Hi, I have been employed at a local hospital for 4 months now. I work a general med surg floor and I am hitting the point where I feel unsafe and like I am screaming at a brick wall.
We often get ER patients who meet sepsis criteria (we have a protocol) and within 3 hours fluids need given, with a lactic drawn, and an antibiotic. During ER report I tell the nurse these things need done before pt can come to the floor. Her reponse is that they can't get an IV. We had to page the supervisor and complain and suddenly she has an IV in. Then we had to call the dr after she arrived and get the orders (after the 3 hour mark). He was told he didn't know her labs were that critical. This happens, often. We actually have a frequently filled sheet to add admissions that shouldn't have came to our floor... is this normal? To have to take unsafe pts at least once a shift?
No one between days and nights knows policies for AM procedures. I've tried to be proactive and ask for a sheet, but no one has done anything. So during AM report, I am always yelled at for doing something that no one knows to do.
Advice is absolutely terrible. I will ask how to approach a situation and be told "I dont know" (from nurses for 30+ years) or "don't worry about it." Example: distended abdomen with fecal management system and decreased output from it. I asked how to know if its clogged or not in right or how to irrigate it and was told to not worry about it.
These are just a handful of things I've witnessed.
There is just no continuity between what I'm scolded for during days and what I'm told at night. We often get patients meant for ICU or a telemetry floor, neither of which we are prepared to handle. Our DON actually stayed late one night to lecture me and tell me I should have RRTd a stable patient when she came to the floor, as they shouldn't have came there originally. (Not any blame on the supervisor or ER for sending her like that)
Are a lot of nurses on your unit newer? When I'm on a floor with a great deal of "institutional knowledge" (aka experienced nurses), I feel so supported and safe. But when I go to a floor manned by a bunch of newer nurses, well, it can be much more chaotic. Sometimes, newer nurses don't even know what they don't know. Everyone of us was (is) new at some point and we make mistakes, miss things, and doubt ourselves. However, it's not ok to be nonchalant about it.
It's mostly 50/50. We have a good amount of seasoned nurses, and many around 5 years who are confident in their own choices. Most of the seasoned nurses actually respond with "wow I don't know what I would do in that situation "
I appreciate all these comments. I don't want to give up on my first hospital job, but some nights have left a bitter taste in my mouth. My biggest concern is that the next few years will shape who I am as a nurse and that this isn't going to help me become the nurse I want to be. I know no place is rainbows and butterflies.
Specializes in ICU/community health/school nursing.
I have often asked for and received wrong advice I knew wasn't safe for the patient. Example of this is getting an order at 10pm at night from a specialist. The computer flagged it as an interaction with an SSRI. My charge nurse told me to override it as physician aware. I wasn't comfortable doing that because it's not like he physically had that pts med list with him and it was late and antidepressants probably aren't high on the ID drs concern. I ended up digging for info from pharmacy and getting tons of new orders (including telemetry) because the risk of ssri syndrome was actually extremely high and common with these 2 meds.
You're doing a great job of patient advocacy. The first year is definitely difficult, but I don't think it's supposed to be as bad as this. This is a terrible thing to say but if the answers to your questions from your peers are "don't worry about it," and you still are worried, I'd stop asking those people.
are you union? If you are you can fill an "assignment despite objection" form. It basically is you saying that you were assigned a patient even though you stated to charge or whomever that you felt the patient was higher acuity of care, not appropriate for your unit, etc. It won't change your assignment but allegedly it will help protect you legally if something happens.
are you union? If you are you can fill an "assignment despite objection" form. It basically is you saying that you were assigned a patient even though you stated to charge or whomever that you felt the patient was higher acuity of care, not appropriate for your unit, etc. It won't change your assignment but allegedly it will help protect you legally if something happens.
An ER that can't start IV's- weird.
We are union! I will have to look into this.
And the IV was started within 20 minutes of me calling our supervisor.. but our supervisors initial response was "it's not necessarily their job to start them".. on a potentially septic patient... we had to basically threaten to rrt the patient as soon as we would receive her to get her to do anything.
To add to my post, I have also been shorted a sitter, and received a patient assignment. I had to be my own sitter on top of my other 5 patients.
You technically can't be a sitter while carrying a patient load, as a sitter is not supposed to leave the bedside/room of the person being minded. The hospital screwed up there.
IMO, brush up the resume and start looking for the next job. This doesn't sound like a good place to be.
What you describe actually sounds not all that unusual, and you could argue that 'normal' workloads and patient acuity these days is unsafe, but outside of a teaching hospital I haven't known of hospitals that are all that different than this, even the 'good' ones.
