Is this the norm or unfair? thoughts and opinions needed!!

  1. 0
    place: cardiac icu

    scenario:
    bob is working an 8 hr shift and has two patients. one pt is expected to transfer to stepdown unit. the charge nurse tameka just learned that an patient must be placed in their unit from the or. a bed is needed. there are 2 other nurses in the unit, sherry and sandy that have one patient. sherry has had one patient all morning and she is working a 12hr shift. sherry and sandra both have an open bedspaces that are clean and ready to receive a pt from the or.

    two hours before bob's end of shift:
    the charge nurse tameka asks bob how soon can he get his patients up. the nurse informs tameka that he has to give iv meds, recheck labs, awaiting floor orders, pull lines, etc so no, not ready. tameka sighs under her breath and walks away.

    1 1/2 hours before end of shift:
    charge nurse tameka asks bob if he can get his patient out. bob stated that he called report and is in the process of preparing his patient for transport. he states that his patient will be ready to leave in about 10-15 minutes. tameka says, "good" you have a case called from the or. you have 30 minutes.

    60 minutes before end of shift:
    15 minutes has past and bob's patient is discharged from the unit, leaving 15 minutes for bob to set up the bedspace (getting supplies, setting kvo pump) all the while while briefly tending to the needs of his other patient. the cleaning crew also spend those same 15 minute disinfecting the bedspace (bed, pillows, pumps, taking out trash, mop floor etc).

    45 minutes before end of shift:

    the floor has just dried and the case is on its way from the or. bob receives the case. three nurses including tameka and sherry assists bob with getting report and getting patient settled into the bedspace. bob tends to patient needs, getting pt hemodynamically stable and addressing pain issues, retrieving meds, reviewing new icu orders, sending labs, and talking to family members.

    bob notices that as he is doing his work, the charge rn tameka, sherry and sandy are all gossiping and laughing at the nursing station.

    5 minutes before end of shift:
    bob is unprepared but gives report to the oncoming nurse. the oncoming nurse is rushed to complete a lot of task for the new patient in addition to tending to the 2nd patient. bob spends and extra 20 minutes past his shift (10 minutes till next hour) finishing up his work (signing off meds, charting, shift i&o's).


    what are your thoughts and opinions on this scenario?
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  3. 18 Comments so far...

  4. 0
    i would say if this is happening a lot then i would ask the charge if so and so could take this patient for continuity of care as i will be ending my shift soon ect...and see what she says. if this is just an occasional occurrence then i would grin and bear it. most charge nurses try to make things a s even as possible and sometimes they have other reasons for keeping certain nurses open for admits. hope this helps. heather
  5. 13
    Bob got hosed.
  6. 0
    Quote from hherrn
    Bob got hosed.
    Ok. How would you have handled the situation?
  7. 2
    Bob has the right to inquire as to why he is getting this new pt. when it seems clear that there are other nurses who are available/underassigned and more capable of being able to accept this pt. My question is what are the accuities of the other two nurses pts. Are they one on one pts? Are the other two nurses trained to take this level of OR pt.? Did Bob state any objection, now or previously, or is Bob such a nice guy he doesn't stand up for himself? I would have delegated a few things such as: asked for someone else to transfer my pt. ( pack him up, take him out, get meds ready...whatever) and ask someone else to get my meds or do accucheks for my remaining pt or whatever else i could have delegated to ensure that i stood up for myself and let Tameka know that she can't bowl me over. In the future, Bob should professionally state his opinion and delegate his needs thru his charge nurse.
    Last edit by nrsgnerd on Dec 21, '09 : Reason: Forgot a key thought
    Super_RN and tamnurse2 like this.
  8. 0
    Quote from nrsgnerd
    Bob has the right to inquire as to why he is getting this new pt. when it seems clear that there are other nurses who are available/underassigned and more capable of being able to accept this pt. My question is what are the accuities of the other two nurses pts. Are they one on one pts? Are the other two nurses trained to take this level of OR pt.? Did Bob state any objection, now or previously, or is Bob such a nice guy he doesn't stand up for himself? I would have delegated a few things such as: asked for someone else to transfer my pt. ( pack him up, take him out, get meds ready...whatever) and ask someone else to get my meds or do accucheks for my remaining pt or whatever else i could have delegated to ensure that i stood up for myself and let Tameka know that she can't bowl me over. In the future, Bob should professionally state his opinion and delegate his needs thru his charge nurse.
    Just think about it. If your patient has high acuity would you be gossiping at the nursing station or would you be at the bedside?

