I've realize most of all the places I've worked have had high turnover, but my current job takes the cake. In the six months I've been employed here I have seen 10 nurses come and go or reduce their status from full to part time or per diem on day shift alone, nights is worse. I've seen both new and experienced nurses quit while on orientation, or interview and not take the job. A few doctors even jokingly begged me not to leave as that nurses and docs just came and went.
Nurses who just came off orientation who are already proclaiming how much they hate it. The medical residents are stressed and have been openly complaining about their concerns, the attendings are detached. Techs could care less and don't work together.
Staff both RNs and ED techs are burned out from working short which leads to increased sick calls.
I've never seen such a mess of a unit. I'm calling out tomorrow for the 3rd time in 6 months and I feel awful but although its so early in ...I'm tired of being dumped upon. Last few shifts I've had full ICU, intubated patients with at least 7 other ED patients, 2 of which were potential strokes and another possible sepsis.
Equipment doesn't work... 3 of our 4 defibrillators stopped working and still have not been replaced.
Working ED in this town is rough. Less hospitals, terribly high acuity, and atrocious nurse turnover numbers. And yes there have been multiple meetings with administration and on the nightmare goes...
I think I'm sadly thru with bedside nursing after about 9 years. I'm just hoping to stick it out another 6 months here, then hopefully transfer to any ICU adult or peds/PACU or OR/Cath lab heck anywhere but the ed which I really do love. After that advanced practice here I come. It won't be easy but at least it'll be less physically demanding... sigh.
I can tell you from experience that it's not everywhere. In my long career it seems the problems of this type of facility/unit is increasing as time goes by. I've worked a total of 4 places in my over 20 years and I worked at one where it was a dream. All worked together, everyone did their job, the DON was a hippie gone yuppie and let us do our thing and it worked out great. The other people I worked with were all responsible and I loved it. Family issues caused me to move, that was the end of it, but good places do exist.
Lately, it's like a rat race, no one is looking out for anyone but themselves. Management is disconnected and it falls to the staff to try to work together with limited resources and limited staffing which really hurts the patient population.
When you need to work it's incredible what you'll put up with but it's so demeaning on the individual as a whole. I'm done...I'm moving to WA state and starting a collective.
I don't know what the solution is because it's futility at it's worst. The system wants to work the nurses like second class citizens, what they don't realize is we are the very backbone of the healthcare world. As RNs we are not really represented and have no real voice to speak of. Our system is fragmented, therefore chaos ensues.
I can tell you from experience that it's not everywhere. In my long career it seems the problems of this type of facility/unit is increasing as time goes by. I've worked a total of 4 places in my over 20 years and I worked at one where it was a dream. All worked together, everyone did their job, the DON was a hippie gone yuppie and let us do our thing and it worked out great. The other people I worked with were all responsible and I loved it. Family issues caused me to move, that was the end of it, but good places do exist.
Lately, it's like a rat race, no one is looking out for anyone but themselves. Management is disconnected and it falls to the staff to try to work together with limited resources and limited staffing which really hurts the patient population.
When you need to work it's incredible what you'll put up with but it's so demeaning on the individual as a whole. I'm done...I'm moving to WA state and starting a collective.
I don't know what the solution is because it's futility at it's worst. The system wants to work the nurses like second class citizens, what they don't realize is we are the very backbone of the healthcare world. As RNs we are not really represented and have no real voice to speak of. Our system is fragmented, therefore chaos ensues.
Don't let your sympathy for your manager get in the way of your life. If it's as bad as you're saying, if she's smart she'll move on too.
The only way change will come is if it's supported by upper management, beyond a unit director's scope. She can attempt some positive change, but those above her have to be willing to change.
I'm impressed you've lasted this long. I'd be looking for a new job. If sounds like a scary and awful place to work.
Yeah you're right. In fact I overhead her jokingly saying she'd wouldn't be here for long.... no lie. I mean no one really expects her to stay, she's worked better jobs and she has been upfront about that. She came here due to ''connections'' and God knows whatever other reason.
