Had two bad nights in a row, new RN feeling defeated and discouraged...

[nurseclairebear]

I had two bad nights in a row and really just need to vent in a safe place where hopefully some other people will understand.

I'm pretty much over what happened the night before, but last night was the icing on the cake - couldn't take the pressure and had a breakdown in our "nutrition room" in front of about 4 other nurses.

I work the 3-11:30 shift, so it got pretty busy after I admitted my fifth patient. My -new- tech for two of my patients kept calling me to tell me that they each needed something (insignificant things, like "Can bed 10 have a popsicle?", but probably 5 calls within 15 minutes as I was trying to pass medications and deal with my post-op patient). One of my patients was a non-verbal "psych" patient who needed a 1:1 sitter because he was at times impulsive - trying to get out of bed so that he could go to the bathroom and go on a walk. By no means was he more than one sitter could handle, and I had even given him his scheduled Lorazepam and Geodon. At around 9:15 the 1:1 sitter for that patient called my phone yelling, telling me that I needed to do something about that patient because they couldn't handle him, he was just too impulsive and she didn't want to deal with it anymore.

So I go in the room to assess him, and he's laying there, on his back, reaching for the bedrail but not actually getting a hold of it. Keep in mind I had been checking on the patient since 3pm that day, and noticed that the sitter from the earlier shift was verbally de-escalating him, or talking him to the bathroom when he was attempting to get out of bed. He had been continent the entire day for her.

This tech just didn't want to have to get the patient out of bed every hour to go to the bathroom. When I came in the room, she greeted me sarcastically and told me I had to get him something to "knock him out" or "tie him down". I got another, more experienced nurse, to come in the room with me, and even ran it over with the charge RN. They both told me that they agreed, they didn't see any indicating factor to "tie him down", that there was no real indication and I just try a PRN medication instead. I was furious and fed up with this tech, who has a history of a major attitude problem that most people just put up with. I did give this patient a Geodon IM injection, which his wife said was sometimes necessary when I spoke to her on the phone. This helped the patient calm down even further.

Luckily I handed off this patient to another nurse at 11, but I had to stay after to catch up on charting due to the breakdown I had in the nutrition room earlier. I kept overhearing that tech say how she was in such a bad mood, kept telling the charge RN that nobody would listen to her, and then the next nurse (who is strangely good friends with that tech) told me that she was putting the patient in a posey. I do feel like that was to please that tech, but that was not my assessment.

I feel like the tech, who is the same age as me, can sense my "newness" and my desire to please. I just did not want to be told what to do because it was not what I believed was necessary. I guess I'm just looking for some advice. I know I will have to work with this tech in the future, and I am seriously glad that I have four days off because I don't think I could handle communicating with her. How do I become more firm? What could I have said or done differently?

[MN-Nurse, ASN, RN]

How do I become more firm? What could I have said or done differently?

Give the tech direct, simple orders and if she doesn't follow them, write her up.

This is mainly a leadership problem. If her behavior is tolerated by management, there isn't anything you can do.

[nurseclairebear]

Thank you. I agree, I think it is a problem that's above me. I am glad I brought it to my charge RN's attention, but I think I will have to be more firm next time instead of hesitating to make a judgement call.

[netglow, ASN, RN]

You are giving that tech too much importance.

You are the boss. You get to say yes or no. Keep it simple, and say it with the authority that comes from your position and the fact that those patients are yours. Don't even start to try and please other staff. Do what presents itself as needing doing, don't read into it just do it. Those who come after you are under the same rule. Don't worry if they do different than you would do -- you are not the same person. It's OK to educate staff, but keep it short and to the point and honest. No need to be pals. What is needed is for you to get what you need to do done and done right. All else can fall aside.

[CapeCodMermaid, RN]

I'm sorry you had such a bad time. Keep in mind that you were advocating for your patient. It sounds to me like the sitter needed a major attitude adjustment.

[tokmom, BSN, RN]

Aww, I'm sorry to hear you had two bad nights in a row. That does not make for a fun week!!

I think you did the right thing by not tying the pt down. It sounds like he toned it down after the IM geodon. We don't do what is the best easiest thing for us, as you know, but what is right for the patient. So kudo's to you.

