Gripe List 2017
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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.