Help! Critical lab: morale -2.5

Lev, MSN, RN, NP · Jul 1, 2014

I'm 1.5 years into med-surg. 5 patients, but often some of them step down type acuities (our hospital doesn't have a step-down unit). Also, often, only 1 CNA for our 25 bed unit which has up to 7 or 8 total care patients with maybe also a few active CIWA patients and of course the bone fracture patients with dementia who are set on walking home on their non weight bearing limb. No med clerk. No lunch or any other kind of breaks. Yes, am aware some of y'all dream about having even these working conditions! You're entitled to vent too, even more than me! And...maybe your own thread?

Nurse to patient ratio is average. CNA ratio is abysmal. It's hard to work without breaks.

Night shift, which doesn't help me. Not a night person. Plus recently dx'ed with a metabolic disorder which drains my energy and makes me more prone to brain fog and fatigue, ESPECIALLY in metabolically subprime hours like night. Taking meds for it. Are they working yet?????

Does your unit have straight day shift?

Pro's: work with some very good nurses that I respect a lot. Everyone helps, some more enthusiastically in some ways than others but all have strengths. I can't ask the elder stateswoman with a bad back for help with a turn but she will give me great advice on adjusting care for condition, what to suggest to the MD. Overt bullying is low to almost nonexistent.

Great teamwork and experienced nurses are essential. Is this specific to your shift, or in general on the unit.

Nursing superpowers: recognizing changes in condition. Passionate about safe pain management. Thorough assessments. Compassion. My CNA last week said that patients keep asking her, "Is Cinquefoil going to be my nurse again tonight?" when she rounds at start of shift. Ninja at convincing the paranoid schitzophrenic patients that they need their antibiotics, or can stop freaking out now. Education using plain, approachable language. Listening. Handwashing. I will always help other nurses with whatever. Or CNAs. My patients tend to wear their SCD's. I take them on walks. I've been known to give backrubs. I've kept CIWA patients with initial scores of 23 "off the unit" and safely recovered.

You're a competent nurse who cares.

I floated, as a new grad. Got good feedback from the floors I was on. They always asked to have me back. I enjoyed it.

Do you think other floors in the hospital are a little lighter? Which floors did you float to?

Much better lately at: prioritization, venipuncture, time management of care tasks.

Important...

Kryptonites: Charting. I never feel good about putting patient care off for charting. The doctors never read what we chart, only the lawyers and insurance people. I would love to chart in rooms but we are never adequately staffed with call light/bed alarm answering people to allow this. Am either doing THINGS or out at nurse's station, trying to chart while always interrupted.

I suck at charting interrupted. When I do chart I like to do it thoroughly. Not doing that lately.

Always charting late. Get a subtle stink-eye from next shift about it, indulgent smiling eye roll type behavior from my own shift. "Oh, that Cinquefoil!" I am a manager's nightmare of overtime.

Are you the only one who's charting at the end of the shift and staying late? If everyone else is doing it too, it's not you, it's just impossible to get it all done. Charting is a necessary evil. I hate telling my patients that I will do their dressing change as soon as I document their assessment in the computer, (this is what I told my patient today), but it has to be done.

Also, I suck when I'm hungry. Almost always hungry from 10pm on. I shove enough items in my face to be (suboptimally) functional. Don't always chew though.

I carry around sugary drinks with me. Gatorade, snapple, coffee/tea with sugar.

I suck at saying no. Yes to warm blanket. Yes to fixing how your legs are. Yes to the new admit along with my 2 total cares and 2 nutcases, all of whom I perversely connect well with, one of whom needs to go down to CT. Yeah, I know. GET BETTER AT SAYING NO AND STICKING UP FOR MYSELF! Getting better. Apparently not fast enough.

Yeah, cannot be trampled upon.

Getting better at: helping patients set realistic expectations.

Very important. They need guidance. No, a realistic pain goal after knee surgery is not 0/10!

But what I really suck at is making progress at these growth areas when I'm tired, hungry, brain-foggy, with a constant nagging inner voice saying "This is typical! You got yourself in a hole again! Why are you still running around when everyone else is already charting! Can't you suck LESS for a change??"

We are all our own worst critics. Very wise person told me that the other day.

Home life: marriage pretty rocky in the last year, in couples counseling. Making things better, but will it make them good, again, ever??? In time to have babies at my late age?? Several deaths in the immediate family just when I'd moved far away, fewer jobs for husband near family, stress of last move was not good for our relationship. New town, miss my friends. Tired all the time. A few good new friends, weekly family phone calls, the great outdoors, and the love of one good dog - plus reality TV shows and the library - keep me going.

Life sucks, work sucks. Time for a change. You can't survive like this.

