maythen 876 Views
Joined: Jul 1, '03;
Posts: 25 (0% Liked)
I work in a small rural hospital in Northern CA. My facility decided to follow the staffing ratio laws (sort of, since it's relatively toothless). They also decided that the nurses don't need any help (at night particularly). Night shift functions with no ward clerk and 1 aid at the most (average of 35 patients). But most nights it's just me and my pts all by ourselves in the hall.
I don't mind wiping a hiney or two. I don't mind any patient care tasks. If I thought it was "beneath me" to take care of people (and all the icky bits too) then I wouldn't be a nurse.
BUT (and i hope you guys don't beat me too harshly) I DO think that my level of education, training, knowledge, etc... is being used unwisely. Perhaps I'm dealing with an unusual pt population, but my pts (almost uniformly) expect the Nurse (not anyone else) to be their own personal slave. Example: "you're My nurse and you'll do what I tell you when I tell you and no more or less" and "You're just like my little slave for the night, I love this hospital" Both are direct quotes from pts I've cared for within the last month, and not uncommon sentiments.
We have patients (routinely) who refuse to allow any care to be done unless it's done by an RN. Apparently it takes a college degree and critical assessment skills to brush their teeth for them.
I really didn't get all this education to wipe your behind. I did it so I could SAVE your behind!
Please don't misunderstand, I have no problem doing pt care. But I often feel that my ability to care for my pts is compromised by my facilities insistance that nurses are capable of handling all the ancillary staff duties, in addition to their own.
I'm sitting here after a VERY nasty shift and I think I'm the only poster who's said this... but poop should not be My job. Answering call lights should not be my priority. Changing your linens, brushing your teeth, massaging your back, wiping your bottom... I've done these things, and I'll do them again, and I don't think I'm "too good" for it. But I do feel that it's not an appropriate use of my skills and level of knowledge. Not when I've got a full pt load of high acuity fresh post ops. While I'm fluffing your pillows and fetching your 7th cup of coffee I've got pts who need my critical thinking and assessment skills...
Just one dissenting voice...
I had no idea how critical these pts were untill after report. The day shift RN was relatively flippant about their status. By the time I came racing out of my resp distress pts room day nurse was long gone. Because we don't have a step down unit, my hospital sometimes uses ICU like a step down. Since the resp distress was supposedly stable and oriented with a 50% venti mask (according to report) I didn't realize she really needed ICU level care. The other pt had been converted from SVT in ER (which normally would have bought him at least an over night in our ICU since he had no previouse known medical problems and no known cause for the SVT). I was not told in report that he was combative, mentally challenged, or blind.
I recieved report (inaccurate though it was) and assumed care. I've had a couple issues where I refused to accept care (the first when I was a brand new grad being preceptored) so I would have done it.
I know I should have filed a report. But, honestly, when I left work that morning I was worn to a frazzle. All I could think of was that I was going to get away from there and thankful that nobody died. It was my 4th shift after 3 REALLY nasty nights and very little sleep at home. I know, it's not an excuse, and that it wont help me or those pts. But I also knew that I didn't have anything left to give right then.
After hearing the rules for the day shift RN and the attempted lecture... well... it was either walk out the door, dissolve in a tear puddle, or leap on the day supervisors head like a rabid squirrel and start beating her senseless (too late). None of those would have helped me OR my patients.
I prioritized, everyone survived. But I just hate the feeling that No One got good care. And the sense that it didn't really matter how inapropriate it was for me... it's not like I'm day shift... all my pts are sleeping right? How hard could it have been?
It could have been worse. But it shouldn't have to be.
cyberkat asked :
Does your hospital have no way to send out critical patients that your hospital can't handle? Why not?
We have transport available. Our sister hospital has a helicopter (which has been used several times this week alone). We also have ambulances available. My hospital routinely ships pts to one of the larger hospitals a short drive away for increased care or procedures that our facility doesn't have the equipment for. These MDs Chose not to send these ICU pts. Transport was available but we are not allowed to transfer without MD orders. Both the ER doc and attending MD flatly refused.
