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

libragirl924 · Jan 11, 2012

AMEN!!!

Wishinonastar, BSN · Jan 11, 2012

What the heck good would a posey do anyway? She probably has been trained by this tech to do whatever she wants just to shut her up. Once your shift ends it is not your problem, let it go. The other nurse is the one who is guilty by not standing up to her. Your assessment, your shift. Her shift is up to her.

I am sure every single one of those who witnessed you breaking down have had the same experience of losing it before. Maybe not at work, but at home or on the way home. It happens to the best. Forget it. Move on. Continue to use YOUR NURSING judgement, be polite but firm in your actions, that is what you went to school for and you are the one who has to answer for your own nursing actions.

Guest372004 · Jan 11, 2012

Now you have learned a good lesson. You are in charge. You know what is best. Most have given the best adivce. Very nicely let the tech know she needs to get him up every hour to the bathroom and that is how it is. And tell her yes it is a bit of a pain but it is what is best for everyone.

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?

aanwyn, BSN, RN · Jan 13, 2012

This tech's behavior is unacceptable. The patient does not need a physical restraint nor a chemical restraint. He has a 1:1 sitter because it has likely been care planned that this is enough to keep him safe. Frankly if the patient wants to go to the bathroom every hour, she needs to take him. Sitter does not mean the tech gets to sit around and do nothing. It is her responsibility to maintain the patient's safety to the best of her ability so long as the patient is not a violent risk to himself or others. You are ultimately responsible for this patient and your assessment is the basis for decision-making (within your scope of practice of course). As others have said, firmly and respectfully let this tech know that as long as she is with the patient she needs to attend to his needs (again within her scope of practice). Inform her that restraints are not based on convenience, they are a last resort for safety only (which I'm sure she knows). If she continues with her behavior , write her up. You have that authority. However, I would verbally warn her first. Do not accept any form of insubordination from your ancillary staff. They do not have a license to protect. Essentially they work under yours. Keep in mind that your license is always in jeopardy whether or not you're new nurse. It is your responsibility to keep your patients safe and seek disciplinary actions against your techs if needed. Clearly the other nurses have allowed her behavior so she believes she will be able to behave that way with you as well. NIP IT IN THE BUD! We need good working relationships with our techs. While it is nice to make friends with them, it can be quite detrimental to your working relations. More than friendship, they need to respect your authority.

qnmimi · Jan 13, 2012

Sometimes doing the right thing gives us a stomach ache, but is still the necessary thing to do. She was intimidating you to coerce you to treat this patient according to her wants, and not the patients needs, and this type of behavior needs to be addressed with her manager asap. As a nurse who has floated all 25 years at the hospital I currently work at, this type of behavior is the norm towards us, mainly because the staff doesn't know us. She saw you as a newbie, and you followed suit. Learn from this. Direct communication with clear expectations, with quick follow up is what that tech needs to understand and get from the RN's she's practicing under. YOU can be a good leader. The most unfortunate aspect of this whole scenario, is that you got no support to address this behavior, or even to help you to cope with your bad assignment. I find that disheartening. I've found that staff behaving badly are best treated with respect, but kinda like an errant toddler.

EAST1981 · Jan 14, 2012

I am new grad and I am a sitter in a local hospital (until I get an RN position, that is!) I think this sitter's behavior is ridiculous!! One thing I have found in the last year and a half of doing this job is that typically, the patient's behavior during your shift is directly proportional to how hard you're willing to work. Not always, but usually. I have elderly patients with UTIs who needed to get up literally every 20 minutes to pee. And technically, at my hospital, that's not even part of the sitter's job. But I do it, as long as I feel it's safe, because that's what the patient deserves. I will let the patient do whatever they want, as long as they are safe. If the patient wants to get up and walk the halls at 3 in the morning, I take them out in the hall and walk with them as long as the RN okays it. If they want to talk to me for 8 hours, cool, I'll chat with them as long as they like. And you know what? I very rarely have problems with patients. Generally, restraints only make the patient worse... and it doesn't always stop them from getting lines out either. I wouldn't hesitate to report her. She obviously doesn't care about the patient's best interest and simply wants to get paid for doing nothing for an entire shift.

CapeCodMermaid, RN · Jan 14, 2012

EAST1981--whoever hires you as an RN will be lucky. Keep your attitude about always putting the patient first and you will be a terrific nurse!

EAST1981 · Jan 14, 2012

Aww, shucks. Thanks!

nurseclairebear · Jan 15, 2012

Update - The nurse who was charge the night the incident happened told me tonight that she wrote up the tech for an incident that night, and a separate incident. We discussed how I could be more firm with her in the future and how/when to write someone up, but she told me that she spoke with our manager about it and our manager had called the tech's behavior "bullying". I'm so relieved that the behavior is finally being dealt with and that I know how to go on in the future. Thank you everyone for all your support, sometimes you just need another person to tell you that you did the right thing!

nurse_tnb · Jan 15, 2012

I have been in this situation many times with techs. My advice is to remember you are the RN. You have the more indepth education and training. You are trained to assess! And it sounds like you have excellent assessment skills. I know it can be hard at times, but if you have done a thorough assessment, stand behind that assessment with confidence. The longer you're a nurse the more confident you will become. Until then, "fake it till you make it!" LOL!!! I'm only talking about faking the confidence part by the way. That does not mean don't ask other nurses what they think. But when you ask for help do it with confidence. That's the trick to gaining respect as a nurse when you are a newbie. ie; I assessed my patient. These are my findings. This is what I am thinking of doing based on those findings. Do you have any suggestions that I may have over looked. That is confidence. But going and complaining about the tech or crying is just not professional and will not get you respect. Im telling you this because I used to cry at work. At first people were symathetic, after awhile it can get old to your co-workers. And who wants to be known as the nurse who cries about everything. You are going to have many many many many many many many many many bad days at work as a nurse. It comes with the job. Set it in your mind now that you will always handle bad days like a professional. From what I read you are a great nurse, assessment skills sound great! Talking with the family to find out what his baseline is--Great! I wish you the best in your career!!!!!