CONTINUED IN WHAT IS THE MAJOR REASON Why are they all leaving?

EmerNurse, BSN, RN · Nov 28, 2006

When I think of breaks, it's funny, I try to figure out why I didn't get one... Let's see.

I could have gone on break at 2am but my pt needed a BP med for a seriously high BP. I won't go on break and leave my "cover" to have to give meds I know need to be given. So ok I give the BP med. Now.... I'm one of those "anal", "too intense" nurses - I feel that if *I* give a vasoactive med (or insulin or whatever), I should evaluate the result. So I wait to go on break until I check the BP again. Hmmm... still very high. Ok, maybe give another dose (md order of course). Now I'm gonna wait again. No problem. Now it's 3am. BP much better. Ok I'll go on break (we get an hour, unpaid lunch). Off I go, having given report to my cover (on ALL my pts, not just this one). Back at 4am. Pt. BP is 84/48?? Oh. MD ordered CP protocol while I was gone. 1" of nitro paste. Lopressor 25mg (HR is fine), oh and some Lasix, since BNP came back 2405. M'kay. Go wipe off the nitro paste, trendelenburg, bolus? hmm.. they're in CHF...etc. Deal with this AND catch up on my other 4 pts.

Does it always happen that way? Nope. But (and here's that anal, too intense part), if I'd been there, I'd have known better what to question, suggest etc as those orders came up. Remember my cover is "covering" me - still has his/her own 5-6 patients right? And 4 other patients of mine being covered while I'm on break - I didn't only leave him/her that ONE patient. Then when the doc asks me, how come the pt's BP is 84/48 , it reallly doesn't feel right to say "well, *I* was on break, go ask XXX, RN!" Doesn't fly. That's MY patient - break or no break.

So you can say that the nurse covering me should have KNOWN better - sure, she probably would have, if s/he'd not also had my other patients to cover, and his/her own patients with issues, etc blah blah. S/he had 10 patients for a whole hour, each with something going on, transport to x-ray or CT, pain meds, BP meds, insulin, consult calls, orders to write for admit. And when I return from break, she gets to go and *I* have all those patients.

Lord, by the time you get through all that - it's easier just to stay on your own patients and eat on the fly. At least you know what's going on.

And for those nursing students - I very well remember feeling the same way, even when I was a PCT during school. When *I* am an RN, I will certainly know how to prioritize, organize, get my breaks. But let me tell you something - that license you work so hard for... it is a very HEAVY weight around your neck. The spectre of all that responsibility descends onto your shoulders and never leaves you. It's very easy to get your breaks, give report to your cover, on the theory that it's your "right" and the covering nurse has an "RN" too so they can be responsible, but IF something happens, IF there's something that could have been done differently, better, whatever, that weight on your shoulders presses down down down on you. Yeah, you can say "well the one covering me is risking his/her license, it's not MY fault". Sure - but we nurses are a possessive bunch too. I've spent hours with this patient, I KNOW this patient, it's MY patient, it's MY responsibility. That license gives you the right and responsibility to give the BEST care you CAN to each of "your" patients. It's their life (health) AND your life (license) every minute of every single day on every single shift.

Anal? Yep thank you. "Too intense"? Yep thank you. Bladder the size of a 6-person RV? Yeah that too. Do I always get breaks? Nope. Do my patients get the best care I can possibly give, given the working environment of nurses today? You damn well bet they do. Is it ALWAYS enough. No.

Oh and just to top it off... the buck stops with the nurse. The doctor isn't responsible for catching MY mistakes, but I'm damn well responsible for catching the doctor's mistakes!! Someone might say to the doctor "hey why'd you order that - blah blah - be more careful!" The NURSE gets "you gave the med that made the pt. hypotensive! Medication ERROR! Write it up! Shame on you!" Heaven forbid the patient is seriously injured or killed due to that wrong order that you implemented. Bye bye license. Jail time maybe? The buck stops with the nurse. You very well BETTER be anal, intense and appreciate that weight around your shoulders. That's what keeps your license intact!

And one more thing... when I give the best I can give. When I do what's best for the patient, when the doc TAKES my advice or suggestions for the betterment of the patient, I drive home tired, irritable, dying to pee, hungry, and VERY fulfilled knowing that I made a difference.

(sorry so long - vent/rant/whatever. I'm OFF tonite!)

Dixielee, BSN, RN · Nov 28, 2006

very well said emernurse. that is why i am so tired. when no one else will do it, the nurse will. when housekeeping won't clean the room because it is too dirty, the nurse does it. when there is no transporter to take that patient to ct, the floor, x-ray, the nurse does it. when there is no iv team, phlebotomist, etc. (and there never is in the er), the nurse does it. when there is no one to get a meal for the patient, the nurse does it, even when we don't get one ourself. when the tube system is broken, who takes the blood tubes to the lab, who gets meds from the pharmacy? of course the nurse does. yep, and who covers the doctors butt when they are tired or inexperienced and make mistakes.....yep, the nurse.

it is a very heavy weight. one i have carried well for 30+ years, but my neck is getting tired from the weight.

btw, i love your tagline, because if not for stupid people, we would be unemployed!! "sweetheart, there ain't no cure for stupid!"

mom and nurse · Nov 28, 2006

I've only been an RN for two years in a hospital.

If I were to leave hospital nursing I would still like to remain a nurse.

Why would I leave hospital nursing?

