I am a little hesitant posting this thread but here it goes...
I have been working on a busy Med-Surg unit for a few months now. I have been off orientation for a month and while I enjoy learning new things, I feel like I am stuck in med-surg hell.
Today I almost snapped at the day shift nurse who had the nerve to complain about having seven patients knowing I had seven patients, no unit clerk and only two techs for the entire unit (but she had three more techs, a unit clerk). I was also forced to sit with a suicide patient for nearly two hours while call lights went off (did I mention there were two cases?) while the day shift nurses weren't expected to waste nursing time by acting as a sitter.
One of my patients complained she had waited over an hour for someone to help her off the bedside commode. I was furious. I was stuck sitting with a patient and no one bothered to answer the call light. When I am not sitting, I am answering call lights and helping with beeping IVs and ADLs but there are some nurses who will walk past a beeping IV or a patient in need of toileting assistance if it isn't their patient.
There are some nurses and techs who take smoke breaks which forces me to cover their patients as well as mine. That isn't fair to me or the other patients, nor is it safe.
I know all the seasoned nurses are probably going to say "suck it up, Buttercup" for a year but to be honest, I am just so disgusted. I want to be proud of the care I give, but I can't give good care to seven patients while being forced to sit for two hours at a time or having coworkers and techs leave for smoke breaks and leaving me and one other nurse and tech to cover the unit while acting as the unit clerk.
I am currently in the nurse residency program. The coordinator knows the unsafe working conditions but doesn't seem to get it. When told about the nurse to patient ratios, she asked why didn't I just say no and refuse to take on a patient? I don't have the option...I have to take it.
As a new grad, I have no clout. If I go to the manager, I might screw myself over and put a target on my back. Everyone seems complacent and they seem to have accepted poor working conditions, sub-par care and embarrassingly low patient satisfaction scores.
As a new grad, I don't have the power to make any changes, nor do I have a choice. So I have a few options:
1. Quit
2. Ask the coordinator about transferring at six months- which may not be possible as a new grad in the residency program
3. Put my neck out there and try to come up with new strategies to improve patient care
4. Ask to be moved to day shift where there is better staffing and more support.
I will be meeting up with my manager soon regarding my progress...should I even bring up my concerns? She has been manager for quite for sometime so I am sure she is aware of the issues of the unit.
I am sorry about the long post, but I don't know what to do. I am leaning towards trying to transfer at six months or requesting day shift.
As a former psych nurse, I'm horrified that a patient who attempted suicide was placed on a med-surg unit. You don't have time to sit and watch someone who is suicidal when you have other patients. Who was covering for you? What a terrible set up.
I would also vote for moving to day shift where there is more help. If you can somehow manage to stick with it till you get that year of experience, it should make you more marketable.
I wouldn't say anything to the manager. There's something called "willful blindness," and it sounds like that's your manager's way of dealing with everything going on on her unit.
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Every place I did clinicals and the places I've worked - the psych unit won't take a patient until they have been "medically cleared" to be moved to that unit. If you have a medical issue, you stay on the medical floor until it is resolved, then get transferred to the psych unit if you continue to need it.
you sitting with another patient that isn't assigned to you is absolutely, unequivocally ridiculous. I had to sit with my patient one night for one hour and the rest of the nurses took turns medicating my other patients. (I did get charting done so it wasn't totally wasted time).
OCNRN - we frequently got psych patients, OD's and suicide attempts until they were medically cleared, however if they were a 302/201 (involuntary or voluntary commitment) they came with a sitter. Our hospital was trying to do away with "safety sitters" by making the nurse check on the pt Q15 minutes and chart in the room if possible.
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Who has time to check on a patient every 15 minutes?
You really do need to go up the chain of command, too, with the whole sitter incident. It makes me mad now that you mentioned there were techs available but they had you sit instead.... you can do things a tech can do if a tech is out of commission sitting for a couple of hours, but a tech cannot do YOUR duties. That is completely unacceptable.
I have no problems getting sitters breaks myself, I can usually use the uninterrupted 30 minutes of charting time and we don't have techs/CNAs on my unit to cover for them. I give report to someone on my other patient so someone knows I can't get to my other room if I need to. However, if the sitters were trying to take advantage and were gone for two hours, like this one was, I'd be reporting them. And I'm not usually the type to report anyone for anything.
This is in no way, shape, or form an issue of sucking it up, buttercup (although your avatar makes me want to call you Buttercup!) :)
This is unacceptable. I hope you wrote incident reports for every single thing you were forced to miss--every late med, every unanswered call light, everything.
Your charge nurse and hospital are darned fortunate that that hour on the commode didn't give that poor woman a pressure ulcer!!!!!
You really do need to go up the chain of command, too, with the whole sitter incident. It makes me mad now that you mentioned there were techs available but they had you sit instead.... you can do things a tech can do if a tech is out of commission sitting for a couple of hours, but a tech cannot do YOUR duties. That is completely unacceptable.
I have no problems getting sitters breaks myself, I can usually use the uninterrupted 30 minutes of charting time and we don't have techs/CNAs on my unit to cover for them. I give report to someone on my other patient so someone knows I can't get to my other room if I need to. However, if the sitters were trying to take advantage and were gone for two hours, like this one was, I'd be reporting them. And I'm not usually the type to report anyone for anything.
There wasn't an assigned sitter. The staff members had to rotate sitting with the patients (there was more than one sitting case) and neither of those patients were mine.
Because there were so few staff members, nurses had to sit for an hour more at the time. The techs we had should have been made to sit while the nurses provided total care or we should have gotten more staffing from the float pool.
