Just started a month ago, and I have a bad, bad feeling about this hospital...

[Theragran101]

Greetings to all of you lovely nurses,

I just switched to a different hospital, I have been on the job for a month. I already want to leave. During orientation, my preceptor and I had a patient who had a sodium level of 121. I let the MD know, annnnd...nothing. He didn't care. I asked my preceptor if the patient was going to be on seizure precautions, and she looked at me like I had grown a second head. So I gave the patient a bowl of chicken broth with some salt in it, a few packs of saltines and called it a day. The next night? The primary MD hadn't even cared enough to order labs on the patient. At my old hospital, people would be admitted for low sodium levels, would have been put on seizure precautions, all that jazz, but I guess they don't care at my new one. Also, the staff seems to be more concerned with patient satisfaction and avoiding conflict than with infection control; we had a patient with a horrible attitude who pitched a fit when I refused to reheat his chicken wings in the unit's microwave because he was in contact precautions for c-diff, and it would put my other patients at risk. "Well the other nurse did it!" He fumed at me, my response

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was "That doesn't mean it's right, and that doesn't mean I am going to do it." The patient got mad, and wanted to speak with the nursing supervisor, who I called for him. At shift change the next morning, when I was talking about the incident with the next nurse, she acted shocked that I had taken any kind of stand regarding infection control.

My concern is this: I used to work on a medicine floor and am now on a surgical floor. I am encountering some different types of patients on this floor than what I had previously taken care of - patients fresh from surgery wasn't really my old unit's thing. I am concerned that if I stay a full year on this unit I will pick up bad habits. Eventually I would like to become a travel nurse in the not so distant future, and don't want to have learned things the wrong way, which I strongly suspect is about to happen. Do you think leaving my current job to go travel nursing in the next month or two would be rash? I had initially taken the job intending to stay for at least a full year, but I am growing more and more concerned with the way things are done at the hospital I just switched to.

[NursehoneyBeBe]

You have to do what is best for you and your license. Just know that with travel nursing you will be encountering many hospitals like this as well. Follow the nursing standards of practice and do everything the way you learned it in school. If anyone tries to scold you for correct actions then show them the literature to back up why you did it that way. They won't be able to say much. You also have to know hospital policies too and be compliant with them. As far as heating up the food you could have done that for the patient and called environmental services to come and disinfect the entire pantry. Hospitals are chasing good customer service because their reimbursement depends on good hcaps and press ganey scores. Everything is about money.

[HouTx, BSN, MSN, EdD]

It would seem - from the situations you've described - that your colleagues may have a much lower level of applied physiology. I refuse to believe that any nurse would knowingly take any action (or fail to take action) that would result in patient harm. What is the organization's 'chain of command' policy? It would apply whenever you KNOW that action should be taken, but the physician refuses to do so. There should be some sort of escalation process that you can follow. In the meantime, I would also suggest talking to your clinical educator about the need for additional education on electrolytes.

Don't worry about falling into 'slacker' behavior. There is an abundance of evidence which shows what happens when you put someone who is at a higher level of thinking/reasoning into a group that is functioning at a lower level.... he/she may become dissatisfied and unhappy, but it does not result in degradation of his/her own function. However, if you put a lower functioning person into a group that functions at a higher level, she/he will either: a) gradually increase to meet the group level or b) leave. It's fascinating stuff. Here's a reference if you're interested.