How to let go of work-home, shiftism, witch hunt

Indy, LPN, LVN · Aug 28, 2006

Sounds a bit like my unit. How many patients do you typically have? (At a time, not all totaled though when you d/c and admit a bunch you tend to total 'em in your mind) How long have you been off orientation? Are you being dumped on? 'Cause it sounds to me like there might be some dumping going on here, not sure.

My tele unit is really scarce on techs as well. There is ONE for nightshift. So between 37 beds, spread out in 3 units, and 7 nights a week, I might work with her once a month or so. Dayshift is actually similar, I think. Days takes off with a bang and it's a rush in the AM to get all doc's orders done, baths, etc. Days feeds 3 meals, lots of insulin and blood sugar checks... then from 3p to 7p it's a rush of discharges and admits, usually makes their heads spin.

Nights is a wee bit more laid back; we do have time to comb the charts a bit more thoroughly IF no patients crash, IF they'll go to sleep and stay off the call lights for an hour or so, and IF the late-rounding doc doesn't come by at 8 pm and take an hour of my time ordering procedures on half the patients for the next day. The workload is different. Nights tends to do what we perceive as a whole shift of work between 7pm and midnight, spend the rest of the time up to our nose in paperwork trying to figure out what we did, and at 4 am, start waking people up and get moving again.

So when nights is able to point out that things weren't done during the day, IF they corrected them, then that means they had a decent night. And things can get done at night sometimes that were missed. If it looks worse than when dayshift left, if you come in and the code cart's parked in the hallway (or worse yet, missing altogether), dynamaps in the strangest places and nurses running back and forth slurping juice in desperation at 0630, well it's been a night that we'll take home and have nightmares about.

It seems to me there is a nurse or three on days that... never seems to have her act together. One of the ones I'm thinking about can't admit she's wrong, so that learning and correction never takes place. Drives me bananas. One of our newer ones I can tell, is being dumped on left and right because she's very conscientious and still winds up leaving stuff undone - we usually tell her to just go home, we'll fix whatever it is. I don't know how her time management skills are, because I'm not working side by side with her. But I do know that if you don't have it tied up tight and focused, and your lunch bag ON your desk some days so you can grab a quick bite, you won't get out on time no matter what shift you're on.

Suggestion for leaving work at work: process it. Whether it's talking with your sweetie, talking to the dog, keeping a journal, or whatever. Get it out of your system so you can rest and enjoy your time off.

SitcomNurse, BSN, MSN, EdD, RN · Aug 28, 2006

Sounds like you need constructive measures to help you get things done. I did this. I invited the DAY shift in early, so see what the NIGHT shift is trying to acomplish. so, instead of hearing when I get back to work, This and that didnt get done, they saw the best possible world in action, Emergency transfer out... patient injury, med pass, morning routine madness... So, when I say.. this didnt get done.. they understand. I tell them outright, it just didnt get done. They know I am a good nurse(thats the other half of it) so I am not pushing my work on others, or trying to elude the evils of a decubiti dressing... No matter how we try to deny it, we do work in a 24* work world, and if I didnt get to it in my 12 hours, maybe you can.

"Every day" is not time specific(our majority of dressings are done on days, of course, for MD evaluation as needed). If you know you are doing a good job, and not slouching, then jsut get on with it, and carry that confidence into your report.

you know you did your best. Thats all we can ask, and remember...

Maybe God turned on the FurOfFire channel for a giggle and is giving me a break.

catlady, BSN, RN · Aug 28, 2006

Golly, I thought maybe I wrote that post in my sleep, because the OP sounds exactly like what I'm going through on my tele unit. I've been there for six weeks; I've had three weeks off orientation. We do have nursing assistants, but I can almost never find them, and it seems like almost every day the manager takes away one of their responsibilities and gives it back to us--because one or another of them screwed up. Gee, if I screw up, can I make someone else do my work for me? Now it's our responsibility to do the baths, too, because they aren't getting done. Exactly what is the CNA supposed to do?

