I had no idea... med/surg vent

Nurses New Nurse

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I am a new med/surg nurse and just wanted to say I hate it. It's been 4 months so far and I have never been more stressed out in my life. I applied for everything BUT med/surg (at first) because I had a feeling that this wouldn't be for me, but as everyone knows, jobs are slim pickings for new grads. My primary complaint is that this is an environment in which you are expected to lie incessantly. Late med administration? Lie or be written up. Couldn't make the pain reassessment in time? Lie or be written up. Stuck with a pt who is tanking for 3 hours until the transfer to ICU? Lie for the rest of them or be written up. Almost every night at the end of my shift, I spend between 2 extra hours charting my lies because there is no time for charting during the shift. Even the experienced nurses are having to stay late with me. And this floor is so busy, it's not uncommon to turn over almost your entire team of patients in one shift. It's insane.

Specializes in Critical Care, Education.

"Lying" in the medical record is falsification. At the very least, this is grounds for action by your BON. Worst case scenario? Your false documentation serves as the basis for (false) billing - this gets picked up in an audit and your & your employer are tangled in a Federal Fraud action. Just becoming involved is enough to get you on the Federal exclusion list.. meaning you cannot work for any individual or organization that accepts Medicare/Medicaid reimbursement. Knowingly participating in healthcare fraud is a crime - punishable with jail time and very heavy fines.

We are all accountable for our own behavioral choices. These choices define our personal integrity. What if a patient was jeopardized because of your actions? Think carefully about the consequences you may have to deal with if the truth emerges.

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I know what you mean. My preceptor got all the papers and meds (signed/dated) done even before seeing the pts. Pain assessment? Just pick a number, write it down, and give the med.

One time during lunch he asked me if I knew the pt has staples. I said yes because I saw it on the note and I went to do the assessment. He didn't know about it because it was not on the shift report.

But I got to say. He never stayed after shift to finish anything.

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i'm not even going to sugar coat it...med surg is the most depressing place to work. ever. this has nothing to do with the patients, more with the staff and EVERYONE always being snippy and having an attitude. I completely understand we have a lot on our plates, but most of my other coworkers pass all their work off to the poor techs, who bust their ass more than a lot of the nurses I work with. The atmosphere on a med surg unit isn't a very comforting one too. Remember always hearing how nurses like to eat their young? well, this is what they were talking about.

They don't care if you succeed or not, and even when I brought this up to the supervisor she dismissed my claims as just being nervous to get to know everyone. Little did my staff know, I come from a very strong psych background of about 10 years with at an inpatient penitentiary as well performing all the initial assessment for patients being admitted into the psych ward. So, you kind of just have to keep acting polite and cordial, make sure the supervisor is aware of how hard you're working.

And as for the meds not being passed on time, either deal with it or become that patient's advocate and make your voice known that you actually care about the people in the hospital, and are making them your first priority rather than denying them their scheduled medications that the Doctor ordered to be given at certain times. I would first make anonymous complaints to another supervisor in human resources or call over to patient rights and responsibilities. At least make it known that people aren't charting accurate information, and you don't want to put anyone in danger by disobeying the rules because the nurses are too busy lounging around ******** how hard their career is.....when ironically, most of them do them do bare minimum to get by each day.

Did I hear right? '...the poor techs...' Really? Someone actually acknowledging that the patient care techs/CNA's sometimes get dumped on with tasks that the nurses just don't want to do? I may faint. **swoons**

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Specializes in ER, ICU.

Med surg is hard work, but I think your issues have more to do with poor management. There are med surg units that are well run. If no one can get their work and charting done then, almost by definition, the patient ratio is too high. I know this might be wishful thinking but can you bring up these issues with receptive charge nurse or your boss? If you are using overtime to finish charting you could do the math and present the cost. For example If 8 nurses who make $25/hr stay 1/2 hour late every day that costs $54,750 per year extra. Otherwise just hang in there until you can find a better place to work. Good luck.

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Specializes in Care Coordination, MDS, med-surg, Peds.

Ok, I am horrified that anyone would seem to condone LYING on a patients record. I would RUN to any other job if I could not get my DON or someone to be aware of the patient: nurse ratio that may be contribbuting to this action. THe Nurse manage should be reported to her supervisor. POOR management of a unit should not result in FALSIFICATION of records. Are you not aware that your license is on the line for falsification, as well as being on the exclusion list?

You didn't state the raito, but I have worked med-surg 15 years in 2 hospitals and NEVER felt that I had to LIE. If I could not get to a treatment, eg, I told the next shift, they did it, and I did the same for them-24/hr nursing, you know.. I feel that the work CAN be done and so there is no need to lie. OMG.. I am honestly FLOORED by this......

>>>>>

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Specializes in Research, ED, Critical Care.

