Unwritten Social Contract: Your Needs Come First! - page 2

by TheCommuter Asst. Admin

8,154 Views | 33 Comments

According the the unwritten social contract, "each individual in a society has an underlying obligation, to the best of his ability, and before all else, to take care of his own basic needs, both immediate and for the foreseeable... Read More


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    Unfortunately the management mentality of "what have you done for me lately" has forced many nurses to take on lot of pressure. Just remember that regardless of how well you are performing, your manager will never be totally pleased. Managers are always demanding more...
    RoyalNurse likes this.
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    Quote from BrandonLPN
    I think I must not be explaining myself clearly, because people keep misinterpreting me re: the whole "can't stop to pee all shift" thing. I worked at a horrible LTC facility for a few months and was so overworked that I never took a single 15 minute break, let alone a lunch. And I'd stay over an hour every night to chart. It was an unacceptable work environment. But I still would stop passing meds or charting or whatever to pee once or twice. My point was that no matter how busy you are, there's always a chance to sneak in a BR break at SOME point during a shift. Not even the ICU has solid code blues for twelve straight hours. People implying that they literally had no chance to pee for their ENTIRE shift just struck me as silly. That's all. Trust me, I 100% agree with this article that EVERY nurse has a fundamental right to keep himself hydrated, fed and rested. I'll leave the whole "pee break" thing alone from now on, as i'm really just splitting hairs.
    Perhaps you are simply being too literal.
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    When hypertension became a part of my life, I found out real quickly that I had been choosing to put things like hydration and potty breaks at the bottom of my priority list. HCTZ in my combo med taught me that lesson. Whoo hoo, I always have a closed water container somewhere that I fill up and consume, and potty breaks happen. When your body tells you, you are gonna pee in the next thirty seconds whether or not you are near a toilet, you will listen.

    The odd thing is that med "vesicare" that supposedly makes you have fewer potty breaks, worked out the opposite for me. Though to be sure, I took it preventatively prior to a cysto and lithotripsy, but my god. The night before the procedure I worked, and I went to the BR 13 times. I really don't like that med. The ads, they lie.
    TheCommuter likes this.
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    So, how can we support each other better? How can we advocate for ourselves and our peers? It's our culture, right? Don't we have some ability to change it?

    I work in a Magnet hospital and the nurse managers have a tracking system for if nurses get their 30 min break. It puts some pressure on the floor to make that happen. It stems, in part, from the research that says that nurses with breaks make fewer mistakes. I'm "only" a CNA and nursing student now, but don't you think these are simple goals we can work for, rather than complain endlessly about as if there will never be any hope?

    I get it. I've worked in LTC too and I understand the crappy situation of too many things to do. I get it that 30 min is sometimes impossible. But don't you feel faster when you actually sit?

    If you don't have time to do it twice, be sure to go slow enough to do it right the first time, right?

    So for people who do manage breaks--what's working that we can look toward?
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    First of all, I don't care where you work, if you don't take three minutes to use the bathroom when you need to, that's your fault. The lunch break thing is a whole other animal, but honestly, the sky is not going to fall if a nurse stops for three minutes to use the bathroom. I used to have that mentality when I was younger, but not anymore. God gave me one bladder. If I destroy it, are the patients that I was serving all those times that I skipped the bathroom really going to be around to care? When I answered that question for myself is when I stopped being a martyr about using the bathroom.

    Taking a 30 minute lunch break, OTOH...nope, never do it. My usual routine is to snack while I chart, which on most twelve hour nights is at around 1 or 2 am. It's not refreshing, to say the least, and I hate it, but in my job, I really only have the options of doing that or taking a real break and staying over in the morning to chart, which I will not do unless it absolutely cannot be avoided. For one thing, at least for me when I take any kind of break on the night shift, there is usually no one else to take a break with, because we don't have the staff for more than one person to take a break at a time. Our cafeteria is not open on the night shift at all, not even for an hour or two, which I personally think is discriminatory, but whatever, so there's nowhere to really go and sit unless you like sitting in a darkened cafeteria that is not serving food alone. I can't call a friend or family member to chat, because they're asleep. And the main thing is, I get tired and my body wants to fall asleep, so the break ends up making me feel worse instead of better, not to mention the thing about it setting me back so that I have to stay over, so what good was the break anyway if it turned a twelve hour shift into a thirteen or fourteen hour shift?
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    Quote from CherylRNBSN
    Perhaps you are simply being too literal.
    That's very possible. At any rate, I apologize to the Commuter if I hijacked this thread. As usual, it's well written and timely. As a community, nurses need to figure out WHY we so seldom get the breaks and meals other professions take for granted. It's not okay and it's not going to change as long as we keep treating it as the "norm".
    afranklin, lpinkham, and TheCommuter like this.
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    Quote from BrandonLPN
    At any rate, I apologize to the Commuter if I hijacked this thread.
    No problem, Brandon. I welcome comments and dialogue, even if people might express differences in opinions. I create these threads and articles because I want to get people, especially nurses, talking and thinking about different issues instead of merely drifting.
    BrandonLPN likes this.
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    At first glance I "Freudian-ly" read the title as "Unwritten Social Contract: Your Needs Don't Come First." lol. Great article, as usual.

