New Grad: Worried about unsafe working conditions

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a new(ish) graduate med surg tele nurse and I would like to know what advice you have when it comes to personal and patient safety issues. Where do you draw the line and how would you address the following:

- Equipment shortages - everything from a lack of IV pumps to not enough sequential compression devices to no applesauce to give crushed meds in and a closed kitchen at night (no one to call to restock)

- Lack of procedural safety including intermittent telemetry monitoring, antiquated equipment, no working vital sign machinery and full sharps containers that are "only replaced on Fridays" (that's a direct quote from management).

I was really thankful to find a job but am having difficulty coping with these issues and have found mgmt brushes over many of these issues as part of the job. I feel it's only a matter of time before something dangerous happens @ this facility. Am I overreacting as a new grad? Should I just grin and bear these things?

---

Dear Working in Unsafe Conditions,

You are not overreacting. All organizations have intermittent supply problems, or an occasional shortage of equipment. But all of these things bundled together speak to a culture of a disregard for both employee and patient safety.

Nurses working in this kind of environment are forced to practice unsafe work-arounds.

Some of these issues you list are out and out regulatory violations, such as emptying sharps containers based on a pre-set schedule, instead of when they're full (please be careful!). Not following VTE prophylaxis which includes applying IPCs (intermittent pneumatic compression) or SCDs (sequential compression devices) will result in loss of Medicare reimbursement.

I'm not sure what the intermittent telemetry monitoring problem is, unless you mean the signal cuts out? Yikes.

The problem is, you are a new(ish) grad and need to get 1-2 years experience under your belt. I would start looking for another job, but not leave until you have another position.

In the meantime, document defensively, such as Patient placed on continuous telemetry monitoring. Charge Nurse notified of interruption in signal ” (or whatever you did to try and remedy the situation).

You are going to be amazed at the difference when you land a job in a well-run facility.

Best wishes,

Nurse Beth

[Myrtle1061RN, BSN]

Oh my gosh, that sounds like the hospital I work for! Our "budget" can't afford working vital sign machines (I have literally been required to roll 4 different VS machines into a room to get a full set of vitals on several occasions) the decrepit telemetry system is a joke 'cuz it constantly loses signal (maybe because it is located upstairs at the other end of the building?) just last year we got a full working pharmacy on the night shift (silly nurses, patients don't need drugs after 7 pm!) the kitchen still shuts down at six pm, we went for over a month without an ice machine on a med surg/post op floor ("ice chips" is literally a doctor's order! McDonalds would have a new, working ice machine in 24 hours! But patients in a hospital have to wait over a month?!) but somehow, miraculously, the hospital system has a healthy budget for land acquisition and expansion since we just gobbled up yet another local hospital. Oh, yeah, my personal pet peeve? We waste untold hours documenting using a very poor 1980's version of software AND the hospital system pays a FINE EVERY DAY because it doesn't meet minimum standards... How does this make any sense ethically or business wise?

I guess what scares me most is the way we are regularly understaffed and overworked. I would feel more secure about my license if I had the time to document all those little things that go wrong, but I can either be at my patient's bedside helping them to the commode or document that the Tele monitor has lost signal again. My patient's immediate needs win over the worry that I may someday sit in a courtroom. And yes, I've tried staying late to document, but my sanity has limits, and so does my husband's patience.

The small community I am currently stuck in for 3 more years doesn't have a plethora of job opportunities or I would have been long gone.

As a fairly new nurse, practicing since 2011, but with years of experience in other businesses and industries, it looks to me like nursing needs to undergo a radical change in order to protect both patients and nurses.

Who's up for a Revolution? Anybody?? A show of hands?

Yeah... Me neither... I'm too tired from working overtime. í ½í¸¥