Dealing With Weak Nurse Managers!

Specialties Emergency

Published

So working in a busy (110,000+visits/yr sometimes 400 visits per day) level 1 ER is stressful, but add to that very little structure and most of all nurse managers who cannot make decisions is really stressing me out!

So basically the Main ED at night is 2 medical teams with 3 sections per team-1 RN per section at night making 6 sections.

The ambulance triage nurse basically controls the flow of patients and who goes to what section. But everyone knows that it all depends on who is triaging. Some triage nurses will slam you with patients while other sections get less patients. A whole lot of favoritism and cliquish-ness goes into this.

So some sections will end of with a varying amount of patients and/or some sections will get the easier patients (hence quicker discharge) vs the extensive workups or just less frequency of patients. It happens all the time that one nurse (for example) has 10 patients while another nurse has 3 or 4.

On a busy day (which is pretty much every day you will get a patient every 20 minutes)

Anyway the other day I just about had it because the nurse in bay A consistently had the least amount of patients all night. All throughout the night every other nurse had atleast 5 patients sometimes up to 8 (and remember this was a light night) while the RN in bay A had no to only 1 patient at times.

I cooly brought it up to the charge nurse (one of the staff RN's who was in charge along with the nurse manager) and she just shrugged it off like she does most things)

So then I was brought a patient from the trauma bay, he became my 4th patient, ok fine. Then 40 minutes later was brought a patient from triage, 5th patient, all the while I'm watching Bay A where there are no patients, that RN is just sitting, staring at the computer. I walk up to the nurse manager and tell her I refuse to take a new patient because Bay A has no patients and I just recieved 2 new patients within an hour.

She sputters and calls triage who tells her some nonsense. Then she says well she can't send the patient there because she will be giving the MD a patient back to back. (which most MD's don't make a fuss over unless it's really excessive compared to the other team) and then she says give the patient to the RN next to me. I just walk away because I am fuming at this point. The RN next to me has 4 or 5 patients and says she does not want to take the patient because of x,y,z so I just throw up my hands and say I'm taking the patient.

(Everyone knows this nurse manager and charge nurse are very weak and beat around the bush about almost everything)

I proceed to make a copy of the assignment for that hour and write down both the charge nurse and nurse managers name along with the triage nurses name to keep this for my records.

The nurse in the bay beside mine says she's going on break and to cover her 4 patients. ok, so now I'm covering her 4 patients and my 5 patients, well now 6 at this point because triage sends me ANOTHER patient with complaint of chest pain. This time bay A now has 1 patient... YIPPIE???? NOT!

The RN comes back from break and gets ready to take report so that I can go on break and I tell her I'm not leaving her with things on my side not done as that I still had to see the patient who was brought from trauma, give report send him to the floor and see my two new patients.

By the time I was done finishing all that stuff it was 8 am and my shift was over. NO BREAK. I tell the charge RN that I had no break and to please sign that I had no break, she just looks at me like whatever.

This is a daily problem in this ER. Most nurses secretly complain about the favoritism that goes on both by the NM's and by peers but almost all of them are too scared to bring it up. To top it off the some of the NM's are very passive and have poor leadership skills. None of them that work my shift ever pay attention to how many patients or the acuity of patients on your side. They just walk around calling the admission department all shift, speaking with the supervisor then disappear for a while.

I am thinking of collecting evidence of this and just going to the director of nursing. At this point I'm so fed up I don't care whether I go or stay. And it's so hard to find jobs here. I cannot tell you the amount of RN's who are more than ready to jump ship.

I don't care if I mess up everyone's little favoritism, cliques up. I'm tired of being a team player when people clearly have agendas. I know how nurses can be towards one another, but what's more sickening is how the NM's aren't doing their jobs.

Being the first ER I've worked in. I've heard varying ways of regulating patients so that everyone has an even amount of patients.

I'm thinking the nurse managers should be required to do an hourly count to submit to the head nurse manager each morning.

It's just so sickening. They write you up here for anything, literally (that's a whole other thread, although I do NOT get written up often at all, I'm sure they'd love to) yet they don't pay attention to what really matters.

