Is everyplace like this?

[Ankh]

On the surface I would seem like the luckiest person in the world. I landed a hospital job - med/surg - as a new grad in a very competitive city and market. I was thrilled when I got the job, excited during orientation. Learning a lot on my own. But I am finding a tremendous amount of ethical issues that just don't sit right with me shift after shift. I know many people will say these issues exist everywhere. But does that make them okay? Do I want to be implicated in these unethical and inhumane actions? This is definitely not why I became a nurse. Here is a shortlist:

- A manager who doesn't care about ANYTHING you bring to his attention on the unit, just throws it right back at you like you are doing something wrong when you say you need supplies or you need help with a problem

- Lack of nurses aides leads to an inability to turn and position on schedule, especially very obese patients

- A hospital that spends money on frilly VIP kinds of things but not on sufficient staffing or even addressing basic safety issues.

- Requests for equipment training that go unanswered

- Disprespectful physicians who literally tell you "not to bother them unless a patient is dying" (and that's a direct quote)

- Safety issues galore including broken equipment, non-working or missing IV pumps and there aren't even enough for the floor so you have to hang most bags by gravity, sometime certain needle gauges or sizes are out of stock so you have to use other less safe ones, full sharps containers that facilities maintenance will not change no matter how many times you call

Here's my thing. People try to say it's okay, it's just the way it is. I'm so uncomfortable with this because it doesn't have to be this way, nor should it. Does survival mean going along with these unsafe practices? What if you are penalized for speaking up? Do you just walk away from all of it? Is there anyplace better to go or is this just the way all hospitals are? This is truly disheartening and sad. I find solutions where I can but I can't force some of these issues and I've grown really uncomfortable with the feeling like I could make a mistake that didn't have to happen if things were run as they should be. So what does one do? Do you make this your "normal" to survive? How do you live day to day in good conscience knowing that you practice in a completely unsafe and poorly managed environment? I swear I wouldn't even send someone I really disliked to this hospital because I wouldn't wish that kind of harm on anyone.

[TorresFNP2b]

This all sounds very familiar. Its this way pretty much everywhere that I've worked. The best you can do is the best you can do.

[Pangea Reunited, ASN, RN]

It can be a little better or a little worse, but it's never perfect. If you're lucky, AND you can prioritize well, AND you can be creative you'll make sure most of the people most of what they need most of the time.

[calivianya, BSN, RN]

I hate to tell you, but everywhere I've worked was like this to one degree or another.

Probably the closest thing to an exception was my first job. Brand new shiny unit with comfortable (easily sanitized) couches for families that folded down into beds like futons, beautiful new laminate flooring, welcoming atmosphere. I always had everything I needed in terms of supplies and all of the equipment was brand new. They had some of the worst, most evil, most incompetent physicians I have ever worked with. One surgeon whose patients almost always got nasty surgical site infections, two who would rain holy heck down on your head if you called them at night (calling your boss and trying to get you written up kinds of holy heck), and hospitalists that couldn't even figure out how to order potassium replacement, just crazy stupid stuff.

So nowhere is perfect! I will take somewhere with just horrible, unsafe supplies if they have excellent physicians who have excellent relationships with the nurses.

[applewhitern, BSN, RN]

Your manager may act as if he doesn't care about your requests, simply because this isn't new to him and he has gotten nowhere in trying to obtain proper equipment himself. Many hospitals will claim they have no money to buy new equipment with, and in many cases, that might well be true. Unfortunately, outside appearances do matter. If a building looks run-down, worn-out, old, then who would want to be a patient there? Most of us are used to "making do" with what we have. Why don't you keep sharps containers on your floor so the nursing staff can change it out themselves? As for physician's attitudes, most hospitals will side with the doctor, because that is who is making money for them. If a doctor pulls out of any particular hospital, their patients usually go with them. As far as education regarding equipment is concerned, have you looked in your policy and procedure manual for this? I know it is frustrating, esp. for a newer nurse. Good luck.

[jadelpn, LPN, EMT-B]

You have to remember that hospitals are businesses. Period. And you need to make due with what you have. And yes, there are many, many facilities that are exactly like this. Part of their business is to fluff and buff VIPs. You would be equally if not more outraged to discover how much your CEO gets paid, the various "bonuses" that the senior management gets, and the kind of PR garbage that most of the money is spent on.

Your manager is a middle manager. So he can only take things to the upper management and hope for the best. And nine times out of 10, it will get him exactly no where. Except that the nurses will be held accountable if there's full sharp boxes or not enough supplies. So when you go to him, ask him if you can help create a plan to make sure needs are met. If there's a problem, there is a solution.

Where are supplies located on your floor? Is there materials management that can bring an order if someone puts it in? How about a running list of items, and the unit clerk puts an order in 2 times a week?

How about the CNA's are told that their priority is that they need to stay on a turn and repo schedule q 2 hours? If there's patients that can be set up to wash up independently, that can be done rather quicker than a full on shower. (and some would say that if they are well enough to shower, they can go home). That they go down the line of patients in 2's. That nurses get their own vitals as part of the assessment process and CNA's can assist patients instead?

If pumps are broken, what is the procedure? Who do you contact when that happens? Find out, and follow the process. And go onto the company website of whatever equipment that you are having issue with in using and print the brochure. Again, this is all things that the ward clerk could help with.

I am not sure what is unethical or inhumane. Unorganized and lacking in proper planning seems more like it. A pump is a luxury item. There is no reason (unless you have critical meds) that you can't hang to gravity.

Know your resources and how to use them. If an MD is not willing to get phone calls, then your charge nurse I am sure is quite used to this, and be sure that your patient requests are in her hands before MD rounds. Even if you could institute a MD request sheet.

You will notice that these things are everywhere. It is the most recent culture of nursing. And of healthcare in general. Things only change when the Joint Commission is due to visit, or there's a VIP tour of the unit.

I would advocate for obese patients to have PT and OT consults. How do they move at home? If this is not LTC, they need to reach a functional level to go home. And if they have 24 hour care that turns and repos them every 2 hours that is one thing, otherwise, see what they have done, can do--and employ other disciplines.

Bottom line--Think outside the box, use your resources, advocate for function, find out procedures by--using your resources--and find out what you need to be doing to find a solution. If there's a full needle box, find out where the keys are, where the boxes are, where you put the dirty full box--and change it. Find out how your patients move themselves at home. They need to be active as they can be in their function. Learn how to count drips--assuming that your IV's are all going to be on gravity--and if you get a pump, even better!

You need to try and adapt to what you have. And advocate where you can.

[flying_ace2]

Add on top of all that co-workers who go out of their way to stab each other in the back, an "every man for himself" work culture, and a charge nurse and nurse manager that gossip about other nurses/staff behind their backs, and you could be describing the place I work in (with some changes in terms of equipment used, etc.). I have only been there a little over a year, fresh out of nursing school, and I have already had enough. I start my new nursing job outside the hospital next month - while no job is perfect, it's going to be a lot less stress, no more 12 hour shifts, and a few of my nursing school friends work there already and have given me the inside scoop about how much they love their jobs and the work culture. Plus, it's quite a raise! I'd try to hang in there for a year if you haven't already - that one year of experience really does help to open doors, some of which were unexpected to me. I've heard that the other hospitals in the area here are similar or worse to what you're describing, which is part of the reason why I have no intention of ever working in a hospital again.