JRP1120, RN 6,153 Views
Joined: Apr 26, '11;
Posts: 160 (36% Liked)
; Likes: 138
I've been having a bit of an issue with this one nurse that I follow, 95% of the time (we both have set schedules so I usually take report from her and give her report when I'm going off). I don't know what to do about it as I don't want to "report her" but it's becoming an every time thing. We usually have the same patients every week as well so we both know them pretty well. First of all, she comes in 15 min late which leaves me 15 min to report off to her as our unit has been under the gun to get out no later than 20 after or we get a nasty gram from our manager (apparently there have been a select few who like to stay late on the clock, so much so the higher ups have brought it to her attention and now we all must hurry along and get out "on time" so as to not create the extra min=more money coming out of our budget). I realize sometimes it cannot be avoided. However, this nurse comes in late every single time she's on. My guess is that she keeps doing it because she's been allowed to get away with it for so long. She was on time the last morning I had to report off to her though and was watching the clock and telling me we needed to hurry so I could get out on time so I guess maybe the NM finally said something to her as she did mumble something about getting a nasty-gram email about getting in and out on time. I hope it lasts!
As I've been following her though, it seems more and more, meds on her shift show up as "late" and appear to be not given. There are things like Colace or Nystatin, etc., and those are not real biggies as usually she tells me why. One night though, she told me of one of our pts blood sugar checks, which was like 159, at dinner time. This pt is to get 15 units of 70/30 with breakfast and dinner and then get sliding scale coverage. She said she didn't cover her and "she ate her entire meal". I asked her why and she didn't really have an answer for me; we got interrupted at that point and when we went back to report, she looked at the clock and said how she had to hurry to get out on time. Nothing more was said. So of course, at 2100 when I take her BS, it's 240! I am puzzled why she didn't give her the scheduled 70/30 and the SSI as ordered.
Another time, on another patient, they were scheduled to get their Inderal every 8 hours. She gave me report, never said she didn't give the 1900 dose so it showed up on my EMAR as late and not given. We are not supposed to have any meds due at that time as it's shift change (I wondered why the night before I was giving it to her at 3AM). So I notified the pharmacy and asked them to change the times of the Inderal admin so it wouldn't fall during shift change; that is protocol in our hospital, pharmacy knows this but it got missed and so that's why it was still set up that way (on previous nights I never saw it come up on my EMAR because the day shift nurses were giving it between 1800-1830). So I told her what I did the next AM when I gave her report and she told me she GAVE THE MED (No, I did not give her the 1900 dose, partly because I didn't know if she had given it but just didn't chart it so it just remained missed and I watched my patient closely throughout the night and after the pharmacy changed the times, I gave her my dose at 0100). She was upset with me that I had the pharmacy change the times and asked me why I did that. When I explained that it's protocol for our hospital that meds not be scheduled for during shift change times, she just rolled her eyes at me; now she'd have to give the med twice during her shift instead of just once. Well, I'm sorry, there's a protocol in place for a reason, so that meds don't get missed, just like this one did. Based on my pt's BP and pulse, she couldn't have given her the med. And this is what I don't understand: If you give a med, you have to scan it, then the pt, and it goes away on your EMAR and shows that you gave it and what time...how is she giving meds and not charting them? That's not safe practice! This has been going on for weeks now, and more and more meds are showing up as late, that she's not giving, insulins, BP meds, etc...not to mention she always says she's going to give so and so this and ask the Dr that, and then when she reports off to me she's like, "nope I didn't" She also doesn't sign off on things and do her chart checks. So I'm left picking up her pieces and doing a lot of her work she leaves undone. It's not so much that that bothers me, it's the potential harm that could be caused some of these patients by her seemingly lack of...I don't know what you'd call it, that scares me. I've only been a nurse a little over a year so I'm still trying to keep all my ducks in a row. I've never had to follow someone yet with so much left over stuff. Thankfully, I've been diligent and always ask my fellow nurses I'm working with if this is right, or looks right, or why did she leave this or that...I am determined not to make a med error because of her.
