You Guessed It! Coworker Probs...

Nurses Relations

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Specializes in Cardiac/Respiratory/PCU.

This is about to be long...

So let me start with a disclaimer. I, of course, do not consider myself lazy nor do I feel like anyone should absolutely bend over backwards to make my job easy. I accept my responsibilities and I can say I work my orifice off for my patients.

Let me describe my unit for you...

So I work on an IMCU at a local hospital that is decent in size. We are a 3 part unit- 32 beds. 12 beds are basic tele (which we usually staff with float nurses/resource)- ratio 6:1, 12 beds are PCU/IMCU/stepdown (whatever you want to call it) ratio 4:1/5:1, and 8 beds are the same as the latter but are usually reserved for patients who need ever closer monitoring with bedside monitors plus we can take vents, hi-flos, BiPAP, and further intensive drips- ratio 4:1 strict. We are ridiculously understaffed at times. Barely ever CNAs, etc etc. You can imagine, we get BUSY.

That being said...

I am sick and tired of minimal support from some charge nurses/team leaders/whatever you call yours. Some are GREAT, don't get me wrong. Some are...eh...which I can deal with. But there are a couple who just don't help 90% of the time. Like I said, I don't expect anyone to just take over and do my job, but if I am 5:1 with a cardizem drip, nitro drip, and insulin drip (qh BG checks) and no CNA?? Sorry not sorry, but I do expect help. If you are TL and you are not in staffing, you can't walk around and grab vitals on 12 pts? You can't check my pts BG? You can't help me turn my 400lb patient in isolation? That is the kind of situation that grinds my gears. EVEN WORSE, are the team leaders who leave the floor for hours upon hours to do paperwork in the office. I totally get that the paperwork is insane. Floor nurses, like myself, often help out with this. But WHY oh WHY does it seem paperwork has become higher priority than the well being of the patient?? Then we get fussed at when we are on the clock past 7:30 charting. Its a vicious cycle.

It just seems that these "leaders" have no problem shoving write ups in nurses faces, notes on what hasnt been done yet for the pt (i.e no nurse written label on an already pharmacy labeled abx that infuses for 30 minutes) but aren't there to help when help is so desperately needed. I am forced to prioritize these things. If I JUST walk out of a room of a pt who had active chest pain and was diaphoretic and had just solved that issue, please dont come to me talking about a label and not ask me if I need help. Or, omg, there was even a situation where a isolation pt was in bilat soft wrist restraints and had gotten out of one and ripped of her IJ dsg. The 2 charge nurses discovered this during CVL rounds. The solution for them? Ungown, walk out of the patients room, and call the nurse on her phone to come now and re-tie the restraint and apply a new dsg. I watched them just walk into the next pt's room like nothing had happened. WHAT?! :eek::eek::eek::eek::eek:

I could go on and on. It just infuriates me. I am a newer nurse. I LOVE what I do and I like to think I am good at it. I am looking at working towards being a TL, myself, for reasons that are obvious. But sometimes, this is just SO discouraging. That is not what I want to be. Is this normal? Is this what nursing is? I feel like a hamster in a wheel :sorry:

Share your input, my nursing brothers and sisters. Any opinions, input, or encouragement is more than welcome.

EDIT: I would LOVE input from team leaders/charge nurses! What is it like from your perspective? Am I being unreasonable? Be honest with me ya'll!

/rant.

The solution is get together with your co- workers, come to an agreement on what you all expect from the team leaders , put it in writing and present up the chain of command.

As far as the princesses who left the isolation patient?.. I would have written them up for leaving a patient in an unsafe situation. Whether or not they were the assigned nurse, they were liable to address the immediate need of patient safety.

It's a tough go, but it can be done.

most charge nurses /team leaders where I am take assignments.Your assignments sound crazy and unsafe.

Specializes in Cardiac/Respiratory/PCU.
The solution is get together with your co- workers, come to an agreement on what you all expect from the team leaders , put it in writing and present up the chain of command.

As far as the princesses who left the isolation patient?.. I would have written them up for leaving a patient in an unsafe situation. Whether or not they were the assigned nurse, they were liable to address the immediate need of patient safety.

