How do I overcome toxic hospital environments?

[medsurgrnco]

I've had repeated problems with controlling/mean charge RNs who make unfair assignments, CNAs who do poor work, toxic coworkers, inept managers, and managers who encourage backstabbing by coworkers in EVERY hospital unit I've worked in. Somehow patient complaints don't seem to be taken seriously about other nurses, while they are when made about me. I've tried informing management of the problems I see - with suggestions for improvement - but that seems to backfire on me. While some managers will inform me of complaints made about me, they don't seem to ever have suggestions for improving the situation and never care to hear my side of the story. Due to the above, I don't last long at jobs. While I so far quickly get new jobs due to my experience level (several years) and have good cover stories for why I left all previous jobs, I'm getting quite paranoid and wonder when this will change due to my frequency of job changes since becoming a nurse and I'm also tired of this repeating pattern. It seems that problems with coworkers and patient complaints are what hangs me over and over.

I am very focused on work, make few mistakes as I don't cut corners, try to avoid gossip and complaining, and get numerous compliments from day shift when giving report (you're so thorough & I know you get things done) and from patients. But I personally have great difficulty with all the numerous (& often unneccessary) interruptions at work, often feel overwhelmed & get frazzled, and tend to run behind & work OT due to the time needed for documentation esp. when stuck with a bad computer system. At every job, while I am feeling like this I see some of the other nurses calmly going about their work, spending most of the night on the computer documentating, having lots of time for personal conversations, and leaving on time regularly.

I ask lots of questions in interviews to try to find out about the unit environment, but it seems managers will say anything in order to get a new nurse on the floor. I tried agency work, but was given the worst patients, had to deal with a new computer system, and coworkers were quite unhelpful so I don't want to try that again. While I had "personality conflicts" with a few coworkers here and there in previous jobs & in my previous career (MA level), it has never been anywhere close to this magnitude. Anyone have any suggestions, other than leaving hospitals?

[medsurgrnco, BSN, RN]

I seem to have problems getting past the new kid on the block scenario. I make friends at all jobs, get along well with some RNs and CNAs, but some people just seem out to get me every time. I did not say I lost all my previous jobs, I said I didn't last long. Pretty much everything I've listed as being a problem at work has been discussed elsewhere in this forum, and others have been supported for their view of the situation.

I've had up to 3 different managers at some positions, and got along well with some of them. I work nights, so managers don't really know what's going on during my shifts. Managers don't seem to be aware of unfair assignments, and won't take the time to investigate & address the situation. Possibly my bringing this to charge RN & management attention backfires on me. I typically help CNAs when asked, rarely delegate additional tasks to them as it typically isn't worth it, but have problems getting some of them to inform me of VS timely and occasionally ask them to have another CNA help them as I am really busy at that time. I do many tasks for patients that CNAs could do even tho I know I'll end up working OT again while they take breaks I don't have time for, but they don't know that as I get it done and continue trucking on. I help other RNs when asked, check on their patients if IV pumps are beeping or the call light is on and take care of the need if I can quickly and let the RN know if they need to help the patient. I rarely ask other RNs for help as I know where that can lead. I only ask for help when there's no way I can get everything done by day shift other than computer charting, and express great appreciation for help when I get it.

I am asking for help in how others deal with toxic environments, keep from feeling frazzled and overwhelmed which I recognize is a problem I have and contributes to problematic communication with coworkers, and how to improve interactions with coworkers when there is little time for communication due the busyness of the unit.

[medsurgrnco, BSN, RN]

I ran out of time when editing my previous post. In every job I've had, other RNs have agreed with the problems I've seen at those jobs and have admitted their own difficulties in working in the toxic environment.

[ChristyMNOP]

Just from your post it seems like you are working on my unit and not in a good way. We have a new (to our unit) nurse with years of experience. For some reason that I don't understand yet this nurse has no time management skills. For example, we get to work at 7, med pass is at 9 give or take 1 hour to be within limits. She routinely doesn't start her med pass until 10. I've seen her stay in a patients room for 45 minutes and this is routine, not just the crazy patients who have a million things going on. She's just doing an assessment. She says she likes to do a thorough assessment prior to passing meds and so do I but it never takes that long. I repeatedly ask her if she needs help. I ask her if I can do anything and she usually says she's ok when its clear she's not. So all this makes her behind all the time. When you are behind like that on a normal day and something crazy happens, all hell will break loose. All of the nurses on our unit know that if we interupt her she will not tolerate it well and will get frazzled. So if something comes up we usually just try to do it for patient safety otherwise it might not get done. Teamwork makes up for her shortcomings but its easy to become resentful of someone who is constantly frazzled and behind on your team. Plus, since she is so behind all of the time she never has time to build a relationship with coworkers by helping out around the unit and socializing. It is stupid but it is important to build a good relationship with your peers in this field.