I don't want to report her (I've never reported anyone and would rather not ever have to). I guess I'll continue to ask her if she gave this med or that med and ask for explanations if she didn't and insist I get an answer before she leaves. It all just leaves me feeling uneasy and worried and honestly, a little like I can't trust her that she did what she said she did. So, I'm finding myself getting a fresh PEG tube feeding bag and hanging it on my shift and not relying on her "oh that's a new bag hanging; I hung it this AM" because the line isn't marked with a date. I realize things will get missed but I'm scared to death I'm gonna make a mistake as a result of her not doing the right thing, or what she's supposed to do. There are many more little instances here and there of things that I'm seeing coming from her that could be potentially bad and I don't know if I should just keep trying to fix them and tell her or finally get up the nerve to "report her". I know I would want someone to come to me and tell me things first and not just report me. I believe in team work and for the time I've been on my unit, most of the nurses do work as a team and help each other out. There are a few that would throw you under the bus in an instant and lucklily I don't work with them anymore. Thanks for listening to my "rant".
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I'm new too and I make myself lists and check-off when I've done them. I write everything down! At the beginning of my orientation I even had to write down a word or two to remind me what not to forget before doing my assessments on my patients or I'd forget now, I'm almost off orientation and already I don't have to do that part anymore...but for me, I still write a lot of things down that the more experienced nurses just know to do. It comes with time and practice. I find that forgetting the little things, even when they are important, happens because I'm new and nervous. When I would stress about this, for me, it would create more stress on my brain and it seemed I'd forget even more. So I just stop, take a deep breath, go over what I'm about to do in my head then write it down. Then it's there if I need the reminder and it gets checked off as I do it. Don't be so hard on yourself! However, I know what you're feeling. There have been many a time, I'd kick myself afterward and say to myself, "duh! How could you forget that, you idiot!" It's all part of being new. And remember, we can be our own worst critics so watch what you tell yourself too...when you do remember things you need to remember, start replacing that "ugh, you idiot" self-talk with a "yay! I did it". Negative self-talk can make things worse. Keep at it and you'll see that things get easier with time. I'm already seeing that. Good luck!
One of the staff here at AN is trying to get the survey link so all new grads can participate. I apologize for the broken link; should have fwd'd the email here first before I took the survey but didn't know it would be so fitting for new grads until I took it It is linked to each person's email address and once a person has taken it, cannot retake it, so as to not skew results. This I also did not realize before I took it-makes perfect sense now. I hope AN staff get a response from the woman at NSNA with a good link so that any new grad that wishes to participate can do so.
When I was a student, I was a member of the NSNA. I am a new grad (May 2011) and so just received this email from them. It's a survey asking about jobs for new grad RN's. They encourage all to participate. I just filled it out-please let your voices be heard on how tough it actually is to get a new RN position! They will send you a follow-up survey in 6 months. They asked all the right questions and we have our opinions! Haha! Here's the link. Please pass it on to any and all of your fellow classmates! I just got home from work and haven't looked here so I apologize if this survey was already posted!
A copy of the email I received:
Dear New Graduate:
The National Student Nurses' Association (NSNA) is conducting the 4th Annual New Graduate Survey. NSNA is concerned about the job market for new graduates as well as the work experiences of new RNs. *
Please help NSNA to make the voice of new graduates heard. *Your experiences in finding employment and/or working in your first RN position will provide valuable data for policy and program development. *Your participation is kept confidential and only aggregate data will be reported.
A report of the findings of this survey will be posted on www.nsna.org.
Here is a link to the survey:
Thank you for your participation!
Diane J. Mancino, EdD, RN, CAE, FAAN
NSNA Executive Director
Nothing may change now but someone somewhere is getting the hint and asking questions! Either way, it felt good to get it out to them! Have a Blessed day!
