Just how bad is it out there?

[goldilocksrn]

I am just wondering how bad it is a fellow nurse's place of employment. I want to know how bad I have it in the scheme of things. I will tell you a bit about where I work to compare. I work on a 34 bed step down unit, mostly CHF, MI's, post PTCA, CABG, drips, etc. We are currently a department manager, and our assistant doesn't have a clue as to what is happening on our unit. She is supposed to be charge nurse, and she shows up 15-30 minutes late every day. We have a 6:1 ratio, and our staff is skeleton. We have float nurses from PEDS and OB to staff us, and sometimes we have travelers. We have had major incidents on the unit, and a pending lawsuit (that we know of) I just wonder-is it like this everywhere?

[Jay-Jay, RN]

Scary stuff! God, let's DO something to keep this from happening!

My own experience with ICU: I was working as a PSW, assisting a vented pt. with ALS whose care was just too demanding for the RN's on the unit. (I had my RN at the time, but obviously, was not qualified to work ICU! However, the agency I worked for begged me to take this asst. because they though I was one of the few with the knowledge to handle it safely.)

The ICU was dividied into two sections, each working independently from the other. At one point, there was one nurse covering my section, all the rest were at supper. A patient started to crash, and in desperation, the nurse pulled me away from my patient, and asked me to sit at the nursing stn. to answer the phone, and watch the monitors! I'd had no training in telemetry, but a lot of the data on the monitors is self-explanatory, and, of course, alarms would go off if anything serious happened...

I was there for a good 20 min. before the first nurse came back from supper break. Luckily, all the other patients remained stable during that time...

Oh, yes, should add that the patient who crashed had to be intubated for a couple of days, but survived...

[ May 04, 2001: Message edited by: Jay-Jay ]

[Kris10lnC]

Jason,

about the LPN med administration thing?

The facility I worked at told me that theyre just meds. and they oprate the same way. 8am and 9 am scheduled meds are given from 730-1145. when I told my ADON that meds for 30 was more than I could handle, and that I didnt feel good about myself and that it was "half -assed" nursing, she told me that I couldn't be meticulous, and that maybe I wasn't meant to be a nurse. This facility also "lost" MARS with mantoux records on them , when they hadnt been read*--------,so I guess I'm off to walmart.

[Mijourney]

Hi. Years ago after just after PPS hit, it got so bad in the hospital setting compared to what I started out in that I had to leave it. When you are being asked to work charge on a unit with patients you have minimal experience with and/or no interest in caring for because you have an RN license, you leave. When you consistently receive the patients with the highest acuity because you demonstrate high work standards and everyone else just wants to get by, you leave. It was bad then, but from your posts, even with advanced technology, its worse now. I don't believe I'll be coming back to join you.

[Q.]

Unfortunately, my teaching hospital is quite bad - at this point. And not only for nurses, but we lost our techs as well.

I work Labor and Delivery. We have about 180 deliveries a month (a small hospital has 60 - a HUGE one has 300) Our unit was equipped to handle about 75-80. We took over another wing from a med-surg floor to accomodate our census. We don't have enough labor beds, or EFM monitors. We often have to decide which patients require monitoring more than others - hmmm...let's see, does the epidural patient need it more? How about the pitocin drip? Wait, maybe the Magnesium sulfate patient needs it - how about the VBAC (lady partsl birth after cesearan) it is horrible.

We do mandatory overtime about 1 a week. We use travelers and agency staff, no in house help whatsoever. It is common assigment to take an unstable preterm labor patient on magnesium, 2 mom-baby diads (which both aren't breastfeeding well and the babies are jaundiced AND coombs positve) as well as a rule-out rupture of membranes, which, did I mention? She's also been bleeding heavily and her last ultrasound she had a low-lying placenta.

Our OB techs who assemble delivery instruments, stock rooms, and, most importantly, assist the MDs with vacuum extractions and scrub for C-sections, all quit. We have 3 on staff - many of them pull double shifts - or, we simply don't have any on any given day. If we had a crash C-section, let alone TWO, one of us would have to scrub and alot of us haven't scrubbed in years - also, which nurse is going to scrub in? The one with the assignment I mentioned above? Who's going to circulate? My blood pressure is rising just thinking about this. And then, to add to the fun...whoops in walks in from the ER a twin mom who is 6cm dilated and both fetuses are breech - then she breaks her bag of waters in the elevator and she has thick meconium. To be it plainly, my unit just SUCKS right now.

[PhantomRN]

We all make choices. If you don't like the floor you are currently on then try to change it and if you cannot then find another floor or hospital that is more nurse freindly. That is exactly what I have done. I tried for months to change policy to make staffing safer, it was a no go. Not because we didnt have the staff, we did!! Management did not want to spend the money.

I do not feel the need to tolerate crap. If it gets to deep where I am now I will be off looking again. I have little loyalty, I know, but then they have taught me well. Sadly.

[Dplear]

THANK YOU PHANTOM.

As the old saying goes if you can not take the heat, get out of the kitchen. I too have worked places like that in the past and said enough, this is not the only place to work and they cannot make me stay here, after all it is not a prison...it is only a job. I finally found a great place to work...fantastic wage and a great staffing enviroment...max 4:1 with PCA and unit clerks and housekeepers on all shifts. I always have someone to take my vitals and keep the diapers changed for me. All they ask in return is that i help them in kind when they need it, which I gladly do.

[princessangel]

Things no better in the uk.on my first night duty in Accident & emergency we had a lady die in a cubicle, with in view of the whole department, and no one noticed because of pressure of work with other patients. We frequently have 20+ patients sleeping over night in the department as there are no ward beds available, and still have to take minor cases and offer a full service to ambulance and GP referals. Our employers have just decreed that in order to meet the time limits the goverment has imposed for patints waiting for planned surgery , that we will have 25 'ringfenced'beds i.e. unavailable for admissions, each night. So how do we provide an A&E service with all the cubicles,theatre and resus bays full of sleepovers? and the corridors full of emerging patients? And all these to be looked after by 5 nurses and 1 HCA. Mistakes will be made and no doubt the nurse concerned will be held responsible wholely by the authorities.

[ May 07, 2001: Message edited by: princessangel ]

[Q.]

I would like to mention - that I DID leave that floor full time, and work in a clinic now, as well as a smaller hospital with better staffing ratios. However, I still remain on staff at that teaching hospital to maintain my skills - the smaller hospital doesn't do high risk deliveries and I'd like to keep those skills up as well.

I refuse to allow a hospital, no matter what staffing is like, to force me to give up my skills that I worked so hard to get. I just try to limit my time working there and hope that it will improve one day. Until then, I still feel justified in complaining about it.