The charge nurse makes rounds in the morning and basically lets them know they have an RN waitress to take care of their needs. I get to hear that so-and-so didn't get their bed changed yesterday, or so-and-so needs to have their light answered faster. Even though they know I spent the day running, didn't even take a bathroom break, much less lunch, and that I always answer lights as soon as I can--if I know about them. We're supposed to have cell phones so the patients can dial direct, but often there aren't enough phones to go around or the patients still buzz the desk and the message doesn't always get to me. Heaven forbid they could call the CNA, who always has a cell phone, to get the patient a cup of ice (I must do that 20 times a day, including for visitors who stop me while they're roaming the halls ), while I'm trying to admit my cath lab patient. The other day I was admitting a cath lab patient (alone, of course) and trying to page the doctor for pain med orders and my other patient (whom I admitted from ER a few hours earlier with no help, and had spent much time with) threatened to go AMA because nobody got him to the bathroom, and it was all my fault. I spent 45 minutes personally showering a third patient, and my CNA couldn't bring her BSC while I'm admitting another patient?

I walked into a situation on Saturday where my patient had a K+ of 2.6 and Mg of 1.7 and nobody had done anything about it, and found both her arms infiltrated. She had come two days earlier from ICU with one arm completely blown. But the night nurse decided that he wouldn't put the ordered 10 mg of Lidocaine into her potassium bolus "because it would affect her cardiac status" but chose to run IV fluids concurrently instead "to water it down" and destroyed the 22g and the remaining arm. But he stopped running boluses at 1 am, so she went all night with only one bolus for the 2.7 K+. And he didn't report the followup K+ of 2.6, despite protocol that we call for K+ less than 3, so I'm calling at 7:30 am for multiple boluses of K and Mg, and then begging pharmacy to mix my K and Mg together so we can replace simultaneously, while my charge nurse is desperately trying to get another line in somewhere, and find a doctor who can put in a central line. So I wasn't all over my other patient who had come from another floor with CP and a troponin of 20, who had a TO during the night for a cardiology consult but nights didn't ask who they wanted for the consult, and so they didn't do it; so it didn't happen until the attending came through in the morning and wrote for the consult; by then, the cardiologist had already come and gone at 8 am and had to be brought back to the hospital. I think the charge nurse wrote three incident reports just for my morning.

I walk in every day expecting the worst, and usually getting it. I always hear about the negative. I don't hear about the patient who hugs me and tells me I'm the only one who showed her any caring, or the one who was livid about the care she received from the previous shift but now feels confident that she's going to be taken care of as long as I'm there. The patients tell me, but they don't tell anyone else. I got torn apart on my second day of orientation by nights over something minor, and when I said it was my second day at the bedside after six years away, I got looked at like I had three heads. Nights is very hard on us, but I think they live in a glass house. I worked nights for a long time, so I have no illusions about what it's like on that shift.

I can't seem to get my organizational skills down, although I made myself a worksheet on the computer and that has helped a little bit. My background is mostly ICU and long-term care, both of which have a different organizational skillset. I go home exhausted and my head is spinning and I'm having delusions/hallucinations when I wake up in the night or in the morning (had one this morning and yesterday, too). The tape never stops running. I replay it over and over until the next shift and the tape is dubbed over. I now have "sparks" in my lower extremities and am losing the feeling in a couple of toes, similar to what I had when I went to survival school twenty-five years ago.

Oh, and I start school tomorrow. Not sure how I'm supposed to log in and do schoolwork when I'm putting in fourteen hours away from home and coming home a wreck, but hey. What am I thinking?

gonzo1, ASN, RN · Aug 28, 2006

I left med/surg for ER due to all of the above. Never enough time to get everything done that should have been done. I was a fairly new nurse but the very experienced nurses had all the same problems and complaints that I did. Administration continues to wreck havoc on the nurse/patient ratio in their never ending attempts to eek out one more dollar at the expense of good pt care. The nurses on our floor sat down numerous times with administration telling them that things weren't safe and admin would pat our hands, say they care and still things have only gotten worse on the floor since I left.

I find ER to be a lot safer place to work in spite of the fact that the drunks and psyche can turn on you at any time. Just learn to keep yourself close to an open door.

I may get flamed for this but I think administration does careful studies to see how they can balance nurse/patient/deaths ratios and will load up nurses and CNAs until there are just too many deaths to explain. And since most people have no idea what really goes on in the hospital that may take a very long time to come to the breaking point.

It is truly a very sad situation.