It's not the BMs, sputum collections and other bodily fluids (though I would like to not have to deal with those things again). It's the running around nonstop for 8 1/2 hours with a 15 minute break to eat (I do take my 15 minute break to eat (which is really supposed to be 30 minutes ha ha ha!)......oh ok....maybe sometimes its an interrupted 15 minute break but I have my emergency food ready in the nurse's lounge waiting for me at all times and sometimes my 15 minutes is more like a 5 minute gobbling down at record speed before I dash back out to the floor...but its a break). And I do try to take a bathroom break.....of course we now have trackers that can track us into the nursing staff lounge and the bathroom (which shows up as the staff lounge). Honestly sometimes I am so busy I simply don't think about the bathroom..... I just keep running....keeps me thin.... And I do still have days when I love what I do....but I would jump at the chance to do something outside of hospital nursing Monday - Friday with my holidays and weekends off.....perhaps to teach as a Community Health Nurse.....(sigh) who knows....maybe one day...

kellerpatty · Nov 28, 2006

Also, are you even an RN? It doesn't look like it by your profile. If you're not then I don't think you can comment on the situation.

This is a good example of why nurses leave: negativity...someone goes out of their way and writes a nice, sweet, and completely non-negative note...even goes so far as to thank all us nurses...BUT THERE IS STILL SOMEONE OUT THERE who is so negative that they have to rip her a new one...dang!

ShelNewGrad · Nov 28, 2006

i think you may need to work on your organization skills. i am saying this not to offend you. some people can prioritize better than others, maybe you can ask the hospital education if they have a class for organization and prioritizing. i used to work in med-surg/ telemetry so i had very sick med-surg patients and on top of that with heart issues. i always made sure that my patients were taken care of but i always took my break too. so i am not just telling you this because it sounds good, but from experience. i work in surgery now because i just happen to enjoy it better. have you tried any other types of nursing? med-surg is not the only thing out there.........
don't give up........smarty_rn

hi smarty_rn

i am not offended by your comment at all. the only problem is that 99% of the rns on the med/surg floor that i work on do not get any of their breaks at all. so, its not just me - its a lot of rns, half of them who have been rns for over 15 years so i dont think its a time management issue at all.

i work on a busy med-surg/neurology/telemetry unit so we have the med/surg, neuro and tele patients which makes it very difficult :uhoh3:

i am not quitting nursing at all - i would love to be my own boss so i'm starting my business in 2007 and will do nursing part-time. i feel this would make me happy.

i just wanted to explain the situation better. take care & happy holidays :smilecoffeecup:

shelnewgrad

kimmicoobug · Nov 28, 2006

I work nights 19-07. I actually choose not to take a routinely scheduled break.

I do this because there is nothing for me to do on my break. It usually tends to slow down around 01-04 which is when I will sit down to do chart checks, read

progress notes, catch up on charting, etc. etc. So, I will usually pull up my coffee and my food and work and eat throughout the night. This is what I choose to do and it works for me. Now, I do take mental breaks as much as I can, such as surfing the net for this or that.

traveltrash · Nov 28, 2006

Thank you Lizz!:thankya:

traveltrash · Nov 28, 2006

:cheers: :thankya: :bow: :yeahthat:

traveltrash · Nov 28, 2006

AMEN!!!!! ''THE SITUATION WAS MADE'long before we got there!!!!

Hellllllo Nurse, BSN, RN · Nov 28, 2006

As a RN, you have at least 4-5 patients depending on you (typical med/surg floor) ....
ShellyNewGrad

4-5? sounds wonderful. I never had fewer than 7 on med surg, and usually had 12-13. No CNA, no unit clerk. Charge does not take pt's and does not help. 4-5 pt sounds ideal to me.

Kayartea · Nov 28, 2006

Was at a Nursing Symposium last year where one of the speakers said that 90% of critical care nurses end up with some form of PTSD. Must be even worse in the ED. MS has a lot to deal with, too. Maybe that has something to do with all the nurses leaving. That, and the fact that there are more job options now, where you can make a living. The overall treatment of nurses hasn't changed much since it and teaching were the only jobs available to women. Nurses have changed, the job hasn't.

Gromit · Nov 28, 2006

very well said emernurse. that is why i am so tired. when no one else will do it, the nurse will. when housekeeping won't clean the room because it is too dirty, the nurse does it. when there is no transporter to take that patient to ct, the floor, x-ray, the nurse does it. when there is no iv team, phlebotomist, etc. (and there never is in the er), the nurse does it. when there is no one to get a meal for the patient, the nurse does it, even when we don't get one ourself. when the tube system is broken, who takes the blood tubes to the lab, who gets meds from the pharmacy? of course the nurse does. yep, and who covers the doctors butt when they are tired or inexperienced and make mistakes.....yep, the nurse.
it is a very heavy weight. one i have carried well for 30+ years, but my neck is getting tired from the weight.
btw, i love your tagline, because if not for stupid people, we would be unemployed!! "sweetheart, there ain't no cure for stupid!"

aye, well said! and let us not forget that while you're taking that patient down to ct, or xray (or whatever), you have to be with them because they have to be tele-monitored, and while you're gone for that 45+minutes your other patients still need to have their meds passed, evaluations done, charting done, etc etc etc. so you're just getting behind.

food. well, officially, we aren't allowed to eat at the nurses station. in reality, if we eat at all, its bites between tasks -decidedly not healthy- and while charting.

-someone mentioned bariatric patients. sigh, my back aches everytime i see yet another 5-600 pounder being admitted. no way is it practical to turn them effectively q2h -hell, half the time they don't actually fit on the bed lying on their backs! sigh.

some nights i can hear the ventilator alarms going off hours after i've arrived home. i'm so glad my wife doesn't work in the med. field.