So with all that said, you sound kind of like her. So sure of yourself and your ways that it must be other people responsible for the problem. My advice is to do a few things. First of all, if you are quitting these jobs, stop quitting so quickly. It takes a while to get the kinks worked out of a new job. Second, work hard on your time management skills. I have terrible time management skills and when I first started this job no one liked me because they didn't know me. Now that I have improved, my work environment has improved. I hope that makes sense. Its still not a utopia and I feel lots of frustration but it is at least improving. And third, you have to learn to forgive. I've already had a lot of complaints about me and it really hurt my feelings and made me want to quit. But the best thing I could do was forgive those people who complained and made my job hard. I smiled and killed them with kindness. I made a very conscious effort to be pleasant and upbeat at work. And like I said, its no utopia, but it has gotten better. I'm convinced that many problems I initially perceived in the beginning of my work on this unit had to do with my own insecurities in a new career and job. I still have problems with the unit and may move on soon but I feel like since I made all the changes I made, I will be able to adapt in a new environment well.

Anyway, I hope this helps.

[annmariern]

This thread is very interesting for me as I could be reading some of my own complaints/experience, except I have never seemed to have probs with patients. Just the deteriorating working conditions. An entire month of bad shifts, topped off yesterday with another 15 hr marathon fueled by a slice of pizza my manager sent and wanted praise for. 8 patients to chart on for the entire day 9 two dcs and two admits), including my final straw, the incontinent, demented, in restraints and screaming the place down transfer from another hospital who arrived in a mess with no orders. My second restrained pt in the group as well as two drug seeking, non compliant young men, a horribly infected, dehiscing wound, you get the picture. No resource/charge and 0.5 of a cna. My "manager" who I called for help more or less tell me tough. I

am not even sure at this point if I am going back next week and in my entire life have never left a job without notice. Other nurses, the secretary are surfing the internet, having a great old time while charts piled up, orders are signed of but not done and out the door at 7.15pm. Anyway, sorry, off topic, excuse the vent. I recognize some of myself in the original post and I also agree, some of my problems at work are due to my reactions. The book that was mentioned, thanks, I will be reading it today! Repeating patterns as was said are always worth a close look as there has to be a answer there. I have no control over the mess at work, just myself and my actions & thats what this thread highlighted for me, so thanks for the post medsurgrnco, if you find that unit you mentioned please post the address! I'll be applying too.

[SuesquatchRN, BSN, RN]

Well, my 2 cents.

I had terrible trouble on the floor, but never from patients. They all had nice words for me. Other nurses, though, seemed not to like me. I know now what the problems were and they did have something to do with me, but some, just with the nursing culture.

I was perceived as "uppity" because as an older woman I am pretty confident and not easily shaken. I think that some nurses were annoyed that I was as secure in my skills as I am, and that I wasn't nervous about every Lisinopril I administered. I am continuing on in school (I'm an LPN) and was well-ahead of other more experienced LPN's doing the same program but not as quickly. That was twisted into my being "book smart" but without critical thinking skills. Right.

I am now working in informatics and get along very well with everyone. I think, and floor nurses, don't take this as a slam, because it isn't, but I do better with managers as co-workers than I did with floor nurses partly because some were threatened by me, entirely due to their own insecurity.

I was fired from a job for "not fitting in" and "saying weird things." Huh? Can we say, "Subjective"? In that situation, I had had six preceptors in two weeks, all with different styles, all with different focuses, and two of whom decided that they were going to bury me. They did. It didn't matter that OTHER nurses were going to the boss and telling her that I was being tortured, it didn't matter that my patients all had good things to say about me, it was decided not to rock the boat and to get rid of the newb.

Good luck. The only thing that concerns me about you is that you say patients have complaints. What are they? Because there're always gonna be a couple of nasty nurses on your shift and that, eh. Just try to keep your butt away from their teeth.

[medsurgrnco, BSN, RN]

Seems like some responders are selectively reading my posts, and missing some of what I state. I have good time management skills, as much as you can when you are typically given early admits and have confused elderly patients setting off bed alarms repeatedly. Many patients like me, the patient complaints are few when you consider how many patients I have & complaints tend to minor, greatly exaggerated, or completely untrue. I do think part of the problem may be that I'm not a nurse in my 20's on my first career, but am middle-aged and had a prior MA-level career. I do have the problem of pretty much always being frazzled and behind and I'm not good at hiding it. But I rarely ask for help, other nurses don't offer to help me, and management doesn't address the unfair assignments which is a large part of the cause of me getting frazzled. But I do WANT help with dealing with getting frazzled. By the way, I'm not a highly sensitive person - I took the test as I find psych interesting tho I don't know if there's any psychometrics behind it.

