Hospital Insanity and Why I Want to Quit

[hemwolf]

Today, I decided to resign as an ICU RN at what we will refer to as facility X (because I still need a good reference from these people). I have been passionate about ICU nursing since college and have enjoyed my time working with the patients and their families. However, due to their cutthroat culture and scare tactic management I have found I no longer want to be employed at this facility. Instead of fostering a feeling of safety, support, and belonging; management has created an environment that thrives off of gossip, backstabbing, and numbers. As a nurse working in a high-stress environment and caring for the sickest of patients, coworkers and management should show support and encouragement. However, what you'll find are coworkers who will gladly shun you if you forget something rather than letting you know kindly and courteously so you can remember it next time. Every minute you have to mind your p's and q's. Constantly trying to please the patient, their family, your coworkers, and your boss. You are alone in a sea of watchful eyes all waiting for you to make a mistake so they can report you, condemn you, gossip about you, or inform you of your imperfections. They will always document your mess-ups, but rarely your successes. It is rare that you are thanked for your hard work or dedications, your attention to detail, you tidy room, your compassion for patients, or your competent care. When you are complimented, it is always followed by a "but" offering ways in which you can improve. Now, by no means am I perfect, but please let me just bask in sunlight for one day before you go critiquing me for some small unimportant detail like using arrows instead of the words "increase and decrease" on my white board. And for heavens sakes enough with the numbers. I'm tired of you keeping track of every statistic known to man. Yes, I get it, we can always improve on something. However, that's all it is to you. Your numbers mean more than the care I provide, than the compassion I show. You say that the needs of the patient come first, but what you really mean is that your statistics and numbers come first. I'm tired of the "you need 80% or greater" here and "90% or greater" there. If you want me to spend less time caring for my patient and more time working on your numbers then you better get some more staff in here because no nurse has time to sit and worry about your numbers and statistics. Oh, I'm sorry did I not classify my patients acuity right again? I guess I won't be making that 90% accuracy rating. Maybe you should come try to take care of these patients with that amount of staff. Newsflash, your acuity system isn't perfect and not every patient fits into your perfect little acuity bubble. Sometimes, you need more staff than your precious acuity system says you do; particularly if you don't give us a nurse's aid, again. I'm tired of that too.

beginning. I want a manager who looks out for my best interest and the best interest of my patients. When I started, my manager conveniently "forgot" to mention that if I stayed another couple weeks at my current position (like I had asked to do in the first place) that I would have an extra year of nursing under my belt and have a higher pay rate as well as less educational classes to take. I wish she would have told me, rather than sneaking around, not telling me, and asking me to start right away. She never mentioned I would start at new-grad pay and have to take new grad classes when I was two weeks short of a year of experience. Luckily, I had a great nurse train me in. I realize they have struggled with that recently as well. New employees have gone from nurse to nurse to nurse for their training. Many of their training RN's with less than a year of ICU experience themselves. The other thing they should have done is not given out brochures explaining retirement has automatic enrollment at 2% upon employment. This never happened for me and I ended up working for two years without any kind of retirement savings coming out. Thanks, x. I'm glad I caught this two years in and not twenty years down the road. Just another way, they saved themselves a few bucks considering they match what I save, which to this date is 0 since I couldn't enroll until open-enrollment period, which isn't for another month. What's better is how your coworkers treat you once you start. I have seen my cutthroat coworkers turn on each other like sharks looking for a quick and easy meal. Old nurses, young nurses, everyone is fair game. Rather than confronting someone about a mistake, getting the full story, and educating as appropriate; they feel the need to blindside each other and write them up. Now I realize sometimes this is necessary, but shouldn't you confront them first? Shouldn't you stop them and say hey, noticed this Tylenol sitting here, were you going to give that or put it back in the med room? Rather than saying nothing and writing the guy up for forgetting to give a med. I mean it is a prn med, maybe the patient wanted to take it in 20 minutes. Can you give the guy a break? Or at least have the courtesy to ask before writing a naughty note to the bossman? I mean, where is the common courtesy? Do we not give the guy the benefit of the doubt that he was going to give it soon or that the patient didn't want it at that moment but wanted it soon? Since when is it morally okay to assume your hardworking coworker had poor intentions or is incompetent. I mean I know this nurse and while he can be forgetful at times, he has many years of experience and a huge heart. He's compassionate with patients and great at educating patients and families. My guess is the patient wanted Tylenol before bed and he left it there on their counter in the room waiting for the patient to call and ask for it in a few minutes. But why would we ask him that? It's much easier to write him and hope he gets fired. After watching my coworker write him up for this, I then watched her badmouth him to everyone that would listen. And this is how life is at facility x works. Management cares only about their numbers. Staff cares only about themselves. There is no teamwork. There is no joy. There is no laughter. And this is how it has been since I started almost two and a half years ago. In that time, I've been in the office a couple of times. Never patient related. I pride myself in being a good nurse, paying attention to details, and avoiding any mistakes (even the smallest of mistakes) since my coworkers would quickly throw me to the wolves without a second thought. Please note this makes my already stressful ICU job even more stressful since you are in constant fear of forgetting something or making a mistake or having a patient complaint ("Sorry sir, the doctor ordered hourly neuro checks all night." Weekly update: Patient complaints of not being able to sleep and being woken up all night. Learning Opportunity: The night staff needs to be quieter! -No bosslady we weren't loud, what was loud was me yelling at him asking when his birthday is and who the president is every hour on the hour while shining a bright light in his eyes.)

