Does this sound familiar? (very long)

Nurses General Nursing

Published

i started a list of the things that bother me about my job/unit. this is only a portion of what i have. i apologize about length, but i did cut a lot out! it's a shame the way they treat us (and the pts). although this list makes it seem as though the unit is full of imcompetent rns/pcts, this is not actually the case. we, for the most part, have a great, caring group that gets along well. our pt load/acuity is unbearable and we are not given the opportunity to provide the quality care we can and want to. we are now considering writing to the ceo of whole system...maybe that will help i think i'll have a new job lined up first though

  • every time an employee complains about ratio and acuity manager replies we have our "buddy" to help when we need it. our "buddy" watches our pts when we go to lunch (if we are lucky enough to have one). we are supposed to pull other nurses away from their own pts and responsibilities when they are just as busy as we are! on unit there is no time for teamwork. not because we don't want to help our coworkers, but because we do not have time. we don't really have time to take care of our own pts properly.
  • it is really sad and discouraging to hear the ceo of the hospital, when lack of quality care due to poor rn-pt ratios is brought up, reply in regards of comparing our hospital with others in the area, not in that we we strive to better than, but that we (our ratios) are "comparable." really? now i understand... management does not strive to provide the "excellent" care that is so often pushed down our throats (or even better care at that)...but only wants to be "just as good" or (in other words) mediocre. this unacceptable response also leads one to assume this management does not (in reality) really want to hear what employees have to say, but instead will only look at numbers on paper. well, this does, in fact, trickle down to this unit manager (in particular)...as our pts are only looked at as numbers on paper and their individual needs are not considered when shift staffing & assignments are made. if this is the response this health system wants from a ceo, then i really don't want to hear about or see any signs regarding this "hospital of choice" crap...say it how it really is. "xxx medical center...mediocre (at best)!"

things seen regularly, reported by many and never addressed.....

  • trach care is routinely not done.
  • dressing changes are routinely not done.
  • frequently orders are signed off by unit secretary and rn but not completed, verbally passed on in report or documented.
  • frequently events that occur are not documented.
  • routinely documentation not completed
  • occasionally consults are not notified.
  • 2+ pedal pulses documented on pt with bilateral bka (by numerous rns)
  • patients routinely not turned every 2 hours.
  • iv saline locks and picc lines routinely not flushed every 8 hours.
  • g tube not flushed regularly, g tube dressings not changed regularly, ng and g tube sites not routinely checked for placement/residual before use.
  • twin packs, syringes, lancets, etc. frequently found in patient beds, on window sill, bedside tables, floor, etc.
  • daily weights are routinely not done for 2-3 days.
  • input and output is routinely not accurate or not completed for 3-4 days.
  • white boards in patient rooms are routinely not updated for 24-36 hours instead of every shift.
  • patient on oxygen with oxygen not connected to wall.
  • scds/ted hose not on for days after md order written.
  • do not use, dnr and swallow precaution wrist bands frequently not on patients.
  • picc line dressing changes not done after 1st 24hrs as written in policy and procedures
  • iv catheter not changed after 3 days as written in policy and procedures
  • iv tubing not properly changed no sticker put on and signed when initiated, iv fluids have no sticker on them
  • urine, stool and sputum specimens not colected for days after being ordered
  • canisters filled with discharged pt's body fluid still in room when new pt admitted
  • name of previous pts (one time a pt that had died and another the new pt knew the d/c'd one) still above bed/closet when new pt admitted
  • pt belongings found in room after pt discharged, pt belongings lost, pt belonging list not completed upon admisssion
  • numerous incompetent telemetry technicians, tele strips frequently posted in the wrong charts, frequently tele tech does not call for long period of time when pt off monitor. a pt can be gone for an hour without recieving a call, rns have recieved calls from monitor tech hour or more after change occured
  • one rn is repeatedly complained about by patients, other rns and even mds. rn extremely unsafe, scary to patients and families, but remains on unit.
  • unable to find working equipment in emergency situations: blood pressure cuffs, oxygen saturation monitors, suction equipment, oxygen tanks, backboard, oxygen tubing, oxygen masks, etc.
  • some rns leave notes on chart for md for a change in patient condition (e.g. "blood clots in urine", "vomiting blood", "patient temperature 102.6 last night") instead of notifying md of change in patient status. some mds have discussed this with director but it has not been passed on to rns.
  • some night rns do not call in critical values to mds. this is routinely reported to manager and no disciplinary action is taken.
  • no behavioral sitters allowed. if family can't sit with patient, use restraints. this is wrong on so many levels. it goes against evrything we were ever taught in nursing school. it also goes against all current research. also, this new "policy" has been put in place to save money and is in direct conflict with the hospital's stated philosophy of blah, blah and blah of the whole person.
  • pts with c diff have been cohorted with non c diff patients.
  • patients with chest pain have notified their pct and pct has never told the rn.
  • manager bad mouths staff to other departments when staff try to transfer to other departments.
  • no disinfectant containers in or just outside each room as in most other hospitals. must walk around nurses station to (hopefully) find the only container on the unit.
  • often no gowns and other contact/airborne equipment directly outside of pt room and/or possibly on unit
  • every other department knows what a horrible unit this is. ask any of them, especially the ones that come to our unit such as pt, ot, dietary, speech, etc. they all see the chaos. ask the poor souls that have been floated for a shift from other units. ask our own rns and pcts that have been floated to other units how much worse our ratios, acuity and resulting lack of teamwork is.
  • some pcts are rude to patient, family and staff and the issue is not addressed by department management.
  • some pcts refuse to complete required and assigned tasks
  • some pcts found napping and nurse's station, in empty rooms, in locker room and in break room (not during their break).
  • one pct on a saturday with 28 patients is not safe...manager was aware.
  • important pt information often left out during report such as pt previously intubated, procedures done or planned.
  • rn tells charge he/she is "drowning," & need to catch up before getting an admission...then get a new admit before can turn around
  • charge rn are not supposed to have pts, but most of the time do
  • occasionally rn or pct leaves shift early with no one covering his or her patients and no report given to the next shift on their patients. manager is aware.
  • 6 months nursing experience does not a preceptor make!