Antikigirl, ASN, RN · Aug 28, 2006

With only a few exceptions, I always stay till my work is done! This is allowed by the hospital in most circumstances where a shift duty is missed and you need to do it for continuity of shifts. That is nice, and typically I am able to get all my tasks done within 30 max after a shift (helps to have the next shift on duty to get things done quickly without having the responsiblity of your pt load).

Also, it helps to have a mindset and encourage the mindset from one of being mad at other shifts, but getting things done FOR THE PATIENTS well being and health! Focusing on the patient or reminding people of that fact tends to do wonders at times :). We get busy and forget that sometimes...

I have also made up a list for management of things like this before, and put it in without my name. Or will talk to the shift about a list of improvements we think would be better and write down other peoples suggestions and submit that from the shift (so it isn't just on my head!). I make that positive and not blaming or negative...that is big time important (got to use your key words and everything positive and proactive!). If you don't the war between shifts can be worse! So this needs to be done with a crud load of tact, and a bunch of well...pre-emptive kissing of rear! LOL!!!!!!! ( I tend to do that well in writing if I have to!).

OR..you can ask for a time to have a round table with your shift with a manager! That way everyone can voice an opinion! I find if it is controlled that it can be a very positive experience (controlled against cat fights or too much complaining and anger!).

Good luck to you and your fellow staff members!

csiln · Aug 28, 2006

After reading these posts, I'm not sorry I only lasted 2 months at 2 hospitals and resigned and may never actually get to practice nursing. If nurses with years of experience go through these kinds of experiences, how could I ever expect to learn to find nursing a positive experience. Just sorry I spent so much effort, time, and money to come to this. Thankfully, I have a husband that hasn't put pressure on me to earn wages to pay back my school loans. I have an application in at a clinic, but doubt they will hire a new grad.

Furoffire · Aug 29, 2006

Well I am not surprised with the feedback. Carrying around a cell phone is unreal. We wear tracking devices and the CN can locate us at all times as well as the monitor tech and patients call lights ring in the room we are in.

I have had all the precepting one can have, I am actually glad to be on my own. I have a detailed computer sheet I made up that has all my patients meds, treatment, gtts, etc on it with the correct times. It does not take long for the sheet to become worthless because by time you D/C someone, get a quick admit things change very fast. I try and get there a little early, get report, look at the Kardex, meds etc. do VS & assessments and an entry on the DAR so I think my organizational skills are well but the phone calls, family, tests, D/C's can throw one off real quick. It's a lot of pressure to stay on top of things and I still think the average person would not be able to work under these harsh conditions.

The last time I worked we had a very competent ward clerk that did a great job than the CN noted the orders and dealth with the time consuming things that take away from bedside nursing. Now the CN is basically a bed broker, the ward clerks are new and overwhelmed missing many things so things fall back on the RN.

I miss having competent nurse aides that could do the VS, do baths, weight people, pass trays etc. Now its a one man show not to mention updating the careplans daily and making an entry on the education sheet which many choice not to do.

I just can't understand though how the NOC shifts (some) can't have an attitude that its 24/7 and what I can't do (I prioritize my care and some things just don't get done because it is impossible---I feel like a short order cook picking up doctors orders and attempting to do them, some doctors come in several times a day on each patient and write a long list of new things to do, so is the day shift responsible for everything and the Noc shift comes on to it all done and have potlucks and chill? I see many casseroles, chips etc, brought in but on days like I said we're lucky to get one break.

I'm now beginning to get nightmares of my job, my latest is showing up late since I must wake up at 0400, leave at 0500 to get to work 15 minutes before the shift starts just to get that head start.

I am getting sick of becoming a victum and the witch hunt when not all things are perfect. We have 4 patients to one RN, many times we start with 3 and around 0900 the admit comes during the morning rush.

I think as hospitals tighten their belts and things are changing, the media should start showing this and making families aware that they are going to have to pitch in like sticking around and helping with the care like bathing, changing diapers etc. Most families are understanding and prefer to help but you have those that are primadonna and just sit there asking a ton of questions that are for the doctor and wanting that second cup of coffee.

What really is getting to me is that my second probation is coming up and I will be asked, "Well how do you think you are doing?" What am I suppose to say? I'm trying to keep my head above water? Like I said many of my co-workers, even those that have been there a long time are stressed and fed up but living in a small community and no where else to go, we're like a couple of trapped animals, having to make a living.

