Angry Nurse - page 9

I am wondering if this has happened to any of you.... I got "talked to" by my Assistant Nurse Manager (charge nurse) because of an incident with a patient. My patient asked for some water, and I went... Read More

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    We have all worked in understaffed conditions and have taken the dissatisfied comments from both managers and patients. (I don't think any RN would refer to a patient as a customer, but I have heard administrators and board members refer to them that way). The real question is how to get adequate staffing? Intellectually I agree that the public is slowly realizing that there is a Nursing shortage but until they are directly affected by it the usual American response is to ignore it. If the the RN doesn't tell the patients who will? By telling them at the point of service (a nice managed care term) it then becomes real for them. It willl not become real to the administaors of health care facilities untill they can no longer replace the RN's that are leaving their facility. And then they will try to replace the RN's with unlicsensed assistive personel.

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    [QUOTE]Originally posted by fergus51:
    I couldn't disagree with you more. I do believe that a nurse's first obligation is to his/her patient, but the only way to meet that responsibility is to have a reasonable workload. >>

    Oh, I think we do agree completely. I have fought too many battles over this kind of thing at one institution or another. I am remembering an incident where I got 'talked to' because a family member complained:

    I was working in a long-term care facility, and the only licensed person in the building with 100 patients. One of my patients was vomiting bright red blood with a significant decrease in blood pressure and an increase in pulse, also the pulse-ox was showing a drop in oxygen. Does this spell an emergency to anyone?

    While I'm on the phone to the doctor and ambulance, another patient fell. Family came up to the desk to tell me Dad was on the floor while I literally had two phones in my hands, one up to each ear! I said something like, 'I have an emergency, I'll be there as soon as I can,' with the corresponding wail of an ambulance siren in the distance. Duh! Didn't this mean anything to the family? Nope! Their concern was for their Dad, and rightly so! They deserved to have immediate attention, too! But, I couldn't give it. I sent two CMTs to stay with the patient on the floor until the crisis was over.

    In the meantime, another family member came up to the desk complaining that I hadn't changed mother's dressing yet.

    The next day, I was in trouble because of the family members who had complained about me. You see, admin wasn't interested in saving a patient's life who was bleeding out, unless a family member complained! They weren't interested in me doing the right thing. They were interested in public relations and happy family members.

    Not only was I not supported, but I was in trouble, over this unfortunately true situation. Did admin recognize the need for more nurses because of this incident? Nope! I was to blame because I didn't make nice-nice with family members.

    Also, I don't believe there is a real shortage. I think there are plenty of nurses and staffing in the community. But, admin all over the country has cut wages and benefits and increased workload so that the quarterly profit, bottom line, is higher. I know of two nurses who left the profession because of this: one is now a manager at a QuikTrip, the other is a line person at a fast food joint.

    And, like your observation, nothing changes until it costs the corporations more in lawsuits (and Division of Aging fines) than the potential savings they are forcing on the nurses and patients by the cutbacks.

    The community isn't ignorant. They can see that Mom didn't get her ice water, that no one was there to pick Dad up off the floor. And their complaints don't mean anything, either, unless they say the magic word: lawsuit. Unfortunately, that means that the nurse ends up in court, too!

    So, I continue to say that the nurse must NOT try to be SuperNurse, as you said. Find a job that is less stressful and where you can practice in good conscience. Otherwise, the nurse is the one who gets blamed for the shortage, for not being in three places at once; and eventually, it's the nurse who pays for the "bean counters." No one nurse can reform health care. And, we aren't organized enough to demand it, either. Until this country recognizes the nurse for the vital role that we play in health care, in wages, staffing, and respect, then our only alternative is to speak by leaving. Well run institutions won't suffer the "shortage" and the ones who don't respect the nursing staff will "wake up" when they can't provide care, gets sued, and the census drops because of it (and it costs them money).

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    Sorry to clutter the air waves with more of my jammering. But, I did want to mention one more thing.

