Am I a better paper-pusher than floor nurse?

Published

Sooo....I just got let go from my floor nursing job and I am conflicted. I feel like I am a good nurse but I had a really bad night which just led to my being let go. I have to admit I did miss stuff on my shift and that is all valid. The night in question was a sh*t-show for me and honestly I have had more of those than not. I have been a paper-pushing nurse for about 6 years, I worked as a staff nurse for almost 2 years and then went into case management and prior authorization. I just returned to floor nursing about 6 months ago on a busy med/surg floor. I feel that I have tried to keep up with the demands of floor nursing but obviously I have not been able to hack it. Our floor is frequently short staffed, no CNA's or just 1 so you are on your own basically. The night in question started out with me having 4 patients, 3 isolation patients -1 confirmed C-Diff, 1 droplet (rule out meningitis) and contact isolation for C-Diff and 1 neutropenic precaution. My 4th patient was a bowel prep. 2 of my patients were post-ops who still had post-op vitals to be done. There was 1 CNA for the whole floor. Also, 3 of my patients were blood sugars and 1 had basically round-the-clock IV antibiotics and another had several night IV antibiotics as well. I had medications to be given basically the entire night. When I started the night I asked the CNA if she could help with some of the post-op vitals and she said she would try. I started out with 1 of my post-op patients who was also the bowel prep. I found out when I was doing my assessment with this patient that none of the post-op vitals had been done at all and the patient had been on the floor for several hours before my shift even started so I preceded to start the post-op vitals with the 15 minutes x4. I gave all the meds and did the assessment to this patient however I did not chart my entire assessment as frequently I will make "place markers" and just chart the exceptions and come back later to complete the full assessments. I next went to my other post-op patient who was the confirmed C-Diff and did her assessment and gave meds. I then went to my next patient with all the IV antibiotics and did the same thing (meds, assessment etc.). I was literally running the entire night. I did not have time to chart at all and several hours into the shift the charge nurse called to give me another patient as one of the nurses was leaving. I explained to the charge nurse that this assignment was crazy and there is no way I going to be able to keep up with it. She then explained to me that all the nurses had as many patients and that is all. Mind you the acuity of the other patients were 2-3 out of 4 and all of mine were 3-4. I ended up getting a new admission anyway from the ED and the charge nurse finally sent a nurse that came in to help to help me around 11pm or so. She did my blood sugars which were late and several of my meds. I then proceeded to do my admission. Like I said I was running all night with hanging antibiotics, helping my bowel prep to the bedside commode and doing my admission. I completed all of my assessments -we are required to do 2 for the 12 hour shift- but I did not have time to chart them. I also had 2 lab draws because the patients had a port and PICC so the nurses have to do those. I was still passing meds or hanging antibiotics till about 6:30 am. Our 12 hour shift is from 6:30 pm until 7am. The nurse educator had told me a previous time that technically we had 72 hours to complete our charting -this was on a previous occasion when I had another bad night and did not have time to chart- so my intention was to come back that night and complete all my charting as I had to do another 12 night shift and I had to get my kids to school that morning. I gave report and told the oncoming nurses that I had not had time to complete my charting as I was running all night. I don't know where my head was at because although I did all of my assessments I did not do any other vitals on my other patients. We had 1 CNA so she did not do them either. I had been in all of the patients rooms multiple times for meds, assisting to the commode or my assessments but just did not do the damn vitals. I have not made it a practice not to complete my charting before I leave work but I figured I would do them when I come in that night because I knew it would take me at least 1-2 hours and I am about an hour from home and I needed to sleep cause I had to work that night. Now, I am fully aware I did not practice good or safe nursing that night and take responsibility for that. I should also mention that I explained my crazy assignment to the head nurse supervisor when she came to our floor but her only concern was the fact that I should not have been given the contact isolation patients along with a neutropenic precaution AND I voiced my concerns to the charge nurse twice. Some of the nurses complained that my charting was not completed and that now has led to me being let go. I do not want to make excuses for my dropping the ball as I totally did. If this is what nursing has become then maybe I am better behind a desk where I cannot drop the ball and possibly compromise patient safety. I honestly missed floor nursing but I did not feel like I had the time to really grasp it because at least in my case I was usually just running all night and frustrated when there was no CNA support and I was just passing medications. I feel I still had a lot to learn and get better at with many things. But now I am questioning my entire ability to make it as a floor nurse.