Your assignment is 6 patients, which is pretty standard for a medical floor. You're going to get a lot of patients that 'meet sepsis criteria' that don't actually have sepsis, sepsis criteria such as SIRS criteria is not intended to determine who has severe sepsis, it's only intended to narrow down the general patient population somewhat to then look at which of those patients might have severe sepsis where the treatment protocol is indicated, at my current hospital about 60% of admitted patients meet sepsis criteria, only about 2% actually have sepsis.
Your other example was that there no policy for how long an NG can stay in, the reason there is no policy is that it's not a time based definition for when it needs to come out, that's based on a variety of other factors, and in general it seems like you're looking for more clearly defined structure in a world that requires more flexibility than that. Gray areas can be scary, but you'll find at some point that the ability to adapt to each individual situation is far more important.
What you describe actually sounds not all that unusual, and you could argue that 'normal' workloads and patient acuity these days is unsafe, but outside of a teaching hospital I haven't known of hospitals that are all that different than this, even the 'good' ones.
Your assignment is 6 patients, which is pretty standard for a medical floor. You're going to get a lot of patients that 'meet sepsis criteria' that don't actually have sepsis, sepsis criteria such as SIRS criteria is not intended to determine who has severe sepsis, it's only intended to narrow down the general patient population somewhat to then look at which of those patients might have severe sepsis where the treatment protocol is indicated, at my current hospital about 60% of admitted patients meet sepsis criteria, only about 2% actually have sepsis.
Your other example was that there no policy for how long an NG can stay in, the reason there is no policy is that it's not a time based definition for when it needs to come out, that's based on a variety of other factors, and in general it seems like you're looking for more clearly defined structure in a world that requires more flexibility than that. Gray areas can be scary, but you'll find at some point that the ability to adapt to each individual situation is far more important.
But aren't some NGs made of material that isn't safe for extended periods of time? At a NH, I was told no longer than 2 weeks. So I was looking for some sort of basis of information to know for my current location.
And I'm also aware that a lot of sepsis protocol patients aren't truly septic, but when we have a checkbox that should be filled out and implemented by ER (on every patient, per my DON) and they're sent to me without it even started or acknowledged and my DON stays late the next night to scold me for it, it gets frustrating. The nurse to patient ratio doesn't bother me at all. I've had 12 and still managed on our floor. I just felt uncomfortable being my own sitter with an assignment as well-this has happened on multiple occasions. I really do appreciate this other aspect of feedback because there's only one other closeby local hospital and I don't want to burn any bridges this early in my career by quitting somewhere too soon.
But aren't some NGs made of material that isn't safe for extended periods of time? At a NH, I was told no longer than 2 weeks. So I was looking for some sort of basis of information to know for my current location.
And I'm also aware that a lot of sepsis protocol patients aren't truly septic, but when we have a checkbox that should be filled out and implemented by ER (on every patient, per my DON) and they're sent to me without it even started or acknowledged and my DON stays late the next night to scold me for it, it gets frustrating. The nurse to patient ratio doesn't bother me at all. I've had 12 and still managed on our floor. I just felt uncomfortable being my own sitter with an assignment as well-this has happened on multiple occasions. I really do appreciate this other aspect of feedback because there's only one other closeby local hospital and I don't want to burn any bridges this early in my career by quitting somewhere too soon.
Often the easiest way to create a sepsis protocol is just to have check boxes that then produce orders such as the fluid bolus, but this isn't an acceptable way to initiate sepsis interventions and is specifically recommended against by the current sepsis best practice recommendations, so if you're being expected to bolus every patient who pops positive under the SIRS criteria then the appropriate thing to do would be to refuse to initiate an inappropriate order and point this out to your DON if they have issues with you providing safe and appropriate care to your patients.
I haven't ever worked at any facility that filled every sitter request, ideally a large number of patients could use a sitter but usually sitter availability is prioritized to the most in need of a sitter.
You've got a clear idea of how nursing and patient care should work, which is important, you should always be aware of where the care you're able to provide and your workload compares to how it should work, but unfortunately that doesn't mean that you'll always be provided with a workload and environment to provide ideal care.
Unfortunately my knowledge of when to impliment it and when not to isn't great. But we have been told to impliment it on any and all patients meeting it. And many times my charge nurse of the night is also telling me the same-to follow up with the needed orders and fill out the papers ER should have started.
Do you have any advice for resources, as I am struggling to find good ones on the floor? Maybe any good online sites or references I can brush up on, any clinical books to keep on me at work?
krissyycupcake
13 Posts
It's mostly 50/50. We have a good amount of seasoned nurses, and many around 5 years who are confident in their own choices. Most of the seasoned nurses actually respond with "wow I don't know what I would do in that situation "