Mar 12, 2008 10:43 AM - Absolutely! Amen sister! I totally agree and endorse what responses I read. Having been a nurse for a long time and have practiced in different areas of the country, I can atest that my nursing experience has ran parallel to yours. Be prepared that you will not be applauded when you step up for yourself. My charge is to you that you must be gracious and kind. We must speak the truth in love--love for ourselves and for the person who is out of control and have a "cruicial conversation" (I am sure you are aware of the 7 standards of a healthy work environment supported by the American Association of Critical Care Nurses...if not, check out their website at aacn.org--it is a up and coming thing--about true collaboration...also, check out safestaffingsaveslives.com--it is awesome and become a leader where you are, be a solver and not part of the problem, learn out to "partner up" and "manage-up" with your co-workers. As many of y'all have previously written, we choose nursing because we want to help others--such as patients. The probelm that I see is that the concept of what a "patient" is has changed--rather should be called 'consumers of health care'. But this is how it is and there is such a lost of personal accountability in every aspect of our lives. Just yesterday, I received a 77y/o male patient in the ER with a hx of 2 days of diarrhea with a questionable syncopal episode...to make a longer story short, he asked for something to drink and I assessed his age, circumstances and previous health history that cardiac enzymes would be ordered on him and if they were positive that would precipitate a cardiology consult and perhaps a cath--we have cath lab. So it was my advise that it was not in his best interest to drink or eat at this time (I am sure he was thristy and did later wrangle an order fo a bag of NS IV) and proceeded to give him and his family my "nancy-nurse" explanantion and he made gesture with his right hand of a gun and pointed it to me as if to shoot me and his family laughed! Did I share this with my charge nurse...no, because she would have told me to not take it personally but I do to the extent of my interactio/teaching/advocacy as I am the one engaged in a conversation with him. My response to this patient was that he was free to do whatever he wants (he isn't my hostage!) but I am being a patient advocate and am looking ahead and sharing a reasonable esplanation but they aren't bound to follow my advise. Our health care system is in crisis. I wish I knew how to reach more people to take on personal accountablitiy...that is my second love or calling in my professional life but my first is and has always been the bedside nurse...never have wanted a management position. I will continue to run up and down the halls as long as the Lord gives me strength! Just a quick P.S., back to the patient who 'shot' at me, later on his wife as if I could get one of my "girls" to bring her something to eat!
It is so good to have this website and be able to hear that it's not just happening in my little world! Be enoucouraged, just do your best! Take care of yourself and your heart---an empty heart will not have anything to give!

Mar 13, 2008 03:41 PM - Hey! This is a good book for EVERY nurse out there :

http://www.silencetovoice.com/

Mar 13, 2008 07:34 PM - Thanks for posting that there was a second version - I just ordered it!

Mar 13, 2008 09:15 PM - I just ordered some books similiar to this off Amazon. This one is going on my wish list too. Thanks for the link.

Mar 13, 2008 09:17 PM - Thank you so much for your article. I agree that we must take back our power. No, we should not be abused by any one. Not long after I transferred from post partum to my present med/surg position, I had a really nasty run in with a doctor. He was known for his nastiness and for eating nurses for breakfast. My patient, a sweet gentleman of 68 was having urology problems. I was fresh off of an ALL FEMALE unit and hadn't dealt with male plumbing in over a year! Dr.X goes into the room and starts yelling so loud that you could hear him at the other end ot he hall: " What the **** is this, look at this foley, who is his nurse, get in here now"? (I hadn't even seen the patient yet, I had just gotten report). I went into the room and announced myself as his nurse. Then Dr.X, says' What are you some kind of idiot, can't you see that this foley is almost out, what is wrong with you"? I let him rant and rave a bit more. I then replied, well Dr.X, I see why you are so very upset and I am Mr.Y's nurse, but I just got out of report and I am a fairly new nurse, and just transferred from post partum and I would be very glad to help you fix the problem-please tell me how I can help you? He was speechless. Then he said, please remove his foley and monitor his I&O's and I will be back this afternoon to place a new foley or start him on a CBI, by the way, than you nurse. Dr.X, came back at 4pm to put in a new foley, he kindly asked me to assist him, he went and got all of the supplies while I stayed with the patient and he thanked me again when he was throught. After he left the floor everyone asked me what I did to Dr.X? I told them that I was honest and told him the truth. After the incident he had alot more respect for the nurses on my floor--he retired at the end of 2007.
I really do believe that we have to start to document exceptions to assignments, lack of resources etc. We must protect our licenses! The hospital I work for is seeking the Baldridge award----they covet it so badly-we had a visit but didn't get it--we are trying again. We have patients who come to the hospital and think they are at a hotel. The families just make everything worse. For a long time I had trouble setting limits but I am leraning to do so and to be nice about it and if I have to be strict I am. Above all, My allegiance is to my patients needs not the family--the family can go to the cafeteria.
Thanks again for a terriffic article.