The first time I was called into the office was because I had missed more than 5 workdays in a year. I will have you know I commute an hour to work every day and not by choice. As a young adult I have a tremendous amount of student loans and housing is way cheaper where I live in comparison to the city where I work. My house payment now is $350. Rent in the city would be at least $1000/mo. Now several of these days were sick days. Not only did I get influenza this first year as a nurse here, but I also got strep throat and a sinus and ear infection. Not sure why but I was especially sick. I came to work sick many of days before eventually going to the doctor learning I had influenza and being told to stay home but my manager didn't care that I had a doctors note I provided. The numbers say no more than 5 days can I be sick or I get a "coaching plan". After 8 missed days I got written up, despite having doctors notes for the sick days. The other days missed were weather related. One day in particular they closed all the major roads I could take to get to work; both highways and the interstate. In retrospect I guess I could have attempted to drive to work on gravel. But with a car that would be near impossible and I decided I shouldn't risk my life or the life of first responders trying to get to work during a blizzard. I'll agree with my boss in that I should have planned ahead. Now I know if there's a blizzard on a Monday, I should get a hotel both Saturday and Sunday since the roads may close. However, I'm a young kid with major college debt and honestly I can't afford groceries let alone hotel stays all winter. I thought my employer might be understanding given the roads were still closed Monday after a Saturday blizzard. I told them when I started I lived an hour away. I expected too much apparently. The other day I missed was definitely not my fault. On holidays we having something called a holiday lottery. Lucky for me, my name was drawn on Christmas of that first year at facility x. The staffing office called to send me home and man was I excited even if it was 11 at night. I knew the weather was getting bad outside and it was supposed to get worse. I asked them if they were sure they wanted me to go home since it could get busy with this weather. I felt like this may have been a poor decision on their part. I questioned it when the staffing office called, I even called them back and said "Are you sure I should go?" They said, "Oh we are fine, we wouldn't have to call you! We can take several patients and besides you won the holiday lottery! Enjoy it girl!" I even asked my charge nurse, "Do you think I should go? What if they call me back?" to which she replied, "Oh goodness, just go! We won't need you!" So I left, the weather was so bad that it took me almost 3 hours to get home. I just made it to my parents to pick up my dogs when I got the call to come back. The plows hadn't been out, I busted through drifts at 20 miles per hour the whole drive home, and the supervisor threated to write me up if I didn't come in. I kindly explained to her the weather situation. Now at this point it was 5:30 in the morning. My shift gets over at 7:30. I would maybe make it back by 7:30 if the plows came out soon but it was glare ice under all that snow so it didn't look real promising. The supervisor said, "Well, your manager is going to hear about this!" and hung up on me. Not only was she unprofessional, but over the next month she went around the entire hospital telling everyone how I'm a terrible nurse! I had another staff come and tell me, bless her soul. My manager did talk to me and suggested next time I call the supervisor instead of the staffing office. How was I supposed to know this was my question? It was the staffing office that called to give it to me so it felt natural to call them back to question it. Now looking back, I wish I would have had my union rep present since I still feel this truly wasn't my fault. It also led to me having too many missed shifts. Not sure how this counted as a missed shift but it did. It went in my permanent record. Someone down the road will probably think I'm unreliable when in reality they sent me home after I cautioned several staff against it. It also affected my ability to receive tuition reimbursement. Now X will reimburse your tuition if you are a student. My wonderful manager encouraged me to get my masters as X offers tuition reimbursement. After I started, tuition reimbursement was denied. What my manager forgot to mention is that due to my "coaching plan" and "disciplinary action" for missed days, I was not eligible for tuition reimbursement. Once again, no one was looking out for me. I guess I was just supposed to know this, just like I was supposed to know to have my union rep there at my meetings, just like I was supposed to know that when the brochure says your automatically enrolled in retirement savings at 2% you aren't, just like I should have known if I stayed at my last job for an extra 2 shifts I would have started out at a dollar more an hour and without new grad classes necessary, just like I was just supposed to know I should never take the holiday lottery when the weather is poor and should never expect my manager to have my back or be honest when it comes to anything. What a joke. So who looks out for the staff at facility x? No one. Who looks out for the patients? The nurses, who are supported by no one.