    In this scenario, Bob has been a nurse for about 6 months and his patient was 1st day post op and was extubated during night shift. The other two nurses have been ICU RN's for >5 years. Bob did have a nurse tech available who did get the patient packed up (pulled artline, ASSIST with transferring pt from bed to wheelchair, assemble chart and personal belongings) once she was available to do so.

    Anyways, In my unit we rarely do accuchecks when patients have art lines (why stick fingers when we have an artline?). When we draw blood we check respiratory status, potassium, magnesium, lactic acid as well as blood glucose. Only ppl that get accuchecks in our unit are basically long termers (more than 3 days in our unit) of course because we try to convert from IV meds to PO (oral/corpak).

    We have CT's in our unit but there is one or two for 6-8 nurses and they are all over the place. It's unrealistic to think they will be around waiting for one RN hand and foot. CT's can pull central lines, they can't interpret labs, they cant chart for RN's in the ICU, they can't pull or hang meds, they can't assess, they can't call report. So there is so much that they can do WHEN THEY ARE AVAILABLE TO DO SO. If they are not available the RN has to make it happen.

    I just want to know from a professional standpoint how to handle this should it happen to me. In this culture where Nurses "eat their young" I could easily be subjected to this. But just knowing how I am, I don't want to make my work environment hostile. That is what tends to happen when you question authority.

    Now as far as asking those other nurses to help (draw/hang meds), if they are sitting around gossiping at the nurses station do you think they would be willing to help you if you ask? I mean the whole gist of this scenario is about them putting off work so that they won't have to do it.....
  9. 0
    Quote from midnite688
    i would say if this is happening a lot then i would ask the charge if so and so could take this patient for continuity of care as i will be ending my shift soon ect...and see what she says. if this is just an occasional occurrence then i would grin and bear it. most charge nurses try to make things a s even as possible and sometimes they have other reasons for keeping certain nurses open for admits. hope this helps. heather

    thanks for your input. thank you all.
  10. 0
    Woah woah woah! Im on your side here. Lets remember there is more than one way to skin a cat. For instance, we just draw blood from the art line and do our own accucheks....we don't wait on lab results that can take forever in our hospital and its not common practice for us to do stat glucose unless the accuchek reads "high or low"
    Next, if you don't ask people for help then you can't say that they wont help you. Maybe nurses are on their own (as it sounds from your post) just because no one has taken the iniative to point out that teamwork makes for a better work environment.
    Since you are a new nurse, be a brave new nurse, don't be afraid to go against the grain. Its how you handle yourself now that will cause the nurses to either respect you or "eat you". But fear, thats only reinforcing them and giving them power to eat their young.
    As long as you are respectful and reasonable with asking for help then there is no reason for the work environment to be hostile. and if someone is hostile with you, let them know about it in a firm and reasonable way.
    However, if this environment is making you nuts then perhaps you should do your time to get your experience in and find an easier enviroment to work in.

    If it were me, I'd try to cling to other nurses that did show teamwork and talk to them about maybe starting a committee that promotes teamwork. Talk to your manager about bringing it up at the next employee meeting and see who wants on board. Make a bulletin with little rules of courtesy such as: No one sits down until everyone can sit down and things like that. You can google to find some good sayings. Adn to those that are resistant or don't seem enthused aobut it, kill em with kindness...go out of your way to show them that teamwork makes the environment better. Just make sure that your manager is enthusiastic about this because if she/he isn't then the older nurses may buck you all the way....I wouldn't waste my time unless i knew the manager would help me to reinforce this because she/he believes in it to be important.

