Hate my new hospital culture 2 days in, is it me?

[FatsWaller, BSN, RN]

Super quick background on myself, born and raised in California, went to undergrad in Oregon went to RN school in Kentucky. Got a job at a trauma heavy, busy, high acuity Trauma I center following graduation and was thrown right into sick patients, challenging situations and working the trauma bays. I loved it, learned more than I could have imagined, and more importantly loved the environment. The staff were like family, camaraderie was huge, the relationship between the nurses and physicians were top notch with everyone being approachable, involved in the care and decision-making processes. Everyone had each other's back from day one. In all it was a place that was enjoyable to come to work and honestly fun. Now don't get me wrong, I am not painting a picture of some unicorn fairyland environment where everyone was happy go lucky all the time, there were its issues as well, like the standard issues with management and occasional disagreements between RN and RN or MD, but for the most part it was good. I stayed at this hospital for almost two years and finally decided it was time to go home to California.

I knew there would be some changes to get used to. Southern California has a lot of trauma centers and volume wouldn't be as high. I expected there to a lot more protocols and stricter rules, it's the most litigious state so I expected some heavily defensive medicine and nursing practices. I got a job at a Level I ER in a very affluent part of Los Angeles. I won't name the name but that provides enough to know which hospital I am talking about for those familiar enough. This wasn't my first choice of hospital, I prefer the gritty, trauma heavy hospitals which this is not, but the pay was extremely generous and the name carries a lot of weight on the resume. I am 2 weeks in and I cannot stand any aspect of it, and I just don't know if it is a California thing or a hospital specific thing.

There are so many strict protocols I am afraid to perform even an IV start without the ok of another RN and confirmation there is an MD order to do so. There is zero camaraderie or any form of it within the department. Staff is downright afraid of managers and I have been told that I am not to address management in anyway within my first 2 months of employment as they do not wish to hear from me, only from my preceptor the first 13 shifts and then other staff such as charge RN. Apparently after two months I can approach them but they are not approachable, I am not to be personable with them or joke with them about anything, just more of a robotic interaction is to be expected. Staff does not say hello or want to talk in anyway, they do not seem to enjoy their jobs and honestly very few have any substance. They come in, do the work presented to them in front of their face and leave with minimal interactions. The relationships between RNs and MDs are almost nonexistent and disconnected. Many do not want to/nor need to hear from the RN and verbal/phone orders are not allowed, not sure yet if this is written protocol or just a rule (this is an ER, seriously?). I have been told by travelers (the only staff that is personable and will interact normally), that the place is horrible and miserable, and that RNs throw eachother under the bus at any chance they get. A select few of staff who I have been willing to interact have told me the same and told me that the place allows for almost no RN critical thinking or autonomy and that many lose their skills here. I can definitely see that already now 5 shifts in.

Despite being an experienced trauma nurse, I have been told I am "not allowed to touch a trauma patient for at least a year". Honesty I can deal with that (there are almost no traumas anyway) and the rules but I have kept my head down so far but I have watched staff members get chewed out by others for differences in care (not even doing anything wrong just their own way) and for showing even the smallest slip of a personality. Everyone seems to just be a task machine, and there are no interactions with other staff or physicians. Many of the nurses seem to carry a chip on their shoulders and think they are better than other nurses. I have been disgusted with the interactions I've seen with the RNs and the volunteers, transporters, techs, paramedics, emts, and firemen. They treat them like trash and like they are above them and it's not ok. I think many feel they can act this way because they work at a "prestigious" institution, an attitude I do not like.

Teams throughout the night are switched an average of 3 times, requiring a complete change in care team and most RNs don't even give a report. You just come back from break and you get assigned a different team.

I know there are going to be those out there who say it's a job and this is how it should be and camaraderie isn't something that should exist anyway. That I should show up, keep my head down, be a sheep and work and collect my paycheck and go home but I disagree. If that was the work environment I wanted, I would be working in a cubicle in some office. I have to spend 12 hours a day/4 days a week with these people. They become a second family. Camaraderie is extremely important and I should be able to trust and enjoy those I am working alongside. This was true when I was a firefighter, an EMT and even my last ER job.

Overall, I am very unhappy, and I wish I wasn't but I just don't know if this is how every hospital in California is or not. I spoke to some travelers and they all assured me it was not and that this was all very unique to this hospital, (many of which said is their worse assignment they have ever had), but I was just curious if it's me. Should I just stick it out, or find somewhere I click better? I applied for other jobs after my second shift, but I don't want to leave if this is just how every hospital is and I'll just be unhappy at another facility. I would rather take a pay cut and be happy then make what I am with this miserable milieu and group of people.