They only reason I've lasted this long is due to my prior experience. I can work a tough ED.. but should I anymore,, why should making a living be this rough???
My preceptor even told me last week that she's sorry for what the place has become and that I should look for better. The funny thing is I feel sorrier for her... I mean this is the only ED she knows, and apparently it's been not so good for quite some time.
Our department has been overwhelmed since beginning of December. Staff is stressed, we are short staffed. But not to the degree of OP. When you start feeling like your license is at risk its time to get vocal or leave. We just got some agency staff and that is helping to ease the burden a little. But we are sticking to 4:1 ratio - but being pushed to go 5:1.
I currently work in an ED that sounds a lot like what you have going on in your department. I am not a nurse but am a Paramedic that has worked on both sides of the fence in pre-hospital as well currently in an emergency department. A lot of the new nurses we get come because they could not find a job in an acute care setting anywhere eles and we are so hard up for help that we take who ever applies. Then being the only Level 2 Trauma center in a 70 mile radius of a larger facility we see around 250 pts. a day in a 54 bed ED which makes for long and stressful shifts for staff. It seems when department or hospital administration is approached with the on going issues of our department we get the generic response " due to budget constraints..." or the "we are working on staffing issues just hold in there". Though I am able to deal with the high demands of my department my biggest fear is a pt. or staff member being seriously injured due to the "working conditions". In the 3 years I have been in the ED I have seen it go from to much staff and having to send people home to not having enough staff to open sections in the department and mandatory call and OT. I feel that in larger hospitals and when there is not competing hospitals around that employers tend to have there way with employees knowing that there isn't any where else to go. We do have perks that tend to keep some people there such as: self scheduling, we only work every 3rd weekend, and get 3 weeks of vacation a year. I have to say as a current nursing student I do not have the time or can afford to find a new job that allows the schedule that I have and that is the only thing that keeps me there.
I am an ER novice, and to be true I've only been a RN for about three years. This isn't my first career or even my "choice" career as I entered nursing school for the express purpose of entering psychiatry as an APRN. Forgive me if that troubles some of you. I'll detail my motivations for seeking this job later. Interesting, I was later told I was hired because I wore a suit to the interview.
My employer is caught in the midst of two factions, or at least the ED is. First, there exists "the old school" or those that worked in a laissez-faire environment led by a hands off manager. A new administration is in-house, and the present manager, although not formally educated or degreed in modern healthcare trends, is a champion of "patient satisfaction" and "delegation." She has set about a number of committees, trials, and practices that have led the laissez-faire staff to think they are being micromanaged and made to do the manager's duties. The rest of the staff are brand new and don't know anything else, however, they are not invited into the clique that already exists, and they don't know what they're doing sufficiently (myself included) in the ER to play a role in the new leadership practices.
As a result, the old staff is leaving in droves, and the new staff are increasingly dissatisfied. I've already seen employees walk off the job, during their scheduled work day, due to gross the difficulties of our jobs. Personally, I'm biding my time and earning a check until I graduate with my master's in May despite how that may come across. Sometimes life requires that you merely press forward.
For me, I detest the incessant immediacy of the emergency department, and by that I'm not implying that I don't like working quickly for emergencies. Instead, I mean "they're in such a big darn rush to get people in and out that the work setting is absurdly ridiculous." Frequently, triage staff will rush patients into the ED and have them linger at the door of a room while the room is still dirty or being cleaned. The staff are bombarded with ESI level 4 & 5 patients stacked deep in the hallways waiting to be seen thus instead of having them enter when available from the comfort of our rather nice lobby they sit in hard, plastic chairs and get overlooked as the staff run by in a panic to get the patients in rooms out of rooms. They wait as long if not longer as the physician staff thinks "I don't have time for a runny nose patient." It's as if no one perceives the survey results. True, they'll get into the ER faster, but their environment will be less comfortable. They still won't see a provider any sooner or receive a discharger any faster.
