Soooo, I quit

[TX911]

I've posted here quite a bit but have been here in awhile so I couldn't log back in for some reason. Anyway:

I've worked ICU for the last year. I was a paramedic for years, transitioned to RN and got a job out of nursing school in aforementioned local ICU. Throughout this year we have been understaffed, stretched to 3:1 ratios EVERY night, even when caring for CABGS, valves, heads, etc. Didn't matter what it was, you had three every night.

So the night before last, I had a 8 hour old CABG, a 21 year old dying from complications of cystic fibrosis with the family all in the room wanting information (looking to have some sort of control over a bad situation I imagine), and a schizophrenic pt admitted post status epilepticus that I cannot see from my pod with the 2 aforementioned pts in it. I told charge that I could not see the SE pt, had this heart, and that the family needed some attention with the CF patient. No dice. "Everyone has three again, I don't have anyone else to take the heart." I told them I'd get through tonight but I wasn't doing it again (we all say the same thing every night and yet we all come back.) I get through the night with minimal incident.

So the next night I come in, have the same 21 CF pt, a new GI bleed on bowel prep with a hgb- 6.9 getting blood, and a new admit HTN on cardene and getting peritoneal dialysis q 4 hours and is just generally very needy. I can't give this guy the attention he wants, my poor lady with GI bleed keeps messing the bed, and the CF family is still very frazzled. So I get in a groove finally and get some things lined out when I happen by more GI bleed's room and she raises her hand. She tells me she's messed the bed again. I say no problem, just now? Then she proceeds to tell me "No, about an hour ago. I didn't want to bother you, you just looked so busy." And right there ladies and gents, I was done. That was it for me. I told her that no matter what, if she has an accident to hit that call light and I will make sure someone comes immediately (we don't have PCAs regularly either, did I mention that???) . I then proceeded to tell charge that she needed to call someone in because I was done. She tells me that there is no one to come in, so I said fine, I'll finish tonight, give report to oncoming in the morning, but they can consider this my last shift. A year of this garbage is enough.

True to my word, I finished the night, gave report to oncoming, said goodbye to my pts, and approached the "director" and asked her if she wanted to do this here or if she wanted me to go downstairs and talk to the honcho. She gives me this disappointed look (like your mom does) and says, "no I'll take it." I hand her my badge and walk out. In my younger years I would've probably gave her about a 20 minute tirade in front of everyone about exactly what I thought of her and her units staffing practices (the 3:1 ratio is deliberate for "productivity" numbers, though they've been lying through the last year telling us it would get better.)

So, today I feel bad about not giving notice and I know that it was unprofessional. I know that and I'll wear it. But at the same time, in that same situation, finishing the shift and not tearing through the director was all the professionalism I had left in me. I feel cleansed, but at the same time disappointed in myself to a degree. Partially for not blowing my lid at her and partially for not giving notice. I've worked since I was 14 years old and this is the first job I've ever had that I couldn't go back to whenever I wanted. I still talk to my old oil field bosses and I'm headed back to my previous ambulance job full time. So I'm going to mentally chalk this one job up as the exception to my professional history and not the rule. I feel that it was my fault for not gritting my teeth and bearing the two week notice, but I have no plans of ever going back there again or ever working for a hospital that that company owns. I will miss my friends there dearly but I just couldn't stomach it any longer.

The problem is now that as far as nursing goes, that job in ICU was my only experience and now on applications I have to check not eligible for rehire (I'm sure.) So I guess my best bet is to just stay a medic and be honest when it comes to what happened.

Anyone ever have anything similar happen?

[anotherone, BSN, RN]

TX911, you did what many can only dream of doing. Good for you.

[mendu]

how about applying for Transport RN Critical care? one of my friends was laid off and with her experience as ICU/ER nurse she got job right in this field. she still works as RN and she says she is more happy than ever... if that would work for you esp you now are going back to work as medic just try it and see... good luck wherever you end up to be...

[Guttercat, ASN, RN]

I haven't read all the responses.

I personally have always thought it would be difficult to transition from a Paramedic (imho, the most highly-underpaid profession in America...) to an RN in an ICU, especially in the context of the particular ICU you were working in.

Trauma/ER-oriented folks are "fixers". There's a great deal of immediate gratification in that role.

Have you thought about ER? I did both, and MUCH preferred ER.