After three and a half years as a nurse, I began to hate nursing. I hate going to work, I hate the management, the policies, the procedures, the changes, many of my fellow coworkers, and I started looking for jobs online not in nursing. But as I thought about it longer I realized it isn't nursing I hate. I like caring for patients. I enjoy critical patients, I enjoy the critical thinking (another thing facility x likes to take from you). Maybe, I don't hate nursing after all. I just hate facility x and maybe I just need to find a nursing job with a company that appreciates and supports their staff and each other. My question to you is, does that exist or is it like this every where?

[traumaRUs, MSN, APRN]

Wow! It seems as though most of the issues revolve around missed days.

I agree that the first year in nursing is especially rough. Since you live an hour away, have you considered changing to hospital closer to you? What about sharing expenses in the city with a roommate? Then you would be closer.

As to the pettiness of the staff, are you an assertive person, do you come across as confident? Sometimes if you "bluff" your way with these bullies, they will back down.

In the end, if you are miserable, move on to either another unit or another hospital. Life is too short to remain unhappy

[hemwolf]

Well, being in a rural area it's the closest ICU. I hate to give up what I'm passionate about and work in the small small hospitals that are closer. Although, I've considered it and have been looking for openings. In the end, the three and a half years I've been there I haven't missed more then 12 days. 8 of those coming in the first year, 2 this last year, and 2 this year so I don't consider it a problem but maybe management sees it differently.

As far as pettiness of staff, I haven't had a problem directly since the first week I started as I tend to do my job, keep to myself, and am very type A when it comes to my work. I think it just bothers me that people can be so petty and cruel to each other. The lack of teamwork and support makes working with some staff very difficult. ICU nursing is stressful and can be hard emotionally at times. I feel its best if you have a team environment and a supportive group around you to help with that. As always there are good staff among the not so good. I guess my biggest hope is that there are hospitals out there where management and other staff are supportive, kind, and compassionate of one another. Maybe this is too much to hope for.

[Castiela]

I've worked in a couple of ICUs and I've never encountered the majority of that behaviour. One of the ICUs would fill out incident reports if they found even small errors in your work, but they were non punitive and always about learning. I've been fortunate enough to have worked with great teams where people will help you out.

I think no matter where you go, there will always be some who talk about you if you've made a mistake, but they've been the minority in my experience and most people are uncomfortable listening to them.

Sorry you had the experience. I hope you have a better experience next time

[popopopo]

I've worked in a major teaching hospital and experienced the same thing in ICU. I empathize completely.

