How do I handle poor standards of care at a new job?

[Kalipso]

To make a long story short I had a job in an ER that was heaven. We had teamwork, strictly enforced policies that made things efficient, doctors that didn't mind you questioning them, liked to teach, and were willing to listen to your suggestions, educational standards that were not fun to do but kept us practicing with high standards. You hardly had to ask for help because people just didn't sit around.

I had to quit and move with my stupid husband. I was excited about my new full time job in a 22 bed ER in a community hospital that only has 154 beds to start with....it didn't take long for that to change.

1) Their computer system is from the dark ages and I'm constantly missing new orders. It is really making me mad and feel like I'm a poopy nurse. But as I've only been there 6 weeks I'm going to chalk that up to lack of use with the system.

2)Their pyxis is crazy unsafe. They have several drawers where the divider grids have purposely been put in wrong to accommodate drugs. Thus the cubbies on the outer edges of the grid have meds that move from one cubbie to another which is just a HUGE med error waiting to happen if you ask me. I have brought this concern up to my manager but I am not sure if anything will be done about it. You know because I'm suppose to read the label and scan the drug before I give it..... No **** Sherlock. Even so should we make it more likely for a screw up to happen?

3) Their doctors and nursing staff are very poor quality. The kind of people who do a half - *** job because they can. No one has an incentive to do what is best for the patient. One example would be a patient that I took care of. Female 45, epigastric pain radiating to the back, vomiting, sudden in onset. Patient does mention that she has gallstones but this pain seems much worse than any she has experience before. While I believe that the patient is probably having a gallbladder attack at my last job we had a policy that if a patient had 3 complaints that could be heart related we needed to do an EKG. Here I had at least 3...age, where the pain was located, vomiting. So I asked the nurse helping me to get the EKG machine for me and he goes, while rolling his eyes like I'm an idiot, "She's having a gallbladder attack she doesn't need an EKG." Personally I'm offended because I think it is poor nursing to ASSume anything, second is it really necessary to question my judgment with an attitude? You don't agree okay lets talk it out then error on the side of caution. I always say if I don't think something needs to be done but another nurse does then I should just go ahead and do it especially if it is just adding an extra layer of protection to my patient.

Second example: I work 3p to 3a. A psych patient is brought to the psych room for suicidal issues. She has major psych history and is very loud, verbally abusive, and aggressive. For the first 5 hours of my shift she is in the psych room with the door open and a sitter on the outside of the door. Good that is how it should be. When the patient gets loud they close the door and the sitter has to stand and look at the patient through the window in the door. Sucks that they don't have a stool, but still the right thing to do. Night shift comes on and the patient gets a new sitter. The pt's earlier meds are wearing off and she is becoming psychotic once more. The nurse caring for her is at lunch. In an effort not to disturb the nurse at lunch I go to the patient's room to see if I can calm the situation. However, the patient is now in a regular room with the sitter sitting inside the sliding glass door. I mention to the sitter as I go in that she should sit with the door open and her chair needed to be in the doorway or slightly outside the door. I also then mention this to the charge nurse. The patient's nurse is back from lunch hears me say this and goes, aggressively "No the sitter does not need to sit outside! The patient is suicidal, she needs to sit right next to the patient that way she can keep her from hurting herself!" I say "No, the door needs to stay open and she needs to be in the door way incase the patient becomes violent. She is a sitter and should not have to touch the patient at all...she is not medically trained. However even if she was trained she should not sit in the room with a potentially violent patient. Furthermore a patient who is possibly suicidal should not be in a room with equipment and other means to harm themselves!" I was a bit of a smart ass when I replied because this was not the first dum move on behalf of the staff that day. The patient's nurse goes "Well the doctor said we could move her in there because she kept getting loud and we had to keep shutting the door in the psych room and the sitter was tired of standing to look at her through the window!" Then the doctor, hearing all this goes "Why does it matter to you anyway she isn't your patient, you didn't really need to go in there." REALLY!!!!!!!! We moved the patient in to harms way because it was more convenient?!?!!! Oh, and by the way who really gives a poop about the sitter's safety either?

And as a side note NONE of the staff have very good interpersonal relation skills. Today alone I've had 4 families tell me that I was the best care giver they ever had there. None of the other nurses feel any obligation to update the patient on their labs, review the labs they are capable of with the patient, or to even go in the patients rooms in a timely manner when the call light is on. I would like to say it is because they are busy, but mostly it is because they are at the nursing station charting or chit chating.

