My first ranting

[tokebi]

This is the first time I let out a pure personal venting on this site.

My facility is undergoing a stressful stage of preparing for re-survey, so consultants are often hanging around with hawk-eyes. I was followed by one today. One of the many mistakes I made: I drew several syringes of insulin, labeled by their room numbers as trays were being passed. I was caught with handful of them. The consultant said, "What are you doing? What's that in your hand? Go show them to your DON." I meekly opened my hand and showed those syringes to my DON who was sitting nearby. She looked at me and asked "Who oriented you? Is this how you were taught?"

To feel like a child caught doing something naughty, at my age...

Now, I love working there. I still can proudly say I don't regret a thing after working there for several years. However, the nursing practice as I envision it as opposed to what I'm expected to do from the corporate, there's so much disconnect that I sometimes want to say "The hell with it all!"

Is any of you working in LTC capable of doing everything by the book when you're responsible for the number of residents under your care? It's an open secret that we all take shortcuts. Do you actually take BP before every single BP meds every single day? Do you check placements of GT every time? Do you give meds to GT patients by gravity every single time?

For the 30-something number of residents I'm responsible for, it would be a miraculous day if I finish passing meds in two-hour period, doing all those above. And of course there's always something happening with residents that require me to engage in yelling contest with pharmacy people, lab people, doctors' offices, etc, on top of the frustrating amount of redundant paperwork. Then there are your superiors constantly on your back regarding overtime.

They talk of time management, so we learn to manage our time. We somehow learn how to do all the impossible things in the given amount of time. What I did -- drawing up all the insulin at once for the seven or eight people who needed coverage -- was one of them.

I worked telemetry floor prior to this job where any insulin had to be double-checked with another nurse. Believe me, I take insulin very seriously. Also, I take any med error seriously. And I'm always on guard, watching myself, second-guessing myself because I would not forgive myself if I made a med-error. So I devise my own way to do things correctly in the least amount of time.

Now, by taking shortcuts, do I make time to have my lunch? For idle-chat? To sit around? Ugh... I'm running around answering call lights, talking to the family, more importantly, talking to the residents. I have several residents who suffer from uncontrollable outbursts, panic attacks, to name a few. Every day I'm amazed how their symptoms disappear when some one-on-one time is provided, like this elderly lady who constantly calls out "Help Help!" with no apparent reason, but immediately calmed when I take her out to the patio or just wheel her around, talking.

Does the corporate want automatons of nurses who shove the impeccably prepared cups of medicine down the throats of the residents and no rapport? The perfect care plans and the correctly charted entries full of pretty words when none of it took place?

I'm not saying we should be allowed to take shortcuts. I'm saying we should be given the realistic amount of assignment for ideal nusing care, survey or not. Why must I be cornered into having to take shortcuts and then be punished for it without any real solution to do otherwise?

[cebuana_nurse]

I truly understand your pain. I've come to the realization that how nursing is described in books is way too far from reality. I love this profession for being able to provide compassionate care but my God is it sucking the life out of us, not to mention the stress in all aspects that we have to go through.

I totally hate working on weekdays where I see the admin roaming around in their suit and ties and taking their breaks on time. It disgusts me on how these people get paid for the amount of time they spend in their offices and not even touching nor getting a wandering patient blocking the entrance door which always sets off the EXI alarm which happens to be in front of their offices. At the end of every shift, the nursing staff is overworked, unappreciated and underpaid.

[carolmaccas66, BSN, RN]

As to the person commenting that they know what it is like to be in administration & to do intense nursing, don't forget the nurse/patient ratio can be very high at times. For agency staff, we sometimes get a 3 minute orientation to a new ward & hospital (if any), get given a pager and 6 acute patients (dementias, climbers, yellers, demanding older people, you name it) & we hit the ground running. We have to absorb all the care, get it done usually in less time, try to find where eveything is - annoying other, busy nurses - trying to find things ourselves, harrassing the shift coordinator, getting sometimes unfamiliar med's/IV's done (so have to check orders, check med's, ring Dr's, etc), deal with families & Dr's we don't know, get treated like we are pariahs, then later on we are complained about because 'you didn't tick one care plan' after doing 50 different things for each patient. And I know a senior agency RN in Sydney who had to care for 12 - yes 12 - post-op patients in one shift - think that is safe staffing? Do you think she got a break that day? She went home a nervous wreck & cried her heart out. After that episode she complained, then she quit.

Admin knows this goes on time after time and has known for years. They really could not give two hoots. To the person that said they swan around in their suits & ties & make no effort to understand the real nursing duties - you hit the nail on the head. They care more about their designer clothes and if their nail polish is chipped - truly, I had an admin manager complain to me all day about the latter! And we had phones ringing, bells ringing, patients yelling, families wanting to complain/speak to staff, etc - you know the drill.

Don't sit and say it is just about money because you may need the same care yourself one day. Would you want your nurse to say I am too busy to care for you/your family member? We don't say that but we think it.

Comments like this from admin re 'budgets' etc made me lose respect for them a long time ago - all these problems have been around for years and nobody does anything about it, yet managers are paid more to make changes & deal with problems - but they do not bother.

[carolmaccas66, BSN, RN]

Take care of yourself. Remember, how can you meet someone else's needs if your own needs aren't being met?

