Burnt out from the staff I work with - what should I do?

[Golgiapparatus]

Currently I work on a med-surg/tele unit that newly opened this past January. We basically had no core staff hired on at that time, plus with it being winter and high census time, I was charge every night, short staffed with a full patient group of my own. I was totally new to telemetry at this time also. Float pool staff was staffing my unit every night which thankfully they were all wonderful and hard working. Fast forward to now, all the night shift staff are either new resident nurses or nurses that were externally hired. Not to bash on either of these types of nurses since I know many resident nurses and nurses who were from a different facility that are GREAT - but 90% of the staff that I work with now are just flat out lazy, incompetent, and argumentative. I am charge almost every shift I work and whenever a tele alarm goes off, I am the only one who runs into the patient's room to respond to it. High and low blood pressures haven't been paged out to the doctors even though I have personally told several nurses when vitals are out of normal limits to page about it, and I've also mentioned this at our huddles. One night, a nurse deliberately ignored phone calls from the central monitoring unit about a severe sepsis alert on their patient because "they aren't that sick". When I told this nurse to call CMU back immediately, the nurse argued with me that the patient needs rest and is not truly septic so they will not be speaking with CMU. When I tell my supervisor about behavior like this, she tells me "What the RNs do or not do is on their license, don't micromanage them or worry about what they decide to do." But when things go awry it's me being yelled at by doctors, the rapid response team, family members, etc. because of this negligent and imcompent care that occurs. Besides the CNAs, I'm one of the few nurses who responds to bed alarms. The nurses will not even help each other out with simple tasks such as taking a patient to the bedside commode. The night shift supervisor is in charge of 3 units including mine so she hardly ever has time to see what's really going on on the floor. I have spoken to staff multiple times about the importance of responding to bed and tele alarms but I am just not getting through to them. I am feeling defeated and exasperated. I am a pretty new nurse myself, only 3 years of experience, and I don't have "management" experience or disciplinary powers to assist with this. How do I make management pay attention to our unit that these nurses need coaching and that I am utterly overwhelmed? I am wanting to apply to an upcoming MICU residency but this will not open up until spring so it appears I'm stuck in this crappy situation until then.

[JKL33]

It sounds like your unit was set up in an irresponsible and half-a'd manner and has never come up to speed as a well-functioning unit.

There's a lot in your post. A few thoughts (nothing in this reply should be construed as excusing what sounds like fairly terrible and inexcusable behavior of your peers):

I am charge almost every shift I work and whenever a tele alarm goes off, I am the only one who runs into the patient's room to respond to it. High and low blood pressures haven't been paged out to the doctors even though I have personally told several nurses when vitals are out of normal limits to page about it, and I've also mentioned this at our huddles. One night, a nurse deliberately ignored phone calls from the central monitoring unit about a severe sepsis alert on their patient because "they aren't that sick". When I told this nurse to call CMU back immediately, the nurse argued with me that the patient needs rest and is not truly septic so they will not be speaking with CMU.

My guess is that they don't like your style, your brand of energy, your "management" of their work, thus their laziness is compounded by their passive-aggressive reaction.

When I tell my supervisor about behavior like this, she tells me "What the RNs do or not do is on their license, don't micromanage them or worry about what they decide to do."

There's your answer.

But when things go awry it's me being yelled at by doctors, the rapid response team, family members, etc. because of this negligent and incompent care that occurs.

Au contraire! No way. Nope. I do not accept responsibility for others' actions, ever. And by "not accept" I mean I would never tolerate anyone suggesting that others' actions were my responsibility. I would invite all of these people to discuss their problem with the patient's RN.

The nurses will not even help each other out with simple tasks such as taking a patient to the bedside commode. The night shift supervisor is in charge of 3 units including mine so she hardly ever has time to see what's really going on on the floor. I have spoken to staff multiple times about the importance of responding to bed and tele alarms but I am just not getting through to them.

It isn't your job to get through to them. That is management's job.

Look, the idea that you are in charge of these people is wrong. You're supposed to be in charge of the smooth running of the unit while you're on duty, not what other RNs do or don't do. Secondly, it sounds like you've been given zero tools to even be in charge of the smooth running of the unit. So the whole thing becomes a bit of a joke that only you are taking seriously. This is how good, well-meaning people are abused. This type of abuse stops when you end it...or, put another way, never stops if you tolerate it. There's no point in even having a charge nurse on a unit like this. You have a full assignment, for goodness' sake, don't pretend that it's okay for anyone to make you feel like you should be "in charge" of the smooth running of the unit.

How do I make management pay attention to our unit that these nurses need coaching and that I am utterly overwhelmed?

I think you're gonna have to start exploring other options; you will not fix this. They've already chosen to tell you not to worry about your peers, while at the same time knowing they've put you "in charge" and that this malfunctioning unit is pretty much safe because of you. They simply have no incentive to change anything.

I'll tell you what I'd do: I'd spend a shift visibly taking care of my patients only. On the sly I'd keep my eyes open for any critical matters not being addressed by other RNs. I would address these myself and then write out incident reports (which I despise doing) for occasions of RNs not responding to their patients. I would not answer every call light, bed alarm and tele alarm. [i do kind of wonder whether your "jumping up" to answer every alarm and your frequent verbal declarations about what should be happening aren't making things worse...Sorry. I think they're probably digging in their heels a little because your demeanor is a little much?? Sorry!! I'm not there, I know. Just think that through and answer for yourself whether it is a possibility or not. :) ]

If you can't tolerate this for another 6+ months, you'll have to look for another position sooner.

Take care ~

[Golgiapparatus]

Sorry my post was so long - but thank you so much for your thoughtful reply.

[Jmira.BSN.RN]

OP, it ISNT your responsibility to handle the problems of these other nurses. They have a license to protect. I understand that as the charge you are the one gonna be stuck dealing with incident reports and xyz if it happens. But sometimes there's nothing wrong with letting them know that you will not be serving as charge, you just wanna be staff nurse. I could not work as charge with nurses who didn't give a hoot about their patients (as it seems to imply). Its too much babysitting and stress and no $2 differential will make it worth it. I would much rather work on the floor and be a great teammember to my fellow nurses. This may be something to consider