I'm six months in as a night RN in a small community hospital on a med-surg floor. The majority of my first three years nursing experience were at a large level one trauma center in another state. Transitioning to a 20-bed hospital with limited resources has presented a fairly steep learning curve for me. Most of my coworkers have been welcoming and supportive as I navigate through the process.
Even though we're small I've been surprised with the higher acuity of our patients. In my limited time we've had about five codes, all with poor outcomes, and multiple rapid responses. At night it's basically just us nurses, a respiratory therapist, and phlebotomist. Our doctors usually leave the premises to go home to sleep and are reachable by pager. Our ED doc is alone with one RN in the ER and usually does not come down to our codes during night shift.
The rule at night is all calls to the doctor must funnel through the charge nurse. With this I've perceived hesitance/reluctance to burden the doctor in the middle of the night, although 9/10 the doctors are polite and helpful. This has contributed to, in my opinion, a lot of cutting corners.
Since starting, there have been a countless incidents where I've been more or less told to do things clearly outside of protocol/policy (and sometimes my license). This includes ordering and administer a medication without communicating to the doctor; not call the doctor when a two-stage spine surgery patient fell; a patient left the building for three hours and came back intoxicated with her pit bull and the dog was permitted to stay in the room; to keep a full-code patient with new-onset chest pain, chest pain protocol ordered, off telemetry and without an IV. This has resulted in me being extra careful when told to do things I'm not comfortable with by taking extra time to consider and investigate the policy myself, or just go straight to the doctor for him/her to address what I perceive as outside my scope. I try to follow up politely and professionally while advocating for my patient.
These scenarios have contributed to some tension between myself and a charge nurse who has tried to convince me to proceed against policy in a few of the situations above. Beyond all that, she has undermined my patient care at the bedside on a few occasions, once while was with training a preceptee. On my last shift she busted into a patient room while I was in the middle of a dressing change and loudly demanded I, "get out here right now!" to tell me one of my other patients pulled out his NG tube. She was irate because as he pulled it out some of the contents got on her scrubs. In addition to above, I've seen her make a serious, careless, and potentially fatal medication error - and pushed me away when I attempted to intervene before she made the error - while she lead a code. In summary, I don't always have the best confidence in her judgement or care approach, but I consistently try to lighten our relationship by expressing a lot of gratitude when she is helpful and keeping things as positive as I can.
So fast forward to yesterday. I had my review. The charge performed a peer review on me along with a few others. Overall my review was positive, however her's stood out as quite poor. 2/5 on all categories, with the only explanation, "we've gotten into arguments and she doesn't take my advice." She said I'm anxious and talk about my old job too much (I approached her months ago with that self-realization, owned up to it, and apologized and have since made attempts to improve). Her review contributes to my merit raise.
I took the opportunity to express why I don't always take her advice to my boss - and in doing so brought up a lot of what I mentioned above when she asked for examples. My boss seemed alarmed and backed up my approach of following policy and my nursing judgment. She ended the discussion stating she believes we're both great nurses and asked that I talk with my charge directly.
So here I am now. I need to talk to the charge. Does anyone have any words of advice to offer in dealing with confrontation? Especially at a new job and with the charge nurse nonetheless?
**Added later*** I moved here a year ago, worked six months per diem at another hospital I also wasn't terribly impressed with before taking this job, and my partner and I plan to move next June. If I leave this job to work somewhere else I will have worked three jobs in two years, and I'm afraid that might reflect poorly to future employers. In some ways I feel forced to stick this through. I just don't want to create an even more miserable/hostile situation with the charge in the meantime.
