Caving under pressure

[garciadiego]

I worked for years as LTC nurse, a good LTC nurse. I moved to MED SURG. about one year ago. I made two med errors, potentially dangerous errors, during times of pressure, the pressure of a busy med surg floor. I wouldn't have made these errors without the stress of the floor. I can't leave med surg at this time but I would like to know how others deal with the stress, pressure and the business of med surg? How can I feel less stress so I am thinking better and don't make any more mistakes? I enjoy the fact that I'm learning alot as a med surg nurse but my nurse manager has told me I'm not progressing fast enough after a year, I'm too nervous with patients, I have poor critical thinking skills and poor time management, plus those med errors. Some of what she says is true, some is not.

Any help?

[Vito Andolini]

We all make mistakes, so don't be so tough on yourself. I know it's very scary but these things happen.

I think you should ask your manager for specific pointers. She is the one who seems dissatisfied, so she needs to help you figure out how to change whatever you are or are not doing to her satisfaction. She does you a disservice by criticizing you without giving you specifics on how to improve

and without giving you some hope and encouragement. Is she a new manager? Old? Young? Is she well-liked and trusted by staff? How long do nurses stay with her?

Are you in a state that mandates staffing ratios? If so, are you routinely getting more patients than that?

Are you doing forced overtime?

do you have a good preceptor? Did you have a good one?

How long was your orientation and did it cover most of what you need to do a good job?

Do you have a good schedule or are you being forced to work more than 1 shift, thereby messing up your sleep and making it hard to balance the rest of your life?

Are you in good health?

What are your coworkers like?

I believe it takes a full year to feel confident when you are a new or relatively new nurse. So be patient with yourself.

You might want to start looking around for a different position, either there at that same facility or an entirely new one. don't wait to be asked to leave or get fired. If the manager won't/can't work with you, it's time to go.

[garciadiego]

Actually I am going to ask her for specific pointers because I could be terminated if I dont improve in 2 months, I cant change positions because I'm n this discipline program.....but I have only been given one guide line which is to follow the Policy for Med Administration. Until I get something more specific I'm afraid to step on the floor. She is a Old manager, she is not old but has been there a while.

Usually I have 6 patients, rarely 7.

There is not forced OT, I'm in good health

Some of the nurses are less than helpful, which isnt helpful. Some nurses make the same mistakes I have, except for the two I mentioned which will NEVER happen again.

Its just things happen all at once on this floor and there is a pressure to do everything at once, although I thought my prioritizing was coming along.

[wooh, BSN, RN]

I got this tip from a nurse while I was in nursing school, and it has always served me well:

You can only do one thing at a time.

Keep that in mind, no matter WHAT is going on. If you're doing something, and something tries to interrupt, unless it's TRULY important, finish what you're currently doing before going on to the next thing. This is especially true when you're getting meds together. Trying to do multiple things at once is in the end just going to open you up to mistakes and actually slow you down.

[caliotter3]

You said in your second post that you could be terminated in two months. Sounds to me like you were given an ultimatum. Normally a losing battle. Start vigorously seeking other employment and resign when you get a new job. The handwriting on the wall does not look good for you. Essentially, you have been given two months to find a new job. Take advantage of the time and don't let them terminate you. Good luck.

[Batman24]

You said in your second post that you could be terminated in two months. Sounds to me like you were given an ultimatum. Normally a losing battle. Start vigorously seeking other employment and resign when you get a new job. The handwriting on the wall does not look good for you. Essentially, you have been given two months to find a new job. Take advantage of the time and don't let them terminate you. Good luck.

Agreed. Rarely when a threat like that is made do things go well. I would find another job ASAP and one where the stress level isn't so high. I think that will work best for you.

In the interim...SLOW DOWN. Most errors occur when we rush and don't take time to think. As Wooh says we can only do one thing at a time. It is especially crucial during med pass to be calm and collected. Keep your concentration on the med pass and if anything isn't an emergency it waits.

[garciadiego]

As it turns out, according to my union contract, the employer has not gone thru the proper procedure to fire me...but I will try to return to my previous job in LTC.