[annmariern]

I am im the same boat. I just want to go to work, give adequate care to my pts (good, i have given up on) work with people who do their jobs, and go home. Doesn't seem to much to ask. I am told that I do too much for my pts, in this yes, I don't accept that unless you have a family member to feed you you shoud starve to death. Not my job. I have reallly looked at what i do, and have cut back on a lot, but I still cant get to that point where I leave someone lying in feces for 4 hrs because my aide is charting and isnt going to answer the light anytime soon. But as i realised on Friday, why would she? Shes working 5 12 hrs shifts in a row with one day off between her next stretch. If you have issues with support staff, well your doomed. While I accept that healthcare has changed so much that the details are now considered dinosaur, I still cant get my head around fake charting, fake med giving, the things that make my job tolerable and allow people to work unfazed. I work with some great people, they seem to cope with finding allies, you know give the crappy admit to the one they dont like, or the "strong" nurse, All poilitics and BS. Their work goes unappreciated. It seems that a pulse is the only requirement for a job.

[Mulan]

some places are toxic, some people are toxic

you complain about the assignment being unfair, you get a worse one the next time, and the next, and the next

some people like to run off the good nurses, they make the rest of them look bad

people complain all the time, sometimes without merit and unfairly and some people lie, just because a patient complained, so what? consider the complaint and the source

[ecnav]

seems like some responders are selectively reading my posts, and missing some of what i state. i have good time management skills, as much as you can when you are typically given early admits and have confused elderly patients setting off bed alarms repeatedly. many patients like me, the patient complaints are few when you consider how many patients i have & complaints tend to minor, greatly exaggerated, or completely untrue. i do think part of the problem may be that i'm not a nurse in my 20's on my first career, but am middle-aged and had a prior ma-level career. i do have the problem of pretty much always being frazzled and behind and i'm not good at hiding it. but i rarely ask for help, other nurses don't offer to help me, and management doesn't address the unfair assignments which is a large part of the cause of me getting frazzled. but i do want help with dealing with getting frazzled. by the way, i'm not a highly sensitive person - i took the test as i find psych interesting tho i don't know if there's any psychometrics behind it.

the base pack mentality you are experiencing, it seems, has little concern for your individual merit or developmental needs. they simply are looking for an integrated member who works like them - a snap in member of the collective. what if you can't meet this imperative? do you really think that nursing culture is going to change to accommodate you? unless you enjoy a "protected status" or have finally earned tenure through assimilating... you will be looking in from the outside. so, whatcha ya gonna do now? that's what i ask myself frequently. you are not alone friend.

another thought. the culture some of us are asked to endure, doesn't appreciate individuality. it shuns 'different'. outside-the-box is a dirty word. moreover, some are openly hostile toward nurses who are pursuing educational goals or lifestyles that aren't all about nursing. i keep my personal life a secret. some come onto ya like they're about to be your new found buddy, they draw you out and then before you know it, bam!

listen, you are a good nurse. you and i both know this to be true. good nurses don't reflect hard and try to improve as you do. we need to reconsider how to balance your aspirations with reality. sometimes reality just isn't going to support us. now we're at the proverbial fork in the road. i say, take the road less traveled. you may need to set aside your courageous desire to master the unit but, do you really want that tenure? look carefully at who you are working with. how far are you willing to go to be a member? your call.

oh, and about being frazzled. it's a stress response. science tells us that the mind and body do not perform as expected when stressed. your physiology is sabotaging your performance. it's altering your senses, perception, judgment, motor skills, personality. stress is insidious. 'frazzled' is a sign/symptom that your nervous system is overloaded. it's not uncommon. lol. start with a strong dose of pre-shift jitters, add a tough assignment, judgmental, leering coworkers, a smattering of the 'impending doom' sensation and voila! ... frazzled ... crappy day ... and the inevitable ensuing fallout. take care.

god grant me the serenity

to accept the things i cannot change;

courage to change the things i can;

and wisdom to know the difference.

living one day at a time;

enjoying one moment at a time;

accepting hardships as the pathway to peace;

taking, as he did, this sinful world

as it is, not as i would have it;

trusting that he will make all things right

if i surrender to his will;

that i may be reasonably happy in this life

and supremely happy with him

forever in the next.

amen.

--reinhold niebuhr

[CuteNurseUnl]

FireStarterRN,

Thank you so much for the book and the link. I'm one of those highly sensitive people. It feels good to know I'm not the only one and that it is a relatively normal trait (I thought something was wrong with me). I'm definitely going to check that book and website now. Thanks again!