A Hard Lesson Learned - page 2

As we who have reached our middle years know, there are few things more satisfying than the realization that we have finally come into our own. It's not that we know everything, but we are wise... Read More

  1. by   VivaLasViejas
    ((((((((all of you!)))))))

    Your support means the world to me, and I thank you all so much for speaking up and confirming what I felt: the situation was, indeed, untenable, and I did NOT get the backup I needed. I was left to twist in the wind while God only knows what TPTB were doing.......although since that night, I've not only received extra help with heavy patients from the managers themselves as well as from other nurses, the manager who called me on the carpet on Thursday even found a way to treat me like a human being when I was working in ICU on Friday. Weird.

    Of course, I have to confess to a bit of paranoia---the way things have been going, maybe this is just the calm before the storm:uhoh21: There are a couple of us nurses who are older and perhaps less physically fit than others; we've talked on a couple of occasions, and let's just say I'm not the only one who wonders if she's being eased out........as the saying goes, just because you're paranoid doesn't mean they're not out to get you! This one nurse and I have both been sick a lot this year, we both have bad backs and arthritis, and we're both over 45 (actually, she just turned 50, and I'm 47 in two months). Worse, BOTH of us have a tendency to resist taking on still more work when we feel we're overburdened........and the combination of these factors may be steering us toward the door.

    Well, let's assess this for a minute. They can't fire us for being old---that's age discrimination. They can't fire us for our physical ailments---that's against the Americans with Disabilities Act. They can't even fire us for having big mouths---we have a union to protect us from that. But I can't help wondering if management isn't saying something along the line of hey, let's put these PITA nurses in situations where they are almost certain to futz up or forget some vital element in providing care, then we can fire them for incompetence or, better yet, negligence.

    The stink of it is, I've never been a particularly suspicious-minded individual, but I KNOW some of the management doesn't like me much. The 'big boss' of my department is the exception; she is a positive, dynamic woman who in fact has made it clear she thinks I'm a damned good nurse.....she also knows I'm good with the patients, and she finds ways to encourage me even when things aren't going well. If she weren't my boss, she's someone I would choose for a friend; even when she has to say "No" to something I ask, she's fair about it, and having been a manager myself, I don't have a problem with that. Now, I don't completely trust ANYONE I work with, but I'll be glad when she comes back from her vacation; I've got a few questions for her, and her answers may very well help to determine the direction in which I'll take my career. I've never gone to her with my issues with other managers before; we shall see what happens here.

    The nursing supervisors and staffing office people are also some of my staunchest allies, which made this particular episode easier to bear, even though I felt let down by the one who treated the affair like a hot potato. I know there are times when you can put 50 staff members out there on the floor and it still wouldn't be enough---last Monday night was only the latest example---but it seems this is happening more often than not, and I'm not sure what it's going to take to get this across to the bigwigs.....or if they will even give a hoot. I've never felt more like a pack animal than I do nowadays, not even when I was a lowly factory worker making $2.50 an hour. In fact, there are days when I'm asked "How are you?", and I'm half-tempted to say "Fine. I'm ALWAYS fine. I'm a horse."

    Reading back over all your thoughtful responses, I must say it's comforting to know I'm far from alone, although I do have to wonder just why this is so. Why must every shift be an endurance contest, something merely to be gotten through until I can finally go home and fall into bed exhausted, only to have to get up the next morning and do it all over again? Why must working conditions be so stressful and frightening that I spend the drive to work praying that I won't mess up bad enough to get fired, lose my license, or worst of all, KILL some poor patient who needs more of my time than I can possibly give them?

    No one nurse can change an entire system, and even if one could, I know it won't be me.:stone I've seen too much of life not to know that it takes a person of extraordinary energy and courage to overcome an entrenched system such as the corporate element that runs health care in our country today, and I'm just too used-up to lead the fight. If someone out there is willing to get it started, I'll follow; for now, I'm doing all I can just to get through each day and give the best care I can. If I fall short of that goal, I will take responsibility for my share of the consequences, but you all are right, I can't blame myself for the entire !*#$% system, and I appreciate the reminder. Bless you.
  2. by   steelcityrn
    Why Were No Orders For A Ng Tube, Stat Blood Work, D/c Meds,order For New Medication,or Anything For Gosh Sakes By Her Physician Ordered When You Spoke To Him. Yup, Documentation Is Your Problem But Not As Critical As Why This Dr Gave No Orders To Help Her.
  3. by   P_RN
    Marla you did NOT let your patient down. As Tweety said it would have happend.