I'm not the only nurse, EVER. We always have at least 2 RNs in our ICU (depending upon how many pts in there), several in ER, and never less than 3 on the floor. Last night there were 5 other nurses besides me (4 RNs one LVN) and one new grad RN being precepted. At least one other nurse (my hall mate) got an ICU pt as well, though she had 4 pts and got her ICU person about 3 hours before shift change. My hall mate is the only reason I'm sitting here typing instead of lying in a puddle of tears. She's been nursing since the 1950's and she saved my hiney last night helping me as much as her own pt load allowed. I'm not sure I or my pts would have survived the night withou her. At the very least I would have probably cracked under the pressure and said something unprofessional to my supervisor, the MD, or the psych pt.
I got the lecture from oncoming day shift charge nurse (my supervisor who was giving report told her to shut up and approved my over time). I'm not sure what the heck was going on last night. My hall mates pt would normally have gone our ICU not because she was as unstable as mine, but because the pt was more step down appropriate ut we don't have a step down unit.
I love my co workers and, for the most part, my hospital. Being employed elsewhere is also an "it could be worse" because both the larger facilities have worse working conditions and more unsafe staffing. I can't move out of the area because husband is finishing his masters program and we Desperatly need health coverage with no lag due to his medication costs.
I'm just scared that this is a new trend I'm seeing.
I've been on Z coils for little less than a year. Really hard shifts leave me sore, but I'm not waking up screaming in pain anymore. (scared my husband half to death).
They're expensive, and in my case didn't last too long. I've already had to get them reglued to the foot base twice and resoled once (which I had to pay for, despite that upon purchase I was assured EVERYTHING was guaranteed for 3 years).
I've had the springs changed out once and the positioning altered twice (free). According to the lady I was using the springs to propel myself down the halls faster and needed a heavier spring than normal for my weight and shoe size to compensate.
They look odd and I've had several co workers make fun of me. They were IMHO awfully expensive. You've got to learn to walk in them and to do this weird twitchy shuffle when cords get caught in your springs (they sell spring covers if you want them). The springs also can get caught on chair rungs (a co worker on springs nearly broke his nose when he did a face plant attempting to run to a code and his coil caught on a chair rung).
But at the end of those 13 hour shifts... my feet are tired but they don't hurt. My legs might be a little sore but I'm not achy or cramping. My posture is better. It even gives me an extra inch or so in height (which isn't a big deal for most people but I'm only 5 foot and need all the help I can get.)
Z coils can be a hassel. But they were worth it for me.
(please excuse all the grammar and punctuation weirdness, I'm getting ready to flop into bed after my 4th in a row and my brain is a little numb)
I'm a relatively new nurse (a little over 1.5 years) working at a small rural hospital in Northern California. I work med surg night shift. We have no ward clerk, 1 aid (approx 40 pts) and one respiratory therapist for the entire hospital (ER, OB, ICU, Peds, and med/surg). Our average pt load is 5 (which I know is ridiculously low for most states, but it's the legal max in CA) and I've never personally had to take care of more than 7.
I recieved report that I had 2 pts that were supposed to go to ICU but we didn't have any ICU beds so they sent them to the floor. One is respiratory distress, the other is a recently converted from SVT blind elderly mentally challenged combative male. I'm also getting an Enemas 'till clear psych pt and an icu transfer (right at shift change) CHF COPD mildly confused female.
All are full codes.
I check my resp distress and she's on a 50% venti mask and satting in low 70's. I call RT STAT, get her on 100% NRB and now she's really struggling, satting in low 80's and attempting to rip off o2. Notified supervisor and MD. MD tells me that he knows she needs to be in ICU and vented, but we don't have any ICU beds and to call him when she codes.
