Blind Sided

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I graduated from my hospital's Open Heart program approximately 5 months ago, and am enjoying my new role in the Cardiovascular ICU, except two nights ago I was blindsided. I have developed many good relationships with the staff, and we work well as a team together. Management sees a lot of potential in me, and the cardiothoracic surgeons have said nothing but great things about the post op care I provide. However, I found out that the other night shift nurses have all been talking behind my back, and complaining that when I have a 1:1 patient, I close the door, and don't make myself available to help (this maybe happens twice a month, because we are all rotated through having fresh hearts to keep our skills sharp). There has been some bullying going on from a couple nurses, that I had attributed to something wrong with them.

When I was on orientation, I oriented on day shift. The standard I was taught is that the freshly operated on open heart patient is 1:1. They are typically hemodynamically unstable. I was told to stay in the room with them. I normally did not close the door on day shift. The difference on night shift, is that I noticed that my coworkers would talk very loudly right outside the room when my patient is trying to sleep so I instinctively close the door on a regular basis. I had no idea it was bothering people to the point that they were starting to get passive aggressive with me. I just thought they were in a bad mood.

I am being told to sit outside of my patients room, and watch the monitors from there. The only problem with this, is with the arrangement of the monitors, this position does not give visualilization of the cardiac output/index and SCVO2. This night shift practice really seems unsafe to me. I don't know why it took them 5 months to say anything, but now I feel like leaving. Ironically, we never get to take vacations when we want, because of staffing issues. We are sometimes given two patients when one patient should be 1:1 or we are tripled with more stable patients, which is a lot of work for ICU. It seems like pushing your staff away is not the solution. I will say I am very hurt that I was starting to consider some of the people friends until this.

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When you attributed the issues to them, you are correct.

Don't mix work with establishing friendships. You can be appropriate and professional without making friends at work.

There are many ICU nurses on AN who speak about larger patient loads. And question the safety in that. But not inclusive to the ICU, as many nurses may have less critical patients, but acute and 8-10. It's called doing more with less.

And you closing the door and doing 1:1 per your unit policy, I am not sure you can get up and help someone in another room if in fact you are supposed to be 1:1 anyway--door open or closed. What would be the need to sit in the hall if you can't leave?

If you are 1:1, I would assume there's at lest 2 other nurses on the floor. Can't they team up?

Keep on doing what your policy tells you to do. And what is most effective for the patient. Because if your patient tanks because you can't see the monitor from the hall, I am oh so sure that the nurse who insisted you sit in the hall is going to back you up with that and come clean about asking you to sit in the hall when you get in hot water over it. Not.

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Specializes in Dialysis.

I would ask your manager specifically. That should settle it. If your role would call it the way you state, perhaps then you could address directly with your coworkers

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Specializes in ICU, Postpartum, Onc, PACU.

This is where nursing (and working with mostly females) can be really REALLY annoying. the gossip and talking about people bit drives me bonkers. I've gotten called out by a couple managers in my time for being "antisocial" when I refuse to take part in these conversations (but still chit chat about non-work things like everybody else). If that makes me antisocial, let it be.

I don't see anything wrong with you closing the door if your pt is 1:1 and have done that numerous times since, like other's have said, you can't go help anyone else out anyways while the pt is fresh post-op. Loudness on nights has always been a pet peeve of mine as well so I completely understand...

xo

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It sounds to me like you have your priorities straight! Fresh open hearts should be one-to-one until stable, and if closing the door helps keep the room quiet to facilitate patient recovery and nurse concentration, then keep the door closed. There will always be snarky co-workers looking for something to find fault with. Ignore them. You sound like a nurse I would want taking care of my loved ones.

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Specializes in tele, ICU, CVICU.

I also did CVICU and 1:1 fresh heart means your butt (& hopefully brain) remain at the bedside monitoring everything, titrating, etc. When others are with these patients, are they available to help? just a 2 second boost in the next room (with possibly a shared bathroom, where you can open both doors & still see/hear everything from your room?) or a 30 minute dressing change in the full isolation room located caddy corner from yours in the unit?

Did these colleagues ask you or did you ever say something like "just closing the door a bit for noise"? Forgive me, but if the patient is fresh, are they still tubed and/or sedated? Thus, noise reduction would be for your benefit, versus the patients'. I think that is fine though. If that noise reduction allows you to better provide care for your patient it's perfectly understandable. However, I do wonder if that might be a factor in their not liking the door being closed (it's for your concentration, not patients' need)? Are the doors solid, or glass/see-through as many ICU's are? (That you could visualize an emergency situation if you can't hear it.) Regardless, a 1:1 patient, in theory, warrants a nurse at their side 24/7 until 1:1 is changed. I won't describe what I've seen others do when they are assigned a 1:1 patient.

I also work nights & absolutely abhor noise.. not just hate, but save a code, or other emergency situation, there is no need for the noise level to be what it is on that shift (at least in my experience). I think people as a whole seem to have difficulty making the connection between them preferring less lite & noise when they go home & try to sleep. But I digress.

I would assume (from what you've said & not knowing these nurses) that they are your typical clique-y ones, possibly do not care for all the wonderful feedback you're receiving and want to find a way to take you down a peg, or something goofy. I can see this scenario very likely being the issue, especially since you are relatively new.

Who is telling you to sit outside the room? Management or the staff members causing issues?

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You really do have to get along with your peers. If you don't, they'll lie on you to the bosses. It wouldn't have hurt, in retrospect, to let them know why you were closing the door. It might have prevented (might) this current mess.

I have no real advice, but good luck. I am so very sick of stuff like this.

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Don't mix work with establishing friendships. You can be appropriate and professional without making friends at work...

And you closing the door and doing 1:1 per your unit policy, I am not sure you can get up and help someone in another room if in fact you are supposed to be 1:1 anyway--door open or closed. What would be the need to sit in the hall if you can't leave?

...

Keep on doing what your policy tells you to do. And what is most effective for the patient. Because if your patient tanks because you can't see the monitor from the hall, I am oh so sure that the nurse who insisted you sit in the hall is going to back you up with that and come clean about asking you to sit in the hall when you get in hot water over it. Not.

Agreed. A couple other things: when I close a pts door due to noise I tell the noisy party, whether it's the pt/visitors, other visitors in the hall or staff, "I'm just going to close this door because noise really carries in here and people are trying to sleep" or something like that. If you tell your coworkers "I'm closing the door because he's getting a little agitated and I want to keep the noise down" there will be no wondering if they misunderstood your intentions.

Also, sadly, many nursing units are like this. In my experience it's especially prevalent in ICUs. People gossip about everything about everyone, and that includes people the gossiper may actually like. Maybe it's that group mentality thing where once one person does it the others feel like it's ok. But it happens. I assume my coworkers- even the ones I like- at least occasionally talk about something I did or the way I do something. You can't take it personally because, at least anywhere I've worked , it happens to everyone.

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