please help

  1. I graduated last may and am in icu. I have been out of orientation less then 2 months and management has recently decided to quit paying incentive pay for nurses to cover scheduling holes. they are also not aggressively hiring (no big ads in the paper vs other hospitals). The result is we are constantly understaffed and I am being asked to take 3 ICU patients tommorow. I did take a 3rd ICU pt for the last 4 hours of my 12 hour shift a few days ago(on thanks giving) and it went badly. the new patient I picked up started crashing and I nearly ran levophed in at 15 mg/hour instead of 15 ml/ hr. obviuosly it has scared me. I am just at a point where I can take care of 2 patients competently , and of course i need help sometimes. should i refuse to take a 3rd oatient and risk getting fired? i am so stressed. this is my 5th 12 in a row. and btw, i am not planning on becoming an np, so ignore the name. Thanks!
    NP
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  2. 13 Comments

  3. by   august_snow
    Holy cow! 3 ICU patients is a lot, plus you are barely out of orientation. You are about to work your 5th 12 in a row?! Plus your stress/exhaustion almost created a med error!

    You need to start screaming at the higher ups that they cannot do this-it is UNSAFE-not only for you but for your patients. You need to advocate for your patients that they deserve so much better than what administration is giving them!

    By continuing to work under these conditions is not safe for your patients and you are putting your license at a HUGE risk!

    Please keep us posted and take care of yourself!
    Last edit by august_snow on Nov 26, '05
  4. by   NP2BE
    Quote from august_snow
    Holy cow! 3 ICU patients is a lot, plus you are barely out of orientation. You are about to work your 5th 12 in a row?! Plus your stress/exhaustion almost created a med error!

    You need to start screaming at the higher ups that they cannot do this-it is UNSAFE-not only for you but for your patients. You need to advocate for your patients that they deserve so much better than what administration is giving them!

    By continuing to work under these conditions is not safe for your patients and you are putting your license at a HUGE risk!

    Please keep us posted and take care of yourself!
    thanks, I didnt know if i was just being a baby or what. I am just not excited about this. i cant sleep.
  5. by   sjrn85
    Three ICU patients would stress most seasoned ICU nurses, let alone someone with 6-7 mo. of experience. What is your unit's written policy on staffing ratios?

    The other problem I see is that you say this is your 5th 12h shift in a row. That is unhealthy! Not only are you stressed, you're exhausted, too. You can't think coherently when you're that tired.

    And face it (this is not a slam), you are still green. You may be off official orientation, but there is so much more learning to be done the first year of nursing (actually, it's lifelong, but YKWIM). It's unfair that you are being treated this way.

    When you are rested and can think clearly, I'd suggest writing down your concerns. Review things you can control, and those which are beyond your control. If you have a mentor or trusted colleague, talk to her. Or bring your thoughts here and bounce them off us.

    But from the start, I would suggest you put an end to ridiculous 12h stretches. You're setting yourself up for making mistakes due to fatigue, and eventual burnout.

    Let us know how you're doing!
  6. by   Corvette Guy
    Quote from NP2BE
    I graduated last may and am in icu. I have been out of orientation less then 2 months and management has recently decided to quit paying incentive pay for nurses to cover scheduling holes. they are also not aggressively hiring (no big ads in the paper vs other hospitals). The result is we are constantly understaffed and I am being asked to take 3 ICU patients tommorow. I did take a 3rd ICU pt for the last 4 hours of my 12 hour shift a few days ago(on thanks giving) and it went badly. the new patient I picked up started crashing and I nearly ran levophed in at 15 mg/hour instead of 15 ml/ hr. obviuosly it has scared me. I am just at a point where I can take care of 2 patients competently , and of course i need help sometimes. should i refuse to take a 3rd patient and risk getting fired? i am so stressed. this is my 5th 12 in a row. and btw, i am not planning on becoming an np, so ignore the name. Thanks!
    NP
    Have you ever heard of Safe Harbor? Look into the Nurse Practice Act of your state. If you think you can take care of only 2 ICU patients, then IMHO you have the right to refuse to take a change of shift report on a third ICU patient. Yet, once you take report on a third patient, then its abandonment if leave that patient.