Thirty years later, same sad story - but not every place is like this. You can do something about this. First - nurture yourself. When you are off work - be off. Go to the gym, read novels, fish, hike, swim, watch TV. Eat healthy. Have a variety of friends and interests outside healthcare. Next, every shift - have a smile and have a plan. Outline your priorities/must do's. Who is getting discharged? What time are meds? Dressings? Feedings? Be as organized as you can. Plan in time to chart - DO NOT MAKE A HABIT OF PUTTING IT OFF UNTIL THE END OF THE DAY - know what must be charted versus fluff - read hospital SOP. Start work on time and leave work on time - Everytime, unless you are in the middle of a code. Round on every patient at the beginning - eyes on, if only for a minute. Let the patients know you will do your best to see them every hour. Stay flexible, your plan will be constantly changing - based on needs. But know what you will be doing every hour - rounds, turning, meds, bath, what ever - plan it out as best you can. Plan in lunch/a break/ a drink of water/the bathroom. Most Med SOPs allow 30 minutes before/30 after, so if meds are due at 09/12/14/16, your window is 0830 - 0930, 1130 - 1230 etc. - read your SOP and make this work for you and your patients. Find something to appreciate every shift you work. A patient discharge (finally), a smile, a thank you, a sucessful foley insert, an IV start - anything that makes you feel good and productive. Always be honest. You do not have to buy in to the manipulation/complaining, but you do have to deal with the fallout. Do not join your co-workers coping/cover with laughing off issues - You do not have to participate, and you do not have to comment - smile and walk away, you are too busy and your patients need you, you do not have time to participate. Do help your co-workers when they need it, see one struggle to transfer a patient - help, do not wait to be asked, and ask for help when you need it - can't get the IV? Start asking for help now. It does not sound as if this culture is a new/recent event on your unit - you can be sure that the people who have been there for awhile have reasons for staying, and you can be sure the management/HR are aware of everything - complaining/anoynmous messages will not help you or your patients - and this behavior and the drama it will create will make it worse for you. Remember, you are part of the problem or part of the solution, you cannot have it both ways.Start planning your next move - where do you want to be? What is your interest? How will you get there? Research opportunities. Use this experience as a learning time/ladder out. You can do this for a year, be a great nurse and plan your next move. This time is invaluable and will serve you, and your patients, for the rest of your career no matter where you go.

Chin up!

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I personally would not call it "lying". There is so much documentation and when audited it needs to be "perfect" so that is how the "lying" starts. Who actually remembers exactly when a pain med was given when the MAR is not in front of you? Who actually runs back into a room which is far down the hall to ask "what is your pain # now"? So, you put down a pain score in the computer and guess at approx time, and then next to it put down a better pain score which reflects pain med results. It is how it is done. We have an "hour window" regarding meds. So in order for me to get out on time, I start my 9 pm meds at 8:01 so the computer shows a decent time removal in case I am audited. Working med/surg is often a rough awful terrible job but most hospital paying jobs are hard. It is all about the CORPORATION so just go with the flow and do your best and don't go around telling people you are lying as it will get back to manager.

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Specializes in Care Coordination, MDS, med-surg, Peds.

needshaldol... I disagree. what else is it if not lying... good golly. for instance: What if you put a better pain score, but the pt actually hd no relief, or has an adverse effect from not receiving adequate pain control and then SUES you for the problem ocurring, and you say you asked him at 1400 and he said a 3, and he says, she couldn't have asked me at two, I was in Xray at that time. Lying is lying is lying....and will get you license yanked!!!

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Specializes in School Nursing.

I feel so very badly for you. There is nothing worse than that kind of stress on the job. Please stop lying on your reports or in the charts. I owned a RCF for 18 years and caught a valuable and trusted manager lying on a chart. I just caught it one time, however, knew it had probably happened many times before, and then I could never trust her again. I had to terminate her employment because of the jeapordy she put us all in, including the residents and their well being. I sincerely hope you actions won't come back to haunt you.

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I agree with needshaldol. Yes no check list columns with 20 plus assessments that look good when the chart is audited but have nothing to do with the patient force "lying" or "buffing the chart."

On a busy day I am not going to do CMS checks on all extremities of an otherwise healthy adult in no apparent distress who had ophthalmic surgery! I am not going to spend 20 minutes listening to all four quadrants of the abdomen of an otherwise healthy adult patient in with asthma who just pooped!

I will get flamed, I will get nurses who caught some peripheral vascular disease because they always do CMS on all extremities on all of their patients.

I will adapt my assessments to what the patient has or needs, not the same head to toe on every patient regardless of what I know about that patients history, disease process, meds., etc. But I know I will have to lie on my charting.

Personally I hate the pain scale. I have had patients give me the "look" when asked what number their pain is, I roll my eyes with them and say "It hurts a lot." and they say "yes!" I plug in what numbers look good on the chart.

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Specializes in Emergency Department, Float Pool.

Welcome to Nursing, as a float I hate getting floated to med-surg all the units are hard!!! And can get crazy, you need this foundation to build your career. Even specialize units like ICU have days of chaos where some pt.s are truly neglected because one other PT.s crisis, ask for help! Everyone needs help, if you can't get help you have to prioritize which is more critical. Example my pts IV infiltrated, I also had a lethargic pt with

High ammonia levels. I dc the IV and fluids and attended to my more Critical pt.asked lthe charge to put a new IV in my pt, but she

Was Busy too!!! Before I knew it my shift was over I never got a chance to put a new IV in my pt. so I reported off to the next nurse & I'm 100% fine with that!!! I'm a RN not a miracle worker/Superwomen, always attended to what's important now!

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Specializes in Emergency Department, Float Pool.

Don't lie though if you gave the med late re time it, plus techs and CNAs are barley around at my hospital we do it all!! Pt care labs and ekgs. I sometime sweating at work! I work hard for my money lol

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