Demoted, now what to do

[cenote]

I recently started a month long 7P-7A contract at an HCA facility. As is their policy, I had no orientation except for a computer course. On my 7th shift there, and still not up to speed on their computer system, and how they do things, I had a horrible night, running all night long and getting behind. The morning I left I forgot to do my chart checks, and actually got all the way home before I remembered. I phoned the nurse to whom I had given report to tell her I was coming back to the hospital and wanted to make sure she double-checked anything I might have missed, until I could get there. She said it was ok and not to return. She actually said that it was no problem. She'd check it.

I worked two more nights with another horrific night on my 9th shift there. (I call it "dumping" when the contract nurses get the worse patients but I've learned to accept this).

On both of these nights, I have to admit I was overwhelmed but received no help from my fellow nurses and scant from the Charge. I clocked out late (a big NO NO) on both of these mornings.

The following day I received a call from my agency saying that due to the fact that I missed the chart check where a procedure was not scheduled that should have been and had not acknowledged something on the computer (that I didn't know had to be done), and that a patient's wife complained that I didn't address her husband when I came into the room, that I was not up to snuff. The "powers that be" stated that I could no longer work on the Tele unit but could finish out my contract on med-surg...(which, by the way, has 2 more patients than I'm used to having.)

I wrote a response explaining the medical problems my patients had on both of these nights that sent me into overtime, etc. I am confused about the patient complaint but the wife was demanding, the patient non-verbal and confused. I went into that room at least 20 times due to the problems he was having and in the morning he had improved and I felt I had done a good job keeping him from harm. (I do try to be quiet when I go into patient rooms in the middle of the night...but I must have been too quiet).

Also, I recalled that the nurse before me (one of their staff), had signed off of the scheduling of the "missed" procedure. (The patient did get his procedure as the AM nurse was alerted by my call to check. This patient was on the list, but it was not acknowledged by me).

Anyway, I am so down about all of this. No matter the circumstances, I do my very best to take care of my patients, had some horrific nights with no help (other nurses were playing computer while I ran amoung rooms), and have felt pride in my work. But I feel so depressed. No only do I not get recognized for working my A_ _ off those nights, I get slammed. If they wanted perfection, they could have given me some orientation or at least, something to read about procedures! Hell, I admit I made mistakes but I can't help feeling that the reaction was too punative and non-construtive. And leave a bad taste in my mouth.

I don't know what to do. If I go now to the Med-surg floor, I may well not be able to keep up. If I don't, I'm letting myself open to a bad reference.

Advice? Encouragement? Alternative career?

[BabyCatchr, ADN, ASN, RN]

I just wanted to say I'm sorry that happened. It seems in life sometimes the good die young. I have had similar experiences, and when you learn to CYA, you can get negative reactions for that as well.

Can you schedule a meeting with your supervisor to discuss what happened?

[cenote]

Thanks, BabyCatchr, I needed some understanding from other nurses right now. I'm confused and hurt. . . feeling inadequate. I want out of nursing so badly sometimes and it's experiences like this one that kill the drive in me. What are hospitals thinking when they are so destructive?

[oramar]

My guess just about everybody the bring in under the same circumstances will fall short. Sounds just about impossible.

[soulofme]

I don't do hospitals.........

[miss81, BSN, RN]

Three letters for ya... H.C.A

[Straydandelion]

I have found in my experience that nurses seem to just dive in and "take it" no matter what, thinking that they will "deal with it" in order to make sure their patients have the best care. Yet someone new to the area (even IF the other nurses had similar schedule and MAY be used to all the procedures, or may be too busy to help someone new), and getting behind deserves a response. Letting the charge/supervisor know you are behind due to whatever... and also talking to your agency AFTER that night is completed. Even though you were told by the next shift not to come in, it would have helped to also call your agency and get their opinion. Letting people know something BEFORE there is a problem helps. There are some areas that WILL help to new/agency nurses, some not. I wouldn't call moving to a different area a "demotion" in that situation and even if you have two more patients, the floor could work with you better then the telemetry, and the acuity could be different. Be that as it may, I wish you luck!

[caroladybelle, BSN, RN]

Several thoughts:

HCA - those initials should warn anyone off a contract.

What part of sending you to medsurg is "demotion"? If indeed were easier and a true "demotion", it should mean that the patients are so easy, that it would be a cake walk compared to tele and you should be thrilled with the lower stress (sarcasm intended).

The word 'demoted" has a certain baggage to it that I hope that you did not intend and indicates, says a certain amount about what you think about medsurg and its nurses.

Enough about semantics, though.

I personally think, and you seem to agree that this would put you in a place that would actually endanger pts because of the higher ratio...and this makes no sense on the part of management.....if they are really worried about your work, they would DNS you, offer more orientation, and not thrust you in another unfamiliar environment. But this HCA and little that they do makes real sense....your very brief orientation should clinch that idea.

I suspect that they wanted to cancel contract, but didn't want to pay the fees involved, and that like all HCAs, no one ever wants to work medsurg (for some reason!!). Thus, they had a complaint and they used it to move you. That way, either you will quit (they don't have to pay cancellation fees, they win) or you work medsurg where there is always a shortage (they get a captive MS nurse). They win either way.

Your choice is either deal....(it is only a month long contract, correct), or quit. The problem though is that HCA has long vicious tentacles, that can reach pretty far (They subscribe to Group One in some places (Texas), or own a large number of hospitals in others (Florida). Thus crossing them can have very long term consequences.

I learned my lesson with an HCA facility....took a 13 week contract on the onco floor with a reasonable ratio - they deliberately overstaffed the unit, and then floated all of the captive travelers to every unit w/understaffing in the place. Tenet occasionally plays the same game also.

Having said that demotion

[BabyCatchr, ADN, ASN, RN]

I think this goes for many professions. I know as a teacher I would be criticized if a student was sitting incorrectly, holding a book incorrectly, if I let the children laugh, if I didn't let the children laugh, if I focused on learning too much, if I didn't focus on learning enough, if I was too strict, too lenient, smiled too much, didn't smile enough, too mean, too nice...AAACKK! One time our dean showed me how to have the children write a paper - by putting "power words" in the margin first, then building paragraphs off of that. She gave me a poster to explain the process and asked to see the papers when they were done. When I showed her the papers, she said, "What's this???" I explained those were the power words. She said, "What is a power word? I'm tired of you always wanting to do things your own way. I guess if it works for you you can continue to do it but that's not the way we do it here." :banghead:

Thanks, BabyCatchr, I needed some understanding from other nurses right now. I'm confused and hurt. . . feeling inadequate. I want out of nursing so badly sometimes and it's experiences like this one that kill the drive in me. What are hospitals thinking when they are so destructive?

[cenote]

My agency has been supportive since I've been with them for 3 years and never had a negative report. But I've just made a decision NOT to take the offer to finish my contract in Med-Surg. At this point, I feel it is better to cut my losses. Please understand that I am not disparaging Med-Surg, on the contrary, I know that these nurse are experienced in areas that I normally don't deal with...remember, I'm into the Cardiac thingy.

Ok, I made some mistakes and I'm willing to take criticism...I am not willing to accept HCA's interpretation that I, after 4 years of experience, and with no orientation, am "not qualified" "not adaptable" "not approriately trained" for Tele.