I "got the talk" at the end of my shift today sorry long

RN1989 · Apr 17, 2008

Yes, this talk is probably going to be noted in your record as evidence that they have discussed the problem with you and can have a paper trail to terminate you if things do not improve.

You said you took the job for a sign on bonus.....if a hospital has to give sign on bonuses, chances are there are problems that cause high turnover and it should warn you that it might not be the best place to work.

morte, LPN, LVN · Apr 17, 2008

have they ever paid this bonus out to anyone? or are they settng you up to fire you before they have to?

MAISY, RN-ER, BSN, RN · Apr 17, 2008

While it is fresh in your mind, outline the type of assignment you were given and the demands placed upon you that night. Put this in writing and hang onto it, just in case they call you on that "little discussion". Better yet, if it were me I'd bring it to my manager and ask for a sit down. Sometimes it's better to be on the offensive. Insist it go in your file as written, but keep a copy for yourself!f

You may also want to start looking at the assignments others are getting, if you are constantly bombarded and it seems uneven, it probably is. I would make sure you do this now! If you have computers-print the screen, if not, make a table and fill it in daily. No one can take advantage of you without your ok, even in nursing.

Hope it all works out for you,

Maisy

ER06 · Apr 18, 2008

well, I talked in passing with my Manager, she was on the way to a meeting and said she would get back to me later, but she didn't have time so she sent another assistant manager and we talked about what happened. She said she would check on it but that she hadn't heard anything about me and neither had my manager. I talked with another nurse and she sid "oh, you got a talk from the charge" so apparently this charge nurse will do this. And the talks can be ugly I guess at times. Our moralle is not very high in this er and the rumor mill is rampant, I'm not used to that. I found out today that another person quit who started a little before me; I don't know for sure what happened and they aren't talkin'about it either. Thanks for listening.

alkaleidi · Apr 20, 2008

I would like to respond completely differently than everyone else has so far. Why? Just to give a well-rounded point of view from the other side of the fence as a nurse who gets dumped on as a result of other nurses who don't pull their weight in the ER (and that is NOT referring to you, because I don't know you -- I'm referring to my own co-workers).

I think that the 90-day probation time is very underused in the healthcare setting, especially in the ED. I started out in the ED almost 9 months ago, and feel that while I definitely DON'T know everything, or even a portion of everything, I've done really well and my co-workers and lead/charge nurses really trust me with literally any patient that rolls through or walks in the door. Prior to starting in the level 2 trauma center I work in now, I applied at *2* different facilities that told me they would only to hire me in a med/surg type position because I wasn't coming directly from another acute care setting. (I was leaving psych/behavioral health/corrections to take a stab at the ED.) I really emphasized that I learn quickly, VERY quickly, have strong assessment skills, and WANT to learn the ED, but, no luck -- 2 letters saying that they would continue to look for a better fit that already had ACLS and TNCC/TNS and some previous ED experience. Their loss, I think now looking back.

So I have learned a great deal in my new position, and of course have ACLS under my belt and, in about a month, will have TNS (Trauma Nurse Specialist, a course put on by the IL Dept of Public Health for trauma nurses).

In our ED, there are a handful of nurses who do "hog" the float, and constantly require assistance, to make it through a shift. When you come in for your shift, you avoid them like the plague because you know that if you take patients from them, no matter WHAT the diagnosis/chief complaint, you will be playing catch-up and be behind for the first part of your shift. You don't want them in with you during a code -- you would prefer to have an experienced ED Tech who knows what they're doing. In my case, there is one nurse who went through orientation with myself and 3 other RNs as "new to the ED" but transferred from another floor or another facility, and I was the only one of that whole group that didn't come from an acute care setting. This nurse is an example of everything I mentioned above.

Our ratio is 4:1 -- rarely do we have more than 4 patients, and if we do, generally 2-3 are psych evals, drunks, toothaches, or sore throats that require little attention. This nurse rarely takes more than 2-3 patients, and is never given a full arrest, SVT, hot chest pain, stabbing/other trauma, acute respiratory distress, or anything else that requires you to think on your feet, act quickly, and multi-task while managing your other patients as well. They often ask for help starting IVs because they rarely get in anything larger than a 20/22g IF they even get that after 2-3 sticks, always ask the techs to mini-cath, draw blood, take their patients to the bathroom, get their EKGs, put patients on cardiac monitors in the room, recheck all their patients vitals, etc. They pretty much rely on the rest of the staff to be able to make it through a shift. Not fair to everyone else at ALL.

There are a handful of other nurses on day shift and maybe 1 or 2 on nights that are the same way. However, these nurses have been there from anywhere between 2 and 18 years. In the ED. And they STILL don't pull their weight. How frustrating is this?