You could use a combination of your paramedic experience and ICU experience... and perhaps find your own little slice of Nirvana, in the right ER setting.

But whatever, you have options. Remember that.

[Hagabel]

I did ICU for 13 years and the only time we ever had 3 pts was when they were about to be transferred to the floor and they were stable. The heart should have been a 1:1 for at least the first few hrs and there is NO way anyone could have taken care of all of those pts.

Good luck with everything and as someone else said do not beat yourself up, but don't give up on Nursing, try a different field or an ICU somewhere else.

I moved to ED and have been doing that for 9 yrs and love it!

[sauconyrunner]

I think you might have some luck in the job market. Firstly, you have experience, and you have an explanation about why. I left a job (with notice) after participating in a code where I was the RN, the medics who brought the pt in continued to do the CPR and we had an MD in the room....who was looking at me in disbelief, saying, "Where is everyone?" After that I decided m yeah not the place for me. I had been there exactly 90 days when I left. During my interview a few eyebrows were raised at the 80 days (then)...I jsut said, "I don't want to run codes with only these people in a room". I was offerred the job immediately.

[ProgressiveActivist, BSN, RN]

To TX911,

you made a sane and healthy decision to not accept an unsafe situation. You kept your sanity and self respect.

I bet you feel like someone took a huge weight off of your shoulders. Email me if you need info on becoming an ICU travel RN

[TX911]

I do feel like a big weight has been lifted off my shoulders, but I still feel like kind of a bastard. I think we'd all been so brainwashed up there into thinking that this was an acceptable working environment that it's going to take little while to shake off. Thank you to everyone again. It feels good to have confirmed that this situation isn't acceptable elsewhere.

libby, I applied yesterday online for some travel companies. Maybe I'll hear something soon.

[Tinabeanrn]

I have been pushed to the same point in the ICU. For years we worked short. There was some unwritten rule that said Tina has to have 3 pts no matter what. Had pts with CVVHD which should be one to one, but I would be trippled. I too quit in the middle of a shift, but I typed up my resignation and gave it to the assistant manager/charge nurse who always felt I needed to be trippled no matter what. And when I did work my last two weeks, I refused ridiculous assignments bc they knew I was leaving. I didn't even have another job lined up. I just knew I would have a peace of mind, which was more important to me than anything. Its so unsafe, so no one blames you for leaving. You do have a nursing license to protect. You will get another job, no doubt. Try to get into a place with a nursing union where things like this do not happen. I went to an ICU that had an union, and I loved it! Wish I would have been there from the start.

My hat goes off to you for not dealing with that mess anymore. So many ppl just stay there and take it, and that is why it continues. Maybe they will start thinking twice about their staffing. But probably not. You should contact the state and let them know the unsafe patient conditions in that place. That is what I would do.

Best luck to you!

[hiddencatRN, BSN, RN]

My team leaders (charges) and co-workers have all called and such and said to put them down as references. One of my old nursing instructors also found out about it and called to ask if she could do anything and to use her as a reference.

So, that's all really good. I think you can be honest and say you just didn't feel care was safe for patients, that you held on longer than you probably should have and that one day you just didn't think you could participate in such poor management of patients anymore. That yes, you quit without notice, but here are X Y and Z people who you worked with who can attest to your professionalism. I think you can talk about exactly what you said here.

[jd74_RN]

I am sorry you are put on those situations. Looking back at your schedule at worked those past shifts it is very unsafe.. Post CABG OR day in our facility where I worked in gets 1:1 nursing care but to add 2 more ICU status patient is very unsafe and I would have felt the same way as you do. However GOOD LUCK on your next journey and take care...

[GhostWindRider]

I'm with you on your decision. Medicine these days is questionable in it's execution of patient care and patient advocacy. I'm a former 18D, Special Forces Medical Sergeant. As such, we were trained to do procedures that you have to have 8 years of school and spend thousands of dollars on useless pre-requisite courses to get in the civilian world. In 2008, I obtained my civilian nursing license and went to work at two hospitals. Hyperbaric Technology at one and Med/Surg at the other. First two years in med surg was a great deal of fun and challenge. Heavy patient loads were not an issue when you're used to managed 2-3 or more life threatening trauma events, etc.

