Nurscee's Freaking Out!

BETSRN · Feb 24, 2005

I feel for you. I am sad to say, the nurse patient ratio overload is occurring all over the USA. I am curious about the acuity level of the patients you were assigned and accountable for providing all the appropriate care and treatments ordered, constantly checking the charts for new orders written that might have been missed, if you had nurse aides available to help or if they were available but had an attitude problem which management should nip it in the bud immediately.Three years ago I took on a job as a telemetry nurse. I noticed that staff were transfering out like rats on a sinking ship and at that time I was in orientation so my case load was low. The hospital marketing did a wonderful job of tv commercials showing that we had bedside computers with all the necessary equipment in each room to do a complete set of vital signs, and O2 SAT check ,etc.this particular area of the state they had the only computer system where you read the bar code on the patients wrist band and checked it against the bar code on an individually packaged medication which allowed you to have made sure that you had the correct med for the correct patient at the right time. The computer checked bar code of the patients ID bracelet against the bar code on the individually packaged medication which you had carried into the room. If it was the right med, right patient, right dose, right time, you gave the medication and then documented each med you had to give into the computer. You had 1 hour to gewt this done, otherwise you were considered having given your medications late. REALITY CHECK: the unit only had at that time 6 working portable computers. Staff assignments were made out by the charge nurse at the beginning of the shift. The staff was kept at bare bones minimum and some were sent home, they were not on call,but yet needed to be available to come in if needed. On a good day you had a ratio of 6 patients to 1 nurse. ( I felt it was still a little excessive for a tele floor that received and required close monitoring of post angiogram/ cardiac cath patients straight from the cath lab. Many patients were older and needed total care. There were days were had no nurse assistants to help..and then on the days we did have some help ...it appeared that the more aggressive, in your face, nurses( few but they were present) always had the extra help and the Charge Nurdse and management played ostrich and chose to pick their battles carefully. They were still losing staff. One day I had 9 patients, all total care, no one going home, all were to be up and walking for their cardiac rehab, and I was to be receiving two cardiac caths back from the cath lab almost back to back in time. Let me tell you, the unit was each man or woman for themselves. No one helped each other. Nurses would pull the computers out of the rooms receiving cardiac caths....they needed them too.....the hospital mandated that we be documenting our caths on the computer.
Lucky me, the cath lab came up and delivered a patient who had a clean cath and had been perclosed. They wheeled her into her new room. I began my head to toe assessment while hooking her up to our telemonitor and WOW WEE!!! The patient had a huge grapefruit sized hematoma to her right side, way above the cath site and her B/P was 60/ systolic. I started a fluid challenge, set the dinamap to take vitals every 4 minutes. The nurse from cath lab said, " Oh, that was not there in thecath lab, it must have happened when we moved her into this room." ( She had not yet been transferred off the cath lab cart...and had not been in the room a full minute when I saw this. I said there was no way that this occurred " just now", that she had to have had it in cath lab or it developed during their transport. I went and got a C-Clamp and put it on until I could speek to the cardiologist who had done the cath. I paged him over head, I called the Cath Lab and they were not answering their phone which meant they had started another procedure. I paged the Dr. on his pager. In runs my helpful Charge Nurse, best friends with the cath lab nurse. The patient was moaning dueto pain from the C-clamp. What does my great and helpful charge nurse say??? Why did I not call her. OOPS! So Sorry. " You did not post your number of the phone you were carrying today"...and I also thought the patient was my first priority and finding out the truth of the matter, and receive a full report from the cath lab RN. The other nurse with her kept her mouth shut and never said a word. My charge nurse then thought she would give some morphine for the pain without looking at the vital signs, asking what had been done so far, etc and did such a beautiful job of quickly pulling out of her pocket and pushing 10 of Morphine IV. Well great, now my Systolic B/P was 40/. The Charge nurse commanded to the nurse at the head of the bed, " Give her a fluid challenge!!! Run it wide open!!!" We took the C-Clamp off. The doc later came up and said the patient was going to have a nice sized bruise but would be fine. I continued to monitor her and check on all the other patients I was overseeing. LESSON #1.
ALWAYS AND IMMEDIATELY FIND AND WRITE OUT AN INCIDENT REPORT.. IF THE PATIENT IS STABLE, RUN, DON'T WALK AND GET ONE QUICKLY!!!FILL IT OUT, STATING THE FACTS, NAMES OF THOSE INVOLVED, TIMES,ETC,WHO GAVE ANY MEDICATIONS,, VITAL SIGNS AT THE TIME,ETC. YOU GET THE PICTURE??? I am sorry to say that I was too busy taking care of my patient to think I was going to be set up. The next day the Department Director called me into an office on the unit. She had a Green Incident report form filled out by guess who??? The helpful Charge Nurse. I was blamed for the patient having the hematoma. It was documented that I gave the Morphine 10 mg IV that caused her B/P to bottom out more to 40/systolic. It was documented that I did not give a fluid challenge, and that I just stood their and watched making no efforts to help the poor suffering patient. I was told to sign the form..which I refused and I said that what was documented was no where close to what REALLY OCCURRED. I was told signing the incident report did not mean I agreed with what was written but that I had read it. I still refused to sign. I wasthen told that I was being placed on two months probation due to this incident. I was also told ( I had 7 patients on this day ) that I would be receiving two patients from the cath lab and that they would be coming back at pretty much the same time. I was furious inside. I have seen nurses set other nurses up before but I had never had it occur to me. You can bet your money I will never ever fully trust other nurses. There were motives by the Charge Nurse .. she would cover her Cath Lab friends butt and cover her own for pushing the morphine. It was documented that I had given the morphine. I asked the Director for a clean white sheet of paper. Several nurses had been allowed to go home early this particular morning. Sorry guys.
Some one would be returning. I wrote on the whitesheet of paper that I was resigning my position on telemetry, effective immediately. I documented that what was written by the Charge Nurse on the incident,false statements, lies, and was not anywhere close to what had truly taken place. I documented that it was the Charge Nurse, not I who had given the Morphine ,nd she had bottomed out the patients blood pressure by running in the room and taking over on a patient that was being appropriately cared for and being observed.
When you go look at new job possiblities in the future, notice the stability of the unit, just because they say staff? patient ratio is 1 nurse for 6 patients, plan on having a larger case load than this after you are done with your orientation. And always, always, be sure to carry your own malpractice insurance coverage. Do not expect that the hosapital is going to always be there to stand behind you and be your buddy. Healthcare is a cut throat business now, they look at profits and losses. If it helps them save money by sending some RNs home..even though its going to put added pressure and stress on the rest of the team, to bad. I know this all sounds very negative but I have been burned more than once. You learn your lessons quickly.
Best of luck to you in your new role. Think about how the staff on the unit you are working on ... are they true team players and will help you. Is it I will help you only if you help me? Is it I am in overload sorry dear you are on your own? Keep your eyes and ears wide open.

