New Flex Pool RN Losing Her Focus

[Vespertinas]

In my nursing career up until now I've been detail-oriented, patient-focused, and somewhat of a know-it-all insofar as I made it my business to know everything I could about the patient's history and admission and I only felt comfortable and satisfied with my work on the unit if I knew every way in and out of managing "the system" and I utilized all my resources. This level comfort comes with working in the same hospital for at least a year, asking lots of questions, and also getting a decent orientation.

In a moment of caprice and circumstance, I quit my last job and started as a flex pool RN in a brand new hospital. Granted, it's only been one week so far but I am quickly fearing that I am spiraling into a awful sense of ambivalence about my job and patients. As you may or may not know, I get basically no orientation and although I thought I could take care of a patient anywhere, that's hard to do when a brand new "system" is in the way. I have found myself missing IV antibiotic doses, orders, lab draws.. and the only way I can go to sleep at the end of my day is if I tell myself I just don't care. I am skipping those details that I would never have skipped like writing a note, putting on venodynes, placing a new IV because I'm so preoccupied with just getting around that I started telling myself that it always seemed that flex pool nurses just do the bare minimum.. so why can't I? Plus I'm never on the same floor twice so I don't get to "know" my patients well which makes me lose some of that sense of commitment to them.

On the other hand I'm paranoid all the time that I'll get caught making a mistake or even being labeled as anything other than a good nurse. I made a great float nurse when I worked at a hospital I was familiar with but I am lost without my tools (knowing all the protocols, phone directory in my head, a halfway decent charting and order entry system)! It's even hard to get along with the different nursing cultures not only bc it's a new hospital but every FLOOR has different idiosyncrasies that I'm afraid if I don't pick up on them soon I'll be stepping on people's toes. Eg. How long they break for lunch, how much you can ask of a tech, which particular safety standards they're anal about and which can slide, using "other people's" computers

I'm bummed about my new job.

[Good Morning, Gil]

I think being a float would be difficult. I know it takes a while to get used to a new hospital and their policies because I'm newer at a different hospital, too, just recently off orientation. I mean...even though you're experienced, you can still ask the other nurses questions. I'm sure you'll quickly learn which nurses will answer your questions and which won't help you. I know you said you're making mistakes you normally wouldn't make, missing IV abx doses, etc, orders. It's funny how we take work home with us. I did this for a while when I was a brand new RN, but then stopped once I was comfortable where I was, but then...started a new job to increase my skills, knowledge etc. Now I find myself coming home just the other day, "oh..did I check that chart one more time to make sure I didn't miss any orders before I left?" I'm pretty sure I didn't miss anything, but got caught up finishing everything else for my patients, updating MD's, charting, helping other nurses, etc. However, here's the thing.....I usually make it a habit to check my charts one more time at 0645 just to make sure all orders were carried out and nothing snuck in on me. I mean, some docs are good about telling you what they wrote, etc, but we know not all of them do that. I think once you get more comfortable there, you won't take work home as much.

I'm not that experienced, still pretty new, but what I do: try to find a system so I won't miss anything: like now no matter what, I will check those charts before I leave, always check my med list to make sure I gave everything and followed up on PRN's, etc, before I give report. Obviously, we're going to have times when we can't do that, just with crazy nights and all, but even if we can't do that before giving report, we can at least give report, and do our double check before we leave. Not sure which units you float to, but in ICU, always like to make sure my patients are clean, repositioned one last time for the next shift, too, especially if you know they're prone to diarrhea from tube feeds or lactulose. I've come in on a mess of a patient, but we all know that's not a fun way to start; however, I understand nursing is 24 hours, and that more critical patient next door needed their attention, etc. We know that not all nurses see things that way lol, but it's nice when our unit is reasonable and team friendly. We don't get floats at night really, they are usually during the day shift, but I'm thankful they're there if they're good nurses because we would need the staff. I took your poll, and yes, I'm thankful for floats, but only if they're good because I want the patients to have a good nurse lol.

And, also, even though you're a float, shouldn't you get some floor orientation? Like you said...at least to familiarize yourself with policies/charting...

[Vespertinas]

I got one full day shift of floor orientation and THAT was a gift apparently from the last few rounds of new flex pool RNs who suggested that SOME orientation was needed because apparently they got none.

I'm used to working on stepdown/IMC floors where ratio was 1:2-4 but my flex is on tele M/S where it's more like 1:4-6. I'm sure that's partially adding to my anxiety because I still expect to know everything about my patients like I used to even though it's probably not as feasible.

You are right- I do just have to be extra careful now. Because I'm in a position where I'm more prone to making mistakes the only thing I can really do is just double check myself. Thanks for your advice

[PintheD]

Also, you have to realize that you are out there all alone! Your manager and the NM's on the units you float to don't know you. When it hits the fan - and it will due to the nature of the job - you may find your allies nonexistent.

This is not the time in healthcare to work like this. It's too easy for you to be made a scapegoat. Yes, the extra hourly pay is a nice incentive but I have found, personally, not worth it.

Good luck and I strongly encourage you to carry professional Liability Insurance!

[Been there,done that, ASN, RN]

I have survived the float pool position, on a travel assignment and in a HUGE medical center.

Of course you care. Tasks like IV abx , lab draws and missed orders WILL come back to you as errors.

Make it a point to STOP whatever you are doing.. check for current meds due and new orders every 2 hours.

Good luck , it is an extremely difficult position. Feel free to PM me.

