I signed up for what???

[jayebug]

I've been a RN for 10 years, and I have to say I'm at a bit of a crossroads. I realize that it's very rare when someone totally looooves their job. I had a professor at college once tell me that it's not absolutely necessary to love your profession, but if it's something that gives you the ability to do what you really love in your spare time, then it's worth it. However, I often find that nursing is so totally mentally and physically exhausting that I spend most of my spare time recovering and/or preparing for the next onslaught. Don't get me wrong, I love taking care of people. I love spending time with them, making them comfortable, giving them the emotional support they need, and providing them with the information that, most often, they didn't have before. That's the part of nursing I truly love-the patients. I find it difficult to recall a patient I didn't like, or at least relate to on some level (and I work at a large, inner city metropolitan hospital, so I take care of all kinds of patients). It's so rewarding, to me, to provide them with even the smallest of comforts like an extra blanket from the warmer, or actually going down to the kitchen to get the lunch tray that was ordered too late, but they were just allowed to eat after a week of being NPO.

Like, I get it. It sucks being a patient. Being trapped in the hospital, with every contact you have from any of it's employees being rushed and cold. Being awakened at all hours of the night for vital signs and blood draws, or to be whisked off to some test at 3 in the morning without really getting a grasp of exactly what's going on. I'm so flustered by nurses who can literally walk away from a patient who just burst out in tears, or label someone as a drug seeker who asks for more pain meds, simply because they asked, without even a thought of calling the doc or the pain management team to say, hey, this guy keeps asking for pain meds, do you think their pain is well controlled? Not that I haven't had a patient who really just wanted to get high, but even with those people, I ask for a psych or social work referral (often to be looked at like I have 10 heads). I've come to this understanding that the nurses who seem to excel in the field or be a favorite of management are those who distance themselves from the patient and remain fixed at the nurses station glued to a computer or a chart.

I guess that's where I falter. My documentation is, well, adequate. I was also trained (actually by an Ivy leauge, level one trauma center) to document only what is absolutely necessary because of studies that indicated that a lot of litigation where the ruling didn't favor the medical institution was often decided from info derived from abberations found in the nurses' notes. I find, in a lot of cases, that documentation differs greatly from facility to facility based on the type of institution and the existing nursing culture therein. For example, when I worked in California, the particular hospital I was employed at insisted that when you documented info about a patient's PICC line, that you included arm circumference, as well as the measurement of the actual PICC line itself from the tip of insertion to the hub. When I worked in PA, the hospital I was at didn't require those particular measurements, but, guaranteed, you would be called into the manager's office if you didn't change the caps every 3 days and document that you did so. The hospital where I work now as a travel nurse, doesn't seem to care about any of those things, or even if the dressing is changed every seven days, but I was disciplined because I didn't specify every type of IV med in the I &O section of my flow sheet, even though I did in my computer charting.

Of course, it doesn't help that I'm a travel nurse and I get an abbreviated orientation. Travel nursing is not really my choice of venue right now, but the area of the country that I call home is saturated with nurses right now and the job market is too competetive (esp. seeing as many hospitals are cutting costs and don't want to pay for a nurse with 10 yrs of experience). OK, so you may say, well, just take the criticism as it is, acknowledge the input gracefully, and move on-don't stress too much. I used to think like that until I was asked to not return from 2 different facilities because at one place, I was pulled to 3 different units in one day, and when I was transferring my last patient out of the short stay area where I had been assigned so that I could work the last four hours on another floor, the doc wrote (as I was wheeling the patient out the door, because I checked the time the order was placed) for a change in IV fluids, so I showed up on the other unit with "100 ccs left in a bag of incorrect fluids", and I couldn't give them the Plavix that was ordered post cath because it was a new unit that didn't have it's own Pyxis and the Pyxis in the neighboring units didn't stock it.

I was instructed by pharmacy and the charge nurse (who was on a different floor, I manned this particular unit by myself) to wait until pharmacy hand delivered it. I called the supervisor and discussed the situation with her, she said she would call me back, but when she finally did, it was only to tell me that I had to move the patient out of the unit, and fast, because in ten minutes, I had to report to this other floor. So, not only did I transfer the patient with "the incorrect fluids", but I failed to give an ordered medication, and the nurse who received the patient gave me hell for that, even though I explained the situation, and offered to walk down to pharmacy and get the med myself. She also complained that my notes were scant but only because I documented that I received the patient from the cath lab whose vitals were stable and that I was unable to obtain the Plavix that was ordered, which I had discussed with the physician and he was aware. I pointed out that I documented hourly rounds and vitals directly on the flow sheet in the comment section next to the vitals, but they wanted this documented on the back of the flow sheet in the nurses' notes. The other facility that didn't want me back stated I refused to give an ordered anti seizure medication. (In both of these cases, nothing untowards happened to either patient.) This particular patient was NPO, had horrible veins, and had a PICC placed because of this, but both lines were clotted (I couldn't flush or draw back on either port).