I am at a loss as to how that charge nurse could have said you gave the Morphine when she would have had to take it out under her name. I hope (even though you resigned) that you followed up on that. What happened?

ernurse4ill · Feb 24, 2005

sask, i'm sure you feel as though you are being attacked, i think you are probably a very nice person. however, nice people have lapses in judgement too.
there is no room for ego in healthcare. when ego or even just plain inexperienced judgement gets in the way, people get hurt. we learn critical thinking skills early in our nursing training. 13 patients for a new grad is too many for a seasoned nurse, let alone a new one. where did i come upon this 'truth' you may ask? i chatted with some friends that, between them, have over a century of experience in healthcare. one of which has 10 years med surg and 20 years ccu experience. to quote this nurse, "that person may believe they gave adequate care, but i would stake my 30 years that was not the case. the amount of charting required alone would preclude adequate care."
you mentioned that you ran your butt off. i believe you. i think someone could run their butt off just to toilet 13 people on a shift, let alone provide sufficient care. those days will follow you forever, too. heaven forbid should one of those 13 patients get the notion that they had some ill effect during that hospital stay. i can't even fathom trying to defend your assignment in a court of law. you would be chewed up and spit out, and lose your license besides.
i remember reading some research last year about how nurses handle conflict. the number one method used by staff nurses cited by 4 separate studies was avoidance. avoiding the problem doesn't mean that there isn't one. we don't have to be 'nice girls' or 'boys' and accept whatever management throws at us. we need to stop passively accepting this type of treatment. we need to speak out when someone accepts an unsafe assignment.
a friend of mine once said, "there are no supernurses, just superegos'. i think she's right. :)
i wish you the best in your career.