Little bit of tiger balm (or any other mentholated rub type product) under the nose.
This should be printed and posted at every nurse's station!! Bravo!
My brain is getting more organized finally, but some things slip through the crack still when I forget to write it down.
Really enjoyed the video! This is how I have always tried to be and what I teach my children when encountering other people-we truly don't know what others around us are going through so it's important to have patience and tolerance for everyone we encounter in our daily lives. When we take our eyes off of ourselves and instead look at others needs, life becomes easier to take Thanks for sharing!
I'm currently precepting in my first RN job and what I've seen my preceptor do at times like you're describing is if she hasn't gotten all her assessments done and it's time for meds is she'll pull meds for those pts she still needs to assess (we report at bedside so she's already met patients and prioritized who should be assessed first from this). She'll go in to give meds and do her assessment at the same time. If it's particularly crazy for some reason, she will jot down the time she assessed her pts and then go back and chart once all 2100-2200 meds have been given (but, that rarely happens, she's been a nurse for 30+ yrs so she pretty much has her time management thing down pat!). It's been an honor learning from her!
7p - 7a Night shift girl here!
This same thing happened to me once when I was a PCA. Good rapport with the patient, all going well, etc then BAM! I come in the next day and she's a little icy to me, I ask her if she needs anything, could I do anything else for her, etc (I always asked my patients this after taking their vitals, taking their food tray out of the room, etc...nope, she was fine, don't need anything. I go in the next time to take her vitals and she's not facing me and refuses to have her vitals taken. I ask her if she's ok, she barks rudely she just doesn't want them taken. So I leave the room and go tell her nurse she refused vitals. The nurse goes in there and is talking to her and I hear her getting upset about something. The door is open (mistake #1), when I start to walk by the patient yells, "yeah, YOU little girl, come here". Shocked, I walk in (mistake #2). And she proceeds to start yelling at me about how her toilet had not been cleaned or her bathroom trash not been taken out (she was a walkie-talkie, able-bodied, no brief-wearing, clean herself up kind of patient who was scheduled for discharge on this day). It was the weekend and housekeeping hadn't yet made it up to her room. With the nurse standing there, the pt just lambastes me, yelling at me, I'm apologizing for housekeeping, etc. I'm trying to calmly talk while she's yelling over me, not letting me get a word in edge-wise (mistake#3). Then, she gets IN my face and puts her hand in my face and says, "talk to the hand!". I'm flabbergasted and just speechless at this point. Mind you, the nurse is just standing there, letting her lash out at me, not saying a word. So, in my frustration, I calmly say, "ok, whatever" (mistake #4) and turn around to leave the room. Well THAT got her nurse talking, she immediately jumped on me and tells me to leave the room, that wasn't appropriate, etc. I was so shocked, shaken up by this incident I was almost in tears. Once the dust settled her nurse reprimanded me for saying "ok, whatever". And she did it in a very condescending way, calling me "sweetie" like im some little child, ugh, really? Yeah, granted, it wasn't the best thing for me to say but in the moment I didn't know what else to say, so execute me, I'm human. Looking back, I could've said much worse to her; I was trying to keep my cool in the heat of the moment. So then the nurse supervisor comes up and talks to the patient then proceeds to come and talk to me and SHE yells at me telling me what I said was inexcusable then out of nowhere asks me if I have had a problem taking care of this pt because she was a different ethnicity than me??? HUH?? Where did this come from? Again, I tried to explain the situation to her, told her no, we had good rapport, etc...she's talking over me now telling me "well, the customer is always right!". She walked away from me, leaving my jaw on the floor. Turns out, this nurse sup used to work with this pt, knew her personally, etc. The pt writes up a 4 page complaint (my guess is about the entire stay she had). She's discharged about an hour later, I'm at the nurses station charting, she comes up and asks the secretary to make her copies of her complaint and while she's waiting, stands directly in front of me, staring me down. I of course ignore her. Her kid even told her to not say anything and to calm down. Total intimidation tactics!