I am not by any means saying that this is you. NOT at all. But this situation, to the rest of the staff, is VERY frustrating -- as much a compliment it is to feel like your co-workers trust you and are more confident in your skills than you are, it's an insult to know that you are getting paid just as much as a bump on a log who is doing far less than what the typical urgent care nurse does. And those nurses might get great press ganey surveys because they were right on top of their 1-2 patients all night long, while you weren't able to listen to the life stories of your 4 patients and weren't updating them every 10 minutes on delays, and you didn't hound the doc to come talk to them every single time the patient asked, "What's taking so long? We've been here 2 hours!" :rolleyes:

For those who seriously show signs of not being able to pull their weight, I know our ED specifically needs to start USING the probationary period to weed out people who are not going to be an asset to the department. Not saying they shouldn't be offered a transfer to another department, because they very well may be great floor nurses, and in some cases would excell as ICU nurses because while their knowledge base is great and they give fantastic critical care, they aren't able to function in fight-or-flight mode for a constant 12-hour shift.

This is just my :twocents: -- I'm not at all saying any of this applies to you, but merely want to paint you a picture of possibly the other side. The ED is a place where, unlike many floors, you RELY on teamwork. Meaning, as much help as you may require one night, you should be able to give that help back to other nurses, while taking care of your own team at the same time, on other nights.

I don't agree with those who said that anywhere that offers a sign-on bonus has issues that make it a bad place to work, but maybe they do need some improvement. If you received a hefty bonus, I hope that either (a) it was pro-rated so you are not receiving the whole thing at once, or (b) if you received the whole thing as a lump sum, you did not spend it all right off the bat. I think that's a big mistake many make, because who knows whether they are going to like a place after a week or two of being there? If you have truly "not been happy" from the start of your job there (which from your post sounds like about 6 months), it's probably time to find another job. I hate to be the Negative Nelly responding, but it's possible that coddling, pity, and sympathy are not what you need to be able to make the right decision here.

One more paragraph... you mentioned your charge nurse took you aside and spoke with you, then said she would check back with you in a week. What questions did you ask? Did you ask for suggestions on how to improve your efficiency? Have you done a self-assessment and asked yourself "How can I get better?" or "What areas do I need to improve?" or are you taking everything that your charge nurse and maybe other nurses have said personally and chalking it up to them not liking you/them not letting you in their clique/not being happy there anyway? I think that should be your first step -- there are tons of posts under this topic regarding new ED nurses who are questioning their skills, feeling like they aren't catching on, etc and maybe checking out those posts would help you out. Or, if you have questions about things you need to improve on please ask! If you are spending too much time with your patients, talk to your preceptor or charge/lead or assistant managers and let them know you WANT to get better but need their help. Apply their suggestions and see how you do. And please don't spend the next 6 months somewhere you STILL are not happy -- life is far too short to spend 36-40 hours a week miserable!

ER06 · Apr 20, 2008

Dear Alkaleidi,

Thank-you for your reply. This current ER that I work in has a ratio of 4:1 and they don't give a rats ass what they give you. I could have all 4 sick sick pt's in which I usually do. And I'm talking real sick like head bleeds, cva's, uncontrolled a-fib and septic or just plain septic and needing pressors or a person who keeps flipping in and out of svt with no warning and I could go on. And this isn't even in the trauma bay. I rarely utilize the float RN, because I don't want to be that person that they call "needy" or that they avoid. Now I will call on these resources if it all goes to hell and that night it did but usually that is not the case. And techs in the ED? Whats that? We have TWO in the majors. Two warm bodies for 30 pts in the main ED, which is just one part of the ED. And our techs don't st cath. In addition to everything else, I am bedpanning, walking people to the bathroom, getting food trays if they can eat,etc, etc. Because the tech is usually too busy for her 15 other ED pt's. Depending on who it is, they are busy actually doing work or goofing off. In my last ER that I worked, I was a resource,a reliable member of the team and still have friends and my old nurse manger has said the door is open anytime to come back. But I left to gain other experiences and also it would benefit financially. As far as asking them, 'how can I make it better" to me is an insult. From the get go they( a select group in which the charge is a part of) have been nasty and rude and insulting. I cannot even bring myself to even ask that question when I have been treated so poorly. And I know you don't know me, but I would circle the earth to help you if you needed it that's my nature. I am all about improving my skills and gaining knowledge and experience and I am humble. I know that I am not perfect, but I am good at what I do and you wouldn't believe some of the things I have walked into in that ER; common snese things that a nurse should know let alone an ED nurse. Like a pt who was treated on scene for a blood glucose of 32 and no one re-checked it with an accucheck upon arrival to the ED but instead sent all the blood off to the lab and didn't even do an I-Stat and they had already been there an hour and a half when I had come on duty ( and the lab results were still not back). Of course this was the first pt I go to see and wallah,,, he is diaphoretic!! Accucheck was 52 and an amp of D50 later the world was a better place. I think when it is said and done, I don't like how they run their department. I'm not asking for sympathy or pity, but rather other views which happen to be my own conclusion and is to transfer out; possibly to ICU or perhaps an ED that is similar to my old one. This hospital is a part of several hospitals, lots of choices to choose from. I've had 2 years of ED now in addition to obtaining PALS, TNCC, ACLS and am an EMT. I graduated at the top of my class recommended for Who's Who by my nursing instructor and that's just this college degree. I also went through an intensive critical care internship where I rotated through the ICU's in my previous hospital and I think and hope all of this will serve me well.