[smiletoday]

You described the last job that I had in the ED. The stress working in such in environment will take a toll on you. I made the decision a year ago to leave. A lot of people could not believe I gave up an opportunity to be an ED nurse. Yup. My sanity is more important. I feel it was their loss because, I am a damn good nurse. It is pretty ironic the unit is working on ways to prevent nurse to nurse violence. It is not going to work until they first look in the mirror first.

[Julius Seizure]

Reconsider those smaller rural hospitals. Often the really sick patients come to their ED first before getting transferred to the city hospital. Maybe you would like working in a rural ED?

[xoemmylouox, ASN, RN]

I'm pretty sure we work at similar hospitals.. The pettiness, BS manager attitude, and constant number pushing is felt on nearly every floor at my hospital. The CEO and other admin are jumping ship now too. I'm looking for something else. I had a particularly awful night the other night. Sadly I am the sole income for my family so I can't quit without having another job lined up. If we didn't have kids to feed I would have made that my final shift there. We have lost so many staff recently and instead of staffing with travelers they just make us go without. It's awful for us and downright scary for the patients. They closed down a bunch of beds inpatient wise, but expanded our ER quite a bit. So now we have even more patients ready to be admitted RIGHT THIS VERY SECOND, but no beds to admit them too. I don't even know how to describe the things I have seen.

[mtnbiker]

I am a new "old" RN just started at a teaching hospital, working on a telemetry floor, and I so agree with you on the pettiness and the numbers and finding fault and not talking directly to me first about mistakes. UG. why does it have to be like this? What is it in human beings that people function in work environments like this. Is it a nursing career thing?, It is a woman management thing?, Such a cruel and un-fostering way of "learning the ropes". Maybe I will make my capstone project about this! At my evaluation, it was all about my what I am not doing right, numbers, percentages, ect...Nothing about how well I am coming along. So I do empathize with you. I go to work everyday so stressed out over doing everything exactly right, in the eyes of management. Maybe I just need to get thicker skin...? I never question my ability to be a good nurse, but I do question how long I will be a hospital nurse! Blessings to you and your journey!

[RoyalTeaRN]

I really, really, really seriously hope that things turn out better for you, and that you'll land somewhere that'll offer you the support and fulfillment you're making deposits into your karmic account for tolerating such conditions for that long. And for accomplishing what you for have for yourself, those patients and their families within that amount of time, under those circumstances. Thank you for sharing.

[Ambersmom, BSN, RN]

I totally hear you OP on this. The pettiness and viciousness of coworkers is heinous to me. I was the victim of one of those petty write ups, I didnt do anything wrong, just did something different, have the equipment manual to prove it because they chose to believe the team player. How someone can be petty and vindictive enough to cost someone their career is beyond me. My heart has been broken and it just leaves me wanting to be as petty and mean as the pond scum, only difference is its not physically in me to do that to someone else.

[WhortonOKC]

"I just hate facility x and maybe I just need to find a nursing job with a company that appreciates and supports their staff and each other. My question to you is, does that exist or is it like this every where?"

As a 24 year BSN, I hate to break it to you, but generally speaking it is out there everywhere.

Some facilities are much better than others, while some are just intolerable. I wish I could say it all comes back to management, but there are so many factors involved. Upper management certainly is the biggest enabler of the worst elements of those in nursing. Upper management hires a nurse manager who sets the tone for nursing. Generally, they bring in their friends or cadre under them and in the process undermine whatever stability existed at a facility. (all too often) Those friends and cadre often have no alliances, except to those who brought them into the facility. Those same friends carry a myriad of behaviors, beliefs and all too often, problems.

Over eagerness to implement wholesale change without following the beloved "Nursing process," stresses existing personal. Rather than spending time on each shift, and talking to people, such people come in with a grand new vision and implement it by fiat. People feel unappreciated, sometimes insulted and usually dismayed. As a result, turnover rate goes up.

But I digress. . .

These problems seem to be systemic in nursing. Worse in some facilities (especially privately or "not for profit" facilities) but the problems are always there. Sooner or later, you discover that higher level management frequently has little or no background in the healthcare profession and only cares about the financial bottom line.

I hate to say it, but I knew less than a year out of nursing school, that choosing this profession was a grievous strategic error to my carrier that I have been regretting for 24 years. If it were not for the money, I would certainly get out and quickly.