    I once pulled a nurse into an empty room because she was rude and embarrassed me in front of patient. I told her, "Look, I will give everyone here my respect all day long but if you disrespect me then I will stand up for myself. I don't allow anyone in my life, personal or otherwise to speak to me like i am less than who i am so I am giving you the chance to not treat me that way again but if you do then I will get management involved." She immediately appologized and said she was having a bad day and didn't mean to come across that way. We have never had another problem and I learned alot from her. So see, there is a way to get your point across without creating havoc. Just hang in there and do what you can to make it a better place to work, for you and most especially for patient care.
  11. 0
    There should be no problem saying "I notice Sue doesn't have any patients, could she take the admit?" or if someone is sitting while you're running, "Hey, sue, could you hang this antibiotic for me?" Keep asking for help, and they may have a good explanation for their decisions. If they don't you should talk to the charge privately, and then the NM.

    Bottom line is that if you are with a group that doesn't work as a team that's a good spot to move on from, no matter how assertive or professional you are.
  12. 0
    Quote from nrsgnerd
    Woah woah woah! Im on your side here. Lets remember there is more than one way to skin a cat. For instance, we just draw blood from the art line and do our own accucheks....we don't wait on lab results that can take forever in our hospital and its not common practice for us to do stat glucose unless the accuchek reads "high or low"
    Next, if you don't ask people for help then you can't say that they wont help you. Maybe nurses are on their own (as it sounds from your post) just because no one has taken the iniative to point out that teamwork makes for a better work environment.
    Since you are a new nurse, be a brave new nurse, don't be afraid to go against the grain. Its how you handle yourself now that will cause the nurses to either respect you or "eat you". But fear, thats only reinforcing them and giving them power to eat their young.
    As long as you are respectful and reasonable with asking for help then there is no reason for the work environment to be hostile. and if someone is hostile with you, let them know about it in a firm and reasonable way.
    However, if this environment is making you nuts then perhaps you should do your time to get your experience in and find an easier enviroment to work in.

    If it were me, I'd try to cling to other nurses that did show teamwork and talk to them about maybe starting a committee that promotes teamwork. Talk to your manager about bringing it up at the next employee meeting and see who wants on board. Make a bulletin with little rules of courtesy such as: No one sits down until everyone can sit down and things like that. You can google to find some good sayings. Adn to those that are resistant or don't seem enthused aobut it, kill em with kindness...go out of your way to show them that teamwork makes the environment better. Just make sure that your manager is enthusiastic about this because if she/he isn't then the older nurses may buck you all the way....I wouldn't waste my time unless i knew the manager would help me to reinforce this because she/he believes in it to be important.

    I once pulled a nurse into an empty room because she was rude and embarrassed me in front of patient. I told her, "Look, I will give everyone here my respect all day long but if you disrespect me then I will stand up for myself. I don't allow anyone in my life, personal or otherwise to speak to me like i am less than who i am so I am giving you the chance to not treat me that way again but if you do then I will get management involved." She immediately appologized and said she was having a bad day and didn't mean to come across that way. We have never had another problem and I learned alot from her. So see, there is a way to get your point across without creating havoc. Just hang in there and do what you can to make it a better place to work, for you and most especially for patient care.
    Whoa? I wasn't offended by what you said. But the first question I ask is just realistic. I doubt that any nurse would gather around the nursing station if the acuity was high.

    In out unit we get ABG's back in 5 to 10 minutes so the results doesn't take forever. As I stated before blood glucose is not the only reason we draw from the artline. I don't know how your workplace is but we only do accuchecks if they are standing orders by the LIP or if it is emergent and that is the ONLY test we need to obtain.

    The scenario I provided is something that is commonly done in our unit by certain nurses left in "Charge". I have yet to face such a situation. The nurse that it happens to are usually new nurses. Myself and these other new nurses are afraid of retaliation by these senior nurses who are left in charge to make assignments, choose who floats etc. It's a touchy subject. We didn't want to whine to management unless is something significant of course which is what led me to post the scenario. I wanted to see what other nurses thought of it and provide some professional advice in what one would do in that scenario.

    So from what you are saying we should:

    1. Ask for help
    2. Start a committee promoting teamwork
    3. Involve management if people are resistant to teamwork?

    By the way, I love my job. I like my unit, the fast paced environment and the people I work with. I am in the right place. But some people say to "pick your battles" We are trying to see if this is a "battle" worth picking.

    Thanks for your advice.


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