    My mind flashed back to a situation-not as emergent but a spouse who did all you saw, but in addition assaulted me by pushing me into a door frame. On the advice of a relative, I called security and had a warrant for A&B. I also made out beaucoups of occurrence reports.
    1. too far from station......mine was at the end of the hall too.
    2. poor response from pharmacy....
    And so forth.

    How is your patient today? Please believe that you did your best. I believe I'd do some late charting for my own peace of mind. (And keep a copy-I know tht's probably not legal is it?)

    I have kept copies all these years.
    Your system failed you. And for that I am incredibly sorry.

    And I also remember a coworker who got no satisfaction with another pt. going down the hoper. She called a code....she got Good response then.
  4. by   VivaLasViejas
    Quote from steelcityrn
    Why Were No Orders For A Ng Tube, Stat Blood Work, D/c Meds,order For New Medication,or Anything For Gosh Sakes By Her Physician Ordered When You Spoke To Him. Yup, Documentation Is Your Problem But Not As Critical As Why This Dr Gave No Orders To Help Her.
    Actually, I did get orders for stat CBC (which showed the H&H as 13.8 and 38.0 respectively, believe it or not) and Protonix 80 mg IV now (which took almost an hour for pharmacy to send up). The NGT had already been tried, and due to an anatomical abnormality caused by a previous tracheotomy, it was next to impossible to put one down, and indeed it took anesthesia to get it in while they were intubating her in the ICU.

    Because the H&H were still within normal limits, the MD decided it wasn't necessary to send her to ICU even though the vomiting/bleeding continued throughout the four hours I took care of the patient and beyond. I was, of course, criticized for failing to push hard enough for transfer, and again, the documentation wasn't up to my own standards, let alone the facility's, so there's little evidence that I did much of anything beyond talk to the doctor and give the meds that were ordered. How many times have I told students and new nurses the old nursing-school lecture "if it wasn't documented, it wasn't done"? It stinks on ice, even though in retrospect, the deck was stacked against all of us---the patient, the doctor, me, even the spouse. Man, I hate this.........and what galls me is, there's no assurance whatsoever that I---and millions of other nurses, for that matter---won't go to work tomorrow and face a similar situation, or worse.:angryfire
  5. by   VivaLasViejas
    Quote from P_RN
    Marla you did NOT let your patient down. As Tweety said it would have happend.

    My mind flashed back to a situation-not as emergent but a spouse who did all you saw, but in addition assaulted me by pushing me into a door frame. On the advice of a relative, I called security and had a warrant for A&B. I also made out beaucoups of occurrence reports.
    1. too far from station......mine was at the end of the hall too.
    2. poor response from pharmacy....
    And so forth.

    How is your patient today? Please believe that you did your best. I believe I'd do some late charting for my own peace of mind. (And keep a copy-I know tht's probably not legal is it?)

    I have kept copies all these years.
    Your system failed you. And for that I am incredibly sorry.

    And I also remember a coworker who got no satisfaction with another pt. going down the hoper. She called a code....she got Good response then.
    You know, just a couple of weeks ago I had a patient in that same room who started LOOKING like he was going to circle the drain, and I was able to intervene and get him to ICU, where we intubated immediately and saved him from further harm. He survived because I had only three patients that day and caught the change BEFORE he went completely under, and because he had a doctor who was on top of things, and because staffing that day was such that I could hand off my other two pts. and get the situation under control.

    Your post also makes me think why, oh why didn't I think to do an unusual occurrence report?? This all happened last Monday evening, then I had a day off, the following day I worked in postpartum, and by the time I was made aware of the fallout, it was far past time to do a late entry or complete an IR. Oh, well, chalk another one up to experience........but what I WILL do is make some notes of my own for reference if I'm eventually hauled into court over this. It won't be anywhere near as useful as actual charting, but it'll help me convey a sense of the conditions I was working under at the time and refresh my memory of events (like I could forget?).