The charge nurses discharge patients before I'm ready to have them discharged. I can only work so fast, and I'm only mediocre at best with psychomotor skills. I've not previously had a job as a RN that required any "hands on" stuff. Actually, I find that the more I do IVs the worse I become, and why would any new-ish nurse enter a job knowing what goes on "_____ procedure tray." I can't wait for the day to come when I do the last IV and say "you're the last one of these I'll ever do." I've grown to hate needles and plastic tubes.
There is such haste that I find most of the ER nurses never palpate or auscultate the patients. I watched the charge nurse and most of the staff nearly fall out one day when rushing an elderly man into a trauma room because his neck hurt they invoked the coveted "chest pain protocols." They were confident it was a symptom of chest pain as he did have a MI about 40 years prior, and yet if they had merely laid hands in the area of his rhomboid muscle they would have felt the large myofascial trigger point or "knot" that had been hurting his neck "off and on" for the past two to three days. Sure, he could've been having a "silent MI," but so could any older person. Yet not all geriatric patients are battered with a full CP work up. The attending tossed the EKG print out on a table and said "all I wanted was a neck x-ray."
It's this stupid haste that's killing me. I despise my job, and I so looked forward to taking it because I wanted to learn. I wanted exposure before I spend the next 20 glorious years seated at a desk in an outpatient psychiatric office. I wanted reference. I wanted more exposure to primary care-oriented complaints and chronic diseases (and told this in my job interview) that I better understand what sick people have to live with. I don't get sick so I can't personally relate. The mentally ill, my target population, are typically unhealthy so this would have been good experience. I wanted to pick the brains of the physicians, PAs, and NPs staffing the ER, but....there's no time!
We rush patients in, nurse the database, frustrate ourselves with the slow, delayed process of five minutes to "scan" and administer two injections, and we have to personally walk each patient out while apologizing and kissing their hind ends the whole way. Do you realize how long it takes to actually walk people out particularly the slow and feeble when you multiply that over 20 patients a day?! Multiply that by five nurses.
On top of this, there exists the multitude of nurses who spend their day in fear and hiding so they can look at their phones and skim social media all throughout the day while trying to avoid being caught by the ER manager. I was standing in the medication room a couple of months ago when the manager walked in and gave me the look when she saw me using my phone. Before she could say anything I quickly snapped "my wife's eye is bleeding so I'm responding to her text." And it was. I have my priorities.
This is an incident of perpetuating my own outrage. As I write this, my feelings are beginning to boil to the point in which it becomes hard to restrain myself. Behavior yields thoughts, and the more feelings I express the angrier I get particularly when it comes to work. For that reason, I shall sign off.
I just don't want to persevere any longer, and I can't really be hired anywhere else as I'm starting an APRN job before summer arrives. I lament and vent.
Anyway, do you have real world experience with psych? Your post above leads me to think not. And if not, that dream career may not turn out as envisioned.
The er should be giving you exposure to mental illness in pretty much all its forms. What are your thoughts on those patients?
I'm having the same problem at my place. The problem would be did if they hire more nurses to lower patient ratio and higher pay. But that's money away from administration
I have quite a bit of experience working with the mentally ill just not as a RN. Despite that the provider role and nurse role are quite a bit different.
Yes, of course the ER gets patients with psychiatric diagnoses, but just like with everything else there's no time to do anything. Too much haste. We're admonished for doing anything doesn't devote ourselves to getting patients admitted and discharged within 120 minutes.
The psych patients are sadly sedated or strapped down, ran through the 12 lead and general lab work, and closed off in a safe room with a sitter watching in. They won't be seen or heard from again until the required 60 minute rounding.
The essence of my original post is in pointing out the ridiculousness of having to do everything (and nothing) very, very quickly.
I agree with PsychGuy. I work in an ER now, but some years ago I worked in psych. The ER is just a holding tank for psych patients: you can't do anything with them; you can't take the time to build a rapport with them; and there are just too many distractions to do anything other than making sure they're safe until they get placed.