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Have you been told to nurse "smarter not harder"????? That is the response we get when something is brought up

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:(

You are a saint just for going to work everyday.

*shakes head in disgust*

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Nice of you to post a list for me to look out for when I get my first job.

Sorry you are going through this.

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I bet we work at the same hospital. Scary isn't it.

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Thankfully I have not experienced some of these things on my floor. However, I find your list extremely helpful in articulating some of the issues I have experienced in my 6 months as a new nurse. Usually, after I experience a number of those things on any shift, I find myself muttering over and over "this is stupid this is stupid"--why can't I find a non-broken O2 sat machine when I need it? Why is all the paperwork and name still up for a discharged pt when I'm getting a new admit? Why is the ultrasound tech telling me my pt with r/o DVT in c-spine traction can't have her US on the weekend unless she's symptomatic (and what DO you do if your pt in c-spine traction BECOMES symptomatic for a PE? Seriously--anyone know?) And why is there no official note in her chart validating her DNR/DNI status--and what measures--besides contacting every available MD covering this pt, consulting with nurse colleagues and ancillary staff which is what I did--do I need to take to ensure this pt's wishes are honored--and that we don't ultimately neglect to prevent a PE complication and then coding this pt?

Anyways, thanks for taking the time to write up such a coherent list. It is extremely helpful for me to translate my chaotic "this is stupid" mantra into actual problem statements. I do like my job quite a bit, but I definitely need to recognize and name some of the challenges myself and my colleagues regularly experience.

Cheers!

-Kan

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Specializes in SICU.

Wow, hun... I am so sorry that you work in those conditions. I'd suggest finding another job ASAP, then writing a letter not only to the CEO, but Joint Commission, and your state's Department of Health and Hospitals.

What you're describing is extremely dangerous for all involved.