[Vespertinas]

Part of it is that I'm having trouble navigating their computer system for now. All the orders and lab results etc aren't easy to find or even read. I am by no means inept at computer skills.. it's just that I've been lucky to previously work with either paper charting alone or excellent/modern programs.

I'm sure I'll get a grip on it shortly. I just freaked out in my first week that I missed stuff. It's something that may have happened if I was on an orientation and would have been fine bc there'd be a preceptor to catch it... but it's super-scary to make those mistakes on my own when I'm expected to be at 100% from the get-go.

Thank you for your encouragement.

[aboucherrn]

I am so glad you posted this. I have not used this site in years, but have reached out because I am so over-frustrated and anxious, the stories on here seem to help.

I am in the same exact position you are... I relocated out of state for my husband to pursue a job opportunity. Here I am in a new hospital system, new travel-registry assignment out of necessity because I couldn't even get an interview for a staff job, and of course, I have absolutely no friends or resources at work. You get little to no orientation but are expected to perform perfectly. Before this, I was on one unit for eight years. I was looked up to, educated younger nurses, knew my superiors, and felt like I was making a difference. Now, I struggle to get my basic work done, feel looked down upon by coworkers because I don't know about a certain diagnosis or procedure, and management is basically non-existent. Because I am not completely familiar with the computer system, I called a physician at 3 a.m. panicking about something that was already ordered...needless to say, I did not have a good rest of the morning. That was four days ago and I am still angry at myself about that. To make matters worse, the facility I am currently working in is expecting a JCAHO visit within the next few weeks, so I keep getting yelled at for not charting this, that, or whatever (most of which I was never shown in my brief orientation. I keep wanting to scream "WHAT ABOUT THE PATIENT CARE I AM PROVIDING!?!?!"

I keep trying to tell myself that as long as my patients are safe and comfortable, that is all that really matters. I know in my heart I do my best each and every shift, but how do you get past feeling like an idiot? Is there a thread on here for that?

Try to hang in there.... let's keep telling ourselves it will get better :redbeathe

[Vespertinas]

I'm so glad to hear that my venting actually connected with someone else out there. You and me are almost the same- I also was aware of allnurses.com for some time but only reached the point where I wanted to post something now because I was seeking advice where no one else could help me. I too relocated with my husband for a job opportunity. Haha, they always say we are lucky as nurses to be so mobile... lets keep our blessings in mind!

The benefit for you I can say is that I believe since you're been assigned a travel duty, you will at least be consistently on the same unit, right? In time, you'll develop some alliances. I can say this because after a few weeks, I too have made connections with those nurses who do sympathize for our situation. Of course there are also the ones who resent us.. but I just do my best to smile at them and steer clear.

I think it's hilarious that you're having a JCAHO visit soon and everyone's anxious about charting. Poor you.. getting called out for every minor detail. If you look at it positively, you can say that now you're getting the crash course in detailed charting that you probably wouldn't have gotten at all if JCAHO wasn't in the mix.

That's too bad about the MD but really..he's not someone you'll have to deal with on a daily or even weekly basis so the person who was bothered the most that night should have been him. Let it roll off your back. Your relationship with your patients first, then your co-workers, then maybe the attendings. He won't even know who you were if he saw you in the hall next week. Thank GOODness I can say that our (medical) doctors are SO nice. I've also mistakenly called them and they have been exceedingly understanding (I'm on days though).

Anyway, I really hope things start turning around for you. Remember, nursing is crazy demanding so the frustration in whatever form is almost inherent in our jobs. :/

[aboucherrn]

Thank you for the nice reply :) I have floated to a different unit every shift of this new assignment, and each shift has presented a different "challenge". I want to write more, but I need to sleep so I can get up and do it again.

Is your job situation getting better?

[Vespertinas]

Mine definitely is getting better. I'm probably the one who is hardest on myself and I tend to be sensitive when others are critical of me so it probably isn't as bad as I thought. I think (some) others are starting to recognize that I do work hard and when staffing is short (hence our employment), a hard worker is a nice thing to have.

Of course, I still find myself making mistakes. But each time I do, I try to find a reason why it happened so I can be careful to avoid doing it again. It's almost like being a new nurse again where everything is a learning experience but in the back of my mind I have the confidence that inside of me is a capable nurse who just needs to find her footing again.

I am very very lucky to have encountered a staff that has been GRACIOUS in their support. The charge nurses and managers ask me almost every time we cross paths if everything is okay. I ask questions A LOT and I have never met reproach. I only hope you experience the same. Now that doesn't mean that if I get a chart audit, I won't get a phone call from my manager correcting me.. but that's because all the staff nurses get that treatment too in this hospital. If I don't loosen a patient's bandage on their male appendage after he complains that it's too tight and the next shift assessment notes that it's swollen and blue... I'd still get written up! (LOL that happened yesterday to someone else and i just *had* to include this story)

[aboucherrn]

I'm glad things are better for you. I know for sure I am the hardest on myself. My husband thinks I am insane. He thinks I should go into management - that would help my stress level. Ha ha ha.

I keep waiting for the management phone call telling me I messed up!!! I think I have been overcharting (better than not enough). The patients are happy with me (I got a nice letter yesterday!), and today was the best shift I have had since I started my assignment. An MD even told me "good job".

Little triumphs, but I'll sleep a lot easier today :yelclap:

[Vespertinas]

I'm just gonna PM you bc obviously we're having our own conversation here