I just finished one of those night shifts where I ran the entire shift and did not sit down until after giving report. One of my patients was CIWA and required hourly scores/rechecks and was becoming increasingly difficult to manage. My other patients were OK for the most part, but busy. At 3:30 AM, we got a transfer from another floor on contact precautions due to MRSA.
Immediately after taking report by phone, I told my charge that the patient needed an iso cart. In our hospital in pre-covid days, we could just go to the basement and grab one from where they were stored. This was no longer the case, and the iso carts were locked up. I did not know the procedure for getting a cart, because needing to get a cart on nights on this particular floor is rare. I don't think I was ever told the procedure in any meeting or email, but generally charge will call house supervisor and they will bring in a cart. Charge called house sup right away, but there wasn't a cart brought before the patient arrived. There was another iso patient two doors down, so I made sure everyone on the floor was aware and we used that cart for both patients.
Here's my mistake: I didn't get signage on the new patient's door. Call it running my tail off. Call it inexperience. Call it dead tired. Call it sheer stupidity. That is my fault and my mistake. Yes, this should have been done the second the patient arrived and I messed up.
At 6:30, I realized that we still didin't have an iso cart for that patient. I told my charge and she called house sup again. Cart hadn't arrived by shift change. I butted into to huddle to speak up about the issue so that everyone would know. Oncoming charge said she already knew and was on it. Day CNA was late to work, but I made sure she knew too.
I was finishing up charting when the assistant manager over our unit and another unit came by and asked if there were any safety issues. I immediately told her about the difficulty getting an iso cart. She asked if there was a sign on the door, and I told her that I had not put a sign on the door. She tracked down a cart in short order and got signage up.
What happened next has me questioning everything about being a nurse. At the nurse's station, in front of anyone who might have been there, my assistant manager (I'll abbreviate AM) asked me what the breakdown was in getting a cart, and I started telling how we started trying to get one when I took report and I was having difficulty with my CIWA patient during that time. She didn't let me continue. She told me that it took her two minutes to get a cart and there no excuse for not having one. She said it was solely my responsibility, not charge, or anyone else.
My charge was about to leave and walking by. She reiterated that we had tried to get a cart. The AM then told us a process that I have never before heard involving going to a different place and using a door code to get an iso cart. Charge had also never heard this.
The AM is not wrong. I screwed up by not having a door sign, even if was photocopied from the other cart. I left that day feeling humiliated and wondering if I should just get out of nursing. I work tonight and I don't see how I'm going to sleep. I don't know what I'm asking by posting this, just please don't eat me alive. I'm already doing that.
You should try your best and I'm not encouraging you not to. But you need to prioritize what to get so upset about. I feel safe saying no one is going to die from your error, it is inconsequential and flat out insignificant in the grand scheme of things. If it were that important then perhaps when people lock things up they would make sure everyone knew how to access them.
There are innumerable such decisions like the one to lock up your iso carts and trust me no one is getting an upset stomach or losing one wink of sleep over what people like you have to run around and do in order to still take care of patients.
Nursing is all I know so maybe this happens in a lot of other professions too but I have met numerous people in the nursing world who, when screwed with and crapped on, their first thought (which permeates their entire life and being) is some internal version of, "I am such a terrible person" instead of "WTH is wrong with you??" I have never understood this. Nurses need to STOP with constantly accepting blame for other people's problems.
I did an informal poll in report once and asked how many of us came from dysfunctional co dependent families. It was 10 out of the 12 staff. It’s a pattern I’ve noticed over and over as nurse of 36 years. I don’t know if that’s an answer to your question but I suspect that it at least plays a role in the self blame and acceptance of mistreatment.
You have just experienced a bully, don’t give the bully any power.
My husband gave me good advice about 10 years ago when I was bullied by a family member. It was, “ If you want to leave nursing, I will back you 100%. However, leave it because you have decided . Not because of someone else. “ Don’t let anyone intimidate you ever. The AM does not have the right to shame you or make you feel like that. I realize you are new to nursing, but you will see, people who act that way are just trying to boost their own ego at your expense. It sounds like you are an excellent nurse who was not provided with the equipment you needed. That is management’s fault, and you could make a big deal out of that.
Specializes in Oncology (Prior: Ortho-Neuro, Metabolic Surgery).
I have an update. I worked last night and at midnight the AM came in to speak to me directly. She pulled me into an empty room this time. First she appologized for reprimanding me in front of others. However, next she reiterated the entire original reprimand, because she didn't think I was taking her seriously enough.
She emphasized that MRSA is potentially career-ending, and that nearly all healthcare workers will end up with MRSA eventually. She said it wasn't enough that I made sure my shift and the next shift knew, but if there was a code with that patient, then the code team would have been exposed as well as all the ancillary workers. She told me she was disappointed in my critical thinking skills in not solving this problem when the patient arrived on the floor. She said that I should never have asked the charge nurse to obtain a cart because this is my patient, not charge's, and by expecting charge to get a cart was pawning off the responsibility of caring for the patient. Last she told me that in her years of working night shift, she has never had any difficulty in obtaining the supplies for isolation precautions.
