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.
OCNRN63, have you worked with suicidal patients recently? I'm curious because your questions make it sound like you haven't. I've had many 1:1 suicidals, never had a psych tech with them. There was always a CNA or a non-healthcare sitter with special training, except in the ICU. The only time I had a sitter in the ICU was when they were almost ready to transfer out. The rest of the time the patient was often sedated for medical issues, or in the fishbowl room where the whole unit could see if they were up to anything. I often had to cover the lunch break for the sitter in M/S myself. It's a good way to get charting done. Having a psych tech sit may be a regional thing. I like the thought.
ThePrincessBride, what you have described is intolerable. It's up to you whether or not you are the change agent. In your place, I would have refused to sit and cited abandonment for your seven patients. I also would have written up the charge nurse, night manager, house supervisor, admitting office, and whoever else was in on the decision to let that happen. Since you weren't able to do any of that at the time, I would call the corporate compliance line and make a report. I would also write a censorious email to the unit manager with copies to the DON and to the VP of Nursing. I would still write up every one involved and fill out incident reports for all missed and delayed care.
What you experienced was truly horrible and should never have happened.
I know you are a new grad and are fearful for your job, but if you don't make waves, who will? It will just keep getting worse until someone stands up and makes a difference. It sounds like your whole unit is sitting back and waiting for it to happen. Be the first person.
Just know that there will probably be consequences. Make sure you look up your chain of command and your P&P for reporting and follow them to the letter. And have a backup plan. I would start looking for another job NOW, whether you report or not. It sounds like an unsafe environment.
I'm sorry this happened to you.
BTW - I can't believe, in this climate of cost-cutting, that anyone is stupid enough to pay an RN to sit when there are other options available. That just shows how stupid your administration is.
Specializes in ED, Cardiac-step down, tele, med surg.
Your unit sounds unsafe. Not all med/surg floors are like that. I worked in a state on a step down/tele unit and it doesn't sound like the hell hole you're working on. It's not a rite of passage, your unit is just unsafe. Have you talked with your manager about this?
I would love to institute change, but as a new grad, I am not sure how seriously or favorably my manager and coworkers would take it. However, I do plan on looking through my facility's policies and procedures bringing them up gently to the manager's attention. I will definitely keep a personal document of the unsafe practices on my unit just in case.
Or the next time just flat out say that I can't as no one has volunteered to cover my patients and I cannot have them going without a nurse. If I get called into the office, I will explain to management that my coworkers did not help with my patients while I was sitting and that isn't fair to my patients.
Specializes in Certified Med/Surg tele, and other stuff.
I'm going to beat a dead horse, because I have said this 1,994 times. It is not med/surg that sucks. It's your organization, your leaders, nurse manager and co-workers. Dollars to doughnuts that it isn't any better on the other floors/departments.
IMO, I'd try to stay as long as you can and then leave. I was once in your shoes and leaving was the best thing I did. Now I work in a facility that maxes on 5 pt and we always have techs unless one calls in, but then we limit admits.
I would love to institute change, but as a new grad, I am not sure how seriously or favorably my manager and coworkers would take it. However, I do plan on looking through my facility's policies and procedures bringing them up gently to the manager's attention. I will definitely keep a personal document of the unsafe practices on my unit just in case.
Or the next time just flat out say that I can't as no one has volunteered to cover my patients and I cannot have them going without a nurse. If I get called into the office, I will explain to management that my coworkers did not help with my patients while I was sitting and that isn't fair to my patients.
You do what's right for you.
Just don't let them beat you down to where you think you have to put up with that crap, because you don't.
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.
As both a med/surg nurse and psych nurse, where else would you put a suicidal patient who is medically unstable? When I work the psych floor, I am horrified when they try to give us medical patients because we are not equipped to care for them...even simple basic things like nasal cannulas can be used to choke people and oxygen is a fire hazard and a fire alarm will cause our doors of our locked down unit to unlock (which some patients are very aware of)...and we are not staffed with numbers to provide medical care. On the psych floor I tend to have 8 to 10 patients...sometimes more if we are short staffed, and on the med/surg floor 6 is a normal maximum.