I finally made it past minimum wage to "the good life" and I do feel I'm supposed to be a nurse. I love MANY aspects of this job - the physicality and intimacy of direct care, the teamwork, the complexity of pathophys, the always learning new things, the pride of a good IV start or of helping a patient get better or die well. But when does life start to get good, and what kind of nurse am I supposed to be?

They say it takes 2 years to be competent. 1 year to feel like you're finally "getting it." I don't know what type of nurse you're supposed to be. Did you always plan on working in med/surg. I think many among us have a love/hate relationship with nursing. It's the good moments that keep us going.

Is there another kind of nursing that will play to my strengths and downplay my weaknesses? Or do I just need lunch breaks, better staffing, and a full night's sleep? Or???

I could be days will work better for you, but on the other hand, days shift can be busier in some aspects. More people trying to get your attention. Have you every thought of PACU or OR?

Am already trying: counseling, brain sheets (revised over and over), asking other nurses for feedback, asking manager and unit educator for advice. Am cruising for a burnout and wish I knew how to turn it around.

I think you're on the right path. Re-examine your priorities and decide if your current position is in line with the life you want to have. Have you ever thought of working for an agency? This may be an option if you use your husband's insurance.

amoLucia · Jul 1, 2014

To OP - I can't really offer much advice except to say personally, I enjoy 11-7.

But hopefully to brighten you a little, I'd like to offer a compliment. I really enjoyed your style of writing your post. You hit on things succinctly with what I imagine is a wry smile. You commented about your charting. I might offer you may be a tad hard on yourself. Charting is one of those nasty necessary evils we all need to do altho we don't like it. So it seems to be an albatross.

Will hold good thoughts for you.

SierraBravo · Jul 1, 2014

Cinquefoil - I really enjoyed reading your post. It was well thought out and you are a great writer! I especially liked your humor throughout. I think it really says alot about you that you are aware of your strengths and the things that you can improve on. Some people have trouble reflecting on themselves and realizing what they can do better at. Sounds like you are a really good nurse and you are really good to your patients. Sorry to hear about your personal challenges...

The beauty of nursing is that there are so many options such as different shifts, different units, different patient populations, different environments (home care, hospital, etc...), etc... Perhaps reflect on what your ideal unit would be like, and then do some research or shadowing on different units. Best wishes to you, and keep fighting the good fight. :)

Delicate Flower · Jul 1, 2014

I agree with the others who posted that they enjoyed reading your post and writing style. Also, the fact that you have well organized thoughts on your strengths and weaknesses and know what you need to work on shows that you are (or will become with time) an awesome nurse.

But another thought I had....maybe some of your strong points are making the kryptonite worse. I started out kind of like you. I was slow and always late, because I have a tendency to always overanalyze everything. Managers (and teachers from kindergarten on) have told me repeatedly "you make it harder than it needs to be." I know I do that when I am getting the hang of something new. Sometimes just realizing I'm probably making it too hard when I'm struggling makes it easier to get the swing of it.

For example, your thorough assessment. How long are you spending assessing your patients? Make it straight and to the point. It can still be thorough and be fast. And you can multitask. Palpate the pulses while you are assessing neuro status and pain. Get in a routine for your auscultation (watch how doctors do it - fast). Talk to your patient and let them guide you in taking care of them (if they are able). When would you like your bath? What do you like to drink when I bring your medications? Are you warm enough? Can you think of anything else I can bring when I come back with your medications? When you get on the same page with your patient, they won't need to hit their call light as much.

Medications - give 20, 21, and 22 all around 2100 if policy allows. Condense things.

Pay attention to what you are doing in terms of work. Are you making lots of trips to go get things? Backtracking and retracing your steps? Be creative and think about what you can do to minimize that. I once worked on a busy tele floor with 9-10 patients on nights (travel assignment). The first 2 shifts I cried. I didn't eat, pee, or breathe. It was near impossible to stay caught up, and I wanted to quit. What saved me? I got one of those goofy fanny packs and stocked it with flushes, alcohol wipes, syringes, end caps, etc. Saved me constant trips to the utility room, and it was just enough to get through it.

haha. I just got the critical lab reference. Told you I was slow.

Anyway. Here's another thought: I know you said you don't do much charting in rooms, but if there are computers in the rooms, or you have COWS/WOWS, maybe try charting in the room while you are talking with the patient. You are great at relating with your patients, which makes me think you spend a lot of your time in their rooms talking to them. If you can figure out how to chart and talk too, then you can save time that way. Bonus: when you are in the room, you co-workers won't see you at the station and interrupt you!

With experience, you will get faster. There is a reason all those other nurses with more experience are getting out on time. They have learned about shortcuts. Some shortcuts are safe, some are not; you just have to learn the difference before you try to use them.