As for the tech/CNA, whatever you call her, I would be very matter of fact with my decisions and not budge if you think you are right. You could try to give her an explanation as to your decision, but I bet she would argue with you and it would be wasting your time.

I work with one that will bully and nag the nurse to do what she thinks is right. That girl has been in the NM office numerous times. She finally learned to shut up when she realized she could not bully us into changing our minds on pt care and it only got her into trouble.

Curious though, how do the other nurses deal with her?

[nurseclairebear]

Other nurses write her off, both the charge nurse and the nurse I had look at the patient with me both said that "oh, that's just that tech, that's just how she is". My issue is that I think that type of behavior is unacceptable. I am wondering if I should bring it to management if it happens again?

[JoyfulRN14, BSN, RN]

The whole point of a sitter is so that you don't have to chemically or physically restrain a patient to maintain their safety. If you're being "advised" by her to throw a patient in a Posey and knock him out with meds, that completely eliminates the need for her job.

In the end, just remember you have your patient's interests at heart, not your own selfish ones as she did.

[nurseclairebear]

YES! You illustrated the point I was trying to make exactly!

[Pistachio]

I would tell her that she needs to be getting the patient up to the bathroom every hour that that's what he nee. If she only has one patient there is no excuse for not doing the things this patient needs. If she refuses as said above write her up report her to the nurse manager. Techs have been fired for a lot less at my facility. It's not about you or her it's about what right for the patient. Be pleasant and firm. Tell her this is what you need to do.

[waterfall09]

" in front of about 4 other nurses.

I work the 3-11:30 shift, so it got pretty busy after I admitted my fifth patient. My -new- tech for two of my patients kept calling me to tell me that they each needed something (insignificant things, like "Can bed 10 have a popsicle?", but probably 5 calls within 15 minutes as I was trying to pass medications and deal with my post-op patient). One of my patients was a non-verbal "psych" patient who needed a 1:1 sitter because he was at times impulsive - trying to get out of bed so that he could go to the bathroom and go on a walk. By no means was he more than one sitter could handle, and I had even given him his scheduled Lorazepam and Geodon. At around 9:15 the 1:1 sitter for that patient called my phone yelling, telling me that I needed to do something about that patient because they couldn't handle him, he was just too impulsive and she didn't want to deal with it anymore.

So I go in the room to assess him, and he's laying there, on his back, reaching for the bedrail but not actually getting a hold of it. Keep in mind I had been checking on the patient since 3pm that day, and noticed that the sitter from the earlier shift was verbally de-escalating him, or talking him to the bathroom when he was attempting to get out of bed. He had been continent the entire day for her.

This tech just didn't want to have to get the patient out of bed every hour to go to the bathroom. When I came in the room, she greeted me sarcastically and told me I had to get him something to "knock him out" or "tie him down". I got another, more experienced nurse, to come in the room with me, and even ran it over with the charge RN. They both told me that they agreed, they didn't see any indicating factor to "tie him down", that there was no real indication and I just try a PRN medication instead. I was furious and fed up with this tech, who has a history of a major attitude problem that most people just put up with. I did give this patient a Geodon IM injection, which his wife said was sometimes necessary when I spoke to her on the phone. This helped the patient calm down even further.

Luckily I handed off this patient to another nurse at 11, but I had to stay after to catch up on charting due to the breakdown I had in the nutrition room earlier. I kept overhearing that tech say how she was in such a bad mood, kept telling the charge RN that nobody would listen to her, and then the next nurse (who is strangely good friends with that tech) told me that she was putting the patient in a posey. I do feel like that was to please that tech, but that was not my assessment.

I feel like the tech, who is the same age as me, can sense my "newness" and my desire to please. I just did not want to be told what to do because it was not what I believed was necessary. I guess I'm just looking for some advice. I know I will have to work with this tech in the future, and I am seriously glad that I have four days off because I don't think I could handle communicating with her. How do I become more firm? What could I have said or done differently?

[waterfall09]

Yes, I agree with other writers. CNA needs direct order, but not in a condescending way. They can make a nurse life a living hell, they have nothing to loose. Just be confident and offer education to CNA when possible.