Med-surg insanity

[RN@34]

]This post is long so bear with me! I have some gripes I need to share and would like some responses, even if you do not agree.

]First off, the floor I work on does not have nurse manager at present time. So, as you can guess-no supervision and some people take advantage of the situation. Take for instance, our shift is 7A-7P, but what time does one girl show up? Everyday, it is well after 8 before she drags in. Looks to me like if she cannot get there on time for that shift, switch her to the night shift. I have a husband and 2 kids and I manage to make it there on time. I see that situation as her just completely taking advantage of the situation. Then, most of the time we only have 1 PCT/CNA to cover a 26 bed floor, which most of the time is completely full.

Saying that much to say this-I haven't yet made it up to taking a full load of patients, but 2 of the 3 I had the other day were high maintenance. One, was in 4-pt. restraints due to his level of combativeness caused by closed head injury sustained during MVC. During my 12 hrs. he broke his right arm nylon restraint 3 separate times. The other pt. I had was on so many 9am meds that I had to put them in a drinking cup to carry them to her room and she also had 4 piggybacks due at 9am. By 11 am I thought I had a handle on the situation, then my restraint guy managed to reach his member, take it out of his diaper and piss all over the bed. I had already changed his diaper around 8am, but here I went again cleaning him up. We only have that 1 PCT right, and I am doing my best to support/help myself and others get their jobs done and take good care of our patients. Oh, and this would be great had I not walked beside nurse's station and saw our only PCT laid back in chair having a relaxing conversation with our unit secretary. Yeah, I should have probably called her to help, but I assumed she was as busy as I was at that time. My preceptor says I should try to build relationships with the PCTs, but my thought is that I am not there to make friends-I am there to care for patients. Don't get me wrong I am equally nice to everyone, but we all have a job to do and at this point and time I do not have time to be friends with anyone. I do good to get to my charting before 7P.

I know as a new nurse and even as a seasoned nurse there will be days like these, but I feel so out of control, so incompetent. Maybe I am just not cut out for med-surg. We NEVER have enough staff and with only three pts., I am already running around like a chicken with my head cut off. I know, I need to stop being a baby, but I would just like to know if anyone else has experienced these issues, how you dealt with them and does it get any better?

Again, I am sorry this post is so long!

[MedSurgeMess]

Don't worry if they like you or not.....just do the best you can and people will respect you for it. If not, it's their loss! I am having the problem of while I am precepting, the CNAs expect me to answer ALL the call lights, too, since I was a student nurse/CNA also....I try to if I am caught up on charting, but most nights there are more aides than nurses and they want to sit around and BS all night. I am just trying to get them out of expecting me to do a dual role at this point since I am trying to learn my new role. I really don't mind to answer lights and do 'aide work', but expecting me to dump everything so they can sit around on their rears and play computer games and surf the net is a crock of crap. Anyone have any suggestions how to stop this power struggle?

[psalm, RN]

...remember that number of patients does not always tell the story. The acuity is very important. On my floor on nights, we have anywhere from 6-9 and sometimes 10 pts. each. If they were all to sleep, hey that would be great. But if even one of the six is needy with PRN IVP meds every 1-2 hours, trach suction, turning, changing, well, you all have been there. We have 50 beds on our floor, med/oncology. Very stressful, even when we have a med nurse. I have to tell myself after an insane night that I did the best I could with what I had available, I prioritized, and if no one was harmed, I did well.

...I will ask someone who is sitting down for help if I need it. I will ask if they are on break, first as a courtesy. I found out when I was new that the aides were testing me to see how much I would do myself. That is fine if no other pt. is waiting for a PRN or something that only an RN can do. Working as a team takes time. Hope that helps.