When she asked for feedback, I repeated that I messed up and I should have put a sign on the door and set up a temporary iso station until I could get a cart. Then I offered suggestions on how to avoid in the future (big mistake). I told her that none of us on night shift have known any process of getting the iso cart other than charge calling house sup, and it had to be charge calling to follow chain of command. I asked if the processes for getting an iso cart after hours could be shared with the rest of the staff. I also suggested that we keep a set of door signs at the nurse's station so that we can set up a improvised iso cart if necessary.
She said that this was just deflecting the blame and I was not truly taking responsibility for my mistake. The rest of the conversation was a mix of cutting guilt-tripping, expressions of disappointment and restating that she thought I was a better nurse than this.
Tonight is my last shift on night shift, and it has been an unnecessary struggle to get moved to days, mostly because the manager was confusing me with two different nurses. The AM mentioned that she was concerned that I wasn't ready for day shift if I can't manage a simple problem of getting an iso cart for a patient. (This is another problem with management on our unit, the idea that only the best nurses should be on day shift, where the rest of us should stay nights. It is pretty insulting, and probably a topic for a different thread.)
I mostly kept my mouth shut during this conversation unless asked to speak directly. I didn't want to dig deeper, and it didn't seem like I could say anything to make things right or be sorry enough.
I don't have thick skin yet, but I do take correction and I improve. When I make a mistake, I may stew for a little bit and ask for feedback on how to prevent the mistake, but I move on and generally do better. I've been told by several nurses I work with and value their opinions and experience that I am exactly where I should be given my experience. I'm not super-nurse, but I'm not a screw up either. I just do my job and try to do it well. If I need correcting, I don't need to be handled with kid gloves. This level of confrontation does have me rattled. From the floor nurses and those who commented here, this is completely out of proportion to the mistake. However, it is difficult to maintain that perspective when the person who holds my employment in their hand is telling me otherwise.
Specializes in Oncology (Prior: Ortho-Neuro, Metabolic Surgery).
About to head to bed, but I have another thing to say:
I did shed a few tears after being dressed down a second time. And my hands shook when I went into my patients' rooms immediately after, but I was able to keep my voice steady. I felt like trash when she was speaking to me, but now after the perspective of another busy shift, I'm angry.
I'm angry about the treatment of nurses on my unit that drives away fantastic nurses to work elsewhere. I'm angry that I'm being spoken to like an idiot rather than a professional. I'm angry that the needs of my unit are continuously being ignored in favor of the other unit. I'm angry that the only feedback that is given is negative feedback. I'm angry that I have never once gotten a performance evaluation, not during or at the end of orientation, no quarterly evaluations, nothing until the corporate required evaluations that preceed base pay increases (which we may not get this year, but meh, that's a corporate issue). I'm angry that our unit gets NO representation with hospital management, so we have ongoing staffing issues and high acuity patients that are inappropriate for our floor while there are room and staff on other more suitable floors for these patients. I'm angry that my manager doesn't even know who I am and confused me with other nurses when I requested day shift when there was an opening and I was interrogated on what drugs I was taking to sleep and "I worked nights for X years, why can't you". I'm angry that I now hesitate to bring up SAFETY issues with management. I'm angry that nurse injuries (not me) are considered the fault of the nurse, not the lack of staff or equipment.
I know that everybody is struggling right now. I know that healthcare in general just sucks because of COVID and people not wanting to go to the hospital until way too late. I know that I'm very likely to find another stink hole if I go elsewhere.
I'm just tired of this particular stink and I'm ready for a new one.
I'm angry about the treatment of nurses on my unit that drives away fantastic nurses to work elsewhere. I'm angry that I'm being spoken to like an idiot rather than a professional. I'm angry that the needs of my unit are continuously being ignored in favor of the other unit. I'm angry that the only feedback that is given is negative feedback. I'm angry that I have never once gotten a performance evaluation, not during or at the end of orientation, no quarterly evaluations, nothing until the corporate required evaluations that preceed base pay increases (which we may not get this year, but meh, that's a corporate issue). I'm angry that our unit gets NO representation with hospital management, so we have ongoing staffing issues and high acuity patients that are inappropriate for our floor while there are room and staff on other more suitable floors for these patients. I'm angry that my manager doesn't even know who I am and confused me with other nurses when I requested day shift when there was an opening and I was interrogated on what drugs I was taking to sleep and "I worked nights for X years, why can't you". I'm angry that I now hesitate to bring up SAFETY issues with management. I'm angry that nurse injuries (not me) are considered the fault of the nurse, not the lack of staff or equipment.