I was entrusted with the patient care of some of the most difficult and challenging patients. Then a rather incompetent charge nurse was moved up to the first line supervisor's position of the med surg unit. She took great pride in making sure the hospitals financial interests were covered by never calling in the back up nurse "we can handle it". I watched a patient not survive her pushes of haloperidol Q2h while not having cardiac telemetry on the patient. "We couldn't keep it on him, he flopped around too much." I was asked to come in and sit with the patient one on one but was told that I had to leave by 0230 due to hours on the clock. I left, he didn't live to see breakfast. That nurse became the supervisor.

Fast forward a year or so. The hospital is sold to a corporate ownership. CNA ratios went to 12:1 with no CNAs on duty until there were 12 patients on the floor. I arrive for my night shift and get a sketchy report on a patient that had issues. "X-ray is in there now doing a chest x-ray to rule out PE." huh?? So, I walk straight into the room and the pt. is disconnected from his IV, non-responsive, no cardiac telemetry is on him, nor in the room. Tele was ordered at 1600, 3 hours earlier. I had three other patients to see, only 1 of which I had a report on. One was a 12 year old bleeder (can't say more). Phone calls to the pt's doc and IM, orders for a contrast CT to rule out stroke. The charge THAT night was a flake that was later fired for heisting narcs. I had been raising concerns about the day shift charge nurses not correctly staffing the night shift for weeks. It was not a patient ratio issue. 5:1 at that hospital is just fine.

I made a comment to the flake charge that we should have another nurse and aid/monitor tech as we now have a guy on telemetry. She chose to call the supervisor (yep, the same flake that was promoted to supervisor and became the torch bearer for poor staffing and egotistical management practices) and say I was complaining about staffing issues. All of which were lies. I was fired that night. It gets better.

I ask the state's human rights commission to investigate practices of targetting and retribution and provide witness names and phone numbers. 1 1/2 years later I get a nice letter saying all of my claims were substantiated and found true. BUT, as I was not in a "protected" class, there is nothing the HRC would or could do. You see, i'm a white male with 22 years military service, 18 as an 18Delta. I've started thousands of IVs, many under horrible conditions, done 3 chest tubes and participated in many more, "minor exploratory surgery" to find a bleeder after chunks of metal went flying through abdomens, chests, legs and more. After 9/11, I went back and forth to the middle east doing more medicine. Spent weekends hauling wounded from helicopters at the CASH in Baghdad to overworked trauma wards. You did what you know how to do.

Since leaving that hospital 2 years ago, I have been road blocked by this "supervisor" at every turn obtaining nursing work. Several VA positions were withdrawn after a phone discussion with this supervisor. All my references, including 7 doctors (ortho, IM, OB-GYN, family practice and cardiology), several charge nurses and independant nurses as well as patients. All meant nothing as soon as that "supervisor" got on the phone.

Ultimately, i'm disgusted with the potential that poor supervisors have for destroying a career and HR sections that are so incompetent, that i'm leaving nursing (civilian) and pray for the future of patients where their lives are put on the line for budget decisions, egos, poor practices and **** poor HR staff. The nursing staff in the entire hospital has rolled over completely with the exception of 8 people who never or wouldn't dream of rocking the boat. Smile and nod, patient care be damned. It's illusionary.

What i've learned...

1. Patient advocacy is a class in a school that has little place in real practice. It has to be balanced between your career and the ego freak you have to address the patient's issue to.

2. Experience means nothing.

3. _______ nurses always get hired, _______ nurses never get fire. Explanation: I live in an area that is dominated by one particular church. They protect and guard each other like it was their money. I have seen more discrimination regarding other medical staff in favor of this particular group of people on a scale that makes the 60s pale. "Do you know so and so in Ward ___ "? "No, i'm in Ward ____, do you know so and so"? "Oh yes, he's great, we have to watch out for him." and on and on and on.

Sorry for the long story, I pray for our patients, with the future of health care (yes, doctors and nurses will be federalized and unions wiped out). If you're not healthy, get that way, your greatest danger isn't bad traffic, it may be a hospitalization.

Ghostwindrider

[Guest372004]

Remember, you got great experience. One day perhaps you may wish to go back into nursing and when that day possibly comes, you will be in a better place and actually research facilities and even visit them. Then you can take a nurse to the side and get the facts on how things are done in that hospital. Also remember, a new shiny hospital does not mean it is going to be good. I would rather work in an old hospital, running around looking for power cords, yanking on windows to close them, if the work is decent. Shiny things do not impress me anymore.