[NurseDisneyPrincess]

Honestly? It sounds like an awful place to work. I too, would be miserable under those circumstances. But I echo others who told you that all these rules seem unique to this particular hospital, or, at least they are not the norm.

I don't have any advice, but it sounds like you already know that it's not the right environment for you and that you need to find a new job. The name of the hospital might look great on your resume, but I don't think that's worth sticking around. Ultimately the decision is yours.

[RNperdiem, RN]

On the bright side, you have learned something very important to you: cameraderie matters a lot to you.

When you go looking for a new job, this feature which maybe you took for granted because of your previous job, is something you will specifically look for.

Sometimes you can find this team work in a different shift in the same job.

Have you worked any night or weekend shifts? Sometimes a different mix of personalities and less management presence changes the vibe of a department.

[missmollie, ADN, BSN, RN]

Something else to consider during an interview is to ask about the autonomy of the nursing staff. What are you allowed to do and not do. What the expectations are. Thanks for the post, this wasn't something I had considered but will definitely be on the forefront of my mind should I ever change positions or hospitals.

I would look for a different hospital. I couldn't imagine not having the autonomy that I currently have.

[KatieMI, BSN, MSN, RN]

I made an observation that camaderie, work culture, nursing autonomy and interprofessional relationships are frequently (not always) better in the most busy, tough places caring for large numbers of very sick people. Posh hospitals serving affluent clientelle with bells and whistles more commonly (again, not always) are difficult places to work due to inane number of schmolicies, bureucracy, gossip and sometimes worse vices as well. So, no, it might very well be THEM, not you.

I do not know why it is so - maybe, since staff holds stronger for jobs in places where work is easier and pay is better, the existing staff turns to cliquing in order to protect the status quo. But, since I had experienced this phenomenon both as a patient and a nurse, I prefer to stay away from luxurious places. If I would like to feel pampered, I'd go to spa.

[Been there,done that, ASN, RN]

I had a travel assignment at the hallowed halls you are referring to. I found the atmosphere and the protocols stifling, counted down the days until my 13 week sentence was over.

All California hospitals cannot be like hallowed halls!

Depends on how miserable you are, as to when to leave. When you do get another offer, ask to shadow so you can check out the environment.

Best wishes.

[klone, MSN, RN]

I made an observation that camaderie, work culture, nursing autonomy and interprofessional relationships are frequently (not always) better in the most busy, tough places caring for large numbers of very sick people. Posh hospitals serving affluent clientelle with bells and whistles more commonly (again, not always) are difficult places to work due to inane number of schmolicies, bureucracy, gossip and sometimes worse vices as well. So, no, it might very well be THEM, not you.

I do not know why it is so - maybe, since staff holds stronger for jobs in places where work is easier and pay is better, the existing staff turns to cliquing in order to protect the status quo. But, since I had experienced this phenomenon both as a patient and a nurse, I prefer to stay away from luxurious places. If I would like to feel pampered, I'd go to spa.

I think a lot of it has to do with the fact that for the grittier places with challenging clientele, people CHOOSE to work there because they believe in the mission of the facility. People who dislike working with the "dregs of society" as it were, will burn out quickly and move on.

OP, I would suggest seeing if you can find a job at the county hospital. Pay won't be as good, but I bet you'll have a much better work environment.

[canoehead, BSN, RN]

I would have to go elsewhere, pay be damned.

[FatsWaller, BSN, RN]

I had a travel assignment at the hallowed halls you are referring to. I found the atmosphere and the protocols stifling, counted down the days until my 13 week sentence was over.

All California hospitals cannot be like hallowed halls!

Depends on how miserable you are, as to when to leave. When you do get another offer, ask to shadow so you can check out the environment.

Best wishes.

I am glad to know someone else here who has worked there agrees. I know I am not the only one. In fact, it's sad, many of the staff I have talked to say they cannot stand working there and hate. Because so many hate working here the overall attitudes, morale and just environment for lack of a better word...sucks. Many I have spoken to, in fact most, are all new-newish hires within the past few months. I was able to talk to a nurse who had been there for about 6 years and she hates it too but she said turn-around is atrocious and it makes sense why such a "prestigious" well sought after medical center would even require travelers in the first place. They cannot hold onto staff because nobody wants to work there. I would say 3/5 people I've spoken to say they are doing a year "for the resume boost" and getting out. Kind of sad but that's how this place seems to be. My time is too valuable and life is too short for me to work somewhere where not only I am miserable but the vibe/morale is too. Plus, the acuity is so low, I haven't learned but 2 things since working (and its only because I normally don't work with peds.