Sorry this is so long. :)

Up Vote Up Vote ×
Sooo....I just got let go from my floor nursing job and I am conflicted. I feel like I am a good nurse but I had a really bad night which just led to my being let go. I have to admit I did miss stuff on my shift and that is all valid. The night in question was a sh*t-show for me and honestly I have had more of those than not. I have been a paper-pushing nurse for about 6 years, I worked as a staff nurse for almost 2 years and then went into case management and prior authorization. I just returned to floor nursing about 6 months ago on a busy med/surg floor. I feel that I have tried to keep up with the demands of floor nursing but obviously I have not been able to hack it. Our floor is frequently short staffed, no CNA's or just 1 so you are on your own basically. The night in question started out with me having 4 patients, 3 isolation patients -1 confirmed C-Diff, 1 droplet (rule out meningitis) and contact isolation for C-Diff and 1 neutropenic precaution. My 4th patient was a bowel prep. 2 of my patients were post-ops who still had post-op vitals to be done. There was 1 CNA for the whole floor. Also, 3 of my patients were blood sugars and 1 had basically round-the-clock IV antibiotics and another had several night IV antibiotics as well. I had medications to be given basically the entire night. When I started the night I asked the CNA if she could help with some of the post-op vitals and she said she would try. I started out with 1 of my post-op patients who was also the bowel prep. I found out when I was doing my assessment with this patient that none of the post-op vitals had been done at all and the patient had been on the floor for several hours before my shift even started so I preceded to start the post-op vitals with the 15 minutes x4. I gave all the meds and did the assessment to this patient however I did not chart my entire assessment as frequently I will make "place markers" and just chart the exceptions and come back later to complete the full assessments. I next went to my other post-op patient who was the confirmed C-Diff and did her assessment and gave meds. I then went to my next patient with all the IV antibiotics and did the same thing (meds, assessment etc.). I was literally running the entire night. I did not have time to chart at all and several hours into the shift the charge nurse called to give me another patient as one of the nurses was leaving. I explained to the charge nurse that this assignment was crazy and there is no way I going to be able to keep up with it. She then explained to me that all the nurses had as many patients and that is all. Mind you the acuity of the other patients were 2-3 out of 4 and all of mine were 3-4. I ended up getting a new admission anyway from the ED and the charge nurse finally sent a nurse that came in to help to help me around 11pm or so. She did my blood sugars which were late and several of my meds. I then proceeded to do my admission. Like I said I was running all night with hanging antibiotics, helping my bowel prep to the bedside commode and doing my admission. I completed all of my assessments -we are required to do 2 for the 12 hour shift- but I did not have time to chart them. I also had 2 lab draws because the patients had a port and PICC so the nurses have to do those. I was still passing meds or hanging antibiotics till about 6:30 am. Our 12 hour shift is from 6:30 pm until 7am. The nurse educator had told me a previous time that technically we had 72 hours to complete our charting -this was on a previous occasion when I had another bad night and did not have time to chart- so my intention was to come back that night and complete all my charting as I had to do another 12 night shift and I had to get my kids to school that morning. I gave report and told the oncoming nurses that I had not had time to complete my charting as I was running all night. I don't know where my head was at because although I did all of my assessments I did not do any other vitals on my other patients. We had 1 CNA so she did not do them either. I had been in all of the patients rooms multiple times for meds, assisting to the commode or my assessments but just did not do the damn vitals. Now, I am fully aware I did not practice good or safe nursing that night and take responsibility for that. I should also mention that I explained my crazy assignment to the head nurse supervisor when she came to our floor but her only concern was the fact that I should not have been given the contact isolation patients along with a neutropenic precaution AND I voiced my concerns to the charge nurse twice. I do not want to make excuses for my dropping the ball as I totally did. If this is what nursing has become then maybe I am better behind a desk where I cannot drop the ball and possibly compromise patient safety. I honestly missed floor nursing but I did not feel like I had the time to really grasp it because at least in my case I was usually just running all night and frustrated when there was no CNA support and I was just passing medications. I feel I still had a lot to learn and get better at with many things. But now I am questioning my entire ability to make it as a floor nurse.

Sorry this is so long. :)

It sounds like you might need help with prioritizing care. With an impossible assignment, things will get cut ...they just have to be the right things. You assignment and the response to your rough night lead me to assume that this isn't the first difficulty you've had. It sounds like you were already skating on thin ice (fair or not).