Mar 14, 2008 11:15 AM - I commend you on tapping in to your strength. Yes, unions, in theory, help. In the school system down here, where I was before I became a nurse, they are benign and useless. There is a hospital on this campus that has a union and the nurses are, in general, more content. But nothing is perfect. It should not take a union to make working conditions condusive to happiness and success for the staff and patients. But, that is in a perfect world. The question is, do we make do with the status quo or do we take the chance to be an agent of change. That is rarely an easy path. Perhaps, if we can gather our coworkers who have the same beliefs as we do. Strength in numbers would make our message more effective. But, the reality is that the only thing that moves organizations large and small, (with some few exceptions: GE, Disney, Toyota,etc), is the bottom line. SO, if we were to threaten the bottom line, I am not talking about a drastic step like a walk out or the like, just something that would not give them an option but to pay attention to us, what then? Perhaps I am just dreaming. We are losing nurses right and left and while there are waiting lists at most institutions of higher learning, if we do not do something to improve the working enviornment and mindset of the medical establishment, then those young minds will run screaming away just like we feel like doing sometimes.

Mar 22, 2008 12:05 AM - Quite simply, it is NEVER ACCEPTABLE for anyone in any rank or position to corner a person, shake their finger in someone's face, curse, etc. NEVER. This is when a nurse states simply and directly as they walk away, "If this is going to continue, I am calling security" -- and BE PREPARED TO DO IT.

Of course, this is not possible in a small facility. However, most hospitals these days have security, and that is why they are there.

Whether one is male or female, new or experienced nurse, patient or doctor does not matter. NO ONE has the right to abuse. Period.

We as women especially tend to think we should bend over backward as we are being verbally pummeled. NO WAY. No doctor would take it. Why should a nurse?

Indeed, documentation is KEY. Always keep record of the facts. Do not point back, do not yell back, but by all means state clearly what will happen next if it continues. And be prepared to FOLLOW THROUGH.

Mar 22, 2008 04:35 PM - Hi there. I just wanted to share something I found very interesting. I did my critical care semester at a teaching facility in the Dallas/Fort Worth area that has what I think is a unique policy regarding physician abuse directed at nurses. It's called a "code white". When a code white is called, all the available nurses in the area come and surround the doctor! What a novel idea! Presenting a united front when calling physician's on this type of behavior is fabulous! I don't know the exact numbers, but I know the code white doesn't happen very often. My guess is because dr's don't want to be confronted this way. I am very lucky, in the ER where I work, our docs are the best. They know the nurses are the backbone of the ER and they treat us with respect and we are allowed considerable more autonomy than other areas of the hospital because of all of our protocols in place. Hang in there. Nursing is a calling. My best advice is if you aren't happy in your workplace, seek out other opportunities. I am continually amazed at all of the different areas of nursing that exist. One of the things I love about nursing is if you don't like this area, there are a million and one others you can try! Take care!

Mar 28, 2008 04:09 PM - I loved your article! I'm new to this forum and I'm thrilled to find others who share my point of view.

The point you brought up about not being in control is a key point. With regard to nursing, there are so many factors that the nurse has no control over. I'm not just talking about unforseen medical emergencies!!!

I'm talking about things like the RATE at which she gets new patients (E.R. admits/post-op/direct admits). On our floor, we no sooner discharge a patient and the CN is on the line telling us we are getting a new patient and "report" is holding on line 2. I mean this happens within a couple minutes of discharge every day!

Also, "the late-in-the shift admits" are another thing we don't have control over. Notoriously, on our floor, you are wrapping up your shift and preparing report/kardexes/chart checks for the next shift while medicating patients and performing other duties AND, sure enough, the admit you just got report on shows up and all the hard work you did to get yourself out on time (all day long) is for nothing because now you're getting off late no matter what!

Not only do we need more realistic staffing ratios, but we need to have rules in place that provide for a more humane WORK PACE. Barring "medical emergency-related transfers" there should be some rule in place where there is a mandatory 10 to 15 minute time frame BETWEEN patient admits! Also, barring emergent reasons, there should be no patient admits between the hours of 18:00 and 20:00 and 06:00 and 08:00. Those hours should be reserved for sacred "catch up" time for the staff.

I would love to see a future in nursing where nurses fight for THESE rights TOO!!!

Mar 31, 2008 08:11 PM - I think end of the shift admits is as big a problem as nursing ratio's. I work on a "dump" unit...we get everything!!! And you can bet if its within 30 mins of the end of your shift...the phone is going to ring and an admit is going to happen. I have taken the motto that this is a 24 hr facility and somethings are going to be left for the next person to do. I will gladly stay and do everything an admit requires if its in a reasonable time frame. But I certainly do not expect the nurse that I am relieving to stay over 2 hrs to finish up an admit that popped up at 1430. Nor do I expect any of my co workers to EXPECT me to stay when the admit pops up at 2230! This is part of standing up for ourselves, being respectful of our coworkers and toughing it out .