Feeling like Im back in high school...
0Oct 16, '12 by BlueorchidThis isn't the first time I've seen a thread like this but I would love to hear opinions from other people to get a better grasp on reality.
Coming up on February of this year I will have been an ICU nurse for 2 years in an inner city trauma center. I started in the ICU as a new grad and prior to that had experience on the floor for an additional 1.5 years as a student/ student resident. When it comes to the patients I love what I do. There are days it's exhausting and draining and you can't wait for that next shift to come in and give report but I haven't had a day yet where I've gone "I wish I'd taken a job somewhere else." I also genuinely love being a nurse.
Now, that is in reference to the patients themselves.
My coworkers on the other hand are driving me up the wall. Last night I had a breakdown with a little cry in the report room so I didn't go out and blow up/scream at other people. I've been trying to make a concerted effort to take sicker patients as of late to challenge myself. And having spoken with several of the senior partners on my floor, nurses who have 20+ years of experience they agree that I'm ready and encourage me to use them as resources on the floor- which I already do.
Unfortunately the days that those senior nurses aren't in the numbers or on the floor I feel like I'm at my wits end. I'll be the first to admit I'm not part of any clique on my floor and I'm not there to become best buddies with anyone, my job is to take care of the patient. That doesn't mean that I'm going around kicking someone who invites me to lunch but I honestly think it's more important to turn off the beeping IV channel first before sitting down to watch a movie on the computer.
Having a string of three shifts in a row I'll just give a quick sample of the things I've run into where I swear I've backslided into high school.
- Report was given to me on a pedstruck admitted from the OR (who I was encouraged to take) where the nurse had absolutely no idea what was going on, no charting was documented, and all I had to do was check the patient with a head injury's pupils to see what she was telling me was a crock of s**t (cause are they supposed to be two different sizes?...hmmm). She then refused to take the patient back the next day because she told the rest of the shift she was there until 8PM doing work (while she was chatting with three other nurses as I stood at the door and asked for a glucometer and a clean draw sheet).
- I managed to keep said patient from going on dialysis with myoglobins in the 11,000s, monitored ICPs, drain output from a broken pelvis, Grade II liver, and IVC, drew labs, started him on insulin, kept his temperature normothermic, took him for a repeat CT scan, supported the mother, father, and wife, along with the 10,000 other family members that came in to see him and then some and when people asked if I needed help and I mentioned simple things like "could you help me turn" and "could you go get this" I was refused. The next day after spending an hour scrubbing him down during his bath (he was covered in blood) the family complained because there were still dried flecks on his hands. Granted, when I asked for help, the people who were supposed to serve as "resources" were nowhere to be found. I did the best that I could in the time I had.
- The third day with said patient after coaxing pharmacy to send me a medication that was several hours late I notice another patient on the floor has a kangaroo pump that's beeping empty because the tube feedings are done. His nurse is nowhere to be found and the patient's brother keeps coming to me because I'm the only nurse on that side not eating pizza and Chinese food. Instead of changing the patient's bag I turned the pump off and made sure that he wasn't on insulin before tossing a word down to the nurse and going back to my own work. I get reamed out for not doing additional work to help him when I'm busy as it is with my own combo.
Another nurse who had the same combo (and is in a similar situation- we'll call her Lucy) was going to be reprimanded by her charge nurse that day because she resourced another nurse to help her second patient while dealing with this sick guy. The other nurses? They were watching a football game. But that was "over-delegating". Now I'm being told by Lucy that I should report the things Ive been seeing to my nurse manager since they're apparently reporting crap about me (I wouldn't be surprised if I heard that when this patient was admitted the nurse I received report from was there for hours helping me because I couldn't handle things- which is a flat out lie.)
But throughout all of this Im thinking "really?" Has it come down to me tattling on one nurse because she'll do the same to me and more? I've had my ups and downs with my coworkers- the first year I took it really hard when I clashed with different personalities, the second year I've decided to start standing up for myself. However now with standing up for myself and a desire to take things further and learn I feel like this lack of support is going to hold me back. Because Im not a part of the "in-crowd" whenever I ask for a challenge Im going to be treading water on my own and it makes me worried my patient care is going to suffer.
This begs the question should I find another place to continue learning? I don't want to leave the ICU/critical care setting and my heart has always belonged in the ED, but Im wondering if this culture is just specific to that area or if there exists a place where people can work together for a common goal and get their heads out of their rectal cavities? I also know jobs are still hard to come by, if this is what Im stuck with how long do I have to stick this out? Replies are welcome. Thanks!
3Oct 18, '12 by katmarieRNI'm so sorry you are going through this. But I understand it. I do agree you should talk to your manager about it. If anything is being reported about you, your manager should be discussing it with you also.
Unfortunately, what you are seeing is a horizontal hostility and seems to be commonplace. I've seen it in two of the ICUs I've worked in, and many of my colleagues from other units have discussed the same thing.
Document, document, document.. particularly when your assessments are different than your preceeding shift-- CYA. You standing up for yourself will help... unfortunately it can be very clique-ish.
