What am i doing wrong? (LLLOOONNNGGG)

  1. :angryfire
    OK, after 6 months of miserable floor work, I went to work in a small local Chicago ED. It has not been an easy transition, but ED is the only place I wanted to work, ever, and it's been really hard. I need some help. There's the whole way this ED is run... when I was an ED tech, level 1 trauma center, (where my first miserable 6 months of floor nursing was 'served') my goal was to keep the RN out of the room as much as possible. I brought pts back from Triage or ran to the ambulance run, said "I'm the tech the RN'll be here in a minute" got the patient nekkid, in a gown, on the monitor/bp/SPO2. Got vitals. Drew blood.

    The staff don't really talk to me much, yet, and when I try to join in conversation they sort of tune me out. I feel as if I'm bothering them.

    Here, the techs don't get off their @sses unless you ask, or do so rarely. They do not initiate the patient nekkidness or on the monitor-ness. I take my own vitals, empty my own foleys, take my own dirty nasty bedpans to the dirty utility room. I don't ask for much. I take out my own SL, foleys, etc. In short, I don't ask for much help. And I really need it! I'm new to the ED!

    Today, the Nurse Educator tromped up to me at the beginning of the EXTRA shift I had picked up, and said "I need to talk to you". ooookkkkkaaayyyy...She said 'the techs have been c/o about you talking to them in a not so nice way'. I asked her for specifics, she said she could only recall Easter Sunday (incidentally, my first official night off of orientation, and I walked into a code at that) because I asked a tech to put a patient on the bedpan...isn't that part of their responsiblities if I'm busy getting, say, an ABG, Cardizem drip, helping a doc w/ a pelvic? Which priority am I supposed to cater to? Critical patient work, or stroking the tech's ego?

    I asked again for specifics...she wouldn't give me any. I told her that in the future if a tech has a problem with me it'd be better for 'teamwork' if the person just came to me and said 'look, this is a problem'. She said that they didn't feel 'comfortable' doing so. I asked her then how did she expect to fix the problem if there are no specifics I can reflect on, and no one person to reference. I told her that I was very cognizant of how I approached techs and I try to go out of my way to say please and thank you, but when I'm up against two priorities the bedpan is NOT GONNA WIN for me if there is an extra pair of hands available. She said 'we all work as a team and give 110%' here.

    OOOKKKKAAAYYY ... now for the weirder still part. This educator was in charge of my orientation. Not once, but 4 times did she drop the ball. I started mid february so I actually had two weeks of floor time before the formal 'nursing orientation' happened. She called my house, AFTER signing off on my orientation schedule, to see where I was, and then was pissed at me because I wasn't on the floor. Same thing, two weeks later -- general orientation. She called my house 4 times within two hours to see why I wasn't there, scared my husband to death. Another time, I told her that I was going to a critical care class. She again called my house. I spoke with her later, and she SWORE that I never told her I was going to this class. She had written it down, and never checked her notes.

    The reason I go into this is because she has a pattern of accusing first and checking her facts later. It seems to me that she has made many errors and wants to lay the blame someplace else. She also told me, when I had a paper due the next week, to turn in all of my orientation material the next time I came to work, because she hadn't followed the schedule.WTH? I told her that I had a paper to do and she said "not acceptable" "you must give this department 110%". My next shift was 36 hours away so I was able to get some of it done, quite a bit, and she never said 'thank you'.

    I have picked up two shifts this week, no one has said 'thank you'. I'm getting very frustrated and angry at this situation. I get little support from the techs (isn't it the same everywhere though? always favorites).

    I had a similar confrontation at my first job, and since then I have always been very conscientious to be kind to the techs, because we really need them, and they are very valuable to us, but fer crying out loud, if I ask them to re-temp somebody I get the There isn't that much for them to do. They get to do some interesting stuff and I love teaching. I am willing to work on my shortcoming but fer crying out loud (again) we're talking about 2 instances in high-volume, high-pressure situation (I think, I'm not clear on the details) in an ED. Is it possibly there are such fragile egos out there?

    Sorry for the extra long rant. I just need some support, and guidance. I don't know what I'm doing wrong!
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  2. 12 Comments

  3. by   canoehead
    I guess I can't pick out anything that you are doing wrong. It might help to compare your approach to the techs with the way the other RN's do it, see if there is anything they do that gets better results. I agree that you need more specifics about what you did wrong in order to change your behavior. As far as the instructor goes- just be assertive and point out that you both agreed on x and she can't change it to y without notifying or consulting you. Speak with your manager if necessary, saying you are willing to do x, y, z, but have had some scheduling problems since the preceptor changed her requirements and want to renegotiate.

