What the.....?

  1. I just don't get it...

    Here you are: in Charge...with 3 inexperienced, dangerous, slow-as-sh&# nurses on a shift from he##, every pt you touch is an admit, every "bat phone" call a Trauma, no simple "ear ache" or "finger pain" in sight...

    ...your 3 inexperienced, dangerous, slow-as-sh&# nurses (which you've written up MANY MANY times and keep getting told 'upon investigation, their practice is satisfactory', 'your c/o are unfounded', 'you're just picking on them') are unable to start even one IV on their own (too lazy/incompetent), change a soiled pt or do V/S (too lazy), attempt to get pt's to floors (too lazy - want to hold on to pt's so don't have to take new), re-directing ED Techs to perform menial tasks when 3 Stat EKG's are needed, pushing Metoprolol like it's water and wondering why the pt has no pressure, giving additional HTN/cardiac meds to a pt with a HR in 40's, opening Dopamine wide on a pt with a 22ga in their finger (that I found) and not calling either ER MD or Surgeon to start central line, leaving (yes, just up and leaving) as the 3rd Trauma Code gets called and we only have 3 nurses in Dept to start with with an ER full of cardiacs/diff breathers/abd pains who are in the middle of eval or admit or OR (to the point where the Nursing Sup was xporting pts with only Admit orders and no ER notes b/c we, ahem, *I* could not keep up - I had the lot of 'em), trying to give report to me on a pt in "Bed X" while I'm in the middle of the most critical of the 3 traumas...the list goes on - with all problems documented by me and sent to ER Mger, and also placed on House Sup shift report (even she was ready to drop-kick these nurses across the ER after repremanding them a few times herself)...

    Welp, *I* get dragged in front of the ER Mger this am about why I "stayed 4 hours to do charting" after the shift seemed "a little excessive."
    ***WWWHHHAAAATTTT????*****
    I busted my hump to keep the ER safe for 12 hrs d/t *HER* incompetent staffing mix and I'm getting nailed?!?! These blatantly unsafe and irresponsible nurses are not placed on some type of remediation (which, BTW, these nurses' have been "re-oriented" 3 times already, and do not hold *any* ER/Critical Care certs or even simple ACLS after approx 8-10 mos in ER)?!?! I am so mad right now, I don't know whether to scream or cry (oh, hell, to tell the truth, I've already done both).

    How the he## did I get to be the "bad guy" in this situation?

    Kat

    [ May 24, 2001: Message edited by: NurseyK ]
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  2. 19 Comments

  3. by   mustangsheba
    Sounds like deja vu all over again - and again. Print out what you wrote here and send copies to your manager, the hospital administrator(s), your state board of nursing, your representatives, and the governor of your state, and anyone else you can think of. What the hell, send one to Hillary too. It's hard not to walk out, isn't it!?! You might consider looking for employment elsewhere. Now is a good time cuz you certainly are needed almost everywhere. Just don't give up nursing - pleeze!
  4. by   stiritup
    Originally posted by NurseyK:
    <STRONG>I just don't get it...

    Here you are: in Charge...with 3 inexperienced, dangerous, slow-as-sh&# nurses on a shift from he##, every pt you touch is an admit, every "bat phone" call a Trauma, no simple "ear ache" or "finger pain" in sight......your 3 inexperienced, dangerous, slow-as-sh&# nurses (which you've written up MANY MANY times and keep getting told 'upon investigation, their practice is satisfactory', 'your c/o are unfounded', 'you're just picking on them') are unable to start even one IV on their own (too lazy/incompetent), change a soiled pt or do V/S (too lazy), attempt to get pt's to floors (too lazy - want to hold on to pt's so don't have to take new), re-directing ED Techs to perform menial tasks when 3 Stat EKG's are needed, pushing Metoprolol like it's water and wondering why the pt has no pressure, giving additional HTN/cardiac meds to a pt with a HR in 40's, opening Dopamine wide on a pt with a 22ga in their finger (that I found) and not calling either ER MD or Surgeon to start central line, leaving (yes, just up and leaving) as the 3rd Trauma Code gets called and we only have 3 nurses in Dept to start with with an ER full of cardiacs/diff breathers/abd pains who are in the middle of eval or admit or OR (to the point where the Nursing Sup was xporting pts with only Admit orders and no ER notes b/c we, ahem, *I* could not keep up - I had the lot of 'em), trying to give report to me on a pt in "Bed X" while I'm in the middle of the most critical of the 3 traumas...the list goes on - with all problems documented by me and sent to ER Mger, and also placed on House Sup shift report (even she was ready to drop-kick these nurses across the ER after repremanding them a few times herself)...