It's a tough go, but it can be done.

You're absolutely right. I've gone to management twice, but to be honest I haven't really seen much improvement. I guess I will just have to keep it up until something is done.

Specializes in Cardiac/Respiratory/PCU.
most charge nurses /team leaders where I am take assignments.Your assignments sound crazy and unsafe.

They take assignments when absolutely necessary. Ideal ratio for the side I work the most on is 4:1, but at times we are 5:1. Some team leaders push us to that ratio so that they only have 2 patients. Sometimes that is okay, but if I have a lot of high risk patients, its stressful. I can see where it could be dangerous. Fortunately, this is all I know of nursing, so I am pretty conditioned to it. But unfortunately I have to seriously prioritize. So when I am 5:1, yeah, documentation of patient edu, immunization discussions, and labels wont be done. It sucks, but it looks like the price I have to pay to keep everyone alive.

Specializes in Cardiac/Respiratory/PCU.

No other input? :nurse:

Specializes in SICU, trauma, neuro.

Those assignments are ridiculous. I've worked LTAC that had similar pts but not quite the assignments that you did; we could have 4-5:1 with vents, tele, big wounds...but if they were on a drip, they were in the ICU where the ratio was 3:1. (Well heparin drips would be on the floor, since you're only titrating a few times a day at most) I hate to say it, but if a drip(s) had been added into my mixes, something would not have gotten done. Whether it be wound care, mobilizing the pt... at some point you just can't work any faster and still be safe. Or you just can't work faster, period. No help for turning a 500lb pt? No ceiling lift and bed sling? Sorry, the pt isn't getting turned. Even if I didn't care about my own safety, I know my limits and I am not physically strong enough to effectively offload pressure. So basically I'd be hurting myself BUT not preventing pressure ulcers either.

The hospital I work at now has a 3:1 ratio in the IMC floors.

Sorry I know that doesn't help, but no I don't consider your situation okay. I agree w/ Been There, Done That!

Reminds me of my first CNA job. One day, I was the only CNA to show up for work besides one other who was "senior" to me. She spent the entire day at the nurses' station without a word to me. Not knowing what to do, I attempted to do everything for everybody. Needless to say, not much got done by the end of the shift. This woman had the gall to chew me out because "when we're shorthanded you don't do bathing". Well, this was my first CNA job. How was I supposed to know that if nobody was going to tell me, at the beginning of the day, not when it was time to clock out and go home? I have no idea where the charge nurse was in all of this. She was probably hiding somewhere else.

I work in a different specialty, but I have noticed the same thing. Young or old, new or not, I haven't noticed a nurse passing much in the way of valuable tips/tricks on. When I think back to when I first graduated I crossed paths with a few seasoned nurses on three separate instances and none had one iota of advice or encouragement to offer. Even my neighbor, when she first introduced her self to me loudly proclaimed 'Hi, I just moved in downstairs. My name suchandsuch and I AM A NURSE!' I said hello, proceeded to tell her that I would be finishing up w nursing school soon, etc. She quickly changed the subject and hasn't mentioned NURSING since. What a joke. It was strikingly weird. Isn't it true that in any other profession old pros will greet newbies with open arms and show em some things...

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I work in a different specialty, but I have noticed the same thing. Young or old, new or not, I haven't noticed a nurse passing much in the way of valuable tips/tricks on. When I think back to when I first graduated I crossed paths with a few seasoned nurses on three separate instances and none had one iota of advice or encouragement to offer. Even my neighbor, when she first introduced her self to me loudly proclaimed 'Hi, I just moved in downstairs. My name suchandsuch and I AM A NURSE!' I said hello, proceeded to tell her that I would be finishing up w nursing school soon, etc. She quickly changed the subject and hasn't mentioned NURSING since. What a joke. It was strikingly weird. Isn't it true that in any other profession old pros will greet newbies with open arms and show em some things...

I think she wasn't actually a nurse, or she would have embraced you with open arms. No, she was some other type of (maybe) health care personnel but likes passing herself off as a nurse. She obviously knew better than to try to pull it off with a real nurse.