caliotter3 · Apr 20, 2008

Any time a supervisor takes the time to talk to you about your performance you should take it seriously and take appropriate action. At least you are now warned. Much better than getting the axe with no idea that it was coming. It is a very good idea to keep track of circumstances in writing. You never know when you may need this info for a rebuttal of a poor performance appraisal or other adverse action.

Anagray, BSN · Apr 25, 2008

Hi ER06!

I understand how difficult it is for you. I work in a very busy ER where 4 patients is the minimum I usually have. Anyway, when you are working really hard and then someone takes you aside (espeically a person in position of authority) and tells you that they think you are not doing well, it really hits a sore spot. I've been there. I assure you that this is going to blow over and I don't think it really means anything. All that had to happen is one nurse comlained (as many people do all the time), so the CN followed up on it. no big deal. Be attentive, be nice, do the very best job that you can, offer help to other RNs, try to cut down on the chatting with the patients (until things settle down) - just get through this period when the spotlight is on you, and things will get back to normal.

One thing I noticed that works for me, when I say to whoever " if you think you have some good suggestions on how I can improve my performance please let me know". As soon as I start saying that people seem to leave me alone.

So, please, don't feel bad. Everyone goes through this at one time or another. Just the fact that you worry about it makes me think of how much you really care about your job.

Best wishes and keep up the good work.

mom2michael, MSN, RN, NP · Apr 26, 2008

Here is my take on the situation.

I had a PRN job, very similar to the place you describe. It was HELL for 12 hours straight. No one cared that you had the last 4 EMS units, if you had a free bed anywhere near you or the hallway that they suddenly deemed yours, bam, there ya go there's another EMS patient that is circling the drain to add to your already 3-4 drain circling patients that you are trying so hard to care for.

Techs, what are those??? We didn't have those. We did total care for our patients including EKG's, R/T treatments and basic needs for however many patients they slammed you with that shift.

No float RN either.

Lucky for me though - our charge usually had 4+ patients of their own so they didn't have time to ream on me or anyone else for that matter, they were barely afloat themselves.

I finally quit. I made great money there, I mean GREAT money for a 12 hour shift. The experiences I had there were out of this world but it simply wasn't worth it me anymore.

Upper management didn't give a crap about the employees. They thought it was feasible to staff us with 4-5 LESS RN's than day shifts, even though night shift there always saw more patient than days and our acuity was much higher.

I hung in there for almost 1 year just hoping each shift I worked it would get better. I finally had it after a horrible night where we just simply didn't have enough staff to go around and we went on divert, not from lack of beds but from lack of staff. Upper management laughed the next morning about it and made it seem like a joke.

I went back to my rural ER. Sure it doesn't get the high level traumas, but we get some here and there. We are busy, we see 50-60 patients in a 24 hour period. Sure that isn't tons, but it's enough to keep us busy and out of trouble most shifts.

My life has been a lot less stressful since I quit that hell hole. Sure I miss the $$$$$ but all I kept thinking was all the malpractice insurance I would have to buy if I continued working there

So, I know how you feel. That job left me totally gutted. I felt like a failure every single shift I worked. I felt horrible that I couldn't provide simple basic care to my patients anymore because I didn't have time. I felt horrible that I couldn't even speak to my families and/or patients because I didn't have time. I felt horrible because I knew that I would be SOOOOOO busy one day that I knew for sure I would make a med error. It really made me doubt my whole reason for being a nurse. Hell, it made me doubt my ability to even be a nurse most shifts. I felt horrible and I felt like a horrible person. No job should ever make a person feel this way!!!!

I wish I had some advice, but if you know you aren't happy and from the sounds of the posts, you are not happy, then I would suggest either going back "home" or finding another unit there and leaving the ER.

Good luck to you!!!!