I called the doc and asked her to put an order in the computer for antistreplase because we were not allowed to take verbal orders for this med. She was very abrupt with me saying she had several patients in the ER that she hadn't even seen yet, and she would put the order in when "she got around to it". I documented that the med was not given, that I informed the doc, and that I even stuck the patient 3 times for a peripheral IV, which I couldn't get, before he refused any more IV attempts. I passed on to the nurse for the next shift, when she asked why the 10p seizure med wasn't given (my shift ended at 11) that I was waiting for the antistreplase. She asked me if I tried flushing the patient's line, and I replied, of course I did, but I was trained not to force it to avoid pushing a clot into the patient's right atria. I even explained this to the nurse manager, who asked me about it the next day and seemed satisfied with my answer, and I was even allowed to work 3 shifts after the fact which seemed uneventful (i.e no one complained to me about anything). When my recruiter said I was listed as a DNR (do not return) by the facility and I asked why, she said the facility stated the reason was because I failed to give the ordered anti seizure medication. I asked if there were any other reasons, she said no. I worked as staff at three different facilities for 2 years a piece and never had an issue or a complaint filed against me. I won an award two years in a row at one facility for having received the most positive feedback from patients via the patient comment box.

I gotta say, being reprimanded, and even fired, for such minor misunderstandings has left such a bad taste in my mouth as far as nursing goes. Now, every time someone even looks at me cross eyed I think I'm going to lose my job, which I desperately need as a single parent who doesn't receive child support. I wish my career choice hadn't led me to this point. I wish I could one of those nurses who everyone likes so much and speaks of with so much respect. I don't have an especially bubbly personality. I'm not usually "popular" (but not unpopular either) amongst my nursing colleauges because oftentimes, they're a much younger crowd (I'm 40), and I'm friendly, cordial, but not overly so. I usually keep to myself, but I work very hard. I rarely hear comments nowadays about anything I'm doing right. I almost feel like nursing has become like a beauty pageant and I'm killing myself to have perfect makeup, a flawless dress, and super white teeth. I guess it's sort of because I don't have a regular job, and I'm only at these places for a short time, and I keep to myself so that the staff doesn't really get to know me well enough to know that if I'm not a fixture at the nurses' station with my nose in the chart, it's only because I spend most of my time at the patient's bedside.

Any advice? I think I need it because I'm starting to get depressed. Thanks

[roser13, ASN, RN]

I think that if you will edit your post to include some paragraph breaks, it will be so much easier to read that you will receive many more responses.

[Reader007]

Yes.

Yes.

Yes.

[TheCommuter, BSN, RN]

I think that if you will edit your post to include some paragraph breaks, it will be so much easier to read that you will receive many more responses.

Yes.

Yes.

Yes.

Original post has been reformatted. Problem solved!

[Biffbradford]

I've been looking for work the past 6 months, trying to stay motivated about nursing, but loosing that battle. Now I read this, and you're not helping! Maybe I should check to see what kind of apprenticeships I can get into. Electrician?

[Esme12, ASN, BSN, RN]

I understood it fine.

I feel your pain. One of the reasons I didn't like travel or agency is that you are the scapegoat for everything. Nursing has been behaving badly for sometime and with the current economic surplus of nurses, nursing administration they can do exactly as they please when they please....and I don't like seeing this behavior. It's embarrassing.

Everything you described I have seen happen and I don't see that you are negligent. Remember as a traveler there are completion fees...some facilities will terminate the contract blame it on the employee to get out of these fees. I've heard them do it. It really isn't you.

((HUGS))

[Caribbean Character]

Could someone summarize the OP in two paragraphs or less? Reading it makes my brain hurt....

[mclennan, BSN, RN]

I don't really have any advice for you. Hospital floor nursing is a quagmire of stress, politics and failure everywhere. That's why I mostly steered clear of it. I stayed on the Public Health and Case Management side of things and now work at a desk, thank dog. If you have your BSN, look into these specialties. Case management is going to be huge. Start racking up some experience with it. Get your BSN if you don't have it and start focusing on some specialty certifications or even MSN. Get OFF the hospital floors.