    I'm still in orientation right now, so fortunately my preceptor covers my patients so I can get a lunch break. But even then that's not to say I'll get my entire 30 minutes. I've had no problems sneaking away for a bathroom break, and if I didn't take one...yes, that would be my fault because the opportunity was there. I hate to hear that there are so many that can't get a few minutes to go to the bathroom. When nature calls, I have no choice but to listen.

    I had job in LTC when I would literally get called off my break everyday I worked, and I could only manage to use the bathroom located in the nurses station within ear shot of all the bells and whistles. When I was a school nurse, I had a bathroom in my office which was convenient but some kid would be banging at my door without fail soon as I stepped in there.

    As nurses I feel we train our bladders and stomachs to be able to go a long time without be tended to, especially knowing how far we can fall behind if we actually took a proper break. But we also know when it REALLY comes down to it, we will go use the bathroom or take a break long enough to sneak in a few bites.
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    Quote from OCNRN63
    How can this be done, if, as you noted in your previous thread/article, nurses are not being given the opportunity to void, let alone eat? I'm honestly asking this.
    I have worked in an environment where it felt unsafe for me to leave my patients to take a break, where if you had time to sit, you weren't working hard enough, and where I've been too busy for eight hours solid to even think about going to the bathroom.

    What we do about it is advocate for better staffing ratios, refuse to work off the clock, take the overtime if you don't get your break, and stop charting that you did things that you really didn't have time to do. For this to be effective, though, everybody has to participate. When you work in a culture where the majority of nurses are working off the clock, skipping breaks and not taking the overtime, and charting things they didn't really do, they are setting the bar to management that the workload expected of them is doable. If you're the one nurse that doesn't participate in these things, then management can just point to you and single you out for poor performance.

    "Don't work off the clock!" has become one of my mantras. I refuse to do it, and I'm hoping more nurses will also.

    I work for a union facility, and yet I see far too many nurses working off the clock. Fortunately, enough of us are standing up and refusing to do this, and the union has taken up our cause, forcing management to take notice. They've gone so far as to appoint a task force to address the specific issue of missed meal breaks. Hopefully the outcome will be that management is forced to acknowledge that inadequate staffing and other cost cutting measures like eliminating resources for the nurses and thereby increasing their workload, are the root cause of all the excess overtime, and will rethink their decisions in these areas.

    Maybe I'm being optimistic.
    Last edit by ~*Stargazer*~ on Aug 20, '12
    ChiTownRN5, afranklin, and NF_eyenurse like this.
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    We need to be optimistic, because if we aren't, who else will be?

    This is a great conversation. I take my lunch break but I am guilty for taking it late sometimes, 1500 or 1530 (in a 0700-1900 shift). If I wait until 1600 then I am ready to freak out if someone just looks at me wrong. Granted if I take lunch at 1600 I have been having a really crappy day. One thing I notice I do that makes me take lunch later is "Let me do just one more thing.." And that starts a domino effect of "just one more things" that you all know is NOT just one thing. That is when the IV bag you are going to hang "real quick", of course, the patient's IV infiltrates and you have to start a new one, I could go on and on with the scenarios but you all know what I am talking about.

    There is a never ending list of things to do in the 12 hours we are working. Most of the time I am doing three (or more) things at a time. I think this can be dangerous, but what other choice do we have? When I walk to the nurses station I am making a mental list of the 5 things I need to grab for all my patients while I am by the supply room, while I am paging the doctor, answering the phone, checking my charts, answering a doctor's question, talking to a family member....Calgon Take me away!!! (For those of you who are younger, this is from an old commercial about calgon bath bubbles and when for instance, a mom was having a stressful day she would yell this out in the commercial. She would envision herself relaxing with a bubble bath. Ok, back to the thread. )

    With management cutting staff, increasing our ratios and just making it not a fun place to be. I have taken matters into my own hands and decided to leave bedside nursing. I am going to an outpatient surgery center where I will have one patient at a time, have them for only about an hour for recovery and education, all the patients are "walkie-talkies" and (I feel) it will be a more pleasant environment. Some are meant to be bedside nurses and some are not. That is the great thing about nursing. It is such a vast field, it is not just bedside nursing. And for me, I say farewell. I have three days left of bedside nursing (no, I'm not counting ). I have a smile on my face now when I am at work, even when it is crazy because I feel as though a weight has been lifted off my shoulders. Goodbye bedside. Another nurse will gladly take my place.

    (Just a note, thought of after the fact. I guess what I will be doing is still bedside-or gurney side nursing, just not hospital unit bedside nursing. Just thought I would throw that out there. )
    Last edit by NF_eyenurse on Aug 20, '12
    ChiTownRN5, afranklin, pinkfish333, and 1 other like this.


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