I've been a RN for 10 years, and I have to say I'm at a bit of a crossroads. I realize that it's very rare when someone totally looooves their job. I had a professor at college once tell me that it's not absolutely necessary to love your profession, but if it's something that gives you the ability to do what you really love in your spare time, then it's worth it. However, I often find that nursing is so totally mentally and physically exhausting that I spend most of my spare time recovering and/or preparing for the next onslaught. Don't get me wrong, I love taking care of people. I love spending time with them, making them comfortable, giving them the emotional support they need, and providing them with the information that, most often, they didn't have before. That's the part of nursing I truly love-the patients. I find it difficult to recall a patient I didn't like, or at least relate to on some level (and I work at a large, inner city metropolitan hospital, so I take care of all kinds of patients). It's so rewarding, to me, to provide them with even the smallest of comforts like an extra blanket from the warmer, or actually going down to the kitchen to get the lunch tray that was ordered too late, but they were just allowed to eat after a week of being NPO.
Like, I get it. It sucks being a patient. Being trapped in the hospital, with every contact you have from any of it's employees being rushed and cold. Being awakened at all hours of the night for vital signs and blood draws, or to be whisked off to some test at 3 in the morning without really getting a grasp of exactly what's going on. I'm so flustered by nurses who can literally walk away from a patient who just burst out in tears, or label someone as a drug seeker who asks for more pain meds, simply because they asked, without even a thought of calling the doc or the pain management team to say, hey, this guy keeps asking for pain meds, do you think their pain is well controlled? Not that I haven't had a patient who really just wanted to get high, but even with those people, I ask for a psych or social work referral (often to be looked at like I have 10 heads). I've come to this understanding that the nurses who seem to excel in the field or be a favorite of management are those who distance themselves from the patient and remain fixed at the nurses station glued to a computer or a chart.
I guess that's where I falter. My documentation is, well, adequate. I was also trained (actually by an Ivy leauge, level one trauma center) to document only what is absolutely necessary because of studies that indicated that a lot of litigation where the ruling didn't favor the medical institution was often decided from info derived from abberations found in the nurses' notes. I find, in a lot of cases, that documentation differs greatly from facility to facility based on the type of institution and the existing nursing culture therein. For example, when I worked in California, the particular hospital I was employed at insisted that when you documented info about a patient's PICC line, that you included arm circumference, as well as the measurement of the actual PICC line itself from the tip of insertion to the hub. When I worked in PA, the hospital I was at didn't require those particular measurements, but, guaranteed, you would be called into the manager's office if you didn't change the caps every 3 days and document that you did so. The hospital where I work now as a travel nurse, doesn't seem to care about any of those things, or even if the dressing is changed every seven days, but I was disciplined because I didn't specify every type of IV med in the I &O section of my flow sheet, even though I did in my computer charting.
Of course, it doesn't help that I'm a travel nurse and I get an abbreviated orientation. Travel nursing is not really my choice of venue right now, but the area of the country that I call home is saturated with nurses right now and the job market is too competetive (esp. seeing as many hospitals are cutting costs and don't want to pay for a nurse with 10 yrs of experience). OK, so you may say, well, just take the criticism as it is, acknowledge the input gracefully, and move on-don't stress too much. I used to think like that until I was asked to not return from 2 different facilities because at one place, I was pulled to 3 different units in one day, and when I was transferring my last patient out of the short stay area where I had been assigned so that I could work the last four hours on another floor, the doc wrote (as I was wheeling the patient out the door, because I checked the time the order was placed) for a change in IV fluids, so I showed up on the other unit with "100 ccs left in a bag of incorrect fluids", and I couldn't give them the Plavix that was ordered post cath because it was a new unit that didn't have it's own Pyxis and the Pyxis in the neighboring units didn't stock it.
I was instructed by pharmacy and the charge nurse (who was on a different floor, I manned this particular unit by myself) to wait until pharmacy hand delivered it. I called the supervisor and discussed the situation with her, she said she would call me back, but when she finally did, it was only to tell me that I had to move the patient out of the unit, and fast, because in ten minutes, I had to report to this other floor. So, not only did I transfer the patient with "the incorrect fluids", but I failed to give an ordered medication, and the nurse who received the patient gave me hell for that, even though I explained the situation, and offered to walk down to pharmacy and get the med myself. She also complained that my notes were scant but only because I documented that I received the patient from the cath lab whose vitals were stable and that I was unable to obtain the Plavix that was ordered, which I had discussed with the physician and he was aware. I pointed out that I documented hourly rounds and vitals directly on the flow sheet in the comment section next to the vitals, but they wanted this documented on the back of the flow sheet in the nurses' notes. The other facility that didn't want me back stated I refused to give an ordered anti seizure medication. (In both of these cases, nothing untowards happened to either patient.) This particular patient was NPO, had horrible veins, and had a PICC placed because of this, but both lines were clotted (I couldn't flush or draw back on either port).
I called the doc and asked her to put an order in the computer for antistreplase because we were not allowed to take verbal orders for this med. She was very abrupt with me saying she had several patients in the ER that she hadn't even seen yet, and she would put the order in when "she got around to it". I documented that the med was not given, that I informed the doc, and that I even stuck the patient 3 times for a peripheral IV, which I couldn't get, before he refused any more IV attempts. I passed on to the nurse for the next shift, when she asked why the 10p seizure med wasn't given (my shift ended at 11) that I was waiting for the antistreplase. She asked me if I tried flushing the patient's line, and I replied, of course I did, but I was trained not to force it to avoid pushing a clot into the patient's right atria. I even explained this to the nurse manager, who asked me about it the next day and seemed satisfied with my answer, and I was even allowed to work 3 shifts after the fact which seemed uneventful (i.e no one complained to me about anything). When my recruiter said I was listed as a DNR (do not return) by the facility and I asked why, she said the facility stated the reason was because I failed to give the ordered anti seizure medication. I asked if there were any other reasons, she said no. I worked as staff at three different facilities for 2 years a piece and never had an issue or a complaint filed against me. I won an award two years in a row at one facility for having received the most positive feedback from patients via the patient comment box.
I gotta say, being reprimanded, and even fired, for such minor misunderstandings has left such a bad taste in my mouth as far as nursing goes. Now, every time someone even looks at me cross eyed I think I'm going to lose my job, which I desperately need as a single parent who doesn't receive child support. I wish my career choice hadn't led me to this point. I wish I could one of those nurses who everyone likes so much and speaks of with so much respect. I don't have an especially bubbly personality. I'm not usually "popular" (but not unpopular either) amongst my nursing colleauges because oftentimes, they're a much younger crowd (I'm 40), and I'm friendly, cordial, but not overly so. I usually keep to myself, but I work very hard. I rarely hear comments nowadays about anything I'm doing right. I almost feel like nursing has become like a beauty pageant and I'm killing myself to have perfect makeup, a flawless dress, and super white teeth. I guess it's sort of because I don't have a regular job, and I'm only at these places for a short time, and I keep to myself so that the staff doesn't really get to know me well enough to know that if I'm not a fixture at the nurses' station with my nose in the chart, it's only because I spend most of my time at the patient's bedside.
Any advice? I think I need it because I'm starting to get depressed. Thanks