I'll spare the blow by blow details. But here's a basic: resp distress eventually ends up sedated and on 100% o2 BiPap (way out of parameters for floor) with sats that unexpectedly plumet into low 70"s but never get higher than 88% (also has to be transferred to different room because the hall I'm in is dependent upon portable O2 takns due to remodeling). My SVT starts having chest pains, rips out his IV, and keeps spitting Nitro pills while attempting to beat staff to a bloody pulp. My 350+ lb psych pt alternates between screaming her head off and rolling on bed snoring and laughing, my ICU transfer gets even MORE confused and, frightened by BiPap alarming and psych pt, attempts to make a run for it. I recieve an ER pt (no report by the way) vag bleed that needs blood and is weeping hysterically. ER also attempts to send me a confused parapelegic enemas till clear. EVERYONE is incontinent.
Two of these pts were KNOWINGLY placed on floor despite that their conditions required ICU levels of monitoring and care. There are two large hospitals (one owned by the same company that owns my hospital) less than an hours drive away. Neither were on diversion, both had staff and facilities to handle these guys.
I gave report to a day shift RN that is ACLS certified, has over 10 years experience on me, and frequently floats to ICU. She recieved only 2 pts, was PROMISED that she would recieve no others unless they were transferred, and she would be paid as though she was in ICU as that was the level of care they required (this was after I finally got them both stable).
I however, recieved a brief lecture on the importance of better organizing my time because I had not clocked out for a lunch break.
I know, it could have been worse. There could have been 12 pts not just 5. But why is it ok to place ICU pts on the floor? Why was it ok to give ME those pts but not the more experienced day shift nurse?
I've never been so terrified since I started working. The MD and charge nurse knew how unstable these pts were and admitted them to the floor anyway. Charge knew I'm relatively new and gave me this load anyway. I keep telling myself it could have been worse. But it just makes me so angry and frightened feeling that "it could have been worse" is the best I can do. I'm supposed to be taking care of these people, not just madly dashing about attempting to keep their heads above water while I drown.
Is this a normal practice to put ICU pts on the floor? Am I totally out of line for being upset?
My husband had a kidney transplant in high school and his medications supress his immune system. I tend to be a little overly concerned about tracking germs around. I have a large towel that I use to cover my car seat after work (which I keep in a zipped plastic bag). I strip off my clothing and shoes prior to entering the house. I then bag my clothing and set it aside. (my scrubs get washed seperatly in hot water with color safe bleach). Then it's a short march straight to the shower for a good scrub.
I'm probably a little over the top. But the facility that I work with is bursting with MRSA. Now that our big shot ortho surgeon is using great wacking doses of vancomycin as a prophylactic antibiotic I'm betting we start to see a whole lot of VRE in a few more years. :-(
But I also see people wearing scrubs while grocery shopping. I've got to say, I wonder what germs they may be crawling with as they pick over the produce. Then again... I also worry about the shoopers coughing and snotting all over the carts, the little kids who look like they haven't bathed in several weeks, ANYONE who is scratching themselves and/or picking at their skin... It's a pretty germy world. ;-)
I do my best not to bring Super Germs into the house. But I also realize that there's a lot of creeping crud out there in the community. Purel is my friend.
My husband and I don't plan on having children, but we both LOVE weird names. I'd love to name a boy Vladamir and call him Vladdie. I'd love to have a girl and string along several names like Freya Winter, Twilight Dreaming, or Pyretta Blaze. I know they're strange and impractical. I know that it's a teasing waiting to happen. But in my ears they sound lovely and unique. Maybe that's what those moms are thinking when they give their kids unusual names.
Kids are cruel when it comes to teasing. There's no name you can think of, no matter how unusual or traditional, that a bully can't mangle into a taunt.
But, on the other hand, sometimes you wonder if the parents were deliberatly cruel. I went to high school with a girl named Cocaine and her brothers Jack Daniels and Harley Davidson.
I attended junior high with a boy whose first name was Driver and his sister Nussins ('cause "she was just a cute widdle bundle of nussins" according to the mom). My moms best friend named her daughter Holly Bush. One of the girls in my 4th grade class was Tafetta Ann Gold, her sister was Silver Ann Gold and their mom was Emerald Ann Gold.
One of my best friends in high school was named Ruby (which isn't so bad) but her last names was Mount. Everybody teased her and said she would end up a porn star.
