I had a situation occur at work and I'm torn about how to react to it. Very busy hospital med/surg floor with max patient load of 5 patients for each nurse. 5 nurses working the floor, 3 of one race and 2 of the other. there is one "clinical supervisor" who's the same race as the group of 3. the secretary is also the same race as the group of 3. (so that's 5 of one race, and 2 of the other)
Throughout the day there are admissions and discharges. The secretary assigns the patients based on who has discharges to keep the staffing numbers equal, there is no attention paid to acuity or work load (this is a normal occurrence for this floor). Frequently there are times when a nurse will go down to 3 patients because of discharges, while everyone else stays at 5, and that nurse will get back to back admits within minutes of each other. The clinical supervisor on this floor does not assist with admits (not even to put isolation equipment in patient rooms).
On this day, 1 of the nurses, from the race group of 5, goes from 5 patients to 0 patients within a few hours. That nurse is only assigned 1 new admission, that does not arrive until after shift change.
Another nurse, of the race group of 5, starts with 4 patients... discharges 1 and receives a transfer early in the shift... this nurse stays at 4 and is not asked again to take any more admits. (The secretary is observed and overheard pulling this nurse aside saying that she knows that she won't give her any more patients)
One of the nurses of the race group of 2, starts with 4, admits 1, discharges 1, and is asked to take another admission although according to "turns in line" it should be the nurse from the other race group.
The second nurse of the race group of 2, starts with 5, discharges 1, admits 1, and has one pending discharge near the end of the shift. 45 minutes before shift change, the clinical supervisor says to this nurse "can you just take report on the new patient coming up" (This will put this nurse at 6 patients which is over the max patient load. This is this nurses first day off of orientation, this nurse is a new grad). The nurse takes report, is attempting to discharge the one patient, the clinical supervisor is "nagging" them to ensure that isolation equipment is in the room, the secretary assigns the patient to this nurse on the board. And when the patient arrives on the unit the nurse is told "your patient is here" even though this nurse was told all they had to do was take report.
I'm sorry if the story is hard to keep up with. I tried to keep it as simple as I could, while still getting the important details across.
Is the new nurse being "bullied" by the clinical supervisor and the secretary? Why didn't the nurse that went to 0 patients have to take more than 1 admit? Why was the nurse from the race group of 5 skipped over for admits (there is never attention paid to acuity of patients only numbers)? Is it racism because of the difference in treatment of the two race groups? AND if you were a manager would you want this brought to your attention? If you were the one bringing it to your managers attention what would the best way be, in order to not sound whiney or indignant?
Again I apologize for the length of the post, just trying to paint a picture.
So then my question is, if you were there did YOU stick up for the new girl? If you didn't, then you are contributing to the problem. You could have said, hey, she already has 5 and is struggling, you need to give that patient to someone else.
Specializes in Psych, Addictions, SOL (Student of Life).
I think the word 'bullying' is thrown around entirely too much and perhaps overused in society. Based on the events as described above, no one is being bullied. Some people feel comfortable in the midst of victimhood and play the bullying card when it is not always the case.
THANK you! Bullying happens when you're kids and usually it's good for you (to a point). The race doesn't matter, although I could see how it might look to someone who sees that first in every situation (I'm in no way saying that this is you, but you brought it up:yawn:).
It sounds like favoritism and it's really obnoxious and is everywhere. That's one of the reasons one of my old managers got fired. It's toxic and breed contempt.
I don't know of any situation where giving someone an admit who has NO patients is preferred to giving someone with near the max load already. In this situation there were too many bad decisions to make me want to play Devil's advocate, unless one pt needed a negative pressure room and the only place it was available was where that one nurse happened to be primarily working.
I've never worked in a place where that would have flown and if I had, as a new grad I wouldn't have had the ballz to say anything about it because they hadn't dropped yet:). If I were in the new grad's spot (staffing wise), but had the experience I had now, I would have made it clear that I was only taking report and to absolutely NOT bring the patient up because I wouldn't have time to care for them. I also would have said something about the one nurse not having any patients or 1-2 while other nurses are struggling. That makes no sense to me and infuriates me, even more so because the nurse was fresh off orientation.
What a perfect way to have an unsafe, unpleasant workplace as well as maybe sour someone on wanting to work there any longer than absolutely necessary. She needs to know it doesn't have to be that way and shouldn't be. Every hospital/unit has those crazy shifts because of codes, admits, AMAs, RRTs you name it, but this was so uncalled for and to do it to a new grad knowing she probably won't say anything (because she likely doesn't want to come off as a complainer)? Not cool.
