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.