Last week we had a couple in our OB (Oleg and Nona) who named their beautiful baby boy Lucifer.
I'll probably ruffle some feathers here, but we rarely see many "good families" with alot of kids. My state has alot of welfare Moms who keep having kids for the money & food stamps. Krista
The protocol for handling these issues is to write a "Quality Controll report" that gets sent to admin. Unfortunatly the result of these is always a note back on what *you* did wrong, with occasional "helpful suggestions" which are usually impossible to implement due to staffing or else outrageously unsuitable for the situation. In the case of this gentelman I was informed that I must have transferred him wrong, that I should be doing it with two staff members to assist me, and that if I had just been taking better care of his needs then he wouldn't feel the need to act out. It was reccomended that I spend more time in his room talking to him about what he feels would make his stay more "satisfying". I nearly vomited over that one!
There's an "ethics council" meeting at the end of this month. and the nurse I usually work with is part of the committe. He's one of the few BSNs we have and the hospital really listens to him. So he's taking some of my concerns to them for review. Maybe that will help.
But, then again, maybe it wont.
However, my BSN friend is leaving for hospice soon. He wants me to come with him. I've always wanted to do hospice at some point, but thought I would need at least 3 or more years of acute care. I'll only have about a year and a half of experience when he leaves. But more and more it's looking like the avenue I'll be walking.
That's a whole new set of problems :-) LOL
Those are really great suggestions. But the problem is... most would need staff to implement it. My hospital is VERY small. It's not uncommon for a single nurse to have the whole hall. There's only one aid for the entire facility. Most nights I could probably scream my head off and no one could hear me. Last night was actually a really unusual night in that we had 6 nurses. Most nights there's only two or three of us. (that's if you don't count ER, CCU, or OB which are more heavily staffed but also seperated by locked doors and long hallways).
When I enter a room I'm doing it all by myself. Not neccesarily because it's safe or because I want to, but because if I dont then no one else is going to either. It's a small hospital, but it's spread out. We can't even go get help, because then that other nurses patients don't have anyone that can hear them. We also are not allowed to "leave our hall". So if there's only one person per hall, and no help... you're on your own.
Fortunatly, that particular patient finally did get placement. I doubt he's reformed, but at least maybe he's somewhere that has enough staff to deal with him, or administration to back the staff up. Please don't burst my bubble, I'm hoping really hard. :-)
We keep getting these notes from admin about how we're not supposed to move pts without assistance. Which is great for day shift, who have staff. But at night we're pretty much forced to either break the rules or else get another nurse to temporarily abandon her pts. We're also supposed to be using special lift boards and stuff. Which our head admin locks up in her office at night, and which requires at least three people to operate properly.
Maybe if the *entire* staff could pull it together... but I don't see that happening. The day shift thinks nights are sitting around on our butts eating bon bons while all the pts sleep. Night shift is angry because day shift has all the extra staff (and quite a few of the day shift are openly disparaging of night crew). Admin are all wearing magic customer sevice glasses.
It's just really not supportive in any capacity. Patients pick up on this stuff... and, unfortunatly, it often leads to them acting inappropriate.
In fact, I was discussing it with one of my co workers this morning over breakfast. Untill we can stop abusing each other, there's not much chance of getting anyone else to stop abusing us either. :-(
At my small facility this type of behavior isn't uncommon and, unfortunatly, is tolerated. In this community our pts tend to be elderly, homeless, or have substance abuse issues (sometimes all three). Several months ago we had a homeless man that was absolutly impossible to place! He was non compliant, demanding, inappropriate, just about all that you hope NOT to see in your pt load.
He was especially bad at night. He would call for help to the BSC (he really did need help due to weakness and the WORST case of anasarca I've ever seen). But when he was done he would grab the nurse helping him back to bed (at night there's only one Aid for the entire facility), and begin fondling his testicles and stroking himself. All the while acting like there was nothing going on and calling us Darlin' and sweet heart.
