wow

RNforLongTime · Aug 29, 2001

I start my own ivs but the 226 bed hospital that I work at still has Respiratory Therapy, Pharmacy Tech's, Dietary aides--we always have a secretary on days/evenings. But I am going to night shift--for my sanity--so will no longer have a secretary so I need to learn how to put in orders. Plus there is always a phleb tech to draw labs.

soundsLikesirens · Aug 29, 2001

We do all that in the first post except the breathing treatments and that will probably be the next thing.

tonchitoRN · Aug 29, 2001

frustratedRN - you listed at least the jobs of 5 people. Your hospital must be making the bucks with all that labor saved. Glad I am not in your shoes. :cool:

frustratedRN · Aug 29, 2001

we are a 546 bed facility.

we dont have a phlebotomy dept. . im not very good at iv's yet nor am i good at blood draws. our assitants do them but the bottom line is that they are my responsiblity...just like everything else.

not having a secretary on night shift is only really bad when you get an admission. other than that the docs dont come in at night so thats not a problem. cant say the same for the evening shift.

being new i am slow at everything. its frustrating when i see nurses just sitting there when they know this. it wouldnt kill them to help me out.

im so tired of staying late. im so tired of 8 hours turning into 12. and i stay after my shift and still get stuck doing patient care.

i can ***** here all day but thats not going to change anything.

the catch for me is that im trying so hard to learn this and do it well. i keep thinking that the longer im there the better i will get at it but it seems like the longer im there the more i just spin my wheels.

the last two nights have been horrendus.

we have a 62 year old patient who is large and a complete. this poor woman has had diarrhea and her butt is so sore and excoriated. she needs tons of meds and is always uncomfortable.

she has been taking up ALL of my time as well as my assistant.

she asks to be bathed at least once an hour. she asks for breathing treatments hourly as well.

her family is ridiculous. they are constantly demanding care on the spot. yesterday her sister wanted an order written for us to put the patient on the bedpan q15. they started writing down how long it takes to answer her call bell.

i called the nursing supervisor last night. i knew there was going to be some kind of crap with the family and there was.

im so glad i covered my butt.

this woman needed private duty nursing. she needs someone to stay in the room with her constantly.

the daughter has complained to the DON as well as everyone else.

ive have been taking excellent care of her mom. i told her that the other night when she was in. she said...yeah cos i complained....

boy that pissed me off. i told her that i didnt even know she complained.

i was so glad the supervisor came up cos she got to see what was up. just as soon as she left the patients room, the patient started screaming and moaning. she had a bm and needed cleaned. instead of pressing the call bell she just started screaming. we went in to clean her. she was sitting in a chair and we tried to stand her up. of course her legs gave out and we had to catch the dead weight. im suffering for that one today.

nobody would help us with this patient. one assistant was pregnant and she refused to go in the room because the pt is vre positive. the other assistant had back problems so she refused to lift. everyone else declined to help us cos they were too "busy"

the nursing supervisor helped us.

later that night we didnt answer her call bell right away...daughter was on the phone timing us. she called the station and told one of the other nurses that i was in trouble...she was also mad at that nurse cos she answered the phone rather than answer her moms call light. (that nurse wasnt even on duty)

supervisor called me later to say that the daughter had complained and her complaint wasnt taken too seriously.

we cant deliver the care the family demands.

i was so glad i called her so that she could see what was up.

the family might want to spend a little more time at the hospital rather than on the phone. she has been on our unit since the first of the month. ive only seen the daughter once.

longforseaair · Sep 3, 2001

Oh boy howdy, do I know what kind of patient you are describing, and the family! They don't care if you have other patients. I wonder how they would react if you looked straight in their face and smiled and said, I have other patients and I have been taking care of one of them that is much sicker than your mother and that is why I couldn't get here instantly. I just wonder.

These are people who believe in the old squeaky wheel greasy wheel adage. I wonder what the repercussions would be if the family was told that you are the only one left who will take care of their mother, because the other nurses have flat refused to take the patient.