I think the advice to "slow down" will serve me nicely.

[interleukin]

Medical surgical nursing can be a hellhole if one is truly trying to practice the best nursing, to every patient, at all times, and one is working with full loads, fragmented staffing policies, and unsupportive management.

It is simply impossible to be everything to everyone even though your manager may push you to do so.

Attempting to fulfill this will result in either enormous physical and mental stress, at best, or a medical disaster, at worst.

Prioritizing takes:

1. A good chunk of experience

2. The guts to say "no, that is not a priority. What I am doing now, is!"

I agree with the other nurses who urge you to move on. You are in a toxic environment. We all need our wings supported before we can fly. Just step back and find the place that suits your temperament and comfort level.

Life sucks when work sucks.

[tryntolivethemission]

I am in agreement with the previous posts. I work in a toxic environment, where both the manager and nurse educator were let go, an interim manager has been running the unit and hiring staff; staff without the proper orientation and precepting...very unfair to them, the unit and the medical center. This is probably for another thread, but I am sure that the interim manager (a contract person) has their own agenda and it probably does not have much to do with the personal or professional growth of the staff. Staff support is so important and if you are not getting that, then you must move on for your own professional and emotional safety.

[Melinurse]

You said in your second post that you could be terminated in two months. Sounds to me like you were given an ultimatum. Normally a losing battle. Start vigorously seeking other employment and resign when you get a new job. The handwriting on the wall does not look good for you. Essentially, you have been given two months to find a new job. Take advantage of the time and don't let them terminate you. Good luck.

Agreed. Rarely when a threat like that is made do things go well. I would find another job ASAP and one where the stress level isn't so high. I think that will work best for you.

In the interim...SLOW DOWN. Most errors occur when we rush and don't take time to think. As Wooh says we can only do one thing at a time. It is especially crucial during med pass to be calm and collected. Keep your concentration on the med pass and if anything isn't an emergency it waits.

I agree with the above quotes. Med-surg is not for everyone. Perhaps home health, hospice, community/public health might be some other ideas. Whatever you decide I wish you the best. Everyone makes mistakes so don't be too hard on yourself.

[Vito Andolini]

I think you should burn up your sick time. And make sure they pay you for any unused vacation and holidays. Good luck and let us know how your new job goes (you will find it within 2 months, yes?)

Curious - have any staff or docs or patients complained about you?

[Equinox_93]

Actually I am going to ask her for specific pointers because I could be terminated if I dont improve in 2 months, I cant change positions because I'm n this discipline program.....but I have only been given one guide line which is to follow the Policy for Med Administration. Until I get something more specific I'm afraid to step on the floor. She is a Old manager, she is not old but has been there a while.

Usually I have 6 patients, rarely 7.

There is not forced OT, I'm in good health

Some of the nurses are less than helpful, which isnt helpful. Some nurses make the same mistakes I have, except for the two I mentioned which will NEVER happen again.

Its just things happen all at once on this floor and there is a pressure to do everything at once, although I thought my prioritizing was coming along.

Two things- first- learn not to take things personally. I know- easier said than done. But seriously- the pressure from other people will only be an issue if you allow it to be. Second- do things on YOUR time- be present in the moment- mindful of the task at hand, and realize that you can't be multiple places doing multiple things at once so you might as well do what you're doing NOW with your full presence and not distracting yourself by over thinking and thinking ahead- and panicking because you can't be over doing Y while you're still in the middle of doing X (at least when performing important tasks). Sometimes putting too much pressure on yourself makes the situation worse. Destress, relax, just do the best you can and stop letting other people put the pressure on- and see if things don't improve from there. :) MHO.

As for other nurses being less than helpful- court their good will. Bring in treats, compliment them- that sort of thing. Even if you are faking it through your teeth- be as sweet as honey to them. Crabby people tend to lose their sharp edge when confronted with kindness/niceness. Once that good will has been established- they'll be more inclined to be helpful. Think of it as a business relationship in the sense of- if you're creating a more pleasant working environment for them- they'll be much more inclined to be helpful because they're getting something out of the deal.