This is a Charge who has been given way too much power. This has created an ego nurse, that is thinking about herself and not her patients. It reminds me of a story that happened with my Mom. She was a newer nurse, but a pretty darn good one. She had conflict with the Charge due to the Charge just not liking her. This Charge would give negative reviews and tried numerous times to get my Mom fired. She insinuated my Mom was sleeping with the doctors on staff, and even said my Mom had a "whore walk". My Mom had an obvious limp due to having a tumor removed off her hip when she was a teen. It got so bad, in a meeting my Dad asked my Mom to remove her pants and show the Charge her surgery scars. Administration were horrified and promptly fired the Charge nurse for her behavior and allegations. The moral of this, hold your ground. Make sure you document every detail what is said and when, and what situation is going on. Remember she is a big fish in an extremely small pond. But her actions will eventually come back to bite her. I wouldn't take her to heart and I would take it with a grain of salt. If you have plans on moving, I would look into that. This job is no longer self serving and will break you if you stay. You seem to want more and frankly, deserve more. So remember my Mom and her pants down the next time you are faced with a situation like this. She held her ground and cleared her name, and you can do the same!!
CanadianAbroad - Thank you for sharing your mom's story. I'm sorry she went through something so horrific! I'm so pleased to hear everything ended in her favor. I'll remember her story.
I know I haven't been in the field all that long, but this is the first time I've ever had conflict in the workplace. It really dismays me how people can behave toward one another in a professional work environment. The charge and I are the same age and she's been a nurse for a shorter amount of time. This is her only nursing experience. I don't see her treating other people this way, but most of the people who work there have been there a long time and are from the area. I knew this kind of behavior existed, and realize I may face conflict again, so perhaps this situation is a good learning opportunity for me to address people who try to push me around (with cowboyardee's advice in mind). How can anybody get mad at anyone else for simply trying to abide a very appropriate policy? It kind of blows my mind.
She undoubtedly knows, and she allows it all to to on. Full-blown out-of -the-mind things like bringing a large dog in the unit just because a patient wants it to be there (and, I guess, nobody checked shots, vet papers, obedience training done, etc) do not happen routinely unless the whole totem pole knows about them. Smaller, "we're all family here" places are especially prone to that sort of evil.
This is interesting because yes, this hospital pride's itself with its "family feel." And no, the dog's records weren't checked as she didn't have any records - the patient and her dog were homeless. The argument was the dog had nowhere else to go and therefor my charge (not the one in question) and house supervisor permitted the dog to stay per the patient's request. Of course I had to remain the nurse, which was very uncomfortable for me, so I documented how that decision was made and did my best to limit my time in the room for the remainder of my shift.
But as far as my boss not knowing, I believe it's possible she doesn't understand the full breadth of the situation. Her eyes became wide when I told her my examples and she said, "oh boy, maybe I need to spend some time working with night shift." I didn't share my stories about the charge yelling at me to get out of the patient room while I was performing the dressing change, or the few times she's undermined me at the patient's bedside over ridiculous things that she was wrong about no less. I think it's important I share that with her too.
I agree with documenting - I've made a commitment to start documenting more thoroughly, and at least I can now add that I notified the manager and when. I have a follow up conversation with her scheduled for tomorrow and I'm going to tell her everything. I am going to confront the charge, but honestly I might prefer my boss to be involved while I do, so I'm going to see what she thinks.
There is a wealth of good advice in this thread, thank you! I wasn't aware of how easy going agency work is, and it's a good idea to perhaps take that route until we move next June. I'll look into it more. I will also look into transferring to the bigger hospital our community hospital is affiliated with - they have a tremendously better reputation. I wish I would have just applied there to begin with.
I would give my 2 weeks notice now, do agency while I found another job.
YES! Don't allow them any more opportunity to "throw you under the bus!" If you've already practiced outside the scope of your license then you've already set yourself up for potential disaster.
IMO, I agree with most of the posters here. This does not sound like a safe place to work...and the only person who can protect your license is YOU.
I'd consider getting out of Dodge while you can. Start looking for another position, and stay out of the line of fire as much as you can in the meantime.
YES! Don't allow them any more opportunity to "throw you under the bus!" If you've already practiced outside the scope of your license then you've already set yourself up for potential disaster.
I have not practiced outside my license. I have refused when the charge has told me to order and administer meds without talking to the doctor. The only times I have gone along with anything outside of policy is when the charge and house supervisor overrided me, in which case I documented the circumstances heavily. The charge took my review as an opportunity to make her disatisfaction with me known for "disagreeing," and, "not following her advice," in these situations. Which is surprising to me since it demonstrates she doesn't seem to have insight that she is self incriminating.