    Thanks for the idea.......I'm going to go do this right now.
  6. by   live4today
    (((((((((((((((((((((((((((marla)))))))))))))))))) )))))))))

    you are not alone in what you went through that shift. many nurses, including myself, have had shifts like that. i left my job in 2003 for situations similar to that. that year made me regret ever returning to nursing. i'd been out almost six years, and it's been hell ever since. i'm out of work now because i won't settle for just "any job" knowing full well the dangers that may befall me if i took "jobs i've passed on" the past six and a half months.

    i do agree with your take on "older nurses" being put in situations that compromise their license just so the hospital's can get rid of them (us...i'm an older nurse like yourself). it's pathetic and very insensitive what is being done to us. we have the experience, yet we are viewed as being too old by the powers that be who are our own age and older most times. now isn't that the kettle calling the pot black.

    you did all you could. everyone who posted gave you excellent feedback. we've all been there, hon. stop blaming yourself for an impossible situation that would have happened anyway from the sound of the patient's condition.

    :kiss :flowersfo :icon_hug:
  7. by   Bipley
    As usual, I have my "weird" thing to add but I think it's true.

    One of my old guys during my care home days finally finally got a concept through my head that literally took years to sink in. But once it did it made a big difference for me.

    He said that in any given situation we experience in life, if we COULD have done better, we WOULD have done better. He told me to think of something I had done that was perhaps not just stupid, but mean. (He was referring to an extreme example) He said even then, if I could have done better I would have done better. But there was something in the scenario that was stopping me from doing better. Whether it was my own ego, selfishness, stubborn streak, whatever, something prevented me from doing better.

    I'm not suggesting we are not responsible for our own actions regardless of what they are, I'm saying that when we examine what happened we can look at it more objectively and deal with it, then move on.

    Sometimes in those scanarios it was an outside factor that prevented us from doing better. Combine that with getting caught up in the emotion of what is going on and we don't really think long and hard about other options until the emotion is over.

    Honestly, I don't think you are looking at true reality here. You are beating yourself up over something that isn't completely yours to own. If you were sitting on the outside looking in and someone was giving you a run down of what was happening AS it was happening, wouldn't you have told them to do everything you did? You had other patients you were responsible for as well.

    Okay, so you didn't document. But if you could have done better you would have done better. What stopped you from your usual quality documentation? Emotion? Frustration? Too busy? At that point in time you did the best you could do and if you could have done better, by all means... you would have.

    We all draw upon our past experiences to deal with the current. So next time you'll draw upon this experience. So be it. That's what makes you a better nurse than a new grad. You have more "stuff" to draw upon, it really is as simple as that.

    All in all it really is okay to give yourself a break. But before you can do that you are going to have to divide responsibility up and give it to those that earned it - within your own mind.

    I would really urge you to sit down AT HOME when things are totally calm and write down every bloody detail of that day, even what you ate for lunch. Every detail, shoot... even the weather! I promise you, you are going to forget details in the near future. You really can't afford to do that. Write down absolutely everything, make a book out of it. Go to your Word software and start writing. Start from the beginning to the very end. As you think of more details, add them. You may find this really helpful in the future, you just never know. If someone does make a legal issue out of this, "I don't remember," isn't going to work in your favor. It's still fresh in your mind, write it down.
  8. by   SmilingBluEyes
    (((((((((((((((Marla)))))))))))))))))) Now I KNOW you are an excellent nurse; I would have you care for me or mine ANYday. Go easy on yourself, love.
  9. by   DutchgirlRN
    First Marla ((((((HUGS TO YOU)))))), :1luvu:

    Second, I had a similar situation several years ago and nobody would listen to me either. I called the administrative person on call (this was on a Sunday) and told them what was going on and that no one including the doctor was listening to me. I caught absolute H*** from the doctor who then showed up within a few minutes. I didn't care, my patient went to ICU immediately. The following day the doctor was spoken to and I was commended. I'm not trying to toot my own horn, I'm just wanting to share with you and others how I successfully handled a similar situation.

