Is it me? Need guidance and thoughts!

[Tamygutchi123]

Hey fellow nurses!

I'm in a bit of a weird situation at work, and I'm looking for everyone's thoughts. I work in the midwest (currently vacationing in NE), at a fairly large academic center.

I recently switched from a position of ER nursing, to an inpatient position ("stat nurse") where my main job is to provide help throughout the hospital when floors are busy (without being attached to that floor), and to respond to emergencies/codes throughout the hospital, in addition to providing guidance to new nurses on certain procedures, provide guidance, answer questions, etc. Not a bad gig! However, I'm not sure if it's me that's an issue, or if my new manager just doesn't like me. Here are some details regarding the situation:

Prior to changing to my new position, I received excellent reviews, was given "shout-outs" multiple times, and was told on multiple occasions by my supervisors/charge nurses what an asset I was to the floor. Besides the occasional small issue ("hey, FYI this was given to early," that sort of thing), nothing major.

Then I switched to my new position, and a new assistant manager. I get along with almost everybody, but I find this new manager to be rude and abrasive. It is a "my way or the highway" when it comes to him. Here are some examples:

1) Myself and other critical care nurses responded to a code blue. We get ROSC, questionable/unstable BP afterwards. I suggest push-dose neo, resident/intern agrees, I give it (there's a little confusion on the exact dose), but we get the patient to ICU with a pulse. I don't know the outcome after that. At change of shift, manager calls me to the nurses station were we are doing change of shift report, and starts berating me in front of everybody, saying that we "don't do that here!", "how can I trust you to be out there alone?!", something along the lines of "you're not supposed to make suggestions during codes", followed by "you're supposed to be there to help the student doctors through codes." When I tried to explain myself to him, he basically stated "you don't have a side to this story." Later get told by him and their manager that push-dose pressors are "outside my scope of practice." Yet, I can't find any documentation/policy saying that this is true (I can give epi in a code, and epi to a pediatric patient with a pulse, but not this?).

2) Was questioned about warming a hypotensive/hypothermic patient (with heated blanket), because they were concerned about vasodilation and that dropping their BP. Talked to one of our surgeons after the fact, he said that isn't an issue, and to warm patients if needed.

3) Suggested a nurse hold lantus because the patient wasn't eating. Got told that is not my job (I can kind of see this one, maybe)

4) Was put on a "performance improvement plan" because I need to a) work on communication during a cardiac arrest (for the record, I've been given "shout-outs" at work for being extremely good during codes), not completing documentation in a timely manner (never been spoken to about this), not knowing policy and procedure (again, never been an issue), and not knowing my role as a "stat nurse".

5) At a meeting the other day, someone brought up an issue and a suggestion to fix it (totally unrelated to me, just a system's glitch), and the manager just shot down every suggestion that was made.

6) Was told that all "stat nurses" should be on the same level of proficiency, and that anybody going above and beyond that basic level of proficiency could threaten the cohesiveness of the stat nurse group.

7) In fairness, there was a situation the other day that affected me a little bit emotionally, and my manager did check in to make sure I was doing ok, and I do appreciate that he did that.

I've been a nurse for almost 15 years, and have never had an issue like this before. In the words of a close friend, "people don't go from being awesome to sucking." Thoughts? Is it me? Should I quit? Turn in my nursing license and drive for Uber?

Tamy

[Daisy4RN]

Sounds like management just wants everyone on the resource team to be on the same page. Since this is a new position for you there are probably new rules (P/P) that need to be adhered to for this role. Going from one position to another is a change and you just need to adjust accordingly. So, no you shouldn't quit or turn in your license. Just find out what your manager wants, follow P/P and protocols and you will be awesome once again! Good luck. And, hold off on the uber job for now lol.

[TriciaJ, RN]

Frankly, I think your manager is an insecure horse's patoot. He sounds like someone who's clawed his way up the food chain and is deathly afraid he'll be found to be less than stellar. If you are violating protocols the professional thing would be for him to take you aside and let you know specifically what you violated. No yelling, no berating in public.

How are you supposed to "help student doctors through codes" without making suggestions? And no one is allowed to become more proficient than anyone else? You've just entered the Twilight Zone.

Carry on being your conscientious self. The manager will either settle down or you'll hit a saturation point and move on. Resist the urge to start second-guessing yourself. Good luck.

[Tamygutchi123]

19 minutes ago, Daisy4RN said:

Sounds like management just wants everyone on the resource team to be on the same page. Since this is a new position for you there are probably new rules (P/P) that need to be adhered to for this role. Going from one position to another is a change and you just need to adjust accordingly. So, no you shouldn't quit or turn in your license. Just find out what your manager wants, follow P/P and protocols and you will be awesome once again! Good luck. And, hold off on the uber job for now lol.

Thanks for the response. Although I'm not going to turn in my license, I am very seriously considering looking at other positions. But we'll see!

[Nurse SMS, MSN, RN]

He sounds like a jerk, but in some ways I see his point on some of these.

1. Lantus is never held for NPO. Its long acting. Always call the MD for an order if you are concerned Lantus dosing is going to tank the patient.

2. Making suggestions to physician residents may be confusing or just politically not done in your new department. As an ER nurse you are part of the physician's educational process to some degree, but this may not be true in your current role.

It sounds a little bit like you are a strong personality that is stepping on your manager's toes and have enough inconsistencies to make him nervous on top of his own ego issues. (ie: the Lantus thing). Little inaccuracies can definitely interfere with their sense of confidence that you actually do know what you are doing in a crisis.

Going to a new specialty always has an adjustment period similar to that of a new grad. You sound frustrated and baffled. You could try taking a step back, sucking down the feelings of humiliation and partnering with your manager to be more of what he wants - or you could move on if the job just isn't a good fit. Good luck whatever you decide. Its hard to go from being seen as an excellent nurse to being seen as less than adequate. I have been there myself.

[CalicoKitty, BSN, MSN, RN]

Sometimes when my old hospital had rapid responses, it was the RR nurses (probably same as Stat nurses) that would show up first. If there was more than 1 rapid going on, the nurses would be split, but the 2nd physician may just be the hospitalist on overnights. The RR nurses often would 'suggest' stuff to the less experienced physicians. The docs put the orders in. Everyone learns, the patient stays safe.

Lantus, does depend, I think. If their bs was low the day before (same dose) and then going to surgery, the doctors would usually order half dose the night before. But, depends on the clinical picture.