Needless to say, I felt like I was thrown way under that bus! I was severely disappointed in her nurse. A) she should have shut her door when she went in to speak with her. B) she should have told the patient she was handling it when the pt so rudely called me into her room-nurse shouldn't have let me walk back in that room (and I shouldn't have walked back into her room, esp with the way she called me in there). I had never before had any complaints on me but had quite the opposite. The DON liked me and my work and I was told by the other nurses not to worry about it, to shrug it off, she was a pt that just wanted to b**** and moan, AND, she was being discharged that day. Oh yeah, housekeeping was called, they came up and cleaned her bathroom and trash and they got a lashing from this pt too the entire time they were in her room). I did email the DON about this but never heard back and I was told she had been made aware of the situation but wasn't worried about me or the pt's complaints (in other words, she saw it for what it was).
I was glad for it to be over but was really hurt by the lack of support from this pt's nurse. She did not have my back and left me out to hang. I wonder if she would've stepped in finally had that pt actually pushed me or shoved me? She stood there and watched the pt get in my face and put her hands in my face, to the point I had to back away from her. Why didn't she step in then? And the nurse sup who knew the pt? I was extremely disappointed in how she handled it-insinuating the race issue when i never have ever had any issues with that kind of thing-just absurd in my view. The other nurses said i couldve said a lot worse and many said they wouldve had a hard time biting their tongue for so long like i did. I learned I'm not always going to please everyone (I already knew this) and also to have my fellow team members backs (PCA, nurse or other) always! Now that I'm a nurse, I know there will be times I will get the crap from pts but I won't let one of my PCA's go through what I did as a PCA. If I'm in the room, I'll find a way to handle it as professionally as possible. Sorry for the long post but had to get that out!
That if we keep putting each other down, then there would be no one left to build up.
Words matter and words hurt and knowing we have students on board should make a difference. I see threads on bashing nursing student/coworker, I am yet to see one on praising a nursing student/coworker,who did something well or made your day easier.
Let's buildup and not tear down
My rehab is general rehab. the acuity is pretty high on my floor. We get a mix of patients on my floor BI, Stroke, and Spinal.That was also my concern I'm going to be forgetting my skills. I dont use alot. I got to do one IV but missed (go figure) tons of tube feedings, dressing changes but they arent hard. I did trach care once. I hang IV antibiotics once in a blue moon and that's about it.
You have the right to refuse if you feel it is harmful to yourself. I will NOT move a patient that i feel needs a lift. Im 5'2, 110 lbs and cannot do it and will not hurt my back over it.
Our hospital has a new set up that has every single room equipped with ceiling lifts. The are super nice, we can bring patients all over the room, including the bathroom and shower. The lift sheets are easy to get under them, have a hole in the butt area so we don't have to take it off if they are just getting up to use commode or toilet. We can use them as "walking pants" so someone that is needing to start walking, PT uses it mostly, straps what looks like those baby swings. Strap those on the patient and they can walk all over the room without falling. We can set it to different heights depending how much weight bearing they are. we have sheets on the bed that are specifically designed to attach to these ceiling lifts so we can boost a patient in bed without 7+ people assisting.
It just requires 2 people to be present whenever the patient is using it, one on each side. One can lift up to 450 lbs, some of our rooms are labeled bariatric rooms, and the lifts in these rooms do the exact same thing but can lift up to 900 lbs.
They are GREAT!!! i couldn't do my job without them. I depend on these things everyday. I realize some hospitals don't have the luxury of this, and i've done clinical rotations in a hospital that did not have them.
It was really hard, there was a lot more demand on the male nurses. I remember they had a special code word that came over the intercom and whenever this code word came over, it meant ALL avaliable male staff please come to _____. It meant there was a combative patient, they got out all the female staff and put in the male staff.
But yes, i agree i believe there is more of a higher demand on male nurses as far as dealing with combative patients, or difficult patients.
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