Healing Others But Killing Ourselves. Why Nurses Eat Their Young

[LIRBA]

So my name is Jason

thank you for taking the time to read my experience. A little Hx regarding my professional background. I graduated RN school in 2008 and landed a decent gig at a small community H on cape cod. A tele/med surg unit where I accelerated my skills and tantalized my curiosity for cardiac medicine. A year and a half later, I accepted a lateral promotion to the CICU CARDIAC INTERMEDIATE CARE, coined the Penthouse because exclusive entry only.... The Penthouse was located in the rear corner of the top floor in the hospital. The patient load was high with a side dish of high acuity. Clinically speaking I was successful at my new position. like anything exposure leads to adaptation. I learned to navigate through the dysfunction and provide quality nursing care. I stayed in this unit for a year and a half. This was difficult to do when you are being workplace bullied and harassed. (not by the patients) rather my Superior.

you will read my experience with the CICU in a different blog, that is if the Administration of allnurses allows me to rant.

03/23/2015

My name is Jason, I am a 35 year old Registered Nurse employed by American Mobile Nursing. I have up to 7 years of experience in the field of nursing with a solid background in cardiac intermediate care. The statements or facts documented below are truthful and accurate to the best of my recollection.

02/10/2015 time 1619 New Assignment

I received an offer from ********** Hospital, MA. The position was on 6 East Hospital/6 East Tertiary Transitional Telemetry Unit (TTU). This floor was most consistent with my previous experience and future career goals. The nursing staff on the 6 East Hospital unit care for a diverse patient population in their dynamic 24-bed telemetry unit. The majority of patients have had cardiothoracic or vascular surgery, and the nurses enjoy a collegiality among different groups of physicians, PA's, and NP's. The 6 East Hospital unit provides nurses with strong telemetry experience and the support and encouragement needed to enhance their skills. In Addition, the 6 East TTU is a six-bed acute care area specializing in the care of postoperative cardiothoracic and vascular surgery patients. Monitoring capabilities include ECG and arterial pressure, allowing for a higher level of care than traditional telemetry. 6 East Transitional Telemetry Unit nurses provide focused bedside care maintaining a patient-to-nurse ratio of 3:1. The person preparing this document Immediately accepted the offer and notified his recruiter ***********.

02/11/15 1515 Call out to ********

I left a voice message with ******regarding acceptance to 6 East.

02 11 2015 1540 PHONE CALL

Call from ******** updating me on assignment and a small overlooked policy restriction. A bed restriction that limits the size of the facility I am allowed to practice in. ******exceeds this limit, so my recruiter asked for a floor of lesser criticality, *********obliged and put me on unit 7 East hospital.

The nurses on the 7 East Hospital unit are part of a multidisciplinary continuum of care for adult patients in their 30-bed medical-surgical unit. The primary patient population has renal, urological or colon and rectal disorders. Other specialties include patients receiving brachytherapy or high-dose radiation, and those with gastroenterological disorders. Nurses on 7 East also care for patients undergoing kidney transplantation, bariatric surgery and postoperative care of the living-related donor.

03 09 2015 Human Resources orientation. 0800 Begin Day 1

Test taking and self directed Hospital Orientation. Numerous manuals videos and test to complete. Applicant must pass all test to continue with orientation. 8.5 hours later I finished the testing portion of orientation. This was followed by a walk through of the Hospital and staff greet and meet. Time 1530 End Day 1

03 10 2015 0645 Begin Day 2

Obtained a brief report on 5 patients,and successfully finished morning medications/treatments. The morning went fast and Linda and I continued orientation through the different departments. She identified the clean /dirty utility rooms ,all of them requiring usernames and passwords to conduct business. I gained access to Pyxis and multiple various software programs requiring protected access. The day ended on schedule, time 1530 End Day 2.

03 11 2015 0720 Begin Day 3

Upon my arrival to the facility Code Red was in effect. I was held outside and arrived to the Unit just after 7 am . I spent the next 4 hours discussing equipment use and types of surgical interventions old and new, dressing changes, wound management with the educator. The documentation consist of six areas of record keeping some online but most is not. (******** has a go live date for Epic in 10 days ) This means I would go through 2 separate orientations for a 13 week assignment. The Epic training would begin in just under 12 days. My Epic orientation would consist of classroom lectures and hands on practice.

At lunch time I was instructed by my educator to finish the online modules and self guided orientation. The company prefers if we do them on site. I stayed in the library as directed working on the 20 or so video and test modules. 3.5 hours later I packed up and left as instructed 1530 time out. Typically the 3 rd day is spent in front of the computer completing educational requirements.My day was cut short and I was left with 3.5 hours or so to complete the modules. This is half the amount of time a new hire is allowed. End Day 3

03 12 2015 0645 Begin Day 4

I did a morning med pass and gave report to the Nurse finishing the assignment. I would continue working with the clinical educator regarding , documentation, equipment skills and computer/carefusion. The educator expressed that this was not her usual job but she would complete it. The day would end early for the educator, she had to attend a meeting scheduled at 2 pm . I expressed I still had computer modules to complete. I was instructed to finish the day working on this. I did as I was instructed. Time: 1530 End of Day 4

