Getting very frustrated with nursing or just shift work?

[Hagabel]

I have been a nurse for 20 years, mostly ICU and last few years ER. I started work last year at my local hospital, worked ICU (did not like obnoxious night shift charge nurses) and did not like being micromanaged and treated like a new grad. (no offensive to new grads..:)) so I transferred to the ER.

Things are going much better except that they are big into pateint satisfaction scores and hot on 'discharge times'. So if you have 4 pts and 1 is up for DC and maybe you have IV meds etc to do in other 2 rooms they expect you to drop your 'pt care' to dc the pt. Half the time the pt is off the board whils the pt is still there to 'make' numbers look good!

My priority is the pts who need meds, IV etc if they are in pain etc. If it is a DTAP or something then obviously they can wait.

Some charge nurses are great, others like to micromanage. You are lucky if you get to eat and then made to feel guilty if you take 1/2 hr so I have started deucting meal break each shift I do not get it. (we are not paid for it)

The last straw was when I got told that I was spending TOO long in the room with a pt that we had just intubated, ngt, foley, tlc, drips etc (ICU pt). I was trying to chart for last 1 -1/2 hrs (VS,meds etc) as fast as I could as I had 2 other pts and the Charge gave me another pt as well!

I told her i could not do anything with a 4th pt, she told me everything was done so why put my name on the chart? When i checked on my 2 pts 1 had not had VS for 4 hrs!! (I had done them 2 hrs before ICU pt came in)

I told her I was finishing up with ICU pt and them I would come out and what else was I meant to do?... the reply...'well ICU pts are always a dilemma aren't they?'

So I have applied for a job as a school nurse and also at an urgent care and plan on just continuing do per diem there. In th emeantime I have asked for days next schedule for a change.

Not sure if I am frustrated with nursing, shift work or just this place.

I loved my last place of nursing, worked there for 9 yrs!

Any advce appreciated. Sorry this is so long.

[trixie333, ASN]

What you describe is a facility concerned about numbers (and profits) not patient care, no matter what the smiling men in suits say....the pressure starts at the top and is applied southward onto the bedside nurse....fertile ground for lawsuits and medical misadventure...and once again, you are responsible for everything, but control nothing....things probably won't change until the faces in administration change....it is better in other ERs....having just finished a contract at a wonderful little ER, I can tell you what you don't have: teamwork...they may give lipservice to teamwork, but in real teamwork, one of the other nurses would have hung a drip or 2, inserted the foley or NGT, calling out to you what they did, done the VS on your other 2 pts., and the charge nurse would have taken the 4th pt. that everything was done on...leaving you the charting (so important on unstable pts.). You might also be pleasantly surprised to have a nurse offer to do the transfer for you. So, your current position is stressful, lacks support, and potentially adverse to your license. I don't blame you for wanting to find another position....if you can't change soon, take some vacation time for a breather....if you have to stay longer, maybe you can figure out ways to set an example of teamwork while on your time off...it really is the only effective way to cope with a pressure-cooker of an ER....

Good luck...

[CNL2B]

This may be a local staffing trend only, but if an ER nurse winds up taking an ICU level of care patient here (upper midwest) , they 1:1 them until they can get them up to the unit. Her trying to pile more patients on when you had an ICU patient seems inappropriate and not a manageable assignment.

I am constantly amazed on this board at what nurses have to put up with in other parts of the country. I think we do alot up here, and then I talked to a nurse yesterday (classmate) that had worked in NY state, and she said that she often took 10-11 patients on a med-surg ward at a teaching hospital. Another one said that she frequently had laboring patients just separated by curtains and sharing bathrooms (also in NY state.) Holy moly! It just seems crazy to me that there aren't national standards of care on this kind of stuff. Sometimes I feel like we live in the dark ages!

[Hagabel]

That was my argument to the charge nurse too. I have done ICU for years and where I used to work (W Coast) someone, if even charge 'picked up' your pts till your ICU pt moved upstairs.

Here they just don't care.

To clarify to the previous poster I did receive plenty of help from my coworkers with the ICU pt when she initally came in with foley etc but they all had heavy assigments to go back to and that is where I think charge nurse (who has no pts) should have picked up the slack.

Thanks for your replies.

[emtb2rn, BSN, RN, EMT-B]

Where I work, if you've got a unit pt, your other pts are handled by co-workers until the icu pt is upstairs or stable.

[Lunah, MSN, RN]

If we have a 1:1, someone else (usually our charge nurse) picks up the rest of our patients while we're with our 1:1. Usually. As long as we're not already working short and our charge doesn't already have an assignment to begin with (which is usually when the ICU patients show up, right?!). We do our best to cover each other. I hope you let them know why you're dropping back to PRN when you get another job!!

[LilgirlRN, ADN, RN]

I feel your pain. I can only say that you are ONE person and can't do everything on the crazy schedule that is set forth by companies that rate satisfaction. I often feel like l work an assembly line. From what I hear this will only become worse when Medicare/Medicaid reimbursment is based on patient satisfaction.

I was born to be an ER nurse. I thrive on a diet of controlled chaos. I love the autonomy when compared to other areas of the hospital. I love teaching my patients. I love watching the almost dead spring back to life. HOWEVER... I do NOT like to be micromanaged. I do not like someone telling me I have 3 new patients when the one I am 1 on 1 with needs me so desperately. It doesn't have to be that they need me in physical way, like to start an IV, gives meds etc. They can be scared to death, even when what's wrong with them is not life threatening.

Ironically, spending that little extra time with a patient may help in that all important patient satisfaction score.