Not bullying, racial, or overreacting. Just plain wrong.
The nurse that had zero patients was assisting the other nurse that had 4 patients. Which is so crazy to me! The nurse that had 0 patients is the clinical supervisor several days a week, and helps nobody except that one nurse.
I absolutely agree that the secretary should not be assigning patients, it's been addressed on multiple occasions but continues to happen so it's a lost cause. Although, the secretary assigning patients unfairly often creates a resentful work environment. That same secretary also tells the PCTs what they should or shouldn't do. For example, on this same day the PCT offered to do accu checks for the nurses, but after finding out there were 15 the PCT didn't want to do them anymore. So, the secretary turns around and yells "You nurses need to do your own accu checks!". But the kicker is the secretary says to the PCT you can do a couple of them for nurses A and B (that happen to be in the larger race group)
Does it make a difference if the manager is new to the position, only manager for less than 6 months? And the first time being a manager, used to work as a staff nurse on the same unit.
Here's the thing. When all the chips fall, the secretary doesn't have a license to protect, or any liability what-so-ever for the "assignments" that she is making. She is clinically directing RN's which is incorrect. She is delegating PCT's, the responsibility of which falls under the RN.
The secretary is acting far out of scope. And as pointed out by a pp, doesn't have the clinical skill or judgment to be making assignments.
As you noted, this has been addressed numerous times without any change. It would be time to bring it up the ladder. I would think that part of the clinical supervisor or charge nurse role would be to make assignment.
As far as the accu-check situation--that the PCT's don't "feel like" doing them is craziness. That can be part of their job. However, if that resentful, I would do my own. All that being said, it is a safety issue, as any nurse who did not hear the secretary yelling "you will do your own accu-checks"--that is a patient safety issue, and can be a medication error waiting to happen. Which would fall on the nurse, and not on the secretary, and not sure how well "the secretary informed everyone I didn't hear it" would go over.
Is every unit like this, or just yours?
It seems to be, in my opinion, not bullying, not racism, but rather a secretary who has been allowed to do a job far out of her scope that she is not licensed to do. And doesn't have the clinical basis to make the decisions.
If your parent company has a website, use it to report this. It is poor practice for the clinical supervisor/manager to allow this to continue.
Maybe there needs to be a charge nurse (you all rotate) that makes assignment and is a general floater helping everyone. Maybe you have a lead PCT (who also rotates) that floats, helps and ensures that the NURSE'S delegation and directions are being adhered to.
I would also report this to risk management. This is a giant risk. For a lot of reasons. If you have a union, fill out an unsafe staffing report. Get your delegate in the mix by informing of what is happening.
Bullying and racism are words used way too generally. It doesn't seem like racism is the issue (people may be racist or more likely bigoted) but the actions described are not. Using that term takes away from true occurrences of racism. Similarly, this doesn't sound like bullying either. As previous posters have suggested, speak to the team if possible and identify a way to ensure more equitable distribution of patients. This isn't bullying, racism, or overreaction. This is patient safety in jeopardy.
Guess I had experienced that before. I am brand new nurse too. Before passed my probation, the supervisor will give me more patients under my care than other experienced nurse A. The supervisor is same race as the experienced nurse A too. Though it may sound like race "bullying", but I took it as challenge to see how I can handle the cases alone. This included the supervisor asked me to receive new admission 15 minutes before shift end. I was in night duty that time.
So when handling over, the morning shift staff saw I was doing nursing initial assessment and waited me to pass report to her, she asked why not just let her receive the admission in the morning.
What I answered was " I received the case for you" because I know it will be busy in morning shift and the patient need to undergo diagnostic test in the morning shift. Imagine the admission is delayed!
Well, guess that it all win-win condition for patient and staff!
Sometimes we need walk extra mile though some people may not appreciate it but still it give satisfaction in my job as long as choose to think positively.
If I were in the new grad's spot (staffing wise), but had the experience I had now, I would have made it clear that I was only taking report and to absolutely NOT bring the patient up because I wouldn't have time to care for them.