I just don't know how I can stay here. I've brought my concerns up to my manager...I'm not sure yet how seriously she is taking them. I know it has only been 6 weeks, but those listed above were just episodes that happened tonight while I was at work. And those were the biggest of all the frustratingly bad care that I had to witness today. I didn't want to come into my job and be the snotty know-it-all but can you see why I'm being forced to be? I can't let it go....I just can't. I spend 2 or 3 trips to the bathroom today just crying out of frustration....something I haven't done since my first year of nursing. I'm so frustrated and edgy lately that I've started to think I might have a hormonal problem or something....I mean when I'm there I don't go into work dreading the day but it only takes an hour before I'm clenching my jaw, throwing down something in frustrating, or feeling on the verge of crying or seriously giving someone a tongue lashing.

Am I crazy? Had anyone else gone to a hospital with poorer standards than the last hospital they were at....did you cope or just move on?

Any advice is appreciated, thank you.

[emtb2rn, BSN, RN, EMT-B]

Sounds like they have an embedded culture. It will be very difficult to change that without buy-in and support from the top down. And it sounds like that will not be happening.

No ekg on the over 35y/o epigastric pain with n/v? Yeesh.

Any other job possibilities near you?

Good luck.

[lifesagarden]

I agree, it's time to start looking!! In these toxic environments, the only time changes are made (or actually implemented) is when, not if, a patient has an adverse outcome and the family takes their complaint up the chain. Personally, I would advise you to protect your license, your health and your sanity:wacky: ...besides, you were looking for a job when you found that one. Hope this might help

[caliotter3]

Tone it down and look for a new job. Don't poison the well here because you don't know what the future may bring. It never bodes well for someone who does a better job than the others. And it is fatal for that person if they let it be known that they do a better job than the others.

[HappyWife77, BSN, RN]

You just called your husband stupid.

That's where you lost me.

[niecy_nurse]

I am a nurse manager in a busy ED. From reading your posting, it seems to me that you are really an asset to that chompany. I personally would seek other employment. The culture there is not going to change. Take your skills to another facility. Don't ever jeopardize your license.

[Kalipso]

HappyWife77. I love my husband, I am just really sad that we had to leave my awesome job behind. I've worked at 7 different facilities in my 10 years of nursing, now I did travel work for 1.5 of those years and that is where half of the hospitals I've been at came into play. But out of 7 facilities only 2 have ever been patient focused with great teamwork promotion. Niecy_nurse, thanks for the compliment. :) caliotter3, you are right about that, but it is very hard for me not to speak up in obvious patient danger situations. Mostly because I think about my dad and how some of his issues are due to the fact that someone was lazy. Oddly, even though I'm a nurse, I am not an 'A' personality type. I don't expect perfection and there were plenty of things at my old job that I thought were way over kill, but since that was the culture I followed suit because it didn't HARM my patient's any. When it goes the other way I get pretty irate. I can hold it down for a week or two but if issues are consistent I just end up going beserk.

[ChristineN, BSN, RN]

I went into this thread assuming most of the problems you are having are related to a difficult transition and an inability to put past job standards and expectations behind you. However, this place does not sound like a supportive work environment. I would start looking for new employment ASAP

[imanedrn]

I concur with the others. I just started travel nursing in hopes of seeing that the grass can truly be greener -- and it is! It sounds as thought you went from lush gardens to the desert -- the opposite of my current situation. It's hard to know what standards of care are and have your facility completely disregard them. For the sake of your license and sanity, look elsewhere!

[canoehead, BSN, RN]

Inside the door vrs outside the door, an argument could be made both ways. It's not something I'd get in a twist about. The discussion itself was not helpful for the patient to hear.

EKG would be done in some ERs I've worked, but not in others, especially with known gallbladder disease. Most hospitals have written standing orders for differing presentations. I suggest you check your policies, and push the issue if it says to do an EKG. But, if this is your own patient, and you feel strongly, an EKG never hurt anyone. When you comment on what others are doing it's wise to do it gently, and be ready to back it up with policies.

if you keep showing anger about substandard care, you will have a target on your back. Be silent, and give YOUR patients five star nursing. You can't change the whole unit, they will eat you alive if you try.

[Kalipso]

canoehead, from personal experience I am pretty passionate about safety when it comes to sitters. So yes, inside or outside the door is a big issue IF the door is closed, which it was. But the more concerning part of the story is moving a suicidal patient from a secure environment to a regular room JUST because it is more convenient for the sitter or staff. Yeah, I could just shut up and only be concerned about 'my' patients. But since I'm a good nurse I tend to answer call lights which makes other nurses patient's mine, the attitude you describe is how to survive in a hospital environment where others don't give a ****. Not something I'm willing to put up with for the long term.

[icuRNmaggie, BSN, RN]

If you know after six weeks that this ER is not following standards of care then resign. Bad units cant keep nurses. Start applying elsewhere even if you have a longer drive to work. You are wasting mental and emotional energy thinking that you can improve their practices all by yourself.