It's very discouraging to have to work in conditions like this. I think that nurses had more freedom to react in "tough love" in the past than we do know. Could get away with being more assertive and instructive. I know that we have insisted to pt. families lately that we don't have adeq. staffing and they must have a sitter or family member to help. They sometimes get reality shock back into humanity.

I have told pt. and families lately that I have very critical patients and will not be able to come immediately if I am helping one of them. It helps sometimes.

It is these things that are causing the nursing shortage. Do you ever wonder what would happen if the public were reading all these posts. Would they still not get it? Maybe you can't really know how it feels to put your physical, financial, emotional future on the line every shift unless you are the nurse.

Good news: You will get better as a nurse, I have.

Bad news: The situations will remain the same.

RNforLongTime · Sep 3, 2001

FrustratedRn,

Boy, do I know where you are coming from. Have dealt with numerous families similar to the one you describe but yours takes the cake.

I sometimes apologize to pt's and family members who complain when their loved ones call light doesn't get answered quickly enough. I explain that I was tied up with another pt. Most times the family members don't care cause no one is more important than their loved one. I explain that another pt is having difficulty breathing and that takes priority. This is usually the case or that a pt was having chest pain and I had to take care of him.

I can only be in one place at a time and only have two arms and two legs. Of course, I never say that to patients or their families. But it is true! One person can only do so much with so little. Good Luck.

Jay Levan · Sep 3, 2001

Dear Frustrated, I have been following your Threads now for approximately 1 week, and I have noticed that you received, a compendium of Good, Sound, and obviously Well thought Out "Advice" on your situation :confused: At first I thought, "Oh no, another shinning example of Nurses Eating Their Young" However now I, as well as others here see another side of your plight. It causes me to wonder if you have considered any of the options offered to you here??? Which begs the question, "What steps have you taken to alleiviate the obvious stress you are under" I am from New York originally, and when I was in your shoes, both when I started out in E.R. Nursing, and in the not to distant past, I had to make decisions regarding my continuing carreer(28 years now) Of course the latter situation was made much easier, because of my experience, and confidence in my clinical skills. What you are dealing with is not in your control. There are many people who are frustrated, for various reasons, and one can only speculate on those reasons(You can never be sure)

So, to the heart of the matter, "Do you wish to continue your chosen carreer?" If so, I would strongly advise you to put in a notice of your intent to leave your current position. Without knowing how far you may have to travel to obtain a new beginning, I am positive that staying put in your current situation, can only accomplish one thing, Another Burned Out Nurse! Which in turn will only add to the Nursing Shortage. Add to this, that apparantly anyone can visit here and see our "Professionals" engage in these discussions about our profession(I believe that in order to Post here, one should have to provide a "Valid" Nursing Licence) :eek: This is only restrictive in the sense of Nursing Issues, non-licensed visitors could have their own "Posting Page" without having access to our most private issues :cool: ? It physically makes me sick, to see what we

are doing to one another. Do you suppose that anyone interested in joining our ranks, would voluntarily opt to become a nurse?? after seeing that type behavior as prevelent as it is??? I know that "moving on" is not an easy decision for most people, but for me the option is always made easier by knowing that there are many people who need us, and if I were to quit I might miss the opportunity to help those that truly need my skills, to help them on the "Road to Recovery"

Lastly, my thoughts and prayers are with you as you go through these trying times, as well as all my fellow professionals who have been thoughtful enough to respond to you. Good Luck and Gods Grace be with you.:)

MollyJ · Sep 3, 2001

Do students still see that old movie, _Mrs. Reynolds needs a nurse_? It was an ancient movie when I saw it, so now, 25 years later, it would be mondo ancient. But it was about a Guillian Barre patient who drove all of her nurses nuts and clacked her dentures to get nurses attention.

These kind of patients and their families have been driving us all nuts for years. And I don't believe staffing ratios have helped this little situation one little bit. I would bet the other shifts are not coping with this patient any better than you all are.

When patients drive me crazy, here is one thing I do that helps. What are the common grounds you have with this patient and her family: That you would hate laying in poop one minute longer than you had to. That poop on excoriated skin can be really intolerable. That you would hate being so out of control with your bowels. That, if this were your grandma, you'd be an enraged family member, too.