    Welp, *I* get dragged in front of the ER Mger this am about why I "stayed 4 hours to do charting" after the shift seemed "a little excessive."
    ***WWWHHHAAAATTTT????*****
    I busted my hump to keep the ER safe for 12 hrs d/t *HER* incompetent staffing mix and I'm getting nailed?!?! These blatantly unsafe and irresponsible nurses are not placed on some type of remediation (which, BTW, these nurses' have been "re-oriented" 3 times already, and do not hold *any* ER/Critical Care certs or even simple ACLS after approx 8-10 mos in ER)?!?! I am so mad right now, I don't know whether to scream or cry (oh, hell, to tell the truth, I've already done both).

    How the he## did I get to be the "bad guy" in this situation?

    Kat

    [ May 24, 2001: Message edited by: NurseyK ]</STRONG>
    It is very rare that you find 3 "slow-as-sh$# nurses working together in the ER. You might possibly look at what type a leader you are. Their inadequacies may be your fault. They may be trying to make a statement to you "SUPER-NURSE!!! I bet you even have a "S" tatooed on your chest. You go girl, a one-fast-as-sh#$ nurse. With your attitude, I wouldn't be motivated to work with you either!!! Just my opinion. good day.
  5. by   CEN35
    Well I have to agree, you don't usually find three terrible nurses on one shift. My experience is that you may have one, maybe two that drag the shift down. Never had three at one time? Also, if you are the "charge" or leader, writing people up in your own unit IMO is a no no. They really have to have done something terrible, that you feel puts you at risk to do that. try and work with them a bit, and help them out. The problem is you said, you have written them up countless times. Once you do something like that once or twice, it's hard to recover, gain respect and/or get things positive. However, the "countless times" is going to make this a real difficult task.
    Your in the pot, and now you need to figure out a way to get out.

    (not trying to be or sound mean, cruel, or nasty. No it's not a cut dow either)

  6. by   fiestynurse
    These nurses are all relatively new to the ER (8-10 months) This is quite a burden for you, as the only experienced nurse on duty. This does sound like a staffing mix problem. Try not to blame these nurses, who have been placed in this situation. And please stop writing people up!! Talk with them face to face on an individual basis. Tell them exactly what you want them to do. Also, these nurses need to get the required ACLS training immediately!! I agree, that's not safe!!
  7. by   NurseyK
    First of all, background...we had a mass exodus of 10 FT experienced ER/Trauma Nurses from our ER about 8-10 mos ago with all but 6 senior nurses leaving. The 6 of us left BUSTED OUR HUMPS to orient these new people (a grand total of 6 newbies). We came in on our days off, we held their hands...we did everything to try to make them and their "newness" welcome and to train them.

    3 of these 6 have "made it". They came to us with good skills, we taught them how to be better and how to focus themselves to the practice of Emergency Nursing. The other 3, of which I talk about previously, came to us under duress ("a RN with a pulse was better than no RN at all," to quote the powers that be). The were not good on the floors (they were about to get fired before they came to us). They are not good here either. They do not care. Period. We hold special classes for them - they don't show up. We have bent over backwards to try to help them. They just can't handle it - or maybe just don't want to handle it. Is it OK not to be able to handle ER/Trauma Nursing? Sure it is. Should you get out when you realize it? Yep. Should you get moved out of the Unit if you're incompetent? Yep.

    First of all...I am not the only one who has written these people up. They can be fired only with "adequate documentation" - per our Nsg Mger. We are giving her "adequate documentation." These people have been "spoken to" numerous times by ER Mger, Senior staff...to no avail. The next step must be taken.