It was HORRID. You couldn't get away from him. He really was quite strong in his upper body, but his legs were so weak and edematouse that he would hit the floor for sure if we didn't keep a good hold. He would also insist on us wiping him and would make inappropriate comments encouraging us to "dig in deep" around his anus and testicles (his testicles were also severly edematous).
He was unpleasant most of the time, but only became overtly sexual on night shift. But this guy knew how to get away with it. Was always just fine when Admin was around, and never grabbed *us* sexually.
Eventually the small handfull of male nurses we have on nights started taking turns having him. At least he wasn't sexually inaapropriate with them, just demanding and unpleasant. But that really wasn't fair to them either, he was a real pain to care for.
We ALL complained, documented, wrote things up. Admin did NOTHING. We were informed that we needed to "take better care of him". And that they never saw any problems with his behavior.
Personally, I feel that a lot of this has to do with the fact that we don't have *patients* we have *customers or clients*. I'm now supposed to say "Here at (my hospitals name) we want you to be Very Satisfied with your experience. I have plenty of time right now. Is there anything I can get for you or do for you right now that would enhance your experience?" I'm supposed to say that exact thing before I leave any pts room. Every time. It's mad!
I'm not your waitress. I'm not your slave. I'm not your manicurist. I'm not your personal maid. I'm not your cook. I'm *certainly* not here for you to get a sexual thrill out of! I'm not here to kiss your butt either!
I'm your nurse. If I wanted to be any of those things I *would* be.
But the admin at my hospital is so bent on "customer sevice" that they turn a blind eye to the needs of their own staff.
When we're grabbed or hit or screamed at... we're basically told to shut up and take it by Admin. Most of our pts are mentally competent. The ones that aren't could have their symptoms managed if the MDs would quit leaving us with nothing but PO tylenol.
There are only two of the night charge nurses that will actually back us up, and that's only if they've got the time and the inclination. More and more I'm starting to see why so many nurses seek out other careers. I've only been working here a year, but the lack of support staff recieves (especially on night shift) is a recipe for burnout.
I've often wondered if the shift from pt to customer doesn't have an awful lot to do with why this behavior is allowed. Limit setting and all that doesn't work very well when the pt realizes that nearly anything is going to be tolerated. When there are no consequences to your actions... what's to stop you from continuing?
I've been a nurse just a little under a year now. I also work a diverse med/surg unit, 5-6 pt with no aid or other staff (night shift). There are nights I drag home in tears, certain I've made the wrong choice. Weeks when I ache so bad inside and out that I'm convinced I'll be a broken mess by the time I'm 30 (I'm 27 now). I feel batterd, used, abused, worn out and everything awful you can imagine.
But not every night. There are nights when I feel so sure of myself, so proud of myself. Nights when I walk out into the sunrise and think "today I made a difference". Nights when I do some little thing just right and then remember that it took me so many tries and questions before I got that down. Nights when the iv slips in perfect on the first poke.
When it's bad... it's usually VERY VERY BAD. But I swear, it doesn't stay that way. It's can't rain all the time. Tonight I've got 3 fresh post ops (all very complicated with bood, irrigations, etc), a confused pneumonia, and a confused bowel obstruction that's incontinent and wants up to the BSC every hour. And you know what... I'm ok!!! Heck, I'm typing to you right now!
I actually managed to get a lunch break. I'm caught up on my charting. I'm doing just fine. It really does get better. Ask questions. Find a mentor, or at least people you work well with. Try to get scheduled to work on the same hall way (or at least roughly the same days). Take time out to be just yourself. Be gentle to yourself. This is a difficult profession, and it takes a lot more out that most people realize. Sleep, eat well, exercise. Do something special for yourself at least once a month. You worked your tail off to get here. You deserve to have good things too.
Be strong. It takes time. There really is a huge difference between student and staff. But you'll get there. Remember how hard you struggled in school? But you made it! And, in time, you'll get this too. There will still be questions, bad shifts, all that stuff. But it isn't the only thing out there. If the path were smooth and easy... would it really be worth walking? You're not alone. The learning is never really over.
