Quote from miko014
Okay, so I had kind of a rotten shift the other night. One bad shift wouldn't be so awful if it wasn't for the fact that we had nothing but bad shifts for most of December and January. Then we had a couple of nice weeks, and it seems we are back to unmanageable again. Why do we as nurses, in a field with a huge amount of liability (in a very litigious society), allow this to be the norm?
I was so busy last night (3 - 1130), I did not have time to check my charts until 11pm. Upon doing this, I found 2 med orders that were never taken off. We have been having problems for weeks now with our computer MARs - one time orders that are in our pyxis are not showing up on our to do list on the computer. In the "olden days", I would have had the order transcribed onto a paper MAR by the UC, so I would have seen it. Anyway, this pt had a K+ of 3.0 and was supposed to recieve K-Dur "now" at 1400. He never got it. Then, at 1500, another pt was supposed to get dulcolax suppositories x2 "now". Keep in mind that I am in report until 1530. So I guess that's why I didn't know about the orders till late. I took care of them, but I was pissed. What if that had been something important? Another nurse I work with said that, if it was something important, I would probably have known about it, but maybe not. And the nurse I followed must just not have seen the orders, because she is usally very good.
The main reason that I was so busy was my little houdini. She was in a posey and bilat wrist restarints, and she screamed bloody murder all night long. She managed to get out of the restraints at least once and hour, and even though the ANM could hear her, and knew that I was drowning, she would not go into that room. I flat out said, "I'm dying here." She said, "so is everyone else." Yeah, that's a good way to deal with the situation. I repeatedly asked for a siiter. I had given this little tiny lady 4 of haldol IM, seroquel, 2 prn doses of zyprexa, and a mg of ativan per PEG. It didn't touch her! But she did wear herself out...she was starting to nod off about 2345 - 15 minutes after I was supposed to be gone.
Are your hospitals like this? Where you have to take pt loads that you can't handle alone, or you have nobody to help you, or you constantly stay late every day (most of the time I am finished on time, but I have to wait for the next shift to get out of report)? I work for a good hospital. We keep winning all kinds of awards. It's insane. We aren't union, and it all feels very hopeless right now. I'm sure I'll get over it, but I still think that bad shifts should be the exception, not the norm. I didn't get my BSN to be constantly worried that I don't have enough time to provide adequate care to my patients, and be run off my feet and miserable every night. It jsut feels like there is nothing I can do about it! I like my job! I like my pts! I like (most of) my coworkers! I just feel that we are all being abused by the system now, and it doesn't feel like it's going to get any better.
Aaaaahhhhhhh okay, vent over!
I'm union, I think it makes a big difference. That being said, I have exactly those hell shifts too. Our ward is difficult to staff and we get many sick calls. Management seems to work in complete opposition to the staff, in pushing more and more complex patients onto a tighter staff ratio.
I personally don't put up with it. A few things I do to cope:
1) incident reports, tons of them
2) reports to the union
3) written (recorded) complaints to management
4) ensuring your unit manager and charge nurse are aware of your unreasonable assignment and that you require help. Ensure that you are making it loud and clear that you feel that the situation is unsafe.
5) we still work by the old system, transcribing our orders by paper, often ourself, on top of the busy assignment. MAKE A HABIT OF CHECKING YOUR ORDERS EVERY TIME YOU WALK BY THEM, even if they are not flagged. I walk past the charts/med room every few minutes, and I am anal retentive about checking my charts to ensure nothing is missed. My patients are far too sick for an order to go missed for four hours.
6) Chart chart chart
7) resign if nothing else works. Nothing speaks louder than your staff leaving in droves.
Remember, you can't expect others to advocate for you. You must advocate for yourself and advocate on behalf of your patients. It is your responsibility. If that order is missed and something happens to the patient, you are responsible, unless you take documented steps outlining your concerns and measures.
And if you think you don't have time for documenting this stuff, realize that it MUST BE DONE. Nothing else will save your a$$.