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i started a list of the things that bother me about my job/unit. this is only a portion of what i have. i apologize about length, but i did cut a lot out! it's a shame the way they treat us (and the pts). although this list makes it seem as though the unit is full of imcompetent rns/pcts, this is not actually the case. we, for the most part, have a great, caring group that gets along well. our pt load/acuity is unbearable and we are not given the opportunity to provide the quality care we can and want to. we are now considering writing to the ceo of whole system...maybe that will help i think i'll have a new job lined up first though

  • every time an employee complains about ratio and acuity manager replies we have our "buddy" to help when we need it. our "buddy" watches our pts when we go to lunch (if we are lucky enough to have one). we are supposed to pull other nurses away from their own pts and responsibilities when they are just as busy as we are! on unit there is no time for teamwork. not because we don't want to help our coworkers, but because we do not have time. we don't really have time to take care of our own pts properly.
  • it is really sad and discouraging to hear the ceo of the hospital, when lack of quality care due to poor rn-pt ratios is brought up, reply in regards of comparing our hospital with others in the area, not in that we we strive to better than, but that we (our ratios) are "comparable." really? now i understand... management does not strive to provide the "excellent" care that is so often pushed down our throats (or even better care at that)...but only wants to be "just as good" or (in other words) mediocre. this unacceptable response also leads one to assume this management does not (in reality) really want to hear what employees have to say, but instead will only look at numbers on paper. well, this does, in fact, trickle down to this unit manager (in particular)...as our pts are only looked at as numbers on paper and their individual needs are not considered when shift staffing & assignments are made. if this is the response this health system wants from a ceo, then i really don't want to hear about or see any signs regarding this "hospital of choice" crap...say it how it really is. "xxx medical center...mediocre (at best)!"

things seen regularly, reported by many and never addressed.....

  • trach care is routinely not done.
  • dressing changes are routinely not done.
  • frequently orders are signed off by unit secretary and rn but not completed, verbally passed on in report or documented.
  • frequently events that occur are not documented.
  • routinely documentation not completed
  • occasionally consults are not notified.
  • 2+ pedal pulses documented on pt with bilateral bka (by numerous rns)
  • patients routinely not turned every 2 hours.
  • iv saline locks and picc lines routinely not flushed every 8 hours.
  • g tube not flushed regularly, g tube dressings not changed regularly, ng and g tube sites not routinely checked for placement/residual before use.
  • twin packs, syringes, lancets, etc. frequently found in patient beds, on window sill, bedside tables, floor, etc.
  • daily weights are routinely not done for 2-3 days.
  • input and output is routinely not accurate or not completed for 3-4 days.
  • white boards in patient rooms are routinely not updated for 24-36 hours instead of every shift.
  • patient on oxygen with oxygen not connected to wall.
  • scds/ted hose not on for days after md order written.
  • do not use, dnr and swallow precaution wrist bands frequently not on patients.
  • picc line dressing changes not done after 1st 24hrs as written in policy and procedures
  • iv catheter not changed after 3 days as written in policy and procedures
  • iv tubing not properly changed no sticker put on and signed when initiated, iv fluids have no sticker on them
  • urine, stool and sputum specimens not colected for days after being ordered
  • canisters filled with discharged pt's body fluid still in room when new pt admitted
  • name of previous pts (one time a pt that had died and another the new pt knew the d/c'd one) still above bed/closet when new pt admitted
  • pt belongings found in room after pt discharged, pt belongings lost, pt belonging list not completed upon admisssion
  • numerous incompetent telemetry technicians, tele strips frequently posted in the wrong charts, frequently tele tech does not call for long period of time when pt off monitor. a pt can be gone for an hour without recieving a call, rns have recieved calls from monitor tech hour or more after change occured
  • one rn is repeatedly complained about by patients, other rns and even mds. rn extremely unsafe, scary to patients and families, but remains on unit.
  • unable to find working equipment in emergency situations: blood pressure cuffs, oxygen saturation monitors, suction equipment, oxygen tanks, backboard, oxygen tubing, oxygen masks, etc.
  • some rns leave notes on chart for md for a change in patient condition (e.g. "blood clots in urine", "vomiting blood", "patient temperature 102.6 last night") instead of notifying md of change in patient status. some mds have discussed this with director but it has not been passed on to rns.
  • some night rns do not call in critical values to mds. this is routinely reported to manager and no disciplinary action is taken.
  • no behavioral sitters allowed. if family can’t sit with patient, use restraints. this is wrong on so many levels. it goes against evrything we were ever taught in nursing school. it also goes against all current research. also, this new "policy" has been put in place to save money and is in direct conflict with the hospital's stated philosophy of blah, blah and blah of the whole person.
  • pts with c diff have been cohorted with non c diff patients.
  • patients with chest pain have notified their pct and pct has never told the rn.
  • manager bad mouths staff to other departments when staff try to transfer to other departments.
  • no disinfectant containers in or just outside each room as in most other hospitals. must walk around nurses station to (hopefully) find the only container on the unit.
  • often no gowns and other contact/airborne equipment directly outside of pt room and/or possibly on unit
  • every other department knows what a horrible unit this is. ask any of them, especially the ones that come to our unit such as pt, ot, dietary, speech, etc. they all see the chaos. ask the poor souls that have been floated for a shift from other units. ask our own rns and pcts that have been floated to other units how much worse our ratios, acuity and resulting lack of teamwork is.
  • some pcts are rude to patient, family and staff and the issue is not addressed by department management.
  • some pcts refuse to complete required and assigned tasks
  • some pcts found napping and nurse’s station, in empty rooms, in locker room and in break room (not during their break).
  • one pct on a saturday with 28 patients is not safe...manager was aware.
  • important pt information often left out during report such as pt previously intubated, procedures done or planned.
  • rn tells charge he/she is "drowning," & need to catch up before getting an admission...then get a new admit before can turn around
  • charge rn are not supposed to have pts, but most of the time do
  • occasionally rn or pct leaves shift early with no one covering his or her patients and no report given to the next shift on their patients. manager is aware.
  • 6 months nursing experience does not a preceptor make!