I know that everybody is struggling right now. I know that healthcare in general just sucks because of COVID and people not wanting to go to the hospital until way too late. I know that I'm very likely to find another stink hole if I go elsewhere.
I'm just tired of this particular stink and I'm ready for a new one.
You've summed up the majority of the problems that I experienced with hospital nursing, all three places that I worked, to varying extents. It's a job with insane responsibility and very little autonomy or authority. People get to yell at you from above, below, and all sides, for good reasons or no reasons at all - so you either develop a thick skin, you leave, or you constantly feel anxious and terrible about yourself.
For the record, your AM is being ridiculous. I can't count the number of times I took care of a patient with standard precautions in the ED who - whoops! - was on higher precautions a couple hours later. I can't count the number of times I improvised because we didn't have the right equipment, or the number of times I worked through lunch or got stuck working alone with patients who were threatening and dangerous. Management did not apologize to me or ask for my feedback.
You went above and beyond to keep your coworkers safe, and you're not the one who locked up the damn carts.
I jumped around from one stink to another (before leaving hospital practice for good). If you have the energy to learn policies and logistics over again, sometimes it's a nice temporary break. Or sometimes you can leverage better pay. Just do it as deliberately as you can - interview at multiple places if possible, consider that YOU are also interviewing THEM, and don't feel obligated to take the first job offered. Good luck.
She emphasized that MRSA is potentially career-ending
It's really hard to know what she is even referring to with this...
9 hours ago, Ioreth said:
and that nearly all healthcare workers will end up with MRSA eventually
....and this is just patently untrue.
She is a piece of work and I don't have the energy to even think about why she might be acting this way. She sounds like some toxic combo of insecure and plain mean in addition to lacking very basic knowledge.
The bottom line remains that you cannot allow this behavior to insult you personally. I think of it as: Untrue things spoken by unqualified people can't possibly insult me as there is nothing legitimate about them.
I wouldn't talk to her any more. Do not offer her any more feedback (even if commanded to do so) under any circumstances except to let her know that she owes you an apology if she tries to speak to you again.
What you do with your future at this place is up to you. Take care to find a better atmosphere if you choose to leave. Above all, don't get too angry about all this stuff that you can't change; doing so will blacken your very soul and cause mental health problems. Just move on. Let miserable people find some other way to entertain themselves. Don't stand there and be part of it.
It's really hard to know what she is even referring to with this...
....and this is just patently untrue.
The bottom line remains that you cannot allow this behavior to insult you personally. I think of it as: Untrue things spoken by unqualified people can't possibly insult me as there is nothing legitimate about them.
I wouldn't talk to her any more. Do not offer her any more feedback (even if commanded to do so) under any circumstances except to let her know that she owes you an apology if she tries to speak to you again.
What you do with your future at this place is up to you. Take care to find a better atmosphere if you choose to leave. Above all, don't get too angry about all this stuff that you can't change; doing so will blacken your very soul and cause mental health problems. Just move on. Let miserable people find some other way to entertain themselves. Don't stand there and be part of it.
She is a piece of work and I don't have the energy to even think about why she might be acting this way. She sounds like some toxic combo of insecure and plain mean in addition to lacking very basic knowledge.
This sounds a lot like the SM at the agency I have for my home care now. None of my caregivers are in favor of how she treats them, and everyone misses the SM who moved to another position in the same agency.
So much to process here....you told the AM different ways the situation could be avoided in the future, by pointing out areas that you personally have control over, but also areas that the unit could improve. The fact that the carts are locked up and no one knew how to get one is not your fault. And suggesting signage be available on the unit at all times is smart (we have that on our unit because carts aren't always available). I will also point out that she said she never had issues working nights...well, was that when the carts were locked up? If not, then she has no room to speak.
You attempted to get a cart, and couldn't, so you brought in your charge. This is exactly what you should do. It is called delegating and asking for help when needed. Your priority was dealing with a CIWA pt, among others, which you needed to deal with. The task of securing a cart could be given to someone else.
Your AM obviously sucks at management. Publicly shaming you is unprofessional and uncalled for. Not seeing that people did not know how to get a cart is an issue....who gives a rat's rear end that she knew how...the point is that the floor didn't know. And yes, day shift can get crazy. But to imply that you don't need great nurses on nights is laughable. Guess what? Crap goes down on nights as well. Ugh. So much wrong with this manager.
I have manager experience, just not at the hospital. But I would applaud someone that was able to identify where they could improve and point out other areas that contributed to a problem. Just saying.
jobellestarr
361 Posts
I did an informal poll in report once and asked how many of us came from dysfunctional co dependent families. It was 10 out of the 12 staff. It’s a pattern I’ve noticed over and over as nurse of 36 years. I don’t know if that’s an answer to your question but I suspect that it at least plays a role in the self blame and acceptance of mistreatment.