Gripe List 2017

[MayRN2987]

Forgive the rant, but as the year comes to a close, I need to reflect on what I have found in my first 6 months as a registered nurse. No one told me that nursing was easy; however, the mental, physical, and emotional toll of night shift medical-surgical nursing was not something I was prepared for. Don't get me wrong, I love my patients. The politics of nursing, however, I could do without. A few of my biggest obstacles include short staffing, stocking issues, getting/giving report, and navigating the many personalities you encounter within the health care field.

As far as short staffing goes, this appears to be an issue that is not going anywhere anytime soon. When my peers and I were hired on in May, the hospital still failed to fill the staffing needs for the night shift. Since that time, I have watched my peers drop one by one. Everyone is jumping ship, and I wonder if I am a fool for trying to tough it out. Although hired for 3 days a week, I often work 4, 5, or even 6. With only 6 short weeks of orientation before being left to my own devices, the feeling of being overwhelmed still hasn't left 5 months later and is only exacerbated by patient loads of 6-8 per nurse with varying acuity. For example, the other night I had 6 patients with a total acuity of 16 (that was a good night where I felt comfortable). The night before, I had 6 with an acuity of 26 and then took an admit on top. I feel like an unsafe nurse at times because I am lucky if I have enough time to do my head-to-toe assessments and pass meds in my shift. I feel it is a successful night if I get a chance to read an H&P but often that doesn't happen. I fear making a mistake that will hurt my patient or cause me to lose my license when the workload gets so heavy that I can't do anything besides med pass and my head-to-toe assessment. I pray that this will improve in time as I get better with time management and organization, but I worry this has more to do with under-staffing than my skill set. Only time will tell.

My next issue is poor stocking. I understand there is a nationwide shortage of normal saline, but it is the basic supplies than concern me. I often find my self running through 3 storage rooms to find necessary supplies such as catheters, wound dressings, correct fluids, etc. This is valuable time wasted wandering the floor looking for supplies that should be readily available.

As far as report goes, I feel I have greatly improved on my ability to ask the right questions when taking on a patient and passing off the most pertinent information. Yet I struggle with the politics of report. To clarify, when I come in to start my night shift, I sit down with my patient list and first look up their medications to ensure there are not any 1900 or 2300 meds (depending on my start time) that need to be passed quickly. It also helps me to know exactly what fluids should be hanging and the rate when I do my bedside shift report. Then I seek out 2nd shift for report. When my shift is up on the other hand, I watch day shift come in and spend 10 minutes catching up on their nights, spend another 10 trading assignments until everyone is satisfied, and then they sit down at a computer and start looking up their assignments. I have reached a point where I have determined that I get paid hourly and I will sit and wait for them to come to me for report. It is easier than getting frustrated when, after watching them chat for 15 minutes, being told they are not ready for report yet because they haven't looked up their patients. Perhaps, I am just being bitter, but I am not chasing down 2nd shift and day shift for report. Someone can come to me. I also struggle with all the questions day shift has for me. I do not know how my patient takes pills or eats because I work midnights and don't pass pills or feed a patient very often. Sometimes I don't know what the discharge plan is or even much about the plan of care because I have 6-8 patients and that doesn't always afford me the time to read through the patient's entire chart. Still, I feel incompetent when asked a question I don't have an answer for. Hopefully this too will get better with time and experience as I am beginning to be able to anticipate those questions they will have for me.

The last issue I have encountered is navigating the personalities of my coworkers and the culture of the floor. For example, having an aid who thinks there may be an issue with my patient and instead of discussing it with me or the nurse assigned to take over my patient, the aid goes straight to the floor manager. I don't understand this, and the floor manager, instead of directing her back to me, encourages this behavior. Same goes for our 'incident reporting.' In my opinion, if the wrong fluids were hung or an antibiotic did not infuse properly, certainly a report should be made, BUT I feel the filer should also find the person responsible and educate. Otherwise, what is the purpose? If we cannot learn from our mistakes, how will we prevent them from happening in the future? Another example is a charge nurse who won't give me a straight answer for anything. I am a new nurse asking for direction, please help! Sometimes I am screaming inside trying to get a response from this charge. It's like pulling teeth trying to get them to come take a look at a patient I think is deteriorating.

I don't know. Like I said, I am a new nurse. Still learning how to navigate the health care environment. I am not sure if these are common problems or not. I just needed to get them off my chest. Hopefully as I progress in my career, I will learn how to handle these situations more effectively than a gripe post, but until then, thanks for listening. Please share your biggest gripes or any suggestions you may have for me.

[smf0903]

Yay! You've gotten 6 months under your belt :)

A few things about what you've brought up...why are you working 6 nights a week? If it's because theyMre short and you WANT to, then great. If you DON'T really want to work all of that OT, then quit doing it. No one is going to be in any big hurry to fill positions when they have someone willing to come in and cover. I can guarantee you that if the charge or supervisors have to start taking patients to fill in there will be new hires in there sooner rather than later.

Supplies: find out who stocks them (or isn't stocking them in your case). It's understandable that once in a while something won't be right at hand, but running all over God's country to find a foley or a bag of saline multiple times a shift is ridiculous...not to mention this probably plus a big part in the time management issues you discussed in your post.