I doubt you're doing a half-assed job. And I don't mean in any way to offend, but have you thought about looking for other employment? No job is worth weeping over. I really mean that. I had a very dear friend, who gave up everything for his job - family, social life, he did whatever they asked and then some - and when they got new management he was threatened with being fired. After 20 years! He'd worked there since he was 22 years old! And then he died of a heart attack at the age of 44 in the middle of an assignment. So, please take care of yourself.

How awful. I am sorry you lost a dear friend in this manner. My brother lost his business partner like this, who worked hard and long hours his whole life, gave of himself to everyone then died (think of a heart attack) just before he was to retire. He never got to enjoy it. I have been so scared lately that this will happen to me - jsut shows all this stress and depression really isn't worth it.

[wooh, BSN, RN]

I'm thinking that as an administrator, one may truly be unable to change the 2 hour window rule, but one COULD change the MARs so that one hall has their meds at say 9 and one hall has their meds at 10, creating in effect a 3 hour window for administering those meds.

ETA: as AlmostABubbie has done in similar ways! Good for her!

[wooh, BSN, RN]

I know this will get better. What I resent is when everyone pretends it isn't happening.

I have to say, that's what I like about my current management team. I used to work for ones that would say "you can do anything for 12 hours" which is true. But I can't do anything for 14 hours day in and day out every single day I come to work. And when they'd pretend that there weren't problems, that we just had a bad attitude, wanted to complain, well that just makes us complain more.

Now, if we complain, the current bosses will basically say, "Yeah, it's bad. But I can't do anything about it because of this and this." I can understand hands being tied. But don't fart and pretend it's air freshener. At least validate that we have problems!

I wish more managers just understood that admitting there is a problem that they can't fix is NOT indicative of admitting they're a bad boss. It's actually a good thing!

[CapeCodMermaid, RN]

So for all the people administration bashing....y'all come work for me. I don't wear fingernail polish. I spend more time on the floors than I do in my office. I am there late helping with the admissions, the calls to the pharmacy, the calls to the docs who don't call back. I support the nurses in my building. I go through every TAR to get rid of stupid, useless treatments that do the patient no good so the nurses have time for the things they need to do. I study the MARs and call the docs or the pharmacy consultants to change med times so we can be in compliance...or even better, get rid of the meds the resident doesn't need. Please don't lump all administrators into one big lump. Some of us have worked our way up the ranks and know how hard your jobs can be.

[SuesquatchRN, BSN, RN]

My DON helps a lot, too, CCM. And so do I.

[cebuana_nurse]

So for all the people administration bashing....y'all come work for me. I don't wear fingernail polish. I spend more time on the floors than I do in my office. I am there late helping with the admissions, the calls to the pharmacy, the calls to the docs who don't call back. I support the nurses in my building. I go through every TAR to get rid of stupid, useless treatments that do the patient no good so the nurses have time for the things they need to do. I study the MARs and call the docs or the pharmacy consultants to change med times so we can be in compliance...or even better, get rid of the meds the resident doesn't need. Please don't lump all administrators into one big lump. Some of us have worked our way up the ranks and know how hard your jobs can be.

I wish you work in my facility! I would love to have you as a boss!

[tokebi]

... and today I was told that I was a liability and got suspended...

Mistake after mistake... A person from the corporate saw me pre-signing noon meds -- yes, another time-saving measure of miine, which I thought was harmless, knowing what my residents get at noon by heart...

No one to blame but myself. I do take full responsibility and I don't resent anyone for my own carelessness. My DON seemed so pained as she wrote me up. She always told me how she liked the way I interacted with the residents in the past, among other things. But she had no choice, as the corporate people specifically said I'm not to be put on the floor.

After the initial shock faded, now I'm beginning to wonder if I should resign now while I still have the chance to make a "clean" end, rather than risking the possibility of ending up getting fired.

So sad... in spite of my transgressions, I truly loved the place. Just thinking of the residents brings tears to my eyes right now.

After all these years, I realize how naive I have been... believing that the most important thing was what I do and how I act towards my patients. I never considered that I could lose a job like this...

[wooh, BSN, RN]

I'm so sorry tokebi. No advice, but I'm thinking about you!

[CapeCodMermaid, RN]

I'm sorry you were suspended for that. I'm considered a hard ass and even I wouldn't suspend someone for doing that the first time. Trouble is....you think you have the meds memorized...meds change. Not looking at the MAR before you give meds is dangerous. And...suppose something had happened and you had to leave the unit. The next nurse would look at the MAR and think all those meds were given. It might be time saving, but it's not good practice.

[carolmaccas66, BSN, RN]

So sorry you were suspended. A hospital here not long ago doesn't want me working for them 'due to lack of experience', though 2 clinical nurses gave me excellent references the week before! And this was after 5 months of working there...

I will NEVER understand management. I have seen so many nurses pre or post-sign med's - we have probbly all done it at some time without thinking. I try hard to do med's correctly but I must admit I haven't checked patient wrist bands cos I know that patient intimately, yes & you do get too busy.

Maybe see this as an opportunity to re-think things - like me - and do something else. I am pursuing new studies & even thinking of going interstate again for work.

Can you get your job back?