need advice desperately!!!

  1. I have recently been targeted by my nurse manager, I have been an RN for a year now on her floor and she has been on me like white on rice the past couple of weeks for the most petty problems. One bad night I forgot to document the I and O's and she proceeded to tell the shift following me to let her know if there is anything that I'm not doing and that she may put me back on orientation. Does anyone have any advice on how to deal with someone like her? She doesn't seem to notice the more important things that I catch that hasn't been done by other shifts. For example a post op pt that should have been on telemetry and was sent to a regular med-surg floor, IV rates that a wrong, pts not getting needed medications when ordered stat on the previous shift, recognizing "silent MI's" and a fib vs tachycardia. I follow a new grad sometimes and you don't want to know the stuff that I find that isn't done. I work nights and the I and O documentation for the day ends with me, however all the shifts are poor documenters when it comes to I and O's and when you are prioritizing in the face of too large of a pt load, very sick pts and what have you the I and O's are sometimes missed by all. You can get a basic idea that yes this pt has sufficient Intake and Output but not necessary by the cc. Anyway it seems that she is more concerned with this right now than anything else. I used to love my job, but now my stomach hurst all the time and I'm having headaches. I am so caught up with watching my step and my aides and lpns that I'm afraid that I will miss something more important. I usually have between 5 and 10 direct pts and cover the lpns 5-10. If the lpn misses documenting the I and O's she comes to me only and doesn't speak with the lpn or nurses aide, they are still memebers of her staff and I feel that she should speak with them as well. Has anyone ever experienced this before and what should I do? Is it possible to love what you do but hate your job? Thanks for hearing me.
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  2. 28 Comments

  3. by   frustratedRN
    WHAT????
    YOU DIDNT CHART I AND O'S?
    SHAME ON YOU....WHAT KIND OF NURSE ARE YOU?
    NOW YOU GO STAND IN THE CORNER!

    lol
    it doesnt matter you didnt do that. big deal...what were the consequences of not?
    did someone die? was their health comprimised?

    this is pretty much the same kind of crap im getting with my job. well when i was on that other unit.
    and it was caused by another staff nurse who is not in charge (tho she thinks she is).
    and yes i LOVE what i do but i HATE my job. so much so that if they put me back on that unit i will be forced to resign. and they will be losing one great nurse.

    i was just where you are now. my stomach hurt all the time and i dreaded going to work because i knew i was going to be dumped on and no matter what i did it wasnt going to be right...they would find the least little thing to carry on about and then gossip about my "sins".

    i cant offer you advice other than to be very careful what you say about her and TO her. make sure you have a neutral witness when dealing with her. document everything and cover your ass. oh how i wish i had done that when all this crap was coming down on me.

    other than that i dont know what to tell you cos im dealing with the same damn thing. i can only offer you my support and empathy.
    just hope it passes.
  4. by   NinaC
    I've been an nurse since 1993...I felt the same way when I first started. However, as I got older, there were certain things that I felt were important and things that were not. I worked on a tele floor for 3 years; cried going to work, cried at work and cried going home from work; like you, my stomach would hurt just thinking about going to work......the solution that I found was....quit and go find somewhere else to work especially if the manager is not supportive. Managers who are petty over the meager little things need to get a life.... and if she continues to do that then she'll lose a lot more people in her unit and she'll have more problems. I work in ER now..its busy, hectic, a lot of critical patients but for some reason, I like it better. I think that I work in a more supportive enviroment, with nurses that love to teach and a manager who tries to accomodate our schedules and is supportive...at least she tries. But anyway, you need to sit down and re-evaluate what it is you want to do, and how much you can tolerate of the unfairness you are experiencing. Someone told me at one time...."you need to find your niche." Thats exactly what I did and I'm much happier.
  5. by   Jenny P
    I loved my first job as an RN and left it because I literally got sick from dealing with the "forked-tongued Head Nurse from H*##." I wished later that I would have tried some of these ideas with her, but at the time I was too intimidated to speak out. I have used these techniques since I realized that I do have my own 2 feet to stand on and I am a good nurse; and these suggestions have helped me be more aware of how I can effect change in my workplace.
    Start writing down some of the stuff that you do right each day (after your work shift is over); and write down some of the stuff that you have needed to fix from the previous shift so that: 1.)you feel better about your own capabilities; and 2.)you have some written proof for her that you are doing things to make the workplace function better. If you are slower than your co-workers and stay after your shift a lot, sometimes I think you may be targeted for that (been there, done that). It would be nice to know what she means about giving you more orientation-- does she feel that you have poor organizational skills or what?
    Ask to meet with her after you have been keeping the work journal for 1-2 weeks and bring it with you to the meeting. Tell her that you feel she is targeting you and ask why this is happening. Let her know that you love your job, but that you feel she is putting undue stress on you in the job by making you feel that you are inadequate. Ask what she expects from you. Have her give specific examples; be direct and honest with her and expect her to be the same way with you. Ask how she thinks that you can change the way you work to do things better.
    This may sound dumb, but sit up straight, be calm, and be sure to look her in the eyes when speaking to her and when listening to her; make sure she knows you ARE LISTENING and understanding what she says to you. Reword her advice and rephrase it to her so you both agree on what was said. Act confident and sure of yourself, even if you don't feel that way at first. You are not going in to this meeting to be intimidated, but to discuss ways to make your work- and your workplace- meet her expectations. If she runs the unit by intimidation, going in as an equal may be a way to get her off your back since those that intimidate don't like to be treated as equals.
    At the end of the meeting, you can discuss some of the stuff from the work journal if necessary; for example, if all shifts are messing up the I&Os, discuss with her ways that the UNIT AS A WHOLE can change the way they are doing I&Os so that there is a more accurate and accessible way of doing them. It is impossible for the night shift nurse to know what the pt. ate for breakfast, lunch or dinner, and how often the urine was emptied throughout the day if it wasn't written down. How can it be recorded easier? Suggest posting a sign in the conference room for everyone to check their totals before they leave, for instance, or moving the I&O sheets to the rooms so they can be filled out through each shift.
    By using a direct approach and trying to work with her instead of being afraid of her, you can make your manager know that you are trying to do what you can to make the unit run smoothly. Make her aware that you are trying to improve both your work performance and also your workplace issues.
    Maybe by asking for and meeting with her, you will both leave the meeting with a better understanding of each other and you won't be so stressed out in the future.
    Last edit by Jenny P on Sep 5, '01
  6. by   nicola
    I had a similar problem, not as a nurse, but in my previous career. I was working in a multidisciplinary setting for an agency which had 4 sites in 3 states. I was in outreach and shared a sup. with community services. The CS coord. in my state was at the other site and we just got off on the wrong foot. Instead of coming to me with her issues, she complained to our sup. The sup didn't come to me, either. At my first eval., to get off probation, I was told that I was deficient and needed to stay on probation another 3 months. My sup gave it all to me in writing and I was angry and wanted to cry - d@mn it, I'm good at what I do and don't deserve this! Mind you, I was the youngest coord. ever in this agency. In any case, I found out that the CS coord. was "ratting me out" to the sup and I had no idea. Was I livid or what?!