What essential feelings do you have about this patient? Are you feeling bad or guilty that you cannot clean her up promptly? Are you angry at her and her families demands and what they say about you as a nurse when you feel so powerless to make it better? I ask this question as one who has been there, done that. Human to human, none of us want to be left laying in poop, but when you are juggling priorities, chest pain v poop, what does the prudent nurse choose?

You use those "points of agreement" to talk with your family members. You say, "It is really frustrating to see someone you love laying in excrement." And you don't tack a "but" onto it at that time no matter how much you want to. You listen to them say more hateful things for a while. Then you (or preferably your super) talks to them about the limitations of care in the hospital and that you are assigned a full patient load. In the ED, toward the end of my time there, I got better at offering to get family members supplies to do the job themselves. Most of us despise saying things like this to families, but the realities are that we can only be in one place at one time and we might not be able to be in their place asap or on the schedule they want. If you are served by a CNS on your unit, I would get a care conference going on this dear lady. If there is something self-limiting going on (gi intolerance to a med) that is one thing, but it seems like you guys have been at it a while. Is she not tolerating feedings? There are other feeding solutions that don't cause so much diarrhea. The family wanted "bed pan q 15" is the signal that the family is feeling really out of control on this issue and this is a ridiculous request that would not help things. I also wouldn't bathe her more than once daily but I would do the best peri care on her I could. Hash these things out in a care conference or with a CNS consult.

I hope you reported your back/m-s injury from when she dropped her dead weight on you. Take care of yourself.

I appreciated Jay's comments about how if this is de riguer in this hospital maybe it is time to move on. That is a legit thought but these heavy care patients who don't have the acuity rating to be anywhere but your unit will occur everywhere. Good units with lots of team work share the burden of these folks and rotate the assignment and pitch in on the assigned nurse when they can but weak charge nurses will not do this. I'm glad the house super is pitching in and good that you are keeping her informed.

One last comment in this long missive. Don't do patient care when you are staying late to chart. I know if you are setting at the desk with the chart and family walks up, you can get roped into this. Try to remove yourself to a quiet spot (doc's dictation desk if not in use, a spot adjacent to the unit but not on it, somewhere off center stage). In your spare time read the charting of nurses you admire. How are they making their charting more succinct so that they can more often get off on time?

majic65 · Sep 3, 2001

The original poster MUST work for an HCA hosptial0--that is standard for them. Their "theory" is that "our patients like it if all their care is provided by their nurse". BS!!!! It saves them loads of $$$, and is a total horror story for the nurses on the floor. Not to tmention the fact that since we had to do our own ECG's, and I have done about 1 of those in 15 years, we jepordize patient care. So unfortunately, folk, this is in some places the norm, and doesnt leave you much choice--in our city, the two largest hospitals are HCA and operate the same way Thats why I have alwasys said that HCA hosptials have perfected nurse abuse to a fine art.

frustratedRN · Sep 3, 2001

jay,

thank you for following my posts. i have actually done a few things to relieve my stress. the first was to request a transfer to another part of the unit on the same floor. the people there all work together as a TEAM, quite unlike the units on the other side of the doors.

while the patient load is still heavy, at least the assistants on that side work and we ALWAYS have a secretary except at nights.

this has relieved an enormous amount of stress. i am now able to provide the care i want and the patients deserve and when i do get behind the other nurses offer their help.

i love it there.

the management has agreed to let me stay for two weeks to improve my charting. then they say i have to return to my unit.

i am in the process of writing a letter to the DON with a copy going to my manager, human resources, and the ceo.

if they refuse to accomodate my request to transfer there or to another floor i will resign.

i will not comprimise the quality of care i give and i will not tolerate abuse. if these are the conditions they expect me to work under then i need to find a place to work that shares my philosphy of caregiving.

as a followup...the patient i described above went to a nursing home. they have less staff than we do. i think the family is going to be in for a big shock. and i cant help but feel sorry for the nursing home staff.