Just don't know what to do anymore!!

[foxc1121]

I have only worked at one hospital as an RN (am still a newbie, almost one year as an RN now!! ), so I have no other experience to base this on to say this really stinks. I am relying on other nurses to let me know. I am really exhausted right now having worked one 16 hour shift and two 13 hour shifts right after, but I really would like some feedback and advice.

Three days after I passed my boards I started working on a tele unit. I was told during my interview process I would get 4 patients, no more than five, based on acuity. Almost one year later, I can honestly say that I could handle 4 patients with my eyes closed (hurray for me!) I am up to 6-8 patients none of which are based on acuity. Some days I can get 4 out of 6 or 8 patients that are total care. Now I am really thinking that if I wanted this kind of patient load I would have gone to a med/surg floor. I have a running joke with other nurses and CNAs that a requirment to be on our floor is you need to be either half dead, a psych patient (really - I have had to call security on patients!) or drug seeking.

Management is now saying that we are a med/surg tele floor. I am taking care of patients that are post op lap chole, drug overdoses, post op/pre op D&C, non cardiac monitored patients, prisoners and pre-op/post op ORIF (we do have an ortho unit), you name it - with no cardiac history.

I could go on forever and if this was the worst of my situation I could deal with it, however.....I was one of 6 new nurses hired at one time - we were all classmates (I know, I know...horrible for the existing nurses!! and should have sent a red flag up in my head). We are in the process of switching over to computerized charting, so for how everything is paperwork, paperwork, paperwork. I spend more time doing paperwork than I do with my patients. I discovered that my managers were pulling all nurses bedside charts and making copies of them. One nurse already got fired for her "poor documentation". Granted, I don't know the extent of her situation, nor do I want to know. I just feel sorry for her, knowing that she had been a nurse for over 10 years and patients had nothing but rave reviews about her (I understand now that she has a lawsuit pending for unlawful termination.)

Needless to say ALL of us, even nurses that have extensive experience are walking on egg shells.

Anyway, I just feel that nursing is hard enough - management is on the floor constantly - everyone is nervous. I understand that documentation is super ultra important but people have gotten written up for not giving a walky talky, well hydrated patient lotion.

Before I can finish one discharge, admission, whatever, I am hit with another. It is no wonder that I am there later than I should be finishing up paper work. I have been written up three times for incidental overtime. I can't take it anymore - they want perfection - perfect documentation, perfect customer service - yet when I run over I am written up.

I know many nurses that clock out and continue to work so as not to be written up. Sorry, but I don't work for free, not to mention should a patient try to hurt me or I get hurt still delivering patient care - guess what I was off the clock.

Please some one give me some advise. Is it this bad everywhere?? I have really only hit the tip of the iceburg with problems.

Dee:cry:

[medsurgrnco, BSN, RN]

It is this bad many places. But you were lied to when you applied for the position, and I've only had that happen once. Time to look for a better situation elsewhere. I personally know of several hospitals where there is a 4:1 or 5:1 ratio on days & nights in med/surg. You should be able to find a better situation, esp. if you are willing to relocate (which hospitals will often pay for).

[Cindy-san]

Staffing ratios seem to stink almost everywhere tbh. I'm not gonna lie, it's likely to be just as terrible elsewhere.

What concerns me is whatever management seems to be up to. That charting pulling, write-ups and firing are sounding off alarm bells in my head. Who knows what might end up on your record.

Take your license and run.

[Ginger35]

This may vary state to state - but if you are still doing work and not getting paid for it - then the employer runs the risk of a labor law violation. At least that is what I have been told by HR from 2 different employers in 2 different states.

Sounds like a toxic environment. I have worked under similar conditions and it stinks.

Recently, I managed a med surg floor and the nurses were upset with me because I came up with a staffing matrix to keep the ratio at 5:1 (max)(small hospital). They thought that this staffing was "horrible." It is interesting to note that they are making nurses at other placed take like 8 patients a piece on a regular basis.

Regardless, I hope that you are able to find something that has better staffing than where you are at. I think it is time to have a look at what all of your options are.

Sincerely

Ginger

[RN1982]

They lied to you when you interviewed. You should let your manager know this and let HR know. I would transfer if I were you. You need to think about you. It's your license and only you can protect it. The longer you stay, the more at risk you are. Similar situation happened to my friend when she was hired to work on a progressive care unit. Manager said that ratio were 3:1 which was a big fat lie because I worked on this unit and it was more like 4:1. Patient acuity was so high, like ICU high. Oh and "never say never" to a fifth patient. I resigned from that unit and so did my friend.

[showbizrn]

I feel for you, foxc1121

and commend you

for your dedication to patient care

but...

You're written-up for INCIDENTAL OVER-TIME?