Any suggestions?

Specializes in Emergency & Trauma/Adult ICU.

All4NursingRN ... quite some time ago when you were either still on orientation as a brand new ER nurse or shortly thereafter ... you posted here at AN describing the inadequate orientation you were given, and several other concerns you had about your department.

It would appear that the same patterns have continued. You'll have to decide whether to stay or go.

I'm looking but like I said, very few jobs. I'm actually waiting to transfer out to a different floor. Let's see how that goes.

Specializes in ER.

It sounds like a very difficult ER that you are working within, and a rough team that aren't working together or even being helpful. I want you to know that not all ER's are like that, and sometimes you get a team that is not the perfect mix, and those who don't understand the big picture. Some people, charges and triage nurses, don't see how their decisions impact the whole team and then everyone suffers. I'm sorry you're going through this and hope that you find what you are looking for - whether ER or another floor.

Last night, I took over for a nurse in our trauma room. This nurse had held onto this patient for over 3 hours in our critical care area. He was put in there for being lethargic, CBG 58. Long story short, hypoglycemic event. It was 7:30pm when I got there and had him moved out by 8:15pm, which really is the point - treat them if they're critical, then move them out. This nurse that was leaving was lengthy in their report, giving non-critical narratives on this man. So I interjected asking about D50, how many times he was given this, what meds were given, etc. Trying to direct the nurse and keep this nurse focused, when this nurse said to me with the patient's sister standing within our little circle "if you'd stop talking for a second, I'd tell you." My internal jaw dropped. I said "if you'd just get to the point, please." Bottom line, not everyone CAN see the big picture, even if it's staring them in the face. Some are incapable. This person (and a few more) haven't a clue and I fear never will. Sometimes a duck really is a duck and you don't need to work it up to be sure it's not a giraffe. This patient was hypoglycemic, last ate at 8am and had his insulin. I gave him a snack and told the family we'd still check his CBG every hour until he stabilized. The family was SURE he belonged in the critical care area, for whatever reason that the other nurse inflated his reasons for being there. I just explained that a hypoglycemic patient we always try to get them to eat as soon as possible. This person was awake, alert, not the least bit lethargic. I scratch my head at a lot of things and sometimes it's better and HEALTHIER for me to laugh it off or I fear my mouth might get me into trouble. I certainly don't want this other nurse to appear incompetent, but when I come in and take a very basic approach/direction and it works, what does the family think? I can't help it that the other nurse, and more importantly, the RESIDENT physician, didn't think of some basic reasons and not let this patient sit in our critical care area for 3 hours for a non critical patient.

Anyhoo, that was a huge tangent to mainly say it can be irritating to work with some team members, but thank goodness many of them go home with other shifts!

Transferring to a different unit in the same hospital may just be trading one form of heck for another. Do your homework and find out which floor has the best management, and apply there.

You need to get a new job! This literally blows me away that professionals adults are acting like this!

Just for an example - We have 6 assignments, each nurse has 5 patients MAX (usually only 4). We try to keep 2 trauma rooms open for traumas, but everyone helps out each other if someone has a heavy load. Our charge nurse, an extra triage nurse or a float nurse will cover breaks. When i have a room open up I will either chose a patient to pull from triage, or while one of the triage nurses is floating around checking out the floor they will ask me to hold a room if i have a patient leaving. If we have an ambulance coming in its the same thing, if there are no open rooms and i have a patient leaving i will be asked to hold the room. No favoritism or cliques.

You deserve better than to work in the place you are describing!

Specializes in Emergency, Med/Surg, Vascular Access.

Wow...it blows my mind that y'all can actually care for that no. of pts. per nurse. I think my job's hard and our Max ratio is 4:1! It sounds like you work in an unsafe ER, to put it bluntly. I do believe however, that every experience you have as aa nurse, whether positive or negaative, if u are willing to learn from it, will make u a better nurse in the end. Or at least I hope so...I am a newish nurse myself. :-) good luck!

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