Frustrated with Hospital Disregard for RN and Patient Safety

[Ioreth, ADN, RN]

I think I just felt the straw that broke the camel's back. This is going to take some time to unpack.

TLDR version is: I'm frustrated with my hospital's continued disregard for nurse and patient safety and want to leave this hospital system for the local competitor, but I want to tie up some loose ends and I'm worried that the next job won't be any better.

When Covid started, the Other hospital system in town started testing all admits for any reason for Covid. My hospital did not. On my floor, patients often discharge to a rehab facility, and all require a Covid test to be done before transfer. Many, many times we have had patients Surprise! test positive for Covid when we are doing this test right before setting up transport.

Edit: I wanted to add that I don't mind caring for Covid patients. We've seen less than the other floors but we have had many. I am happy to do my part in caring for these patients. However, we must know their Covid+ status to protect ourselves and our other patients.

So this month, as we are now 2 years into the pandemic, we all got an email from corporate headquarters that all patients admitted to the hospital will be tested "so they can be treated appropriately". No mention of avoiding cross-contamination or protecting direct patient care staff, but I'll take it.

We saw this policy go into effect last week, but it was ugly. All patients admitted from the ED were tested, but not patients admitted under observation status, even though these patients are roomed on the same floors as general admission patients. Patients were also being tested only on admission to the hospital, which meant that this test was the last thing that was done in PACU as surgical patients were to be admitted. We had 4 surgical patients to our floor that afternoon after this policy went into effect and 3 were surprise positives. 

So instead of moving the Covid test to before surgery (wouldn't the surgical team want to know a patient was positive?) the hospital panicked because PACU can't isolate patients. They required that PACU testing be stopped immediately. It doesn't exist if we don't see it, I suppose.

I found out about this a few days ago when I admitted a surgical patient from PACU and a warning came up on my computer that this patient had not been tested. I ordered a test per protocol and let my charge nurse know that a patient had come up without being tested. I was then told to cancel the order and there's no protocol (despite the email from corporate headquarters?!), so it was an inappropriate order. My manager then let me know the changes to PACU not testing. So we are not even testing these patients after they arrive to the floor. Again, it doesn't exist if we don't know about it.

I'm furious, and I am done.

[Ioreth, ADN, RN]

Part II: What to do next? 

I have posted many times about being dissatisfied with this job. I'm still a fairly new nurse, so I've stuck it out, the devil you know and all that. I am so close to being fully vested in my 401K, which will be this August. I'm also close to finishing my BSN, which I am getting partial tuition reimbursement. I wanted to finish those before moving on. On some level, I feel like the hospital owes me after the BS I've dealt with here, so I want to get all I can get from them. 

I'm also a little scared of looking for another job. I hate, hate, hate the job search and would rather just be settled. I don't expect the Other hospital system to be perfect or even better, but I know that they are better in at least the specific areas that I am frustrated with in my current hospital. I've had a horrible manager and a better manager, so I know that my next one could be either.

I think I'm also a little psyched out from the last time I thought about jumping ship. I did land an interview in my preferred area of nursing at the Other hospital, but I did the interview while sick with Covid at home isolating and did the interview online. I didn't get the job but I did get the "we still liked you so feel free to apply again sometime" letter. That was over a year ago, so my nursing skills have improved and I now have a bit of charge experience, but I don't think my confidence has improved. 

I have also thought of just quitting now. If I did that, then I would finish the BSN then start applying to the other hospital. My family finances can take it, though it would delay some of our goals this year. This option "feels" better, but it leaves me even more anxious about actually landing a job I want.

I'm also afraid that the next place will be worse in some other way. I know nowhere is perfect, but what if I have a good thing and don't realize it. Well except for the blatant avoidance of Covid testing. I think this worry comes from when I was floated to a more medically oriented floor and I felt way out of my depth. I have an interest in oncology, but I know that the learning curve there will be steep after working with mostly surgical patients. This may be exhaustion and anxiety of the unknown talking.

[Davey Do]

I admire your well written post and applaud your perspective. beliefs, and actions, Loreth. It appears a lot of thought and consideration has been done.

Usually, we know the answers and/or options, we just put out feelers to others just in case there's something we missed or hadn't considered.

5 hours ago, Ioreth said:

I'm furious, and I am done.

Good luck and best wishes, Loreth.

[2BS Nurse, BSN]

"I'm also a little scared of looking for another job. I hate, hate, hate the job search and would rather just be settled". 

Nobody likes the job search or interviews! They almost always ask the same questions everywhere you go. Now that you have some experience, it's easy to recall and prepare stories ahead of time (write them down, I convey the same stories at every interview). Preparation is key and will make you feel more confident. The more you practice interviewing, the easier it becomes. Experience makes you more marketable too.

I'm sure others can add to this list:

Give me an example of a time you went above and beyond for a patient, Give me an example of a conflict you had with a coworker and how you resolved it. Describe a time when you had to prioritize during your work day. Where do you see yourself 5 years from now? Why do you want to work for XYZ health?

 

[JBMmom, MSN, NP]

I am shocked that your OR is willing to take patients without knowing their COVID status. The OR is the one area of our hospital that was considered sacred above all others and patients going there were always tested before surgery. Unfortunately, these days I treat everyone as potentially positive. We've had admissions with a negative test that develop symptoms and test positive 2-3 days later. Wear your N95- I swear that has kept me from getting it in the past 22 months and I've been with COVID patients almost constantly. 