Report...what's the policy as far as time allotted for report? (Our report time is from 7-7:30) I've got little-to-no patience for report time shenanigans. I just worked 12 hours, I want to go home. When I first started I had another RN trying to figure out the login for her phone...during hand-off time. Uh, no...you've got the next 12 to figure that out. I simply stated "I'm ready to give you report if you want it". I wasn't nasty or anything, I'm just not staying 15 minutes after my shift because someone else is screwing around with something that can be handled during THEIR shift.

When in report, if you don't know just say so. I have found that some people seem to get off on asking questions that either really aren't that important or they can easily answer for themselves when in the chart. Many a night I have not ambulated someone to the bathroom...are they steady on their feet? I have no idea because I simply don't know. On the flip side, I did learn a lot early on when I DIDN'T know something that I should have when asked. You do your best...some shifts are just a crap-show and you're lucky everyone is still breathing and has a heartbeat at the end of it. Other times you have the time to really dig into the chart. It is what it is.

Honesty, some times the charge is not your best resoirce when you have questions. You'll figure out who you can go to, the GREAT resources. At one time we had a charge nurse that I wouldn't trust to tell me how to put a pill in a paper cup. Guess who I never used as a resource when I had questions? I know who I can trust as far as resources, some of those people aren't even on my floor.

The aide I would have to talk to about the issue. S/he should be alerting you (as the primary nurse) first, unless you are unavailable for some reason.

If you have a deteriorating patient and your charge won't help/come, call a RR. Maybe the charge is indisposed at that moment, maybe they don't want to be bothered, who knows. BUT your responsibility is to your patient and if you can't get the help you need then call the rapid. BUT I would try to find out why the charge is reluctant to help when you call with a concern (unless you're calling 75 times a shift, every shift).

Those are just a few of my thoughts :) Congrats on making it through your first 6 months!!! May your next 6 get better for you :)

[MayRN2987]

Thank you so much for the advice. I struggle with finding valuable resource persons mostly because my shift consists of 80% new grads like myself. The best resource is usually the policy and procedure manuals and I wish I had time to refer to them more often. I am optimistic that with time I will become more organized affording me greater opportunity to utilize the manuals. I agree that I need to stop taking extra shifts but struggle with saying no. I need to work on that because I am losing my ability to balance my personal and professional life. Thanks again for the input.

[peripateticRN, BSN, RN]

Congrats on finishing your first 6 months! I am a little over a year in and have actually just jumped ship myself for many of the same reasons. I too am (was?) a straight night shifter (1900-0715) and have found that after a year my body and soul just can't do it anymore.

I too spend FAR too long searching out supplies - we often spend 15-20 mins on a shift calling one of the other Med units trying to track down a particular fluid, med or even things like saline flushes.. ugh. The typical response I get when I have brought up these issues is "our normal service worker is on leave" - I don't know but these service workers must get A LOT of leave - because it seems to be a problem all the time on most of our units. Its terribly frustrating when you're barely keeping your head above water with the to-do list only to have to spend 15 mins tracking something down.

For us orientation as a new grad was 4 classroom days and 7 buddy shifts (4 days, 2 eves and 1 night). This is pretty standard for our area. I am floored by everyone posting that they got like 3+ months - man, that would have been nice. Our hospital is a large inner city hospital and I work as a float to 13 Med units rarely on the same unit two nights in a row. I was 'voluntold' to do charge training about 7 months in. Its a scary thought that it is possible that I could have been be the most experienced person on the unit with 1 year experience - this stressed me out immensly! Luckily we have great LPNs and a very forgiving Rapid response team - when in doubt call Rapid!

We luckily don't have too many issues with short staffing - the medicine program is large enough that there are pretty much always floats available to fill out the lines. But the downside is we often would have shifts in which the whole nursing staff were floats which means no one knows the patients. Our night shift is pretty thin - most units get 2RNs, 2LPNs and a Healthcare aide - each nurse has between 7-9 patients including the Charge/resource nurse. If there are a couple of admissions over night, as there often are, things can get absolutely hairy. I too had real concerns about missing something important or making a big/life changing mistake.

Unlike you I can't say I love my patients (are we even allowed to admit that??). We have a ++high rate of non-compliance, people leaving AMA only to be readmitted the next day after their binge or overdose... Lather, rinse, repeat. I found myself endlessly frustrated with the futility of it all. I think its sad when I come off a shift and think.. wow.. no one swore or threatened me tonight!

Don't worry about not knowing things on shift report. I went through the same thing. Nothing wrong with saying they were asleep your whole shift so you don't know how they eat/ambulate. We have a kardex that is typically filled out with all that info but sometimes you'll get questions about daytime behaviour etc that you have no chance of knowing about. I think some people get a power trip out of trying to trip up the off coming nurse. Don't fall for it - don't feel guilty, just say you don't know. And all that crap about them lolligagging to report - I would lose my mind if they did that. Perhaps bringing this issue up to the unit manager would be appropriate (unless they want to start paying you ot for staying after shift).

Anyway.. I guess this is a bit of a vent for me as well... I just had my last shift at the hospital the other night and I'm going to (hopefully) greener pastures in Public health for a bit. I'm looking forward to working daytime hours and ambulatory patients.

My advice to you is hang in there - soak up as much experience as you can for now, but if you start questioning what the heck you're doing there of a daily basis, maybe its time to get out!

Take care of yourself!

[icthusRN]

6-8 PATIENTS!!! I would be jumping ship too....