    When I called the Missouri State Board of Nursing and spoke with an attorney there about short-staffing issues a couple of years ago, their position was that the nurse is responsible for the care; and that if a nurse accepts an assignment knowing that she is unable (for whatever reason: staffing, her own limitations, etc.) to provide the necessary care, then that nurse is legally liable! Yes, the institution can be sued, too. But, the nurse, by her acceptance of the assignment, is equally to blame for not providing the necessary care to the patient. That's a tough parameter, and very sobering. We can't blame our institutions when we willingly accept ridiculous assignments. The advice I got from the Board was to refuse to take the assignment. Of course, I said that I'd be fired. Their answer was that I might not have a bad job anymore, but I'd still have my license so I could get another one!
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    Today we work in a world based on customer service, and staffing issues need to be taken up with the nurse manager, not the patients. We must hide problems concerning staffing issues from our patients, as this can cause anxiety and guilt, which we do not want. It is not any concern of the patient that the unit is short staffed, so we make up another excuse that you attended an emergency or delegate. In your case, you needed to attend to an emergency and you were right. Unfortunately living in a consumer world, creates patients and families that are picky and will complain, but we need to be one step ahead of them.... You were not wrong to say what you did, you just said it to the wrong person.........
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    Youda, your last posting is exactly what I have said in other discussions on this site: if it's an impossible assignment; don't accept it! It IS your LICENSE you are risking; why put yourself at risk like that? Your Board of Nursingwas quite blunt. I have found that if you do not accept impossible assignments, you get administrations' attention, and although they may not be happy with you, you will not lose your license.You may lose your job, but if so, think about it; do you really want to work in a place that puts your license on the line every time you work? And not only your license, it's also patients' lives that are at stake. I don't think it's worth it in my book. In the situation that started this topic, I don't remember if the assignment was bad to start with or impoosible, but the emergency that caused the slowdown of the pts. glass of water was a priority, and the manager should have supported the staff better. Let the family complain to the manager; but don't take it out on the staff that had their priorities in the right place.
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    Hurray for saying the truth. If we as nurses start acknowledging there is a shortage problem then something might get done about it. If the women wanted a glass of water and the son was there, HE could have got the water. (Maybe he is neglecting his mother)? People we are not waitresses/waiters or supermen or superwomen. Next time tell the patient you are a complete idiot because no one has shown you how to turn on the taps, and all you know how to do is: save peoples lives, hold a hand PRN, talk to frightened or grieving family members, answer the phone, hand out an endless supply of meds, put up with Dr's egos, get WATER, change IV bags, do all the paperwork etc.
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    Youda or JennyP,
    I am just curious, are you able to accept assignments under protest? Here if say I show up for work and another nurse calls in sick and isn't replaced I am not allowed to refuse the assignment because it would be abandonning my patients and I could lose my liscence for that. I can accept it under protest (we fill out a form saying we think the conditions are unsafe and that management is aware) and I am not legally liable for anything that happens because of the lack of staff.
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    Welcome to the world of NURSING SHORTAGE.
    It's wonderful time. I use it as the "I don't need this crap" answer.
    If your nurse manager can't figure out YOUR priorities when doing pt care...tell her to blow. There's always another job on the horizon.
    Every once in awhile I get "talked to"...what do you exactly want me to respond with? You didn't check the pt. ratio? you didn't come kiss their butts?
    MY priorities are...
    1) the live saving of a pt.
    2) the doctor's orders
    3) patient comfort
    4) the administration's fluff
    In that order period
    I wouldn't have said we were short staffed, but I would have drawn down the family member for implying a glass of water was more important than chest pain...EXCUSE ME?
    Where would you like me to be when your mother codes????...Fetching ice?
    To the nurse manager...sorry...doing my job. I'll try not to be so honest about YOUR inability to provide me with a decent workload.
    And ALWAYS ALWAYS have a foot in another door
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    Originally posted by ccelia:
    I think it is simply not worthed to be angry over an unreasonable person. Our energy should be treasured for people who appreciate.
    Nor do I agree with the nurses in this forum who feel a waitress is a lower-ranked person who can be humiliated.

    I don't think the general concensus means to imply that a waitress is lower and can be humiliated. I think what everyone is pointing out is the attitude of patients and others that a nurse is nothing more than a handmaid or a "glorified waitress". We have education and are charged with making life/death decisions on the spur of the moment. That should afford us some modicum of respect on a professional level, which is, admittedly, above the level of the responsibilites a waitress has. We are there to care for our patients, not cater to every whim, as a waitress is expected to do. Our jobs are more complicated and require extensive understanding and critical thinking skills. As I'm sure others in this forum have done, I waitressed my way through college. Don't misunderstand us when we use that analogy.
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    This is a toughie. I think the best way to handle a situation like this if it comes up again is to be forthright. In this situation, you could have said "I'm sorry, I know you were waiting for this water, but I had an emergency with another patient as I was getting it."

    I have mixed feelings about telling patients/families that you are short staffed. Some people will receive this well, and others still will receive it as you ignored them. Understand also that this family member may not have been upset about the water, but concerned or angry about his sick family member. Or, hey, he could just be an impatient jerk. I'm sorry you had to pay the price for being honest. Sometimes no matter what you say, people will react in bizarre ways.

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