I'm a nurse at a rural hospital in Northern California. To comply with the nursing ratio laws my facility has severly cut back on staff in other areas. Night shift has no ward clerk and usually only one aid for the entire hospital. We are also required to sign out for breaks, but there is no break staff available. We were informed it was cheaper to pay the fine than to get us break relief and basically told that our breaks didn't matter because we're night shift. Day shift continues to have the same assistive staff and breaks as before the new law.
We employ registry staff frequently. Within driving distance from the hospital are colleges, 3 offer LVN, 1 offers ADN, the other offers BSN. In my area it's not that we dont have enough nurses, it's that we don't have enough nursing jobs that are attractive. I give total patient care to my 6 patients, and I can't imagine what I would do if there were no limits. JACHO was through here in October, and the only thing the problems were a salad bar that wasn't cold enough, and they wanted our CCU to be bigger.
I'm proud to be a nurse in a state that is trying to put safe staffing laws into place. I truly believe that one of the reasons for the high burnout rate in this profession is that we're being over worked, over stressed, and under appreciated. Nursing ratios aren't the whole answer, but it's a start. Personally, I'm appaled that our Governor is turning back on this. How many studies will it take for people to realize that the more patients you pile on a nurse, the less those people are likely to survive? Please don't buy into the hype about closing hospitals and patients being turned away at the door. If this tiny rural hospital in a very poor community can cope, so can the rest of California.
I work for a Catholic hospital, and I happen to be Wiccan. I've only been employed a little less than a year and we seem to be working on a basic "don't ask don't tell" policy. I don't feel the need to push my religion on anyone else, and I don't do anything overt that would let people know that I'm not Christian. But I have had several co-workers get very pushy over religion, and several of my patients as well (all the pushy patients have been Mormon for some reason). I'm considering hospice when I get a few more years of experience under my belt. But, eventhough I rarely share the same belief system as my pt, I have read them passages from the Bible and prayed with them when they requested it.
My belief system allows for many forms of religiouse expression. If my patient is frightened, anxiouse, whatever... and hearing bible quotes or praying will ease them... I consider that part of my job. If I can do it and feel like I can handle it, then I do my best. But if it gets over my head I have no problem calling Spiritual Care serves in, I'm a nurse not a priest. But I also had no problem "banishing the evil spirit" that a Buddhist pt kept seeing in the corner near her closet. Being pagan sort of makes me an equal opportunity believer in soem respects.
But I've noticed in caring for the deceased that different nurses handle it in different ways. If I'm in the room and there's no family I speak to the deceased, sing softly to them, and in some cases have cried for them. But that's more for me than for them. And, I hope, if their spirit is still hovering about that they will understand I'm trying to honor them. I personally don't think they care if I'm Christian or not.
At my facility we have smokers all the time. We're actually expected to "find someone" to take our smokers out. Nicotine patches are rarely offered and need a MD order (and boy are you going to get ripped apart if you have to call for one). I've had pt's with telemetry go out, as well as those toting PCA or so unsteady they went out with o2.
Recently we had a pt whose pain meds weren't working fast enough for him, and so he called over some friends who brought him marijuanna to smoke. They're all sitting there passing the pipe, right in front of the glass doors to the smoking area and right accross from the nursing station. Administration was aware of it and told the nurses to just try and keep the other pts from going out untill we thought the smoke had cleared. According to admin this was ok because the pt had a perscription and grows his own.
Right now the big thing is "customer satisfaction". But of course, night shift RNs don't get lunch or a single break because "it's not cost effective". We were told that paying for a relief nurse is more expnsive than paying the fines when we call because we don't get any breaks.
I'm an occasional (read that as less than half a pack a week) smoker. These pts know the risks (who doesn't). I just don't understand why their right to smoke is so much more important than our right to be safe, protect our pts, to have our own breaks (non smoking nurses don't have to take patients out for a walk), and to be safe from second hand smoke. I personally don't think it's so much an issue about smoking, it's an issue of rights and responsibilities. Maybe admin needs to remember that these are our PATIENTS, and last time I looked my badge said RN not customer service rep. If I wanted to work retail I would.
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