If you can find another ICU/ED job, you may be rewarded. I left my previous job b/c of the cliques and lack of support from management. I love the unit I'm in now, though I've come across the cliques & grapevines, some hostility. I've learned to stand up for myself (and early on) and have seemed found my niche. But I also have a supportive manager.
Good luck! I hope it works out for you!
2Oct 18, '12 by echoRNC711Boy is the learning curve in units is difficult.
I worked CVRU and felt I was barely surviving 2yrs in. As my skills improved,naturally it got easier. When I didn't need to go to staff for help anymore my own confidence grew. I was there about 4-5 yrs before I was considered "seasoned". By yr 7,everything started to feel easy and almost hum drum.If tnis is any consolation,when I began CVRU it was suggested "you are not unit material ". When I left 8-9 yrs later they kept my job open for a yr in case I choose to come back. And yes, I did remind them that they hadn't thought much of me when I started. So it was rough,but it got better and en route I cried plenty times in the med room.
Try if you can to just focus on getting better. Study. Remember.....Knowledge is power! (especially in units!!!! )
By all means switch to ED your ICU skills will not be wasted. If you can hang in it might be nice to leave when you feel you have mastered the area.
Just keep in the back of your mind,learning here is a lengthy process. I did learn to meditate which was amazing in terms of stress management.I had the "squirts " when a fresh heart came out (for about 6mths ) and can remember feeling my insides shake when I seen my 1st chest cracked open to do cardiac massage.
I am sorry,your having a tough time. There are times in nursing when we feel alone. Be gentle with yourself,eh?
0Oct 20, '12 by BlueorchidUpdated: I took a deep breath and reported to my manager how my shift report was a load of BS. I put it nicely that I was concerned if she was getting an incomplete report from the OR that there might be a communication breakdown. I mean, what if the guy had herniated? Regardless, it was refreshing to hear someone else say the maturity on the unit is obscene at times. I don't know if anything was said but the nurse in question seemed rather pleasant to me as of recent. I'm still keeping my ears open. He said they were working on the clique part and that it will take some time, but it will get better. We'll see.
Either way, the stubborn part of me does not want to be chased out of my job so Im gritting my teeth for now and looking for something potentially PRN. Its hard though when you love the complexity of a sick ICU patient (with that little childlike voice in my head giggling "I have so much to think about...yay!") as opposed to not knowing what's coming through the door and having to gogogo with a sick ED admission. Ah choices...
Thanks for the support guys
PS. EchoRN, its like a secret ambition of mine to do cardiac massage haha. I've only seen one cracked chest on our floor but plenty of thoracotomies. Maybe one day :P
0Oct 22, '12 by libbyliberalYou deserve better working conditions. It is so difficult when you love the actual work but your coworkers are just plain lazy and indifferent. The culture of this unit is just bad. This is not uncommon in nursing. All that you can do is to develop your skills and be as professional as you can be. It really is a safety issue when everyone is on a meal break at the same time.
Tube feeds run dry all the time. Your priority is your two patients. Unless you were supposed to be covering that nurses break I would have let it keep beeping. And let the nurse know that the pt's brother wants to see her or directed him to the secretary or something to be paged.
Always do a bedside report with people whom you don't know and trust. Check pupils, IVs, pulses, drip rates, every dang line and tube and piece of equipment, dressings and a butt check if you suspect that they haven't been turned all day. Document any discrepancy immediately with a call to the doc and mention the problem quietly to your immediate supervisor. It sucks to find that their line is pulled out, the ETT is out too far, the OGT is hanging down to their knees and TF is dribbling out of their mouth, a blue gray pulseless foot with no pulse, the NGT to a gastric surgery pt is to full suction and draining frank blood, the epidural is leaking or the CT is sucking wind after they're gone and they have subq emphsema to their eyeballs. All true stories by the way.
Your antennas should be up when they are in a big fat hurry to leave.
Always ask: Are there any new orders?
Are there any labs that I need to be concerned about?
You have to put that pt first. I was not a good fit at a place like you describe and I am proud of it.
0Oct 29, '12 by mrsredkarmaAs a new grad i experienced very similar conditions in an ICU at a prestigious Atlanta area hospital... There was an absentee director, crazy gossip, intimidation from the senior nurses, and about 3 or 4 20+ year nursing vets that thought they owned the place. It was so bad that i actually left the hospital after about a year and a half, finding the grass a bit better but not so much greener elsewhere. I returned to that first facility, working in a different unit and everyone from the director on down was supportive and friendly. I found that simply having experience gave me the balls to speak up when necessary and the confidence in my practice that was naturally lacking as a new grad. Being in the new dept also helped me to see that not all places are like that, even within the same facility. Now i am a charge Nurse in an ED and a PT nursing supervisor and i still see many of these same issues.the only difference is now i get to help fix them! Best of luck to you. These experiences are unfortunate and unfair but the definitely grow you as a nursing professional!