03 13 2015 0645 Begin Day 5

First day taking a full assignment with a Preceptor at my side . Things didn't go as planned and the Unit had two Nurses who called out . I would not receive the assignment, I was not trained this day. I would assist the educator through a very complicated assignment. The Manager asked me if I could use another day of orientation, I expressed my concerns and we agreed on one more day of orientation. Time 1600 End of Day 5

03 16 2015 0645 Begin Day 6

15 of the COWs (COMPUTER ON WHEELS) had malfunctioned and would not power on (used for documentation and records). The administration had no explanation for it or a resolution. The unit had a limited amount of the older generation COWs to work off. Maybe 8 of the old system (pre epic conversion) computers were working. I shadowed a seasoned Nurse for the first half of the day. Watching and asking questions periodically, I know this is my prefered method of learning. Within the first hour of watching my coworker , I noticed I didn't have access to a documentation system they call LCMC .This electronic system provides access to patient lab and imaging results, both past and current. After many attempts and talking with the educator and help desk, the day would end and I still would be denied entry to such an important program.

Just as I finished the morning routine and was confident to continue the afternoon medication pass, I was looking for a chart when the educator approached me. She asked me, Have you finished the mandatory education modules? I replied, Most of them; do they have to be finished before I'm on the floor ? Her reply, Yes.

I immediately expressed this to my Preceptor and expressed where I would be for the next hour or so. I expressed I would continue with the afternoon work when I am finished with the test.

Upon sitting in the back room, I began to log into my account and the educator approached me. She asked what I was doing sitting down?

I answered, I'm completing the modules.

She said , Not now you aren't.-You had enough time to finish. You had the same time everyone has.

I tried to explain that we are behind schedule with orientation and remained this way as of day 2. The computer day (day 3) on the orientation schedule, was interrupted by carefusion and talking in her office.

The educator continued expressing her frustration with my actions. I remained silent and actively listened to her corrections. After a brief silence from both parties she states,

I mean, even the Spanish people get it done faster …..and the test is in english.

I did not reply to this comment.

I apologized for the miscommunication and explained what I would do next to correct this misunderstanding.I explained, I would close the application and return to the floor immediately, I would attempt the modules at a later time. The educator left the room and 3 or 4 minutes later, ****** my Manager walked in.

The conversation was immediately opened with the same question as the educator, my response was slow seeing how the comment about Spanish people really took me by surprise. ..

I expressed that I was completing the task the educator brought to my attention just a few minutes ago. I suppose I misunderstood what she was requesting of me. It was my understanding that she wanted me to complete the modules now and turn them in before I finished orientation. I now know otherwise, and I am shutting things down and returning to the floor.

The manager **** expressed to me she was thinking of just cancelling the contract now and sending me home. This was the first true conversation I had regarding my performance or the orientation. The Manager pointed her finger as she spoke and raised her tone, she began asking questions wound care ,hemodynamics, blood pressures, pulse checks, rudimentary in nature. I am not sure if she confused me for one of the Nursing students on the floor.

I expressed deep concern and said I am sorry you feel this way, let me correct it.

I was instructed to finish off the day by taking the assignment, then check in with her(manager) at the end of the day. I was told that It would be decided if they would keep me at that discussion. After the conversation with my manager my thoughts were scattered and my nerves shaking, I felt like I was under investigation for a crime. My hands were shaking and I had to perform. I did as I was told and took the assignment back. The first patient I went to was on precautions MRSA wound and blood. I was spiking a new bag of ABX and accidently stuck my hand with the contaminated line. I immediately informed my preceptor of the incident and was directed to the Charge Nurse. After a brief call to her colleague the charge Nurse stated, I don't think you are at risk for anything so you don't have to get checked out or anything. I was offered a bandage for my wound. I returned to the assignment and finished the day. I was informed later that day that the Manager will let me return the following day. (I still don't have a schedule at this point of orientation.)

My actions were very much justified, the afternoon med pass was littered with Labs and results that required LCMC access. I thought possibly the denied access and hold up was a module I did not complete. This was not the case, it appears the person who provides access to staff or new hires was not available. I worked off of my coworkers computer and user account and password until I would gain access. This proved very confusing, time consuming and higher risk for error. Time 1600 End Day 6

03 17 2015 0645 Begin Last Day of Assignment. Day 7

The following day I took the assignment and felt as though I did a fair job considering the circumstances. No patient concerns, complaints or incidents. Morning and afternoon meds were distributed slightly behind schedule r/t workload. Treatments and orders complete without incident. Documentation was behind schedule but this was done intentionally. Advice from my manager stated, This documentation and electronic conversion is messy and confusing, so for the next couple of weeks don't worry so much about your documentation , focus on patient care and satisfaction.

At the follow up meeting, I was asked if I felt confident to proceed with a full assignment the following morning? I thought about it for a brief moment and replied, yes with the proper support I feel I could complete the day, additionally if I could gain access to patient test results this would be invaluable. The managers present at this meeting, shuffled files in the computer looking through emails( looking for usernames or passwords) while they described the reasons I can't access this crucial program. The best response I got was ,pointing the finger to their associate who wasn't available.

