Just a little help please

[SweetLemon]

Where do you even begin.

So last night was one of the first really awful nights I have had so far. As a newer nurse I knew it was coming but still when it was all said and done I just feel so defeated. To be honest looking back over the night I dont think there is a whole lot I would change. My main focus was patient safety and I feel like if nothing else occurred last night I was able to keep all my patients safe. I am the least senior nurse on my team and therefore do not take on the role as "charge nurse" but because the actual charge nurse on my team refuses to take any kind of responsibility I am left with 1: take control myself: or 2: all hell breaks loose. I work as a psych nurse on noc shift and when things go bad they can go really bad really fast. Sparing you the details last night was such a night. I was understaffed without adequate people just to complete basic paperwork and do rounds. All of my nursing assistants were stuck on a 1:1 last night and I did not even have adequate staffing to let them go on breaks. I ran around in between them trying to give them bathroom breaks while completing while my own tasks with one patient in particular "going off". So my question, I have told administration about this nursing staff I am dealing with and the lack of leadership (not to mention lack of competency in the job) and they don’t seem to hear me. I have also told administration that we do not have adequate staffing to run the unit in any kind of safe manner.... nothing happens. I don’t really know what else to do. I want to talk to the DON because non of the supervisors will do anything about it (got to be home by 5pm and all) but I think in the end if I plan on staying in the job I am in it will only cause a lot of hard feelings and problems (that is if she even listens to me). But on the other hand I don’t think I am going to put up with many more nights like last night... any advice on getting administration to hear ya and getting adequate staffing on the unit.

[Virgo_RN, BSN, RN]

All I can say is tread carefully. Do not expect the DON to have your back.

[keithjones]

just do all communication in writing and after your first few are ignored start to CC everything to your state BON. They will be ****** but at least address your concerns.

[nghtfltguy, BSN, RN]

quit worrying!!!

is that pt still alive???

you will run into hard places in your job... dont count on your charge nurse.... take charge yourself!!

get out of psych and go to the ER!!!

learn what autonomy is all about......

[diane227, LPN, RN]

Put your concerns in writing, giving as much specific information as possible. Keep a copy of what you send. I have worked in all areas of nursing, including psychiatry. One of the problems that I encountered in psych nursing was the often passive aggressive nature of some of the staff. I have worked in a very functional unit with a responsive manager and I have worked in units where there was absolutely NO management at all. Charge nurses were useless and you could not depend on anyone but yourself. You may just have to decide that you will move on to something else. Don't depend on anyone to have your back. What you are probably going to find out is that no one cares and they are not going to take any action regarding your concerns.

[Saifudin]

I am DON in mental health and addiction hospital in Saudi Arabia. I understand exactly the kind of situation you faced and will likely face repeatedly in the future.

We routinely have around 20 constant observations in three units. Some are real, others are imagined. I won't go into the 'medical dynamics' but suffice it to say, as the only American and westerner in the facility I am often at odds with the 'cultural differences and approaches' to issues such as ordering special observation status.

As we are a specialized facility I strongly support and advocate for our patients and my staff. We try to keep a strong connection b/tween nsg adm and staff. The good thing in my position is that I have the full trust of the hospital administration to run the department as I see fit so I have significant decision making authority.

I don't know the organizational culture of your nursing department. I read often in these pages of a divide (real or imagined) b/tween nursing staff and the nsg administrations. I remained amazed at the lack of support and connectedness our colleagues complain of in facilities back in the States.

I agree, that documentation is a very good idea. Avoid editorializing and clearly stating your safety concerns for patients and staff. I would not point any fingers, at least not in initial correspondance and better to voice your concerns over the lack of leadership in a direct meeting with your DON, if you believe s/he is competent to consider your concerns professionally and act upon them after a careful evaluation of the issue. If s/he refuses to act upon it, consider a job search to a facility more conducive to your level of practice and commitment.