    My solution was to write a 3 page memo to the sup to let her know what I"d been doing to further my own knowledge of the job (a supervisory position for which I had no experience) and documentation of books (the 1 min manager series) I'd borrowed from the main office HS dept. In that memo I answered with hard data, every deficiency she'd put on my eval and ended with a request for more frequent face to face communication with my sup so that she'd know FROM MY MOUTH what I was doing. It worked like a charm. She had a new respect for me and my wretched co-worker was left without a leg to stand on.

    Ironically, I found that the trouble started when I asked her what her job was so that I could know how better to work with her. I guess she thought I was trying to get into her business. Truth was I had to make referrals to her and wanted to know what was an appropriate referral before having her or one of her workers drive an hour or more one way for nothing! You'd think she'd be happy.. sigh.

    Do document and stand up for yourself in an objective, unemotional way. Rehearse the conversation before hand. Cry and rant and rave after you get off duty. I hope it gets better!
  7. by   outbackannie
    Gee, does your story sound familiar! I was in my ninth year of nursing and had received many awards, kudos, etc. from the hospital I worked until our nurse manager quit. It was logical for me to apply for the position however, I was asked by the DON not to because they had something much better in mind for me, but couldn't go into details at the time. What a stupe I was! One of the nurses that I mentored became the nurse manager and from day one she was nitpicking everything I did or didn't do or blaming me for things that happened on other shifts. She really enjoyed "writing up" everyone. When I asked the DON about the position she had in mind for me, I was told "Oh, that didn't materialize." At once, it occurred to me that I had been set up. It also made me aware that the new nurse manager felt intimidated by me as most of the other staff continued to come to me for problem-solving, advice, etc. The hospital had a policy of 3
    "write-ups" and disciplinary action would follow. They also had a policy that a person who had been "written up" twice could not transfer to another department. The day I submitted my resignation, I felt the weight of the world lifted off my shoulders. I didn't have one knot in my stomach or a headache anymore. My husband and I went out and celebrated! It also compelled me to wonder that all this may have been a way to cheat me out of being vested in retirement as well as enable them to hire a new grad at a much lower salary. I'll never know for sure, but it wasn't long after I left that most of the other staff left too and the nurse manager was asked to step down. I wouldn't go back there for "any of the tea in China". I found it much more rewarding and lucrative to work thru an agency doing staff relief,
    making my own schedule, and making top dollar.
  8. by   Imrnlil
    Whew I'm gonna catch it for this one.
    I have read the replies and they are well intentioned but largely bad advice.
    The reason your stomach hurts is because you are on the defense. The best defense is a good offense.
    I/O is a reflection of cardiac and kidney function. They are not a minor detail. I have checked the disciplinary actions on the websites of several states and guess what?, some nurses get their licenses suspended for just what you did.
    Remember the standard you will be judged by. Do "what any prudent nurse would do." Any prudent nurse charts the I/O. Think like a lawyer. If one part of your charting is deficient then the rest can become suspect. If you are called to court a blank looks very bad and there is no way you can fill it in at that time. Do you have a record of I/O from that night? If you do then enter a late note and cover yourself. If not, fine, own up to it and move on.
    Your manager is looking for a trend. She should audit the chart herself but sadly has enlisted the help of other nurses. Now you just feel paranoid and with good reason. Poor management.
    You need to be proactive and every inch a professional. This is what I would do - I would ask my manager for a moment of her time. Discuss with her the bad night I had and that I am aware that I failed to chart I/O. I would then tell her that I am aware that she has recruited the help of fellow staff to monitor my performance and that the consequence of continued deficits may result in repeat orientation. At this point I would present my own plan to prevent charting errors, a new flow sheet , a new double check, whatever. I would ask for suggestions and things that she has done in her practice to improve in deficient areas. Listen attentatively and take her advice to heart. Then at this point I would express my concern with telling collegues that I may be sent back to orientation. You may find out this is not what