After a brief moment of silence, the assistant floor manager replied, Jason this is not about your ability as a Nurse. My associate and I feel it would be unfair if we put you on the floor with a full assignment, it would be a risk to your license. At this time we are going to say this wasn't a good fit for your experience, your travel company should have prevented this.

My reply, I understand.

(I gathered my belongings and clocked out.)

Time 1600 End of Assignment.

I was called the following business day by a Manager of AMN, they introduced themselves and proceeded to explain he is filling in for my regular team leader. I explained that I sent an email with a complaint to my quality service manager but got an auto response. I asked him if he wanted a copy of the letter explaining my position,this letter also describes my feelings that I was placed into an assignment that was not appropriate .

His reply, no, I will get it from my associate when she returns. Furthermore, I'm wondering if this company is the right company for you to travel with ?

I was informed that he will read the letter and respond the next day with his thoughts. No need to contact AMN until he or someone else calls.

I did not get a response.

Jason RN

[VivaLasViejas, ASN, RN]

Hello there, and welcome to Allnurses. I'm sorry this happened to you; it must be very disappointing. However, even with all of the asterisks used here, there are too many identifiers and too much information given, which would make it all too easy for someone with a bit of time on their hands to figure out who you are and where the events took place. And if that is you in your avatar photo, I'd advise you to change it ASAP because it's just asking for trouble. The beauty of the Internet is that people can post in forums like this anonymously, but even that doesn't protect you 100% from cyber-spying.

Wishing you all the best in your next position.

[Coffee Nurse, BSN, RN]

...so what's the question?

[Dany102]

Jason,

I'm sorry that you had such a lousy time there. I understand that, by now, it's all a bit too late to do anything about it. If I was inclined to wear tinfoil hats, I'd suggest they were conspiring to get rid of you but.. No, they wouldn't do that, would they?

Going over your lengthy post, I can glean a few things that might be helpful for you next time you're in that kind of situation. First, it seems obvious to me that there was some misunderstanding between your preceptor and your educator... And possibly you as well. Your expectations were not their expectations. Next time, take a few moment to clarify with them exactly what they expect from you. Ask questions if things seems confusing. If you get even a whiff of something being off, bring it up to their attention.

Second, you need to be able to recognize problems early so they don't become something that will land you in a tight spot. This orientation period was your chance to get a feel for how this unit worked and understand your role and future responsibilities. I understand there were a few things that you had no control over. But in your situation, perhaps hauling both your educator and preceptor asses in a room to ask what the **** is going on would have been beneficial (might want to tone that down a bit, but you get the idea). You know what they say about assumptions...

Lastly, don't beat yourself too much over it. Take a few days to get your feet under you again, and get back at her. We need people like you in the nursing world.

[BrandonLPN, LPN]

OP, based on your post, I can't help but wonder if part of the issue at this job was poor time management secondary to long-winded and overly detailed documentation.

[klone, MSN, RN]

Wow, that's quite a story. It's weird, based on what you wrote, why both the facility AND the agency decided that you're not working out with them.

I admit that I don't understand the title of your post, though. In what way are we killing ourselves, and in what way was this an example of "Nurses eat their young"?

[liebling5, MSN, RN]

Having been a travel nurse several times with a handful of companies, I can see several issues right away:

1. Did you agree with the change in units before the assignment began?

2. Did your recruiter explain the change in computer systems?

3. Did you call your recruiter after your shift ended and tell them about your computer access issues?

4. I agree about immediately discussing "conflicts" between the preceptor'so and educator's expectations.

I also agree that your explanation was entirely too detailed.

That being said, here are some take aways:

1. Travel contracts get cancelled for less than what you experienced.

2. Hospitals expect travellers to catch on very quickly. Getting seven days of orientation is extremely rare.

3. If your contract gets cancelled for something the company perceives as your 'fault,' the company may blackball you from working with them again.

The other good news is that there are dozens of travel companies out there. It's very easy (although very tedious) to sign up with another one. If you moved to take this assignment, try applying at other facilities in the area as per diem. That includes the SNF's & long term care facilities. Those are usually less pay, but you will have a job.

Signed me,

BTDT (Been there, done that)

[roser13, ASN, RN]

I can't even....

[klone, MSN, RN]

I can't even....

It's okay. I wouldn't have, except that it was 2 am and I had insomnia.

[malenurse69, MSN, NP]

OP, your post literally made me zone out at least three times, please be more succinct next time, I literally can't chew through it

[RNsRWe, ASN, RN]

I'll readily admit to skimming. I can be long-winded, no doubt, but you made it possible for someone to actually SLEEP during the time it takes another to read the entire post.

You posted so many personal identifiers, I do hope you aren't violating some kind of confidentiality rules somewhere; anyone who knows where you work can pick you out in a heartbeat.

So, bottom line: do you feel better now?

[mclennan, BSN, RN]

That is WAY too long for any online forum. Your main issue might be anger management.