well said indeed! sask, i come here as a nurse of 20 years, 15 of which have been critical care. i totally agree with this last post, but also want to add that as an er nurse, i have seen patients crash sooooooo fast. unbelievable to say that you can give adequate nursing care to that many patients at once, much less total care to that many. please re-read your post. you came off as trying to make this new grad feel inadequate. in reality you only looked egotistical. all caring nurses take pride in their nursing care and ability. you do not have to make someone look inferior to make yourself appear as super nurse. it is time that nursing stops eating their young! good luck to you. hope you would never again be put in that staffing nightmare!

SaderNurse05, BSN, RN · Feb 26, 2005

It is good that you realize the problem is with them, not you. Pull out your nurse practice act for your state (or go to the web if it is there) and there should be a part that outlines what new grads can and cannot do. I am in Texas , planning to graduate in May and will be taking it with me. I have worked too hard to get here to have a bad outcome for a patient or myself because of bad policies. Good luck!

hazrat · Feb 27, 2005

Help! I've only been a nurse for a month and a half.
Last two nights I've worked 12 hours (supposed to be 8) that's not the big deal though.
First I had 7 patients alone....won't even go into the hell that was.
Then tonight I had 6 but 5 were on insulin, and one of them was a every hour 20 units of insulin.
That isn't to mention the wet to dry dressings, pegs, brain surgery, and other various and sundrie items.
Not only that but this antiquated hospital still only does handwritten documentation. No computers.
I dissolved into tears. Don't know if I can do this!
YES, I DID ask help. But we have nurses who have 9 pts. They have their own share of problems.
Did you ever feel like you'd freak out????
Did you ever feel too dumb to do this????
Tell me I can make it, or not. Got ANY solutions?
Is my life long dream to be a nurse just a pipe dream?
HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Hi. I am a new nurse, too (4 months). Your feeling of overwhelm is pretty much universal from what I've heard from other new nurses. That feeling will be there just because everything is so unfamiliar. On top of that, you have an absurd patient load. Since your fellow nurses are also swamped, the suggestions of talking to the manager is imperative. If you don't get any result from that, look elsewhere. Nurses are in demand. Ask questions of potential employeres to help you find out what the working conditions will be once you start. (Do the nurses already working there look/act happy?)

Since being a nurse is a life long dream, hang in there for a workable situation. I'm sure you'll do well.

LilRedRN1973 · Feb 27, 2005

WHOA........hold the phone!! You mean you're fresh out of nursing school and you haven't had at LEAST 3 months of orientation??!! That's crazy.....a decent employer doesn't throw a brand-new nurse to the wolves like that

After reading through all of these posts mentioning length of orientation, I'm starting to get FREAKED out over mine!!! I have 3 weeks of being with a preceptor and then I'm on my own (provided I pass boards, of course). The reason I have such a short preceptorship is because I've been working as an Apprentice Nurse for 8 months. I am paired up with a nurse and take the patients as though they were my own. I assess, chart, provide care, and give any NG/OG, SQ, IM meds (am not allowed to administer IV meds). I just starting taking 2 patients about a month ago and am shocked at how adding just one more patient can take up so much more time than one (I work in the ICU where it's 1:2).