happened. If she agrees she discussed that openly then I would tell her I feel that is a discussion that should have been held privately with me, the empolyee. I would also mention confidentiality of my personnel (sp?) file. There is nothing you can do if she asks someone to audit your charting. If however, she openly tells fellow staff that you may have to go back to orientee status, then that is an ethical breech of confidentiality. Your performance and reviews are not public conversation. Stick to your guns. Don't display anger or hostility or emotion. Be very matter of fact. If she should disagree, then casually mention that you will double check that with human resources and get back to her with their policy. Even she has a performance review to worry about and the last place she wants you to go is HR. But never threaten.
    Finally your gossiping coworkers. Ignore them. They are nothing and the worst thing they may do is distract you from the central issue, delivering the best care you can and doing it in a prudent, timely fashion. If they miss charting I/O point it out in a friendly manner and remind them that you know they probably got busy and just a reminder, etc. They will hopefully begin to treat you the way you treat them, with respect. Don't gossip about them, don't carry a cross, etc.
    If my manager asked me to check someone else's charting I would politely decline. I would explain that I really don't have time to check what the prior shift does and care for my patients. What you don't start doing, you don't have to stop..
    Any questions??????????
  9. by   Nytenurse
    Thank you all so much for your replies. You have given me much to think about. Here is what I have so far and let me know if I'm on the right track...
    Once bitten, twice shy. Wanna bet it will be a really long time that I ever miss charting I/O's? I definately will be checking over everything, I don't want to give her a leg to stand on. I have already started the work journal, sadly to say, I already have several pages. We have a pretty new staff, new grads etc. It can be overwhelming. You have opened my eyes to a lot. Worse than my nurse manager, though, would be a day in court. I will be documenting my ass off, I think that with a little tweaking I can do this. As far as communicating with her I really have to prepare myself. The advice and support that I have gotten here has really lifted my spirits. Thank you thank you thank you!!!

    Sincerely,
    nytenurse
    zzzzzzz
  10. by   michelle999
    don't despare, if you feel that it is unsafe then fill in incident forms for each shift.
    Don't worry it's her own insufficiencies that are amking her the way she is. In my experience it is sometimes best to keep your mouth shut and head down, if she is picking on you for their mistakes then start on them!!
  11. by   P_RN
    VEry good advice. I used to have a heck of a time remembering to do I&O....I mean I did it....just sometimes forgot to write it down......I spent a LOT of long distance time calling in to ask someone to please enter the numbers for me. And so, a very wise friend told me to get an index card and list everything I needed to do from clock in to I&O and clock out.
    That worked pretty well.

    BUT the one thing that really helped.....and forgive me..I really HATED that darned computer charting......but our program did a running I&O......no adding/subtracting +/- it was WONDERFUL!!
    It just made SO MUCH sense....you had to put in how they ate each meal, so just put the numbers in as they occurred.

    And PLEASE don't get into the habit of "Guess what I caught xxxshift NOT doing."

    P
  12. by   Nytenurse
    I am the last shift to chart on the flow sheets. Soooo, you gotta be blind to not see the missing documentation ahead of me. Regardless, I am getting pretty meticulous about my charting. The last thing that I do before I walk out the door is check all the charts one last time. Just a quick scan. So far so good. I am keeping a work journal, lots of positive things, also if I do leave I will have something to counter anything negative that may have been said. Ready for this? Pt satisfaction is going to make up %40 of our evaluations. Can you believe it? I work nights! On post op pts! Who are on MSO4 and Dilaudid and Percs! Half the time I am shooing out imaginary birds! They don't remember me from the night before let alone when those surveys go out. I've taken to writing my name in big letters on the dry erase board and the shift that I'm working. Maybe when they are more awake and lucid they will say oh yeah, I remember her... Yep, love my job. The ER and the OR are looking really good right now.
  13. by   PhantomRN
    ihave to agree with wildtime, there is someone on days that does not like you and is trying to make you look bad. the nm is not going to pay attention to i/o unless someone brings it up. watch your back.
  14. by   Nytenurse

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