Neuro = dumping ground for "difficult" pts?

[SopranoKris, MSN, RN, NP]

I'm doing a new grad residency program. My home unit is neuro/trauma critical care. My 2nd unit is the general neuro med-surg floor. It seems like the entire hospital uses the med-surg neuro floor to dump difficult patients or behavior issues. Every shift has been a nightmare on this unit. Last shift, I had a pt who had bilateral hip fracture, bilateral leg fractures, bilateral arm fractures, etc. He should have been on an ORTHOPEDIC floor, not neuro. But because he had dementia and was "difficult" (constantly pulling tubes, pulled out his Dobhoff twice...ugh!), they dumped him on us. I am constantly getting patients that do not belong on neuro. They're just behavior problems. It's really making me dread going in for my shifts. I don't like it whatsoever. I can see why they have a hard time keeping staff on this floor. The worst part is that I'm now scheduled there until the end of October. I should have been back on my neuro/trauma critical care unit, but the person ahead of me in the program is still there, so I'm stuck on this awful unit.

I'm trying to find the golden nugget in all this stress. The good thing is that I'm really learning to prioritize. But I never get to take a break until after 0400 (my shift starts at 1900). Last shift, I didn't get to eat until 2 hours before my shift was over. I'm just exhausted and I'm starting to hate neuro. I don't want to feel this way. This was my first week all on my own (after 6 weeks orientation with a preceptor). I feel like I was thrown to the wolves with no help. And they keep trying to give me new admissions when I'm already maxed out on nurse/pt ratio. When I say there's no way I can take on another pt, the charge nurse gets really snippy with me. I'm NEW, I am at my wits end just trying to keep up with my pts. It wouldn't be safe for me to add another pt, especially when a new admission takes between an hour to hour & a half to do the full admission process. Don't they remember what it was like to be a new nurse? If they want me to take on extra patients, don't give me a slate full of total cares & behavior problems. I feel lucky I made it through the week without a patient falling. I have so many that try to get out of bed all night long (high fall risks).

Sorry, need to vent. It's just so frustrating! When I was in critical care, my patients were 100% total care, but the nurse/pt ratio was so much more manageable. I had 3 to 4 pts max. On the med surg floor, we're supposed to only have 4, but I usually end up with 5 or 6. One night, I had 7. It's not right. I'm dreading going in tonight because it's Sunday. The last Sunday I worked, 2 people called in sick and they left us short-staffed instead of calling in extra staff. Both techs were on 1:1, so we had NO extra help. I have no problem jumping in there and doing total care. But I can't roll a 350 pound patient myself to get him/her cleaned up. Like I said, very frustrating!

I don't want to start dreading going in to work. I love being a nurse, but I do not like this unit. I have the sinking feeling I'm going to be stuck on this floor for the foreseeable future.

Any advice for effectively managing a full load of pts with behavioral issues? Obviously, I can't give them all Ativan...LOL

[cracklingkraken, ASN, RN]

(Hugs) I hope it gets better! Hopefully, they'll place you on your original unit.

[SopranoKris, MSN, RN, NP]

Thanks, cracklingckraken :)

On the bright side...I made it through this shift with no problems. I had 5 patients and they added a 6th, but they did call in another nurse halfway through the night and I was able to give her one of my pts. It was nice having a night that was manageable and not one where I wanted to pull my hair out by the end of shift

Gotta go back in tonight. I'm hoping I have the same patients again tonight. (Fingers crossed)

[FloridaBeagle]

I think you're working at my old unit. I quit and will never, ever, EVER go near neuro again because it is a dumping ground, and yet you don't get a smaller ratio, or more CNAs, or anything that would help make your shift more manageable. Neuro is just horrible. I hope you can escape it soon. Good luck.

[NurseKnope, BSN, MSN, RN]

Sorry you are having such a hard time! I've been working in neurology for about 3 years now. Medical, surgical, trauma, spinal injuries, ICU, I've done it all and I can tell you it is not for the faint of heart! Sometimes it feels like people confuse neuro for psych, but on our unit it's more manageable because we have a 4:1 on days and 5:1 ratio on nights. It still gets crazy, but there's nothing like a success story. The recovered stroke patients are the sweetest thing.

And for the really confused ones? Four point restraints: HALLELUJAH!

[mmccool719]

Yep, neuro floors have the same theme everywhere it sounds like......we are a dumping ground. Someone once told me "if you can work neuro, you can work anywhere". Enjoy your experience, you will learn so much on a neuro floor that you will take with you wherever you land.

[Here.I.Stand, BSN, RN]

That sounds awful!! I started on a neuro/ENT surgical floor, and while the work was very difficult (in large part because of the ENT--disfigurement, flaps, STSG donor sites, pain, tubefeedings....) I never felt like it was a dumping ground. The difficult neuro pts WERE actually neuro pts.

Once we had a young gal (17 or 18 yrs old) who kept getting transferred between us and psych because they couldn't figure out what was wrong with her...transfer to psych because tests for organic causes kept coming up negative but was having these horrific hallucinations...back to neuro because she started having seizures... I think their final verdict was brain damage from hallucinogenic drugs. Very, very sad.

And then we'd get the occasional psych pt whose tonic-clonic activity eventually proved to be pseudoseizures. But again, only the EEG could tell the difference--these people were not faking (common misconception about pseudoseizures)--when admitted, as far as the neuro team and RNs knew, these were neuro pts.

I hope it gets better and you get back to the ICU soon! ((((Hugs))))

[Stephia87RN]

We have the same thing here on our Neuro floor. It gets depressing when we have the same behavioral patient for one to two months because they have no where to go. The difference for us though is we have great charge nurses and a great manager. They really push gen med patients to the gen med floors and rotate staff on the more difficult patients.

[jouRNey8]

Oh man. I am a new grad about to start on a neuro floor. In not sure I can handle all this ^.