, but then again I did also at the same time expect them to pull their weight.

On a good note....at least you do have an end to your contract:)

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Their charge takes a full load and tends not to be helpful. I feel a passive aggressive component is at play. They only 'half answer' my specific questions, avoid me, don't offer assistance, then correct me later because something wasn't 'right' altho there is no written policy I could see..It is making me uncomfortable and pizzing me off...I'm feeling dumped on.

Anybody been here...if so how have you handled it? I am considering telling my agency to tell the unit director I will refuse ICU admissions from now on...but I realize it may sound like an ultimatum and I may get DNR'd (maybe I wouldn't mind...these dump-on-agency admits are really getting to me)

Any suggestions on how to handle this???

Makes you wonder why they might need to be using agency nurses, eh? Definitely sounds like a high level of resentment. Poor patients!

It's not good for the patients and not good for you. I don't have a better idea than the one you suggested, but I wanted to hear what others think, and offer you my (essentially useless) sympathy.

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Nothing useful to suggest.

Can you take some time off? Maybe they'd appreciate you more when you came back.

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Appreciate the empathy guys...sorry to whine...guess as I age this game is getting harder to play. I notice the staff either dumps on me or another agency nurse...so its common practice at 'this' facility. I'm unlikely to change the culture but I will try. I plan to make pointed comments to both shifts of charge nurses next day I work and take things from there.

and Cannoli, great suggestion...I'm taking a mental health day and calling in sick tonite. At least I'm off til Friday. Yeehah. ;)

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Specializes in NICU, PICU,IVT,PedM/S.

In my old NICU unit it was different. The travelers, agency and even the per diem get frustrated because the get the feeder growers!

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In my old NICU unit it was different. The travelers, agency and even the per diem get frustrated because the get the feeder growers!

I have floated to NICU and have enjoyed it, because the staff there did NOT dump on me! I learned a lot, and enjoyed taking care of the feeder growers immensely...probly cuz I'm NOT an NICU nurse, eh? ;) Hey maybe I should retrain to newborn nursery....love those babies! :)

I've been venting a lot lately here and suspect my 'nursing diagnoses' is "alteration in coping due to burnout" and I need to reevaluate my goals. I am angry everyday now and realize this is not such a good thing. :o

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Specializes in Hospice and palliative care.

Mattsmom

In addition to possibly "retooling" as a newborn nursery RN, could you go to another facility? I don't know how many places you go to and if you're treated the same way somewhere else. If so, forget what I just said :chair: However, if there are one or two places that you really like, I would stick with going there exclusively, as much as you can. Good luck

Laurie, MSN, CRNP

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Hi MattsMom:

I hope your week is going better by this point.

I like all the suggestions, not to burn your bridges, and changing an environment is quite impossible when it took years to get so messed up.

Hugs...

night

Staff Member

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You guys are great...thanks for the encouragement!

Update: the gang got pizzy when I set limits so I was forced to a decision. I drafted a letter to the unit manager with my concerns from a patient care standpoint, so she would know what was going on. I CC'd to my agency that I'm too uncomfortable to work further at this facility...(it was a perdiem thing not a contract.) Plus its a 100 mile round trip drive so I'm not going to miss much except the $$$ which was good.

And yes, I am working at several other ICUs in the area and having better experiences...not many facilities dump quite so badly on agency as this one did and I realize now that it was really getting me down excessively.

Still looking at options for the future: thinking acute dialysis vs nursery vs? Nice to have options, eh? Sometimes a change does us good. ;)

Part of me feels like a failure cuz I wasn't able to work things out with the staff...usually I am very good about working well with other critical care nurses. But this was an unusual cliqueish place, the nurses were a little different breed...oh well we can't win 'em all.

Perhaps I worked there too often and they got TOO comfortable with me...I'll have to watch that I guess...LOL!!

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Thanks for the update MattsMom.

I am glad you have other options... I wish I had more in this sleepy area of Co.

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Options are great aren't they.....ever consider a travel assignment Nightngale...lots of available jobs elsewhere. I'm considering this myself.

Suspect I will just have to verrrry specific in my contract to avoid any dumping. I will NOT be 'slave labor' for facilities. :(

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