    Good luck.
  4. by   bluesky
    [QUOTE=canoehead]I guess I can't pick out anything that you are doing wrong. It might help to compare your approach to the techs with the way the other RN's do it, see if there is anything they do that gets better results. I agree that you need more specifics about what you did wrong in order to change your behavior. As far as the instructor goes- just be assertive and point out that you both agreed on x and she can't change it to y without notifying or consulting you. Speak with your manager if necessary, saying you are willing to do x, y, z, but have had some scheduling problems since the preceptor changed her requirements and want to renegotiate.

    Good luck.[/QUOTE

    Maybe it's not so much the content of what you're saying to them as much as the manner in which you are saying it. Maybe try a little diplomacy.
  5. by   athomas91
    ok - here it is - noone will ever thank you for picking up extra shifts in the ED - might as well get used to that. If this nurse educator wants to scold you - let her know next time that she should have specific examples or else it is just hear say - and not very professional....and if the techs are lazy (which is rather common if they don't yet respect you) - just ask them to do things with the most sugar in your voice you can -- (i know you are busy - but can you please .....i really appreciate it - thanks...) - then they cannot complain....
    sometimes the ER isn't a very user friendly place - earn their respect and it should get better...for example - on a slow nite - help the techs do some stocking or empty trash cans...they will be more inclined to help you....just my 2 cent.
  6. by   Stitchie
    Thanks, this is good advice. I need them to be on my side.

    And BTW, I do my darnedest to make sure I ask them as nicely as possible -- and always say please and thank you. And I don't ask often.

    It's the nurse manage who has gotten me kind of wigged. She doesn't really respond to needs, won't give me specifics (and actually got rather nasty when I told her that without specifics I am unable to address the problem). She has messed up, dropped the ball, etc, on every single issue I have ever dealt with her on, and I don't think (or don't want to think) that she is accurate in what she is describing to me.

    And I didn't expect roses for picking up extra shifts but I didn't expect this treatment, either.
  7. by   RNin92
    I would agree with all the above good advice given.

    The ED is a great place to work with the best team you will ever find. But...
    BECAUSE of that great teamwork it can be tough to be the new kid trying to join the team.

    Work hard.
    Help everywhere and everyone you can.
    It WILL work out for you if you keep trying.

    As far as your confrontation with the Educator...gimme a break!!
    We have a manager with a saying..."take the mail to the right mailbox"
    She WILL NOT buy into the "he said/she said" game.
    Since she started with this approach...it took awhile but we do not have the same problems with gossip and bi@#$ing anymore.
    If you gotta problem...take it to the person and deal with it like an adult...otherwise shut the he$$ up.

    Good Luck!

    And by the way...I too work in the Chicago area...well...Northern Suburbs anyway...we are a 196 bed Level II...strong community...great team...took awhile to break in...but you will!!
  8. by   Stitchie
    Quote from RNin92
    I would agree with all the above good advice given.

    The ED is a great place to work with the best team you will ever find. But...
    BECAUSE of that great teamwork it can be tough to be the new kid trying to join the team.

    Work hard.
    Help everywhere and everyone you can.
    It WILL work out for you if you keep trying.

    As far as your confrontation with the Educator...gimme a break!!
    We have a manager with a saying..."take the mail to the right mailbox"
    She WILL NOT buy into the "he said/she said" game.
    Since she started with this approach...it took awhile but we do not have the same problems with gossip and bi@#$ing anymore.
    If you gotta problem...take it to the person and deal with it like an adult...otherwise shut the he$$ up.

    Good Luck!

    And by the way...I too work in the Chicago area...well...Northern Suburbs anyway...we are a 196 bed Level II...strong community...great team...took awhile to break in...but you will!!
    I told the nurse educator to have the person come to me or I am powerless to change anything. Period. She doesn't seem to like someone standing up for herself. I even told her that the he said/she said thing is counterproductive.

    But as has been pointed out, being a good nurse doesn't necessarily mean you're a 'good employee'.

    So thanks, everyone, I am planning on a different approach to see how this works, it may take some time but I'm not going to let them run me off. I really like the ED; this may not be the hospital where I spend the rest of my career but I'm in it for a year, at least.

    The nurse educator is really no one in authority, so if she says anything else I'm going to request we have a meeting with the manager.

