How long do you stay at a job you hate?

zmansc, ASN, RN · Apr 8, 2014

My first question would be do you feel like you are able to treat your patients safely? If you are having issues with the safety of the patients, then I would not hesitate to bring that up to management and if not satisfied with the changes, give my notice. I would be tactful in how I did that, but I would also be firm if it involved patient safety and my license.

Assuming you feel like the care being provided is safe, then I would suggest one of two paths depending on how approachable management is:

1) Approach management with a set of issues and solutions that you think would improve the flow and improve the patient care. I always suggest having this in writing so you have had a chance to formulate your ideas. Evidence to back up your suggestions is always a plus as well. If you have co-workers who also share your concerns, getting their buyin on your suggestions would be a good step prior to approaching management.

2) Look for another position that is able to show you they are not as bad or worse in these issues before you turn in your notice.

I would always suggest option #1 first. Even though many have a fear of approaching management, if done right it almost always turns out better than they expected even if the problem isn't solved to their satisfaction.

godbless-yute · Apr 8, 2014

Thanks zmanc. As far as patient care, I feel like I can take care of my patients, but they aren't getting my absolute best. By that I mean, I'm still very careful with meds and thinking critically about the patients situation, but when it comes to the simple things of taking an extra two minutes to listen to a story ms soandso started while I was starting her IV, I can't. I feel like from the time I walk in to the time I clock out each minute is full of stuff. As far as management I just kinda feel like I might be too new to bring up this type of stuff. At the same time, I want things to improve as soon as possible. This is why I'm trying to get a feel of what other ERs are like so can recondition my mind if the problem is me.

utadahikaru · Apr 9, 2014

In my experience, every ER is different. It's very difficult to compare one to another strictly in terms of patient ratio because so many other factors come into play, such as what software is being used, how critical the patients are, how much support staff do you have, etc.

I have to say that your past job sounds like some people at the top are really using their brains, and that's really the way it should be at all emergency rooms. It's not uncommon for me to get two ambulance patients at once, and the only real reason for that to be happening, is because no one at the top is thinking ahead and coordinating patient flow.

Personally, and I'll probably offend a lot of people by saying this, I think the problem is that ER's should not be run by nurses who do not have higher education in management and a proven track record of success in previous management positions.

emtb2rn, BSN, RN, EMT-B · Apr 9, 2014

Personally and I'll probably offend a lot of people by saying this, I think the problem is that ER's should not be run by nurses who do not have higher education in management and a proven track record of success in previous management positions.[/quote']
Ahh, but then there's the old conundrum of how do you get management experience if you don't manage?
I can also get squads & triage pts at the same time. Almost always d/t lack of communication up front.

zmansc, ASN, RN · Apr 9, 2014

Ahh, but then there's the old conundrum of how do you get management experience if you don't manage?
I can also get squads & triage pts at the same time. Almost always d/t lack of communication up front.

I agree, I actually think my ED's management team is top notch, and they are RNs w/o previous mgmt experience who work very hard to learn and improve their mgmt skills on a regular basis.

Communication is the key for not swamping a nurse. We had a new triage nurse swamp one nurse they other day, and we just had to have a teaching moment. It will probably happen again, because when someone is new they do stupid things. But, in general we flex to figure it out.

I'm glad you feel like your giving safe care. I've worked at places where I don't think they give safe care, and I had to quit because I wasn't going to do that to the patients or risk my license being in a situation like that. It just wasn't worth it to me.

In that case, I would suggest that even if you are new, you still can bring up proposed solutions to problems you have identified if you do it right. I would try to get buyin from others who have been there longer, identify solutions as well as problems, and write up your suggestion so that it shows that your intention is to help improve.

jallen326 · Apr 12, 2014

Each ED is different and so I think that maybe you should give yourself some time to adjust to your new surroundings. You mention that you want to maybe move further south. The ER that I work in there is a patient ratio of 4:1 but at night that tends to change to 5 or 6:1. It has 16 main ed beds and 6 fast track beds. There is one over night doctor and then a mid level that leaves around 3:30 am. The fast track usually closes around midnight or whenever the last patient gets out, then everyone waits to be seen in the main ed. I have worked both night and day shifts and I prefer days. I am curious to keno if you are in central or northern florida? I am looking to relocate up there.

paramedic-RN · Sep 5, 2014

Yea your old place sounded great, the only ER I ever worked at (which I hated every minute of and left after 7 months) if I had 4 open room omg watch out. No mercy. I would get 2 direct beds at the same time and then 30 mins later a new pt and 20 mins later another pt. the stress was off the charts, the turn over at the place was very high.

tech1000 · Sep 13, 2014

Your first one is so similar to my job that I wonder if we're at the same place. I'm traveling now though and am finding that I was SPOILED at that job!

five_apples · Sep 26, 2014

On the question of how long, I would give it at least 6 months, if not a year.

Where I work:

2 triage nurses if fully staffed, with EMT if fully staffed. If not enough staff might have 1 nurse 1 EMT or just 2 nurses. At worst, just 1 nurse & no one to greet incoming pts.

Beds; 20 in main ED, 10 more in obs (also for psych/ETOH), 2 trauma/code bays (3rd level), 5 beds in fast track. One nurse in fast track, 1:3 in highest acuity level area in main ER, 1:4 in moderate, 1:5-6 in obs.

2 docs & 2 midlevels during the day (until 11pm), 1 doc 1 midlevel at night.

Anyone takes EMS radio calls, triage nurse assigns beds to external pts, charge assigns to ambulance, so it really depend on how good the triage and charge nurse are individually, and how well they work together. Not rare to get 2 pts at same time, sometimes ambulance & triage, a lot of times multiple triage pts come into assignment at once. Rarely is there an extra nurse with now assignment just helping around with ambulances.

Help with criticals is not anchored by any protocols or hard rules, really depends on who you're working with.

EMTs 1:6 if staffed, but could be 1:8 and even 1:12.