    Second of all...yes, you can have 3 new ones on at once when you work 12 hr shifts and you only have 6 "old timers" left in the Dept. (and not all of those "old timers" work FT hours).

    Third of all...yes, they are dangerous. One pushed KCl the other nite. Another gave 4 more anti-HTN to a person that had HR of 40 and a pressure of 130/90 after receiving Lopressor. One pushed Lopressor so fast the pt crashed. The same one re-directed the ER Tech from performing a Stat EKG on a CP to change a dirty Attends, while she got on the phone to plan her nite (drinking at the local bar) - my response to this was to again tell the Tech to do the EKG - as this other nurse screamed at me in the middle of the Nurses' Station that she "was too busy to change the diaper!" PS she had only the one pt with no stat orders to be done... The list goes on and on and on. He$$ the DOCTORS are writing them up! In my state, I, as their immediate superior, am in charge of them - and their mistakes. My license is on the line (yes, yes, as well as theirs). I cannot babysit them while taking on 6 criticals of my own and having do to Traige because they won't send another nurse. BTW - we are the area's only Trauma Center with about 50,000 visits/year.

    Fourth of all...you would think that posting on an ER board I could get more support than 2 of 4 respondents (thank you mustang and feisty). I guess I thought wrong - I'll call a co-worker the next time I need to vent.

    [ May 25, 2001: Message edited by: NurseyK ]
  8. by   kaycee
    Sorry you didn't get the support that you needed. Actually NurseyK I can identify with you on a little smaller scale but same problem. I work in a smaller ER that is not supposed to receive trauma but it's sometimes dropped in our laps. We are small but busy. We have 3 nurses on and 1 doc. One nurse is in triage and the other 2 are in the back. I too have worked with 2 nurses that did not carry their load and wanted to pull my hair out by the end of the shift and was greatful that no one died. The doc's know who works and who they can trust so they come to the same person all the time to get things done and that gets old. Thankfully all of the nurses I work with now are pretty good. Some are still lazy and sometimes need a little push but all are competant. Hang in there and hopefully your situation will improve, hopefully without the harming of any patients.
  9. by   ikimiwi
    Sorry it's late NurseyK, but I think you are working in my ER!I I refused to cont with the orientation of one of our latest staff member, who the med surg floor was dancing to be rid of, She went thru 3 preceptors before me, i work part time and dont usually orient staff. 4 months into it and she really was not a good nurse, she didnt take any vitals signs on a pt off to the or for a ectopic preg. I specifically told her what to do and she just didnt do it! Went to nurse manager adn siad I could no longer precept her and would not sign off any of her goals. the answere was to sign her off and take her off orientation. We are also having a mass exodus of experienced staff.. We are getting 6 new RNs, no critical care experience, 2 of them are good and will do well. the other 4 are another matter they have been in orientation for 5 months now.both classs and as staff. contrary to the managements belief that we can make them er nurses, we cant... I dont know why they dont realize, not every nurse can be a ER nurse, I know for a fact I would make a lousy psyc nurse, I can learn what is needed I just wouldnt do well at it, but all they care about is a body. I am probally going to be joining the exodus, last night it was me in charge, with my new orientee, 1 staff who refuses alltogether to orient anyone (some people get away with everything) amd four pool nurses, who are very good thank God. 3 of the pool nurses had orientees with them. Its too bad, I love my job , most of the staffand i have been there for 20 years, 11 in er. but I just cant take it any more, please vent anytime.....you are not alone!!!!!
  10. by   MollyJ
    Sorry, folks, I'm in the mood to pontificate today.

    Kat, sounds like your new recruits are pretty bad, but I think you need to take a leaf from the book of the people who posted here and told you to quit writing them up. Right or wrong, your superiors are finding it easy to blow off your complaints. And I do think it takes more than 8 months to create a good ED nurse. But pushing KCl, not monitoring BP's, avoiding your *own* Code Brown's? Doesn't sound like you are working with future geniuses here.