    Remember, its your nursing license & your patient's safety on the line.
  7. by   redwinggirlie
    Didn't read the other posts....because I didn't really get past the just out of orientation part and then I was hit by your 5th twelve hour day in a row?????
    I can't tie my shoes after a long week (long, but not 12 hours a day, five days in a row). You made it through orientation.... be glad about that.
    I don't like to work with techs who work four days in a row as I feel on that fourth, they are spent..... please, please try not to put yourself in that situation again. Dangerous to you, patients, and just plain unhealthy.
    Oh, please be good to you.
  8. by   redwinggirlie
    Ok, read the other posts......wonderful advice. NOW....
    OK if you are at home now...... read this in tiny, tiny letters.... sleep, sleep, sleep you are ok,,,,, sleep, sleep, i will not think about work..... sleep, I am ok..... sleep ZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
  9. by   Tweety
    If you can't safely take care of three patients, then it's your obligation to refuse.

    Good luck.

    Our hospital dropped our incentive pay for working overtime too.
  10. by   Nurse Ratched
    Repeat after me:

    "Patient safety is severly compromised when we are assigned three critical patients. Which two of these patients would you like me to care for today?"

    Yes, you may lose your job, although I doubt it given the already severe shortage they're dealing with (again, not to hang your hat on that, tho - managers are sometimes just that stupid.) However, if a patient dies because you were not adequately able to tend to them, it won't matter that mgt encouraged you to take three patients - you accept that assignment and you are implying that you can handle it. You may lose you license. More importantly, you wouldn't be able to sleep at night.

    And about those 5 12's in a row - just say no. Your boss will continue to not pay incentive and not actively hire as long as existing staff are willing to pick up the slack. Don't play into that game. Their failure to plan is not your emergency or your responsibility.
  11. by   sjrn85
    I hate to say this, but having taken some time to think about this, I would suggest you start looking for another position. This facility sounds problematic, and as long as they can bully people into overextending themselves, they will.

    You have 6mo exp. in ICU now, so you should be able to get some interviews with no problem. If you do get some interviews, make sure you ask about their nurse/patient ratio and what they do in situations when there are more pts. than the ratio would permit.

    The facility you're working for is abusing its employees and does not care for its patients, either. And Nurse Ratched was right, if you were ever involved in a malpractice case, you would be on your own.

    You worked too hard to get where you are. Don't let their laxity affect your career.
  12. by   Town & Country
    They stopped giving incentive pay for taking extra shifts so they shouldn't be surprised when the nurses refuse!
  13. by   BabyRN2Be
    Quote from NP2BE
    thanks, I didnt know if i was just being a baby or what. I am just not excited about this. i cant sleep.
    No, you aren't being a baby about it. Definitely not. This is an UNSAFE situation. I do hope that you can talk to someone about this w/o risking the loss of your job.
  14. by   Simba&NalasMom
    Good grief, Charlie Brown. If I knew where you were working (no, I'm not asking!), I'd make a mental note to not have any of my loved ones admitted to that hospital, or if they were, I'd get them moved ASAFP. What are they thinking? :angryfire

    Congratulations on getting licensed and making it through orientation. Now it's time to be good to yourself, KNOW that you are an awesome nurse, and you are totally right to question their staffing.

    I'm a new LPN myself, so I know what it feels like to feel bullied into doing what even the most seasoned nurses will refuse; but even this early in my career, I almost had to learn the hard way what it means to my career and license to bite off more than I can chew because of feelings that it's "normal" or "OK" to be thrown that much work as a new grad. It's so easy to feel hesitant about speaking up for fear that you'll be seen as "wimpy", etc. but patient safety has to be the bottom line. If your facility is willing to put productivity before patient care, I agree with the other posts that it's time to move on. Changing jobs is a much more appealing option than taking too much on and losing a patient and then carrying that guilt around the rest of your life.

    Stick to your guns. Stand up for yourself, your license, and your patients, and most importantly get some much-deserved rest!

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