FOR COMPLETING YOUR WORK?

THAT'S CRAP!!!

Get out of there

as fast as you can!!!:igtsyt:

Since your co-workers

are former classmates

You probably give each other

alot of emotional support

and that's a good thing

But...

I would take my nursing skills ELSEWHERE!

[llg, PhD, RN]

If you have survived this long in that job, you are probably a compentent nurse with a lot of positive qualities that other employers would be interested in. In other words, you have a lot of options ... and it's time to start exploring them.

[foxc1121]

Thank you all for your responses and advice. I know I need leave but I am nervous about what my NM would do. 2 of my classmates have already left. One transferred to the ICU in the same hospital - she gave them a months notice. The NM wrote her up within that month for something silly. I later found out that if you get written up you can't transfer for another month. The other nurse transfered to another hospital system, which is not an option for me because I am under a two year contract with this particular hospital system.

My other classmates attitudes have changed. They have bonded with other nurses, and gossip - something I don't feel comfortable doing (but guess what I got called at home by my NM and was accused of gossiping about her). I get along with everyone and help out but I just don't know who to trust anymore. Alot of other nurses watch what others do and run to the NM and let her know of mistakes. Then you are either called at home, written a note or called into her office.

Everyday we have new posts in our lounge of new forms we need to fill out in addition to our regular charting, I swear that I am overflowing in paperwork. We are required to do beside reporting (not a problem) the NM and ANM are on the floor most days in the AM and PM watching us and if we are not in the patient rooms we are approached and questioned. We are required to do rounding on each patient at least every two hours and are required to sign a sheet posted in each patient room proving that we have done it and at the end of each shift it is collected and given to the NM. We are required to do 12 hour chart checks and the ANM and NM check each chart to make sure it is done. Every day the ANM and NM go into each patient's room and question them about the nursing care they are given. Again, I don't know if this is done at other hospitals so I may be complaining about something that is common place. Please let me know.

My NM is the one that interviewed me, not HR, she was the one that told me about the patient ratio. When she was questioned about it by my other classmate (we were interviewed together) the NM said she did not recall ever saying that. Well here is another kicker - the NM sets nurses up. She will ask another nurse to go into a patient room and push the call light, just to see how long it will take the nurse to respond. Well in one particular situation the nurse that was called did not go into the room because she saw the other nurse already in there and figured she was helping her out. Well, it was reported to the NM that the nurse never went into the room and she got called into her office about it.

I swear that my NM has ears everywhere - one nurse was heard complaining that she was clocking out and continuing to work. The NM got wind of it and told this particular nurse that she would never, ever suggest that we do this because it would be against the labor law. When the nurse asked the NM what she could do about it the NM told her to figure it out and work on her time management issues (I was told the same thing when I asked)

I know that no matter where I go there are going to be things that I am not going to like, no job is perfect. What I do not like is the fact that I have worked hard for my RN and am terrified that if, no when, I leave she will find something to write me up about or fire me and it will be on my record. Also I know that when I leave she will ask me why - I don't want to burn my bridges anywhere - what should I say - I am planning to work on another tele floor - so saying that I want a different experience won't cut it. Help!

[MAISY, RN-ER, BSN, RN]

Your nurse manager is taking advantage of your newbie status. RUN, DON'T WALK!

It's one thing to have an occasional extra patient, its another to have it every shift. It's not safe for the patient, or safe for you license.

This manager is counting on your inexperience with other hospitals and nursing on keeping you in line. No one should punch out until their work is completed-it's against the law. If she has so much time to be spying on her workers, she should help out!

Good luck, you sound like you've gained alot of experience....get out before YOU GET BURNED OUT!

JMHO

Maisy

[foxc1121]

It's funny you should mention that...the ANM helped out on the floor one day - not a full shift, only till 4:00pm. She told me the next day that her husband had to rub her feet and she was exhausted. She mentioned that realized the perfection management was asking for from the nurses is impossible to achieve. I heard from other nurses that day that when she left she left alot of work as well as paperwork undone. Since that day the ANM has backed off...but just a little.

[Ginger35]

I would say that if you are able to handle those kind of patient loads - I agree with what others have said. You have gained a lot of experience and sharpened your skills. Get out while you have a license.

Now, if you fear that your nurse manager will be vendictive about you transferring to another department by writing you up and stuff like that to keep you on the unit. I would have a meeting with HR first before putting in the paperwork to transfer and tell them your fears if you plan on working for the same hospital. Perhaps, HR may have an "employee representative" to help you. It isn't right for the nurse manager to do that unless it is legitimate. Keep the conversation factual - things you can prove. You have to be careful what you say to anyone in HR - my experience with them is that they are there to protect the organization from a labor law violation - not you.