I just don't understand how thier is a waiting list for nursing schools??? Why not go into computers for instance. Is there some sort of magical thinking about the profession that protrays an image that is not real, some sort of fantasy?

I do believe there are depts. that do not have to put up with this garage but in my city one has to wait until someone drops dead.

Someday, if I get a chance to change professions where I can make less but still get the benefits, which are excellent, I will gladly settle for some stress free office job in some remote area of the hospital.

Ausculapius · Aug 30, 2006

Furoffire: I worked in IT for 4 years before deciding to enroll in a nursing program at my college.

I think its simply a case of the grass is always greener on the other side.

Have you ever seen the movie Office Space? Watch that movie a few times and you will get an understanding of how many IT jobs are. I worked for a large corporation outside of the D.C. area, so maybe I am a bit jaded.

I found the work to be very dry and unrewarding. Sure, you put up with a certain amount of BS in any job. But at least you as a nurse can walk away at the end of the day no matter how poorly things went and say "I accomplished something meaningful." Which do you consider more meaningful? A. Saving someones life B. Recovering someones accidentally deleted spreadsheet

Another reason I left is due to job security and the job market in general with the IT field. I remember about two months before I left my last IT job,

I went up to another floor to fix a problem and ended up meeting a woman who happened to be there filing papers. Anyway, we talked for about 10 mins and as it turns out she had just graduated from college with a 4yr degree in Comp Sci. She couldnt find a job, so she had to get some temp work making 10 bucks an hr.

Sorry to rant, but IT is not all that it is cracked up to be.

CMarie,RN · Aug 30, 2006

I have worked MICU for almost 5 years; rarely have 3 pt's, mostly just 2 - yet have struggled to keep up, had to have a "moment" behind the linen cart so I could release sobs after my 24 yr old cancer pt (mother of two toddlers - same ages as my boys) died on my shift; have gone home countless evenings at 2100 hrs when my "shift" should have ended at 1900 because I was too busy with high acuity pt. care that I had not done my narrative charting since 0800 that morning . . . then cried all the way home (45 minute drive) because I fell so inadequate, etc., etc. I am one of those nurses that will stay and help bathe the pt if they just stooled at change of shift because I want my pt handoff to go smoothly - it is the patient that matters - and if I was to just leave because "my shift is over", then it is not only the nurse taking over that starts out rough but the patient that suffers . . . I hate it when my patients have to wait to be cleaned but sometimes that is the least of the priorities - although there are a few night nurses I work with that need reminding of that.

Nursing is 24 hours - an unending cycle - and we should all be forgiving of one another when things aren't wrapped up nicely for the next shift (then again - there are those 1 or 2 nurses we all know about that NEVER get their stuff done - but amazingly have played Sudoku all afternoon, never take care of their alarms and can't be found when I need help turning my pt's - it just burns me up!!!

But then there is the little COPD'r that is bitchy to all the other nurses but tells me that I am "alright", and the family of the DNR pt who had cried on my shoulder and confided in me, the families who express sadness that I won't be working the next day, who tell me that I am the first nurse that has explained things to them, the priviledge we have as nurses of being present and instrumental during someone's most vulnerable moments (emotionally, physically and sometimes spiritually) and be able to meet their personal physical needs with respect and dignity in their last moments. . . I really do consider it a priviledge to be a part of that.

After having worked in the banking industry for 12 years prior to nursing and the hospitality industry for 2 years - - at least I am making a real difference in the lives of others. If you are in the profession to help others then you will do fine - if you are in it because you want recognition or money, then maybe another profession might be better. Best Wishes to you.

RGN1 · Aug 30, 2006

If I can't get something done then I just pass it over to the next shift. It doesn't happen very often but it's an unspoken rule where I work. We ALL realise that sometimes things happen that result in a task not being done and as long as the next shift knows then it's not a problem.

Of course if it was always the same nurse every shift etc then mumblings might start but otherwise it's no big deal. I could understand it being a problem then because that staff may have time management issues etc.

However, as a rule I can't understand why the "caring" profession seems to delight in witch hunting it's own staff!

I don't mind if I have to do something from the previous shift as long as there was a good reason & even then so what? It's the patient 1st & foremost every time!!

ISITFRIDAYYET · Aug 30, 2006

I have only two words to say,,,,,,,,,,Home Health