after you obtain another job, then, most certainly, write a letter to the ceo, and 'cc" to the senior partner of the law firm that represents/defends, the hospital. a letter to jcaho might also be in order.

you might also the mention the price to recruit/hire a nurse to take you place on the unit that you work on. $$$ usually get attention.

lindarn, rn, bsn, ccrn

spokane, washington

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Specializes in Ortho, Neuro, Detox, Tele.

Wow....Do we work on the same floor? I Routinely have 13-14 patients on start, and usually get 2-3 sx right away within the first hour of starting...I try to keep an upbeat attitude in front of my patients but that goes Quickly downhill when I'm at the station...I usually try to keep up with my trashes, the stocking, the cleaning, etc...but can't...not because I'm lazy, I'm OVERWORKED!!

I can't even guarentee that my feeders get fed within an hour of dinner coming up, because I'm waiting on 3-4 admits at start...I'm a tech, BTW and I like to think I give excellent care...once I get caught up on everything, I've got no problem..It's taking the first 6 hours to get caught up that's the problem...

It just reminds me how to treat others when I get my RN...my techs will not have to worry about me running out, and finding them cause Patient is "dirty", cause patient wants water, etc...I will ALWAYS remember where I started from.....

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Yes, it sounds very familiar. I think I worked for the same NM.

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Specializes in Jack of all trades, and still learning.
It just reminds me how to treat others when I get my RN...my techs will not have to worry about me running out, and finding them cause Patient is "dirty", cause patient wants water, etc...I will ALWAYS remember where I started from.....

We all need to do that. Good for you...

After you obtain another job, then, most certainly, write a letter to the CEO, and 'CC" to the senior partner of the law firm that represents/defends, the hospital. A letter to JCAHO might also be in order.

You might also the mention the price to recruit/hire a nurse to take you place on the unit that you work on. $$$ usually get attention.

Lindarn, RN, BSN, CCRN

Spokane, Washington

The only problem with this, is, that the ones who will be the scapegoats are ... the nurses!

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.

Woe.What a train wreck waiting to hapen. Take the others advise and get another job and report this to JCAHO....etc.We have all experienced a few of those things on your list and it shocks us and outrages us. What overwhelms me is your constant use of the word FREQUENTLY and NOT BEING ADDRESSED....please leave and don't get caught in the collision.

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