About your home life: unhappy marriage generally doesn't get happier with kids. Ask yourself: is this the person I want to raise children with and grow old with? My first marriage ended when I decided for absolute sure that he was not the person I wanted to father my future children. Have since found that person and had two kids after 30. Many people have children in their 40s.

wooh, BSN, RN · Jul 1, 2014

You like to chart thoroughly, but you know it's only bean counters and (possibly) attorneys that are going to read it. Chart for them. Bare minimum to show you did what you have to do. And something I've tried to get back to lately and is really making a difference, chart immediately after your assessment. I can do a full assessment and all the things I have to chart q shift in just a couple minutes when I do it immediately. It takes forever if I wait, trying to remember which patient is which, what did I forget, go back and chart what I forgot, rinse and repeat.

There may be a better spot for you, but until then, make the most of where you're at. Sounds like you're doing great there for the most part!

WoosahRN, MSN, RN · Jul 1, 2014

My major management rule I have for myself is to always chart my first assessments before my next. In ICU that is charting the 2000 stuff by 2130. I've found that if I get that done (which is usually the most to chart) then I am so much further ahead than if I find I haven't charted until after midnight. Most floors chart by exception but in ICU we chart everything. I had a hard time when I worked PRN in ER to only chart the system that was complained about. It felt so "wrong". So for you, if a system is normal, don't add extra charting. If I'm in a train wreck situation I make sure I at least chart I/Os, meds (we scan now), drip changes and VS.

Sounds like you just really needed to vent. Hang in there. I think other people gave some good advice. First two years is so much "what did I get myself into?". You sound like a strong and compassionate nurse. And I love that you identified that you need to take care of yourself.

PrismRN · Jul 1, 2014

There's some really good info here, I love the fanny-pack idea. I also enjoyed reading your post, good to have such great insight into yourself and have a sense of humor about it :chicken: You kinda sound like you’re right where you need to be as far as the types of patients you connect with, nursing challenges for your personality, the experience you will gain, etc. A lesson I learned (that I still struggle with to this day, eons later), is that when I was new, I focused on everything. Of course you have to, you’re new to the wonderful world of Nursing, but I never really got good at learning what I DIDN’T need to know for my shift. I got into the habit early on of literally knowing everything I could get my hands on for my two pts (ICU), had it all on my pocket-sheets, etc. As I grew as a nurse, I unfortunately kept the same habits, and all I really did was get a smidge faster at “knowing everything”, completely missing the point of what the veteran nurses knew: there’s just some stuff that doesn’t matter tonight. They got out on time, I was there an hour late. I got bogged down in details that they knew were insignificant. Are you still focusing on 100% info on every patient that in reality you may only maybe need to know? Stuff that can be found in the chart or EMR later if it becomes an issue? I suspect the experienced nurses on your floor have learned to streamline, which is hard for a control freak like me :sarcastic:

martymoose, BSN, RN · Jul 1, 2014

night shift is kicking your butt. maybe somewhere else has more days shifts?Ifound recently that if i group my 3 12 days together that gave me some days off together and seemed like a vacation. I know it sux to go back, but it really did help me

btw i am on a stepdown unit and we usually have 4-=5 pts anyhow. all as you describe- and then throw in some drips as well.

not sure what you emr is, but since we round on our pts at report, ive already gotten a quick assessment. i chart that stuff as soon as we are done rounding. I am able to complete about 60 % of charting with in the first to second hour of the shift. Then i go back and see pt more detail- lungs, etc. This has helped me a lot, because if the poop hits the fan later, or get an admit, or end up 1:1 a pt, ive gotten 70% of my charting already done. even if I have to stay to finish it doesnt take that long.

Best wishes- hope you get some relief

tokmom, BSN, RN · Jul 2, 2014

Hello,

I won't comment on the time management thing, because even though you could probably trim some fat off your night, ie..back rubs, chats with patients, I think your problem lies in the shift itself, and the metabolic disorder. How can you even be fully functional when your body is crying for sleep?

Between the rocky marriage, lack of sleep and metabolic disorder, I'm afraid you could be heading to burn out. You have a lot of negatives on your plate with those three issues. Do you do anything positive for yourself? Who fills your glass at the end of a shift?

Taking care of yourself is first and foremost THE most important thing you can do for your patient.

Your hospital staffing sound a lot like a facility I endured and I burned out to the point of leaving the profession. I should have left prior to the 16 year mark, but I didn't and it harmed me. Can you switch to a different floor and shift? And if not at that facility then quit and move to another that has a day shift position?

You sound like an excellent and caring nurse, which is what gets us in trouble with burnout.

See my quote below.... (((hugs)))