As for the job situation, only you know whether it's worth it to stay or go. Conditions at all hospitals are significantly less than ideal these days. Even if the COVID safety might be better somewhere else, something else might be worse. But if you're ready to move on, just go for it. Good luck with your decisions. 

[Rose_Queen, BSN, MSN, RN]

27 minutes ago, JBMmom said:

I am shocked that your OR is willing to take patients without knowing their COVID status.

As am I. Intubation/extubation are both aerosol generating procedures that place staff in the room at risk. If patients came to pre-op without a test, they were treated as infected until a rapid test came back negative or outright cancelled. The only exception was life and death, and if there wasn't a test result we treated them as positive.

[LovingLife123]

So, what does your pacu do with other things that need isolation. Covid isn’t the only thing that needs iso.  

My hospital is overly aggressive with isolation but we have iso rooms in pacu.  You can’t not test and pretend that covid doesn’t exist.  

Every surgery patient should be tested.  The staff needs to be able to protect themselves especially with extubating and covid.  

Are you in a very small hospital?  I mean MRSA and ESBL still exist with surgery patients.  How does your pacu isolate those patients?

[ladedah1, BSN, RN]

23 minutes ago, LovingLife123 said:

My hospital is overly aggressive with isolation but we have iso rooms in pacu.  You can’t not test and pretend that covid doesn’t exist. 

Right!  If we don't test them, they're not positive is a really horrible stance to take when every procedure is going to be aerosol-generating. 

You would think that's the one situation in which everyone would need to be tested... or everyone would just be assumed to be (and treated as if) positive. 

Maybe that's what they're doing (using airborne precautions for everyone), though?  Would really be the only way that it would make sense... still wouldn't be a logical reason to exclude untested surgical patients from inpatient testing protocols though...

[NurseScribe]

Have you considered REPORTING the hospital? Those are unsafe practices that are endangering many people. You would be doing the public a favor if you found the local hotline number and gave a detailed report. It can often be done anonymously. You might even cause a change in policy. It's worth a try. 

[Guest219794]

18 hours ago, LovingLife123 said:

You can’t not test and pretend that covid doesn’t exist.  

Sure you can. 

When my hospital was requiring strict and long quarantines, they were not testing nurses.  Obviously, had they been testing nurses, they would have had to have more staff in quarantine.  My non-medical friends were all pretty surprised that we weren't screened.

Contrast that with my nephew.  He is a tech on m movie sets.  It is very important to them to avoid an outbreak, so they test everybody every day.

I still  have never been tested by my hospital.

I have included an actual photo of admin discussing staff testing.

[LovingLife123]

4 hours ago, ladedah1 said:

Right!  If we don't test them, they're not positive is a really horrible stance to take when every procedure is going to be aerosol-generating. 

You would think that's the one situation in which everyone would need to be tested... or everyone would just be assumed to be (and treated as if) positive. 

Maybe that's what they're doing (using airborne precautions for everyone), though?  Would really be the only way that it would make sense... still wouldn't be a logical reason to exclude untested surgical patients from inpatient testing protocols though...

So every patient in the hospital is in negative airflow?  I guess I’m not understanding.  If you use covid precautions on every patient then you don’t need to test.

My concern was that nobody was being tested and so you didn’t have to take precautions.  We extubate in pacu.  Everyone though is tested so we can isolate and wear appropriate PPE.  Covid patients still need surgery but I also need to be able to protect myself and my family.

[Ioreth, ADN, RN]

Thank you all for the responses. It helps to know that I'm not the only one that finds this situation alarming. I don't know why I hadn't thought about reporting it to the state. I will be looking into that.

In my hospital though, I have frequently voiced my concern about this lack of testing to anyone who will listen, my manager, my manager's boss, the focus groups concerned about RNs leaving the hospital, the infectious disease department, anonymous quarterly surveys, and even the suits that round once in a blue moon. None of my proddings have gone anywhere. 

One of our Trauma surgeons recently died from Covid of an unknown source. I know of at least 2 other physicians that have died in our mid-sized hospital. We frequently have staff out with Covid, and I myself have had it twice, both times from surgical patients who were thought to be Covid negative but never tested due to lack of symptoms and both had been on our floor for several days. (On a related note, both of these patients became symptomatic later, both transferred to ICU, and both eventually died.)

This is a Level 1 trauma center in a large midwestern city, and we have over 350 beds and 16 surgical suites. And we have not stopped or even slowed elective surgeries since the early months of the pandemic. Though the Other hospitals have. This is a very old hospital and in dire need of updating key areas, including PACU which is a single open room. I don't know how they isolate PACU patients for other infectious diseases. I know from an RN that recently transferred from my floor to peri-op that they are using the same precautions that were used pre-covid. For a while, they were using N95s when intubating/extubating only, but they no longer do that either.

I enjoy the work I do, but it isn't my forever job. As I said earlier in this post and in others where I talked about possibly moving on, I would like to move into working Oncology and eventually in-patient Palliative care and/or Hospice. Right now I'd be happy just getting away from my current employer.