About princess team leaders - they are despicable. Bad enough if you want to work your way up the food chain just so you don't have to get your hands dirty, but to have such a low threshold to write up nurses who are actually doing the work! If you have a union, you have an unsafe staffing form. Get good at filling them out. Management will try to intimidate you out of doing that, but the only way to get taken seriously is to find ways to make your problem their problem.

If you don't have a union or unsafe staffing forms, you really need to get your coworkers on board to present a united front. You might have to use blank paper to document that you are accepting an unsafe assignment under protest. The more nurses participate in this, the better.

Good luck!

Specializes in Cardiac/Respiratory/PCU.
Those assignments are ridiculous. I've worked LTAC that had similar pts but not quite the assignments that you did; we could have 4-5:1 with vents, tele, big wounds...but if they were on a drip, they were in the ICU where the ratio was 3:1. (Well heparin drips would be on the floor, since you're only titrating a few times a day at most) I hate to say it, but if a drip(s) had been added into my mixes, something would not have gotten done. Whether it be wound care, mobilizing the pt... at some point you just can't work any faster and still be safe. Or you just can't work faster, period. No help for turning a 500lb pt? No ceiling lift and bed sling? Sorry, the pt isn't getting turned. Even if I didn't care about my own safety, I know my limits and I am not physically strong enough to effectively offload pressure. So basically I'd be hurting myself BUT not preventing pressure ulcers either.

The hospital I work at now has a 3:1 ratio in the IMC floors.

Sorry I know that doesn't help, but no I don't consider your situation okay. I agree w/ Been There, Done That!

Depending on the drip, we typically don't titrate. It's just that, well our IMC is like purgatory. Our patient care supervisors who assign beds don't do a very good job sometimes, so we get the patients who are super simple and need to be downgraded, or we get the silent train wrecks who code 15 minutes after rolling onto the floor. But the drips arent that bad; my bigger concern for the drips are the fact that they take them on the side where we do not have bedside monitors. The side with them is fine, I can cycle the BPs from the desk with no issue. But omg I get nervous to take a dobutamine drip with no bedside monitors. That, to me, is unsafe- even if BPs were stable for the last 24hrs in ICU. As for drips with little to no help...Insulin drips are the worst. QH-Q20m BG checks is insane.

With the turns, luckily we have about 5 rooms with ceiling lifts...but do they consider that when placing the biggies? NO. Ugh. So yeah, sadly, a lot of my people get turned q4-q5, unless I have them on a bed with turn assist- WHICH IS LOVELY.

Ugh. We're supposed to get renovations soon. And we are downgrading and getting rid of our 12 tele beds. SO, no more 6:1 nights on that side. Plus with not having to staff for 6:1 our IMCU ratios will improve...hopefully. Because a LOT of people have/are quitting this year.

I always just try to smile and tell myself, one day when I move on to greener pastures, I will be a time efficient super nurse. LOL

Specializes in Cardiac/Respiratory/PCU.
I work in a different specialty, but I have noticed the same thing. Young or old, new or not, I haven't noticed a nurse passing much in the way of valuable tips/tricks on. When I think back to when I first graduated I crossed paths with a few seasoned nurses on three separate instances and none had one iota of advice or encouragement to offer. Even my neighbor, when she first introduced her self to me loudly proclaimed 'Hi, I just moved in downstairs. My name suchandsuch and I AM A NURSE!' I said hello, proceeded to tell her that I would be finishing up w nursing school soon, etc. She quickly changed the subject and hasn't mentioned NURSING since. What a joke. It was strikingly weird. Isn't it true that in any other profession old pros will greet newbies with open arms and show em some things...

I agree with the other responder to this post. She probably wasn't a nurse. Probably a CNA or another nursing student. Most nurses I know dont just blurt out their profession. Then we get those calls at midnight with the caller describing this weird bump on their god only knows what. :roflmao:

And you know...besides those few TL's who are as I described. I LOVE my team. They always have my back when I need it. That is really the only reason I stay, aside from the fact I am gaining amazing time management and prioritization skills.

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