I don't think that strategy would work in many places. What's the point of taking report if you "don't have time to care for them"? And realistically, how many nurses are going to give report and then just hold on to the patient indefinitely because the receiving nurse "made it clear" that she was "absolutely NOT" to bring the patient up? No, the reporting nurse is giving report because she likely has another admission of her own coming and needs the bed.
As to the OP, not sure if this is cronyism vs. racism, but I agree with the earlier post about the secretary acting WAY beyond her scope in delegating and making assignments with no formal education to give her the understanding of the implications and possible repercussions of her decisions. This should be taken up the chain PRONTO and framed as a safety issue, legal liability, financial risk, etc. so that people actually listen and consider the possible impacts of allowing a non licensed individual to act as though she was licensed to perform these acts. And for God's sake, SPEAK up for the new kiddo, just don't shake your head at the antics and go about your business.
Actually, secretaries make bed assignments where I work, too. The clinical manager covers three units. I don't like the system, because it's based on numbers and not acuity, but it is policy in my fairly large healthcare system.
I'm still getting over the disbelief that there are units where the secretary, with no clinical knowledge, assigns admits. How long have you been on this unit? Does this sort of thing happen often? I rarely ever say this but I would just get out asap.
Also, I think its wise that the OP did not post the actual races. This thread would have become a different animal and just have been filled with tons of arguing if she had.
Personally I don't think it is racism. Since we don't know these people we don't have nearly enough info to decide if they are racist. I think they are a group of people of the same race that are good friends with each other. They are playing favoritism for their friends. Its not right. But it sounds like there is little chance that it will change. Find another job.
Every time I've seen something like this in the workplace, it has much more to do with seniority or who is friends with whom than what race they are. It always seems to me that the nurses with the longest tenure and/or the most friends at work tend to get babied by the other staff, and new nurses or float/agency nurses get the short end of the stick, regardless of race.
Just read this and I agree completely. I work in a large hospital and there are definitely cliques. On my unit, whoever is good friends with the person that is the charge nurse for the day seems to have the easiest assignment. Sometimes assignments are very obviously unfair but the charge will usually try to ensure her friends have it easy. Fortunately, there are also some charge nurses that are fair though.
It's difficult to say without seeing the situation unfold and know all of the players in the scenario. Reading what happened I don't know if I would say its racism per say but I agree with other users who say it could be preferential treatment. I also wonder if there are other things going on behind the scenes that go beyond race. What I mean to say is, regarding the nurse(s) who aren't getting assigned theses patients I would ask these questions:
Are these nurses difficult to work with and they "put up a fit/fuss" every time they get admissions or a more difficult assignment? I know that sometimes when you work with people like that you will find others will accommodate them by trying to avoid upsetting them and tip toe around them (e.g. giving them a smaller assignment or easier admissions). This just feeds into this unprofessional behavior and makes the problem worse.
Are these nurses very friendly with the secretary and/or clinical supervisor? When people are friendly with one another you will see favors being thrown around (e.g. giving easier admissions/assignments). Case in point, when I first started in the ED I work I noticed that my rooms were consistently filled while other nurses would go longer without having a full assignment. I remained positive, professional and helped others when I could but focused on my own patients. I found that after a while when I helped others and people got to know me better I had the same assignment as others and people always came to help me when I was busy.
Are the nurses who are getting a heavier assignment new nurses? I have yet to work in a setting where new nurses aren't given a fuller/heavier assignment after they have finished orientation. The reasons for this are multifactorial, some senior nurses will say its "a part of the learning process" so the new nurses can handle sicker/tougher patients. Some senior nurses will say they they have been working a long time and its what happened to them when they were new grads. and "everyone has to pay their dues". Whether its an honest attempt to help teach the newest generation of nurses or a thinly veiled attempt to pawn off difficult work keep in mind that this is a difficult sitatuion to address. There is a fine line between advocating for yourself as a newer nurse so that you aren't being taken advantage of by your peers and developing a reputation of complaining when you get a difficult assignment/heavy caseload.
To the OP, I am not insuinating that you or anyone in this story is complaining unjustly about having a difficult assignment (to me it appears you just want to be treated fairly) but I would caution that you carefully consider all of your options when addressing this issue. If this is a matter of racism it needs to be delt with promptly and approrpiately with the help of nursing leadership/management. However, if it isn't and someone says or claims that its racism then they will risk ostracising their coworkers and creating a divide in the workplace that will be difficult to come back from or repair. Best of luck!
AJJKRN
1,224 Posts
So where is the charge nurse...?