But yes, I hear everyone on the getting out of dodge, it is sound advice. I'm looking into options while also documenting and preparing to disclose everything to the boss to see if she handlings the situation more directly.
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
Go online and get a copy of your state Nurse Practice Act as well. Look for direct relevancies to the examples you have and point this out to your boss. Keep personal copies of all this. Also keep personal documentation of all conversations you have, names, dates, responses. If this hospital is affiliated within a larger system, that gives you options if you feel you have exhausted all of them where you are.
Out of curiosity, is there a clause in your state Nurse Practice Act that requires reporting instances of possible violations of it to the BON?
I am also wondering if the larger hospital system has a confidential corporate integrity hotline. Not the only option you have, just a thought.
" No doctor on site = not a hospital" is so NOT TRUE. The situation described by OP is normal for small rural facilities.
I realize that nurses in this setting are OUTSTANDING as to the care they provide. I also can perform all the interventions the uber-generalist nurses provide. I want a doctor's order BEFORE I do so.
One of my first posts here , was regarding there was no physician onsite to interpret an EKG for a patient with chest pain. I was directed to fax the EKG to a cardiologist. I was not willing to wait for interpretation.. when time is wasted while the heart muscle is dying.
I broke my contract the next day. I was NOT going to compromise my license and my patient's safety... because there was no doctor on site.
OP has got to do what she see's fit... I chose to get outta dodge.
Specializes in Cardiology, Cardiothoracic Surgical.
&%% this place. It sounds like you're making sound nursing judgments, you've prevented some medical errors from some dangerous coworkers, and you know how to nurse after a few years of working in a Level 1 trauma center.
The ER doc doesn't even come to your codes? Eesh!
People don't know what they don't know, in addition to their codes having poor outcomes. I would get out of there ASAP!!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I would worry more about what losing your license for the dangerous, untenable situations you are constantly in, more---much more---than I would about perceived "job hopping".
Leave. Quit. Get out. Move on. Don't disparage the place or the people, just say it was not a good fit for your career goals. Simple as that.
I have not practiced outside my license. I have refused when the charge has told me to order and administer meds without talking to the doctor. The only times I have gone along with anything outside of policy is when the charge and house supervisor overrided me, in which case I documented the circumstances heavily. The charge took my review as an opportunity to make her disatisfaction with me known for "disagreeing," and, "not following her advice," in these situations. Which is surprising to me since it demonstrates she doesn't seem to have insight that she is self incriminating.
But yes, I hear everyone on the getting out of dodge, it is sound advice. I'm looking into options while also documenting and preparing to disclose everything to the boss to see if she handlings the situation more directly.
" The only times I have gone along with anything outside of policy is when the charge and house supervisor overrided me." This is not about internal policy and this is not about supervision over- rided you. This is about YOU intervening without a physician order.
CanadianAbroad
176 Posts
This is a Charge who has been given way too much power. This has created an ego nurse, that is thinking about herself and not her patients. It reminds me of a story that happened with my Mom. She was a newer nurse, but a pretty darn good one. She had conflict with the Charge due to the Charge just not liking her. This Charge would give negative reviews and tried numerous times to get my Mom fired. She insinuated my Mom was sleeping with the doctors on staff, and even said my Mom had a "whore walk". My Mom had an obvious limp due to having a tumor removed off her hip when she was a teen. It got so bad, in a meeting my Dad asked my Mom to remove her pants and show the Charge her surgery scars. Administration were horrified and promptly fired the Charge nurse for her behavior and allegations. The moral of this, hold your ground. Make sure you document every detail what is said and when, and what situation is going on. Remember she is a big fish in an extremely small pond. But her actions will eventually come back to bite her. I wouldn't take her to heart and I would take it with a grain of salt. If you have plans on moving, I would look into that. This job is no longer self serving and will break you if you stay. You seem to want more and frankly, deserve more. So remember my Mom and her pants down the next time you are faced with a situation like this. She held her ground and cleared her name, and you can do the same!!