    Keep the good advice coming; I need all I can get.
  9. by   Calfax
    Yeah.....sounds like you're getting thrown to the wolves. Welcome to nursing. Give it time and learn what you can. You'll be surprised what a difference 1 year makes. My first year, I remember coming home exhausted trying to just keep my head above water. After a while, it becomes easier, tho.....and you can't get frustrated....you have be your own little Jimmy Buffet concert (and if there ever was a soundtrack to the ER, he'd be it) and go with the flow.
    I'm a guy and I like to solve problems: tech problem: you're gonna slog a lot of bedpans. Other than scream at them until you're blue in the face....what are you gonna do? They've been there longer than you. They're "family". Once you've been there awhile, they will see that you're a hard worker and want to work with you....but you're still on probation, right now.
    Your nurse educator: remember that s(he) is not/no longer is a real nurse due to laziness, incompetence, large doses of psychotropics, herpes encephalitis, or just being too damn fat. Otherwise, they'd be at the bedside, doing what nurses really do. Therefore, you can disregard anything s(he) says as irrelevant....ie......the equivalent of a small and badly groomed poodle yapping at your heels. No kicking the poodle, tho. The secret with her is getting all your paperwork filled out, all your orientation crap done. Whatever you have to do. If she wants you to show up on Tuesday morning at 0830 with a Teddy Ruxspin and a toilet bowl brush, then do it. You may not get much sleep during those days...but remember you can always nap during the actual orientation itself.
    You arent there to impress the nursing education toadie. Who you're looking to impress is the docs....who need to know that you're a strong competent nurse that they can count on. You're also looking to impress your co-workers, especially the old salty dogs who've been there 20 years and seen it all.
    Your nurse manager: you want to see him or her as little as possible. Treat meetings with him/her like sit-downs with "Fat Tony". Only go see them if you're ready to "whack" somebody. Too many sit-downs and it's you who gets whacked.
    If all else fails, you've been there a year and you still get no respect....then shove off. Go find another ER to work for. I highly recommend Miami, FL. Nowhere else will you find so much sex, drugs, money, intoxication, sheer stupidity and utter psychotic human behavior all mixed together and moving at 110 miles an hour. You'll get all the extra shifts you want, believe me. Plus, it's a hell of a lot warmer there in January than Chicago. Good luck to you.....and fuggedaboutit!!!!!!!!!
  10. by   RNKITTY04
    Great post Calfax, I will take said advice to heart.
  11. by   traumaRUs
    Good luck...I've worked a level one ER for almost 8 years now and the respect thing is the most important thing.
  12. by   Shotzie
    I have to say great post too, Calfax...I laughed out loud! Just that stuff about why the nurse educators has her role bugs me a bit. I worked as a nurse educator when I just got plain ole' burned out from the day to day crap in ER nursing. Took a break in Ed., got to teach, be a little creative and work as a resource person. I eventually bounced back to ER and felt good about it.
    I did face almost this same thing at one job. I had come from a big city hospital to a small suburban one. I was excited about working close to home and with patients I might actually know. My first clue that something was wrong was my second day when two nurses cornered me and said "I bet you think you are here to shake up our ER, huh? You going to try to do things the ______ hospital way?
    My answer was No, I'm just here to work.
    No matter what I did, it was wrong. I used the equipment wrong, they complained about my sterile technique and injection techniques (they had never heard of the ventrogluteal site and I used it all the time) and the way I triaged. With each complaint I brought in a nursing textbook to the charge nurse to support the rationale behind what I was doing. It was amazing to me that I could get stellar reviews and merit increases at a job where we were known as the best ER in my big city and then be thought of as a "bad nurse" in some podink-ville institution.
    My advice is to do your best to fit in...but only do it for a defined period of time. Then, if things are not better, "Get the h*ll out of Dodge" as we say in Texas.
    Funny thing is, when I left that hospital I was considered the expert at my next job and was quickly made charge nurse.
    ER, I love it but it truly is all about the egos..docs, paramedics, techs and nurses.
  13. by   Stitchie
    The docs I have worked with have been great -- they understand that this ED hires lots of new grads and they are patient, not at all ego-tudish. They understand why I ask lots of questions and need to double check what I do.

    The paramedics, sigh, just have to be dealt with.

    The nurses are generally supportive, good mentors and there isn't a lot of backstabbing that goes on among the nursing staff. It comes from the tech level on up, which tells me these techs may be resentful for whatever reason.

    And Calfax, thanks for making me laugh about the nurse educator. She's so 'corporate' it's enough to make you gack. Definitely not too fat to fit into the bedside nursing category (that'd be more my area) but what you said about the psychotropics --- you may be onto something. :chuckle

    I do not consider myself a whiner at work. Therefore I try to avoid anyone higher on the food chain than the charge nurse. This whole idea about a paramedic/tech whatever being too intimidated to come forward for a face to face meeting is ridiculous. Who knew paramedics could be so, um, shy?

    I like the reference to Fat Tony. Are you a Soprano's fan too?
  14. by   Calfax
    Sorry if I offend anyone.......I've got a big mouth and a bad attitude and a serious Milk of Mag tan from working too many years of night shifts.

    Fat Tony is a character from "the Simpsons", probably the best social commentary about our generation and time. I remember being asked in Nursing School by a well-meaning but flaky nursing instructor to define the perfect family.....(ah, there's my tuition being well spent). I stated that the Simpsons were the ideal definition of a perfect family and why.........and got this big pause and then "Well that's one definition of a family, can anyone else give me a definition?" No gold star that day.

    There's a lot to be said for a standardized way for doing things based on clear evidence that it works and minimizes harm, infection or reactions. If your education person can teach you this, fine.

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