So hearing this, should I still have a longer orientation??? I'm kinda worried now. I know the grads from last year were the first to go through our Apprentice Program and they got 3 weeks as well. They seem to be doing fine, but were a bit overwhelmed in the beginning. You are assigned patients (the "less" ill ones) and don't take traumas for a few months. But it's still a scary thought that I will be given 3 weeks as opposed to someone who has not been an AN getting 12 weeks (the standard orientation in our ICU).

Melanie

hollyster · Feb 27, 2005

Hi Melanie

Flying solo is going to be a lot different then being an apprentice although you do have a big advantage over most new grads.

The IV meds you give are not like those on a floor. Lives can be lost by a mcg.

Do not allow anyone to rush you. Remember it takes years to become accustomed to being a unit nurse(People who say they are comfortable as unit nurses worry me. If they are too confident someone is going to get hurt.)

I still hold my breath whenever I push Covert.

I love the CCU. I have been a preceptor for four years and the best nurses(and most trustworthy) are those who are able to say I am not ready.

LilRedRN1973 · Feb 27, 2005

That is one thing my preceptor keeps telling me: it's good I'm nervous, scared, apprehensive about becoming a "real nurse". She says she's glad I ask a lot of questions, especially when it comes to orders that just don't sound right or look right. I've caught several mistakes just by questioning something. I ask a LOT of questions and I don't think I will ever be "comfortable" in the ICU. But that's a good thing I think. One of my preceptors has been nursing for 22 year and most of those have been in critical care. She says that even after all the years she's been nursing, she doesn't walk around thinking or feeling she knows everything. She says it's good to have some element of "fear", especially in an environment like the ICU.

I have a couple of classmates who have been acting like they are "super nurse" since the first semester of school :eek: They don't like to ask questions and will just assume they know the answer or will "wing it". Those kind of nurses scare me. They are like that in class as well....always the first one with their hand up, always the first one to announce that they got the highest grade on the exams.

I will be the first to admit that graduating scares the hell outta me because it means I will be the one responsible for these patients, not my preceptor. After that 3 weeks of orientation, it will be all me. Thank God that I work with a group of GREAT nurses are really, really helpful to the new grads. They are quick to jump in and answer questions, offer a helping hand, etc. I am not sure I would feel that way about other areas of the hospital that I've done my clinicals in. I know I will be working with a great group of nurses and that makes it a little easier to fathom!

Melanie

hollyster · Feb 28, 2005

You have a great attitude and that is more then half the battle. Remember there are no dumb questions.

As for the classmates who think that they are supernurses the reality check will come swiftly, hopefully nobody dies because of their arrogance.

Catch · Feb 28, 2005

I don't want to come off as being cold, but when I graduated, I was able to do total care on 13 acute patients. Is seven bad?
If you're having a hard time, I think you should definitely speak with your manager. It is part of professional responsibility and accountability, IMHO.
Hang in there, you'll be ok! :)

Yes, you are being cold. You can't always judge somebody else by your experience. Situations are different. If the nurse says she's having a hard time, then SHE'S HAVING A HARD TIME.

Catch · Feb 28, 2005

:rolleyes:

Hi. I am a new nurse, too (4 months). Your feeling of overwhelm is pretty much universal from what I've heard from other new nurses. That feeling will be there just because everything is so unfamiliar. On top of that, you have an absurd patient load. Since your fellow nurses are also swamped, the suggestions of talking to the manager is imperative. If you don't get any result from that, look elsewhere. Nurses are in demand. Ask questions of potential employeres to help you find out what the working conditions will be once you start. (Do the nurses already working there look/act happy?)
Since being a nurse is a life long dream, hang in there for a workable situation. I'm sure you'll do well.

Claver · Feb 28, 2005

As a nursing supervisor in community care, I once found myself in charge of over a 100 clients with only one nurse to help. I thought I was doing a very great job of keeping every thing under control until the State Auditors came in. Everyone got their medication, and no one died - but attention to labs and test results, follow up appointments, specialty clinics etc. had all gone by the wayside. Sometims we take on too much and kid ourselves that we are able to manage. We have to learn to say NO, NO.