I think the elephant in the middle of the living room here is the fact that, today, hospitals are being run by MBAs and CPAs rather than MDs and RNs. Over the past 16 years, I've seen my own hospital go from being a nice community hospital, where everyone knew everyone else and (whatever got thrown at you) you felt supported, to part of a big, faceless conglomerate. We've gone from having one level of unit management to four, and no one seems to agree on which level handles which issues. Consequently, when you have a problem, you don't know who to take it to.
Meanwhile, our policies are constantly changing; our unit is being redone for the second time; and the main manager is leaving after less than two years (she got a better offer someplace else). Not only are we running around like chickens with their heads cut off, but on any given day we don't know where to find supplies, because they keep changing the system on us. But who do we complain to? Our shift managers? They have nothing to do with how and where supplies are stocked. Their manager? She just oversees personnel, and doesn't know anything about the supplies. The top manager (fourth level)? She doesn't even work in our building, because she was hired to oversee the ERs throughout the corporation. I wouldn't know her if she walked up and smacked me in the face. I'm not even sure what her function is; I'm guessing she just attends meetings with upper management.
We recently had a new nurse leave within 6 weeks of starting. Another new nurse, who's been there about 3 months or so, is talking about leaving if her old employer comes through with the right salary offer. The ADNs are all furiously working on their BSNs, for fear that they'll get fired if they don't get it ASAP. (No one has said that, but the climate of uncertainty is causing everyone to imagine the worst.) This makes it harder for them to pick up extra hours, so the unit runs short most shifts.
We were recently bought out by yet another and bigger corporation. We don't know yet what that means for the future, but we're pretty sure it DOESN'T mean that we can relax and let our guard down. As one newly hired nurse said to me on her first day, "I've heard that, if you can't roll with change, this is not the hospital you should be working at."
I am running into something similar at my work. There is one floor that uses rest of the hospital staff as "reduced rate, float pool staff" Some RN's from the day shift work more hrs on that floor than they do the floor they want to work on. Needless to say, lots and lots of unhappy Rn's and CNA's. I had thought about changing to day shift but decided against it because staying on nights greatly reduces my odds of being pulled. And in the middle of all this they are trying this primary care approach....great idea IF there is enough staff and there are plans in place for sudden spikes in pt population which at this moment the hospital has neither.
...i had to leave my job in the ED in November due to death in the family and school work load ...it was very emotional for me because i truly loved working there, so i appreciate a nurse who loves what they are trained to do ...that said...your situation was untenable ...my heart goes out to you and the rest of the healthcare staff at your facility ...i am saddened to hear that adm is not making every effort to create a culture (and environment) of safety for all staff, patients and family ...your facility needs serious help and perhaps a part of the solution is to inform the powers that can force a transformation: Joint Commission and CMS
...in the in-between time: get the H#LL out of there ...it is killing your spirit and most likely your health ...if that is not possible assert your personal leadership and organize ...the california nurses association/national nurses united is a good resource ...and if you ascribe to prayer...know you (plural) are in mine
tyvin, BSN, RN
1,620 Posts
I can tell you from experience that it's not everywhere. In my long career it seems the problems of this type of facility/unit is increasing as time goes by. I've worked a total of 4 places in my over 20 years and I worked at one where it was a dream. All worked together, everyone did their job, the DON was a hippie gone yuppie and let us do our thing and it worked out great. The other people I worked with were all responsible and I loved it. Family issues caused me to move, that was the end of it, but good places do exist.
Lately, it's like a rat race, no one is looking out for anyone but themselves. Management is disconnected and it falls to the staff to try to work together with limited resources and limited staffing which really hurts the patient population.
When you need to work it's incredible what you'll put up with but it's so demeaning on the individual as a whole. I'm done...I'm moving to WA state and starting a collective.
I don't know what the solution is because it's futility at it's worst. The system wants to work the nurses like second class citizens, what they don't realize is we are the very backbone of the healthcare world. As RNs we are not really represented and have no real voice to speak of. Our system is fragmented, therefore chaos ensues.