    Third, I've been doing med/surg for 30 years on/off and it has gotten to be so much worse in the past 5 years, the patient are getting sicker, the acuity of the patients is sky high, the assignments are too heavy. I have come to realize over the past couple of weeks that I am burned out. I am taking an extended LOA and I am doing home health visits for a while. I have been depressed, eating too much, sleeping too much, crying too much, all because of patients and their families who don't appreciate how hard I work for them and how much I care for them. I had a patient's son ask me last week. When the doctor gets here how long to you think he'll stay? I replied, "it depends on how many patients he has on the floor today. If your Dad is the only one probably 30 minutes, if he has say 3 other patients he will likely be here for about 2 hours, I'll let you know as soon as a see him". I got reported to the supervisor for being uncaring and rude to the son of the patient. The supervisor saw right thru him thankfully and told me "just blow it off". But it hurt to the core to be called uncaring. I do truely believe it is time for me to take a break from med/surg. After a couple of months I plan to go back PRN, if I still feel the same way I'll just have to stick with home health or many do some agency work. I hope this all works out ok for you. I think your NM could have been more understanding in this situation.
  10. by   AFnurse3
    I'm sorry that you've had to deal with this situation. As a nurse all of us that haven't dealt with this will at some point or another in our careers....a bad case that we can see but no one will help us deal with and prevent it from getting worse. I am just thankful that we have sites like this where we can talk an learn from others experiences....good and bad!....to hopefully improve the outcome of the situations that we must deal with.

    I know that as a nurse you did what you could for this patient without having the doctors, managers, and staff to back you up. If given a chance to change things....spend time caring for this patient or documenting on her....would you have changed how you spent your time? I hope not!
  11. by   VivaLasViejas
    Once again, you all have given me well-thought-out, compassionate feedback. Thank you so much---it's given me a great deal of food for thought, especially now that I've had time over the weekend to debrief.

    As several of you suggested, I am writing an accounting of the incident so that if the hospital and/or staff are taken to court, I've at least got something to refer to. I had to do this only one other time in my career, some 8 years ago, and nothing ever came of it.......maybe I'm not such a crummy nurse after all.

    I am now seriously considering leaving Med/Surg, and soon. I'm feeling exactly the way Dutchgirl described: I'm depressed (although not anywhere near as much as I've been at times in the past) and I'm definitely eating too much, which is what I do when something's eating ME. I've already put in a request to go part-time, two 12-hour shifts per week instead of four 8's, because I'm sick to death of being there four days every stinkin' week, but of course management is dragging its feet on this because NOBODY wants my shift. Even though there's no weekends and I get a day off during the week as well. You'd think that would tell 'em something......:stone

    The stink of it is, I don't want to pull up stakes entirely. I've been with this organization almost 5 years altogether, and almost 3 years consecutively. It's the longest I've ever stayed at one job. By the end of March, I'll be earning just over $30 an hour with my step increase and 3% certification differential, and I really enjoy working with our MDs and interdisciplinary team, as well as most of my co-workers. We're all at ease with one another, the way people are who know they'll be working together years after the sensational patient or the family from Hell is long gone.

    All I know is, I can't go on like THIS for much longer. I'm getting close to the outskirts of burnout, which is a place I've been before and never want to go again.........the signposts are all there, the overeating, the depression, the squeamish, squirmy feeling in the pit of my stomach when I have to go to work. I hate it......life's too short to feel like this.

    But I'm NOT going to keep beating myself up over this incident. Yes, part of it was my fault, but not all of it. Nursing is a 24-hour job, there were nurses ahead of me who should've picked up on things, so how was I supposed to fix all this patient's problems in four hours, anyway?? And how in the name of all that is reasonable was I supposed to provide 1:1 care when I had five patients and no one to back me up??
  12. by   UM Review RN
    As several of you suggested, I am writing an accounting of the incident so that if the hospital and/or staff are taken to court, I've at least got something to refer to. I had to do this only one other time in my career, some 8 years ago, and nothing ever came of it.......maybe I'm not such a crummy nurse after all.

    You might also mail yourself a copy of that incident report to yourself and attach an open copy of it so that the mailing date "proves" when you wrote it.

    You will then have a copy you can look over and a copy that "proves" when you actually wrote the information within.

    I have no idea if that will help, I just seem to remember that mail idea from somewhere.

    Oh and you need a whole bunch of these,:flowersfo :icon_hug:because you need to know that the way you advocated for your patient despite everyone ignoring you or actually hindering you--well, you could be my nurse any day and you probably won't find anyone more scared of being a patient than me!

    :flowersfo :flowersfo :icon_hug: :icon_hug:
    Last edit by UM Review RN on Nov 14, '05
  13. by   Ruby Vee
    thanks for sharing! it could have happened to any one of us, and if it hasn't already, it will. hindsight is 20/20.

    big hugs!

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