Why did you quit floor nursing to start out with? And why did you quit case management and decide to go back?

Up Vote Up Vote ×

"I am fully aware I did not practice good or safe nursing that night". That is because you were handed an impossible assignment. As you have case management and prior authorization skills, you are golden. Buff your resume and find a job outside of the hospital that just beat you up. I work from home making really good bucks doing prior authorization. Six years now.

I would NEVER go back to floor nursing.

Best wishes to you.

Up Vote Up Vote ×

I missed floor nursing and direct patient care. Once I graduated from nursing school I worked for about a year and a half on a busy med/surge floor but moved to another city near my family when I got pregnant with my twins. At the time there were not any floor nursing jobs so I ended up in case management. A part of me misses floor nursing and direct patient care. I figure I can always go back to case management or prior authorizations when I get older.

Up Vote Up Vote ×
Specializes in ED, psych.

That sounds like an assignment from beyond the fiery depths of hell. My eye was twitching just reading that. Prioritization or not ... ouch.

Learn from this (which it sounds like you did), and let go. If you want to try again, try again. But I would interview the next placement just as much as they interview you because your shift sounds like a night of horror.

Up Vote Up Vote ×

Ugh, this sounds like my Tele floor. Your assignment was a bum one, you did what you could do to the best of your ability. If they are letting you go because you didn't do vitals, which yes is a big one, but I don't think it warrants termination and you don't want to be there anyway.

The M/S/Tele floor I work on is like this. We are 1:5 on days with 1 PCA. The acuity mirrors our progressive floor so much so that when I'm floated there its easier than my regular floor because of less patients. I've only been doing this 6 months and have a few interviews lined up because I just can't anymore. I've done pretty well but I know nursing doesn't have to be like this and I'm paid far too little to do the impossible. It sounds like you are too.

With the way floor nursing is right now, be a paper pusher. I was torn for awhile too because I love doing hands on care but I'm so tired of being so tired after a 13 hour shift. It isn't a job, its servitude, and it harms the patient and the nurse.

Up Vote Up Vote ×
Specializes in Cardicac Neuro Telemetry.

I feel that your assignment was very unreasonable and unrealistic. Surely they could have split the isolation rooms up better than that? In my opinion, you were set up to fail. I'm sure if you had a more reasonable assignment, you would have done just fine!

If you truly enjoy case management, go back to doing that. There is no shame in not working on the floor.

Up Vote Up Vote ×
I do not want to make excuses for my dropping the ball as I totally did.

Without knowing what all else is going on that may have contributed to the termination, I'll say this: If any nurse has done his/her absolute best at managing something that no one else coud've managed either, we need to stop talking in terms of how we dropped the ball. WRONG. Someone in an office somewhere threw the ball in the gutter and we tried to pick it up and run with it anyway.

We all need to stop accepting so darn much blame for things like this.

Up Vote Up Vote ×

Oh that sounds horrible! Unfortunately and sadly shifts like this are becoming the norm in med/surge. It's a battle ground and can beat you down. Sounds like you did the best you could under the circumstances too bad the hospital doesn't see it that way. They never do. Give you a hell assignment with no help what do they expect?!

Up Vote Up Vote ×

Hey, Been there done that. Can I ask where you do prior authorization from home? I have been looking into that and think that might be a great fit for me. Thanks.

Up Vote Up Vote ×

Try extended care home health for awhile to assauge your desire for direct patient care. There is nothing wrong with taking care of only one patient at a time while you get yourself together. When you are ready for the next step, you will know.

Up Vote Up Vote ×
Specializes in Renal/Urology/HIV.

Reading this gave me shudders because that sounds like a typical shift from back to when I worked on the floor on a crazy acute care unit.

You were given a very difficult assignment and you voiced your concerns to the charge nurse. You were doing so many things at once with barely any help and being the human that you are you forgot to do vitals. While forgetting vitals is pretty serious I do not think it warranted a termination.

I left the bedside last year and I will never return. I nowvwork in an infectious disease clinic where I do a lot of prior authorizations and push papers and sometimes I miss the hands on of the bedside, but reading stories like these and talking to my past coworkers confirms my reasons for leaving.

Up Vote Up Vote ×
+ Join the Discussion