Am I a Product of My Environment, or Just a Crappy Nurse?

[CountryMomma, ASN, RN]

I've been on my own on the floor for a whopping 1 year and 2 months. It really has been a sink or swim first year, and up until recently I honestly thought I was doing a fairly decent job at swimming. I haven't been counseled nor written up, I received a moderate raise at my first review a couple months ago, and my PCS often mentions how I "think outside the box" or am "a great resource for the team".

With that humblebrag out of the way, the past two weekends have seriously made me question my abilities as a nurse. I've been struggling with suddenly not having time for lunchbreaks, and just the last two shifts not only was I late getting out of work (after finally nailing down the time management to being out on time most shifts) but I had a doctor shred me to tears and a family fire me from their care.

I know my floor has had staffing issues and did just hire a bunch of new grads. I'm wondering if my new-onset inability to manage my time correctly and feeling overwhelmed with the acuity of my patients has to do with me getting heavier loads while we ease the new nurses onto the floor, or if I truly am just not trying hard enough.

I guess what I am wondering is, how do you know if your sudden suckiness is simply that you suck as a nurse, or that your floor is really screwing you over in the short-term?

[Been there,done that, ASN, RN]

Consider yourself screwed. You are getting heavier assignments, of course that leads to missed breaks and needing to stay over.

Do not let a doctor verbally abuse you. Why did the family fire you?

[CountryMomma, ASN, RN]

They fired me because they felt I was withholding pain medication from the patient. At that point in the week, I was fine with being fired, because I was damned tired of explaining, over and over, that they can't just go for the IV fentanyl every time they had a twinge, they had to at least TRY the PO hydrocodone. And for longer than 10 minutes, too. The patient got angsty that I was leaving him "to suffer" despite the very clear instructions on the MAR, and the wife was very cranky that I wasn't handing the PRNs out on schedule, so they fired me.

And then they fired the next nurse for not suctioning him often enough.

And then they fired the next nurse after the CT and MRI showed there was nothing wrong with the soft tissue nor the bony stuff, and the nurse suggested to the physician that we look into psychiatry/psychology for ineffective coping during a traumatic event.

I guess logically it wasn't me they were targeting personally, but more just exercising their options out of frustration. Still stings after the last couple go-arounds.

Normally I don't hide in the bathroom and cry (last time I did was when I turned an obviously jonesing, helpless young man back on the streets after he signed himself out AMA) but that Dr... man, I never saw it coming. Thankfully my charge was less than impressed and had a terse word with him or two - I was too blindsided to stand up for myself.

I'm struggling with our doctors being a little more blase about patient care right now too. How does a new nurse deal with physician burnout?

[Natasha, RN, BSN]

Sometimes it's luck of the draw, or chalk it up to heavier assignments from hiring new-grads (no offense new-grads! We love you and know you've got to start with a wee bit lighter load! :)), but you are NOT a sucky nurse. I've seen very experienced nurses have days like you described. It happens. I've seen the sweetest nurses get "fired" by a pt; again, it happens. You just can't please everybody, no matter how hard you try. A mantra I love: I may not BE the best, but I TRY my best. And you know what? That's good enough. If you haven't been written up or spoken to, you are doing something right. Sounds like weird circumstances right now. As the pendulum swings, so does the dynamics of your pt load. Sorry, I know this may not be helpful, but just try and work through it. Now, if you are seeing this is a trend that STAYS, I would reevaluate what is going on, but never question your abilities. Being a nurse for even a year is time enough to know you are doing something right, and sometimes it's the environment, not the nurse, that has changed. Don't be hard on yourself :) No matter how many years one has worked as a nurse, there is ALWAYS something new to learn, and something new that must get worked into the nurse's daily routine in their care for patients. Good luck :)

[RNperdiem, RN]

Confidence is a fragile thing for a new nurse. It takes time to recover from the things you described.

Having new nurses working will affect you. You now are a resource to them, helping them more than they can help you in addition to your heavier patient assignment.

Be kind to yourself; you are not a bad nurse.

[Anna Flaxis, BSN, RN]

You don't sound like a sucky nurse to me. Chalk these events up to "experience" and keep swimming.

[WKShadowNP, DNP, APRN]

I agree with PPs. When I feel I've gotten a heavier assignment I try to tell myself that "they" must think I'm really good and capable. Of course, when I was flex I was saying that often because i was the target for dumping on. But that's a whole different kettle of fish.

[anewsns]

Reading this, I'm not even exactly sure why this would make you think you're a bad nurse. What if you didn't follow the MAR and gave the drug seeker everything they wanted ? You can't please everyone. Doctors can have bad days , so can't managers and CNAs.. These things just Sound out of your control

[VANurse2010]

They fired me because they felt I was withholding pain medication from the patient. At that point in the week, I was fine with being fired, because I was damned tired of explaining, over and over, that they can't just go for the IV fentanyl every time they had a twinge, they had to at least TRY the PO hydrocodone. And for longer than 10 minutes, too. The patient got angsty that I was leaving him "to suffer" despite the very clear instructions on the MAR, and the wife was very cranky that I wasn't handing the PRNs out on schedule, so they fired me.

And then they fired the next nurse for not suctioning him often enough.

And then they fired the next nurse after the CT and MRI showed there was nothing wrong with the soft tissue nor the bony stuff, and the nurse suggested to the physician that we look into psychiatry/psychology for ineffective coping during a traumatic event.

I guess logically it wasn't me they were targeting personally, but more just exercising their options out of frustration. Still stings after the last couple go-arounds.

Normally I don't hide in the bathroom and cry (last time I did was when I turned an obviously jonesing, helpless young man back on the streets after he signed himself out AMA) but that Dr... man, I never saw it coming. Thankfully my charge was less than impressed and had a terse word with him or two - I was too blindsided to stand up for myself.

I'm struggling with our doctors being a little more blase about patient care right now too. How does a new nurse deal with physician burnout?

Your director should have had a long discussion with that crazy family. Firing 3 nurses is unacceptable behavior.

[VANurse2010]

OP, I think perhaps you're not quite experienced enough to distinguish between justifiable self-doubt and "the workload is bull ****." You'll get better at that in time. Just keep trucking along in the meantime.

[Nonyvole, BSN, RN]

Be thankful that you were fired by that family!

But what I'm seeing is that you're a dang GREAT nurse. The doctor was in the wrong - your charge knew it and acted on it.

We all have days that we have to leave the unit for a "moment." And there is nothing wrong with that. Nothing.

Keep smiling!

[Horseshoe, BSN, RN]

Even the best nurse will suck if she is given too many patients. Her "too many" might differ from your too many, but there is a line where the assignment is by definition unsafe because a "reasonable and prudent nurse" is unable to deliver care safely.

BTW, the OP didn't state that the patient whose family fired her was "drug seeking." She said he didn't agree with the drug regimen as ordered. Family members hate to see their loved ones in pain and they often don't understand the rationale behind orders. Not understanding PRN vs. scheduled is a very common problem amongst lay people, and it's actually understandable. Not saying AT ALL that they weren't being unreasonable, but it's quite possible that this had nothing to do with drug seeking to get a high as opposed to not understanding that some pain can only be reduced vs. eliminated and that pain medicine can be dangerous if not given appropriately.