This has taught me to better question the environment and shadow my next position before taking it. I knew this wouldn't be the best fit but didn't think I would dislike it so bad.

Something else to consider during an interview is to ask about the autonomy of the nursing staff. What are you allowed to do and not do. What the expectations are. Thanks for the post, this wasn't something I had considered but will definitely be on the forefront of my mind should I ever change positions or hospitals.

I would look for a different hospital. I couldn't imagine not having the autonomy that I currently have.

Haha autonomy!? What autonomy…at this place as an RN you have none. An MD order is required for every single solitary item. I mean seriously. I went from an institution where RNs were able to put in medication orders and just have the doc co-sign (depending on your rapport with the MD) to a place where we are not allowed to get even a verbal order and have to have a placed order to obtain a peripheral line, an EKG (even emergent), a meal. Don't get me wrong, I get that if I wanted autonomy, I should have gone to Med-School but in some circumstances, there has to be a middle. I feel this institution is so restricting that it leads to delay of care, annoys physicians more as they have to be found or called for every RN intervention, and even dangerous in some circumstances. It's odd for ED. I agree though, it's a question I will most definitely be asking from now on.

I think a lot of it has to do with the fact that for the grittier places with challenging clientele, people CHOOSE to work there because they believe in the mission of the facility. People who dislike working with the "dregs of society" as it were, will burn out quickly and move on.

OP, I would suggest seeing if you can find a job at the county hospital. Pay won't be as good, but I bet you'll have a much better work environment.

I definitely would love to work at county, in fact I have been trying forever but the damned process is just so slow and convoluted. I know my personality would fit much better with county or perhaps even St. Francis. I just love and thrive with grit, low SES patients, high ED acuity and traumas. So, I need to find my niche here in California and I hope it exists!!

[JKL33]

Haha autonomy!? What autonomy…at this place as an RN you have none. An MD order is required for every single solitary item. I mean seriously. I went from an institution where RNs were able to put in medication orders and just have the doc co-sign (depending on your rapport with the MD) to a place where we are not allowed to get even a verbal order and have to have a placed order to obtain a peripheral line, an EKG (even emergent), a meal. Don't get me wrong, I get that if I wanted autonomy, I should have gone to Med-School but in some circumstances, there has to be a middle. I feel this institution is so restricting that it leads to delay of care, annoys physicians more as they have to be found or called for every RN intervention, and even dangerous in some circumstances. It's odd for ED. I agree though, it's a question I will most definitely be asking from now on.

So they don't have any protocols which nurses can initiate? That is so very odd for an ED. I ask because maybe they actually do, in which case these nursing-police can be told to stick it.

It's a common misconception that when I get an EKG (for example) I'm doing it completely autonomously. Ten or 15 years ago we did that in certain places (and with certain docs), yes, but these days when we do it we're backed up by a protocol (which, is, in effect, an active order since the protocol has been approved by the medical and nursing directors and put in place as part of facility policy).

That place sounds just terrible.

[FatsWaller, BSN, RN]

So they don't have any protocols which nurses can initiate? That is so very odd for an ED. I ask because maybe they actually do, in which case these nursing-police can be told to stick it.

It's a common misconception that when I get an EKG (for example) I'm doing it completely autonomously. Ten or 15 years ago we did that in certain places (and with certain docs), yes, but these days when we do it we're backed up by a protocol (which, is, in effect, an active order since the protocol has been approved by the medical and nursing directors and put in place as part of facility policy).

That place sounds just terrible.

Very few protocols, about 5 or 6, of which the majority is just lab work orders. And they do not include very much. The cardiac protocol does not even have an EKG as part of it. And it has been made very clear we are not to initiate the orders if it is suspected the patient will be picked up….not seen…picked up by an MD within 15-20 minutes. And the protocols are never to be initiated once an MD has their name on the patient. Ya this place is odd. No sepsis protocol, no fever protocol, no suspected fracture/obvious deformity protocol, no SOA for a breathing tx protocol, no excessive pain over 7/10 protocol, no hyperglycemic/hypoglycemic protocol, etc. Its sad my rinky dink trauma hospital in Kentucky had more sensible protocols and what not than a place with unlimited resources and clout. Whatever…the job hunt continues haha.