    I think you are going to have to let life play this out. It sounds like your nurse manager is going to do this. believe me, these folks will write their own future if they pass up ops to go to ACLS, don't come to classes that are given for them and DON'T learn from their mistakes, like we all had to. Kat,learn the serenity prayer: Grant me the serenity to accept the things I cannot change, the Courage to change change those I can and the wisdom to know the difference.
    You cannot change the party girl's attitude.
    You cannot make your NM move on this faster than he/she already intends to.
    You cannot suddenly endow them with the perfect knowledge base.
    You CAN do your job as well as possible. (You already are.)
    You CAN notice when they do something right (make it easier for them to want to please you).
    You CAN and should keep your NM aware of critical errors in judgement (like pushing the KCL) but also help _them_ to know where to look if they just don't know how to give that med.

    You have something they clearly don't have: unit pride. You care about the unit and what people think about the care given there. They aren't bonded to the unit; they don't know what good care looks like; and they might not be good nurses. As the "old timer" you are what will bond them to the unit and you are who will demonstrate good care. It also sounds like your ED was in trouble 8 to 10 months ago at the time of the general exodus of nurses. With a 1:3 ratio (you:them), I feel like I'm lecturing you about alligators (ie, when you are up to your a## in alligators, it's hard to remember that your original intent was to drain the swamp).

    Remember the Serenity Prayer and ultimately take care of yourself. May be time to let yourself off the hook and go away for a while.
  11. by   cebo64
    Please bear with me; this is my first post (nothing like a 37 year-old virgin, huh?!). I have to say I feel your pain, Kat. I took a flying leap of faith when I found myself in your position. After 13 years with my ED (7 as charge nurse), I looked in the mirror one morning and realized I hated the person I saw. She was a miserable, overloaded, frustrated, bossy ***** who made everyone around her including her family unhappy. Even though I consistently had the top evaluations, I couldn't do enough for my manager nor could I do it right. I, too, had new nurses who were just downright dangerous but they were a warm body on the clock. I also had a bunch of old timers who just didn't seem to care anymore. I went to my manager, filled out a transfer to go PRN, and left. I took a job as a traveler for a year. It was the best thing I have ever done for myself and my career. I was able to take 4 week assignments at Level 1 trauma centers and boy, were my eyes ever opened! I was lucky enough to have great jobs with willing people and the things I learned were worth their weight in gold. My year is done and now I am back "home" at my old facility. I have a whole new outlook. The things that seemed to stress me the most just don't seem so bad anymore and my self confidence as a nurse is stronger than ever before. Please think about this as an option for yourself. You sound just like I did last year. Our profession can't afford to lose the best we have to offer. You need some "ME" time to regroup and rediscover why you became a nurse in the first place. Someone out there needs you and your knowledge. Hang in there!
  12. by   canoehead
    Sounds to me like you have nurses who not only don't know what they're doing, they don't care that they don't know. It's a dangerous situation for everyone.

    If I was you I would continue with the documentation of major errors, keeping in mind that the more you become an adversary the less they will come to you for help. So, include a 30 second counselling as to why a 40 bpm rate could result in a dead patient with more drugs, and why you HAVE to document the problem for patient safety. (and try to be nice )

    If you get errors like that every night I am surprised your manager can sleep at night. BUT... an alternative to out and out firing those nurses could be to enforce a schedule where they are separated in the scheduling as much as possible and always have an experienced nurse to go to as a resource. If all the experienced RN's get together and demand this it should get done. The newbies will have to eat the inconvienent scheduling as a result of past errors, and the experienced staff can get together on documenting every significant error so you won't be the only bad guy. Maybe your manager could be persuaded to hire a traveller until you have a decent complement of experienced staff.

    Remember though, if new people are treated as incompetents they will turn out just the way you treat them. Have a staff meeting, hash it out and start fresh. Try written expectations, if they say they need help with a skill they need to show up for the class- like that, and I sure hope you have a better night next time.
  13. by   debgirl71
    I think if i found myself charging and none of my staff were ACLS certified, I would be covering my butt with Safe Harbor.
  14. by   kids
    Quote from debgirl71
    I think if i found myself charging and none of my staff were ACLS certified, I would be covering my butt with Safe Harbor.
    Nine years ago when the original post was made 'Safe Harbor' didn't exist

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