You have my sympathy. I'm also 40, and the one year of experience I had at a big Magnet hospital, I TOTALLY know what you mean by a beauty pageant! Older or more experienced nurses had TONS of pressure put on them by management to be perfect, were watched like hawks and written up for even the tiniest infractions. They were costing the organization the most money, and I firmly believe there was a whole culture built around pressuring them to quit or be fired. Younger, prettier and skinnier nurses who kept their mouths shut and did the absolute minimum for their patients were rewarded by management - letting them slide on mistakes, being late, calling off and generally being disengaged with any nursing process.

This is why I chuckle at the whole "nurses eating their young" myth, because I've seen it go both ways!

I'm coming up on 8 years of experience and even though I'm pretty much 'locked in' to Case Management, when I update my résumé (I always keep it current and ready, you just never know), I find myself wondering if I should "dumb it down," and not mention my specialty certs or additional credentials until I land an interview....or mention them at all. I fear that in the bottom-line-focused environment of health care today, I'll be seen as a candidate who will ask for/cost them too much money. Why hire a fat old experienced nurse with a string of letters after her name when you can hire a pretty young one who'll take less money? It's really a sad situation out there and often I also wish I'd taken a different path.

Hang in there OP. You have all my hopes.

[casi, ASN, RN]

Sounds like burn out and time for a change of pace. There is so much more to nursing than the hospital. Try dipping your feet into something new.

[jayebug]

Thanks for the support.(Did ya notice the criticism I got for my format? Geez, it's like I'm pourin' my heart out here, but that's exactly what I'm talking about) I think I just needed to hear someone say what you said because, really, I work most of the time until my feet swell and I've had no lunch, and no break for 12 hrs, and I rotate from days to nights. I think to myself, sometimes, that I should go back to school, and maybe further my career, but when it's like this, I just cringe at the thought of pouring more money into this especially when I'm still paying off my undergrad loans. I may sound whiny, but really, all I want is to go to work and feel like I've accomplished something. I don't need someone to tell me that all day, every day, or be nominated for nurse of the year. Just every couple of weeks or so, if someone from the facility (cuz I get thank yous from my patients all the time) would say to me," hey, I really liked that you did (fill in the blank)." It would seriously make my millenium. I think that's what anyone wants from a job-any job. I would get that more from the jobs I had before I became a nurse. To me, that's really sad.

[melcuba, BSN, LPN, RN]

I'm am aspiring rn and know many nurses with 20 plus yrs under their belt. One of them became a facility inspector to ensure everything is up to code. The pay is great and she gets to travel with expenses paid. She was also an instructor for awhile. The other files insurance claims for her job and she still makes her 40 hr. She told me how cutthroat this field is and how many people could try to jeopardize your license. With your experience try other forms of nursing. Hope this helps.

[MatrixRn]

There is a lot going on in that post....First let me say I feel your pain. Nursing is not an easy field.

From your post -- "I've come to this understanding that the nurses who seem to excel in the field or be a favorite of management are those who distance themselves from the patient and remain fixed at the nurses station glued to a computer or a chart."

Yes, there is the management track and the bedside nurse track. If someone wants to move into management they need to be able get a toe in the water and learn the ropes. And yes, while learning some of these new skills they can be distant or may appear to be a favorite.

Does that mean all of them are learning new skills to be promoted? No, there are other nurses who are favs because they are working the system...if that is the case then that is a management issue. You need to learn to recognize the difference between the two. The first example is a nurse who will help you, the second typically will help herself.

From your post -- "I almost feel like nursing has become like a beauty pageant and I'm killing myself to have perfect makeup, a flawless dress, and super white teeth. I guess it's sort of because I don't have a regular job, and I'm only at these places for a short time..."

Like I said up above nursing is tough field not for the weak. We tend to not only eat our young, but also our agency nurses. Shame on us for this....but it continues.

Second, some floors can look like a beauty pageant with each one scraping to be a top dog. In this case you are bumping into their messy politics. Management may be sending mixed signals about expectations, and the staff is running scared. Feel lucky to be an agency nurse in that case.

Speaking of mixed signals that is exactly what you feel that you got from the hospital that made you a Do Not Return. You missed giving a med, and then after working three more days they inform the agency that they do not want you to return.

My clue that you were in trouble was the nurse manager came and spoke to you. The fact that you worked three more days really does not surprise me frankly. Often it can take that long for a busy nurse manager to complete an investigation. For the record, I agree with the others and think you did nothing wrong, but as this whole post talks about.....we do not know the politics involved.

Once a temp assignment is over the agency typically asks for feedback. The info from above can be reported to the agency and from their they can decide on the risk of having you come back. And if it flowed that way the nurse manager would not be the one to deliver the news, in fact often they don't that info comes from the agency.