It infuriates me that the other staff are so complacent and don't seem motivated to make changes to improve the situation.
I get what you are saying and I realize not all med/surg units are bad but...this unit is perhaps one of the most poorly run units ever. Travel nurses frequent the unit and have stated they have never worked at a place as horribly understaffed as mine.
I do agree that I should be running to something, but having seven patients, no unit clerk, inadequate ancillary and no designated sitters is enough to make me want to flee the scene.
At this point, I can't quit without seriously burning a bridge and I am too early into my career to be doing that.
Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
Hey AutumnApple,
I get what you are saying and I realize not all med/surg units are bad but...this unit is perhaps one of the most poorly run units ever. Travel nurses frequent the unit and have stated they have never worked at a place as horribly understaffed as mine.
I do agree that I should be running to something, but having seven patients, no unit clerk, inadequate ancillary and no designated sitters is enough to make me want to flee the scene.
At this point, I can't quit without seriously burning a bridge and I am too early into my career to be doing that.
I just feel bad for my patients.
That's a shame things have gone so far down hill too. But I gotta tell you, this unit is not unique. There are lots of places I saw that made me wonder "How in the world did JACHO walk through here, EVER?". lol
We've all had those jobs where the goal is to survive, not do anything we seriously regret, and find our way onto other things. The tele unit I mentioned before being my glaring example of me in that situation. I finished the contract. And yes, I stayed late doing admits because, I was the only one who could be bothered. The manager never complained about the OT, and accommodated me when I had day off requests so that was my silver lining.
That was 13 weeks though, I knew exactly when it'd end.
I just want you to go into your next job eyes wide open and not go from fire to frying pan. The other people here have given great advice on how to improve your situation while you're stuck. No need to repeat it.
Only thing I would suggest that maybe hasn't been thus far is: No OT, not ever. Do your 40hrs, and keep all your time off to yourself to recover.
There are many threads in here about taking care of yourself and what to do on off days. Maybe glance at them, see how people in difficult situations de-stress at home.
Specializes in Oncology; medical specialty website.
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Every place I did clinicals and the places I've worked - the psych unit won't take a patient until they have been "medically cleared" to be moved to that unit. If you have a medical issue, you stay on the medical floor until it is resolved, then get transferred to the psych unit if you continue to need it.
I think I didn't word my response the way I was actually thinking.
I know that sometimes patients are too unstable to go straight to psych after a suicide attempt. But why wouldn't psych send one of their techs to sit with the patient? That M/S patient is going to be headed for psych after being D/C from M/S in all likelihood. Why not have someone sit with the patient who the patient will be seeing when admitted to the psych unit?
My workplace wasn't perfect, but at least they did that. Heck, one year when we were swamped with babies who had RSV and other respiratory illnesses, they sent people from psych to come down and rock the babies, feed them, etc.
I think I didn't word my response the way I was actually thinking.
I know that sometimes patients are too unstable to go straight to psych after a suicide attempt. But why wouldn't psych send one of their techs to sit with the patient? That M/S patient is going to be headed for psych after being D/C from M/S in all likelihood. Why not have someone sit with the patient who the patient will be seeing when admitted to the psych unit?
My workplace wasn't perfect, but at least they did that. Heck, one year when we were swamped with babies who had RSV and other respiratory illnesses, they sent people from psych to come down and rock the babies, feed them, etc.
our psych unit was locked so once the patients went there they didn't have a sitter. I don't know that they had techs/aides to send down. As a stepdown unit we always had several of them on our floor until they're medically cleared or the 201/302 expires.
There wasn't an assigned sitter. The staff members had to rotate sitting with the patients (there was more than one sitting case) and neither of those patients were mine.
Because there were so few staff members, nurses had to sit for an hour more at the time. The techs we had should have been made to sit while the nurses provided total care or we should have gotten more staffing from the float pool.
It infuriates me that the other staff are so complacent and don't seem motivated to make changes to improve the situation.
This, grasshopper, is bull ****. A nurse should never be sitting when techs are available. Somebody either doesn't know how to do staffing or has an extremely distorted view of "fairness"
But why wouldn't psych send one of their techs to sit with the patient? That M/S patient is going to be headed for psych after being D/C from M/S in all likelihood. Why not have someone sit with the patient who the patient will be seeing when admitted to the psych unit
That would be great, but it's not how my hospital does it either. My unit has self-inflicted GSWs, jumping, lying on train tracks. The MICU has intentional drug ODs. The burn unit has self-immolations. All 3 of these units, when I've worked has had one of the unit's CNAs or a float pool CNA to sit.
If day shift nurses had 7 patients, that is not better, even if they did have a few extra ancillary staff. I've worked both day and night shift and 7 patients in the day is simply not safe - so don't feel that switching to days will solve all your problems.
2 hours as a sitter with no coverage for your patients is absolutely unacceptable. Never accept that arrangement again. I know its hard to say anything as a new nurse, but what if one of your patients had a heart attack, or fell, or a myriad of other issues? Your patients were basically abandoned during this time. Hopefully this won't ever happen again to you. But if someone tries to push that on you again, require that they cover your patients.
This is yet another reason why all states need nurse-patient staffing mandates like California has.
greenerpastures
190 Posts
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Every place I did clinicals and the places I've worked - the psych unit won't take a patient until they have been "medically cleared" to be moved to that unit. If you have a medical issue, you stay on the medical floor until it is resolved, then get transferred to the psych unit if you continue to need it.