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.
15 minute checks is appropriate nursing care for non-suicidal psych patients...suicidal ones require 1:1; anything less is bad medical care and the hospital would be liable if they found a way to harm themselves in that 15 minute time window.
My recommendation is to stick it out for a year. I am 6 months into my GN residency program although I just passed one year med/surg nursing (first job was a contingency job in a hospital that was having financial problems but it opened the door to my current position). I will say at 3 months, I also hated my current job but after 6 months seem to have been accepted and suddenly my assignments aren't usually so unreasonable as those first ones. I know I went through a period of silent hazing. I must have "passed".
Next time refuse to do the "sitting assignment" on the grounds that it isn't safe for your other patients. What are they going to do? Fire you on the spot? Stick to your guns...I'd rather answer to my nurse manager for why I wouldn't leave my assigned load unsafe and uncovered than explain why someone got hurt while I was sitting. I'd probably start keeping a personal diary at home documenting the shifts that you feel are unsafe or unreasonable. If it is kept current and not a re-creation after the fact, it will hold more credibility if you ever had to protect yourself and your license. I would just state the facts in it like you would in any other official nursing document.
There is a chance your nurse manager really isn't aware of the reality of what goes on during the night shift so don't assume that either...especially if things are run differently during the day when she is present.
(We keep getting in trouble for not taking our whole break and handing off our phones on night shift. Honestly, what exactly are we supposed to DO on that break?...the cafeteria is closed and security doesn't like us wandering the hospital...and the break room is kept dark for those who want to sleep. I'd rather spend the time charting so that I don't find myself in a bind when the 5am med pass starts and patients start waking up in pain or having crisis.)
Whoa - sounds like you work at my job. Seriously tho - it sounds like you work in the lehigh valley area at my job.
That being said, med-surge is hard. The acuity has increased and because there are nurses who don't intend to stay, move, quit, transfer, as soon as we get a good team, we are back to square one with being understaffed.
IF you work where I work, you would know you have to be in a position for 6 months before you move anywhere (from nights to days from med-surge to PACU, etc). I hated my job when I first started (clicky mean girls atmosphere, no one answered my call bells and most nights I am the tech and the RN but miraculously it got easier. I knew where to find things, I could start an IV on a decent day, I could chart in a confused pt. room when I couldn't get that 1:1.
It's all perspective. :)
I did have the benefit though of working somewhere else where it was a team approach, the ratios were lower, the people were nicer it was paradise just too far of a commute.
My advice? Hang in there, try to love the opportunity you have and make the best out of it. You can't worry about what other nurses don't do for you. Worry about what you do for you. Go in, get organized, find a system and make it work.
From the outside looking in, dayshift always look like they have better working conditions. I have worked both days nd nights on MedSurg units. Give me nights any day of the week. Yes there are more ancillary staff and distractions. There are also more chances for something to slip through the cracks because multiple disciplines are entering information on computer, there are three meals to be observed and charted, baths, scheduled procedures that require reports to and from different departments. Yes night shift is usually a tough shift and you must have a good team with the ability to work together and pool resources to get done what must be done. It is also rewarding because if you can become part of that team and build that experience, you can handle almost anything thrown at you.
I've been known to take a smoke break. But I don't smoke.
I'm not understanding why so many here are down on the thought of you quitting before one year, Princess. I quit a horrible unit 8 months in, and it was the best decision ever. I'm at a hospital with an acute care ratio of 4 to 1, great pay and benefits, and I couldn't be happier. I no longer feel rushed, and I can give good care now. I also even have time to pee. Do what I did and quit. Short of becoming the new manager, you aren't going to change your unit. So look out for #1 and get out of there. There are good nursing jobs out there, few and far between as they might be.
icuRNmaggie, BSN, RN
1,970 Posts
Some CNAs make a huge fuss when assigned sitter duty.
It sounds as if the CNAs in this unit dont want to be assigned to be sitters because it interferes with their smoke breaks.