A while back, I had posted about my discomfort of being assigned to work the COVID unit. My main thing was that the COVID unit didn’t bring out my strengths, but sure highlighted my weaknesses.
Now, again, I am in a similar position. Because there are not enough patients to fill 2 rehab units...in other words, my normal unit is closed...I have now been reassigned to help on the LTC unit.
I find myself in a similar position in which working this unit does not highlight or emphasize my strengths. Just as a background, my strongest skills as a manager and nurse include documentation, writing SBARs and completing admissions. However, with it being a LTC unit, we don’t accept nearly as many admissions. Mainly, we accept “leftover” patients from the rehab unit who are transitioning to LTC. This also means there aren’t as many things to follow up on, and therefore, not as many SBARs to write or as many assessments to complete or orders to put in. Instead, the work is mostly on hands on skills which, while I can perform, I am not as efficient with and don’t enjoy as much. We also have a patient who has medical needs that I am not familiar with or comfortable meeting.
In other words, this is another change I am not thrilled with because tasks I am being asked to complete are not my areas of strength and I am being given fewer opportunities to complete the activities I do well at. Once again, I feel I would do a much better job in the admissions role, which I have offered to learn, but continue to be denied that role because for some reason they’d rather assign me elsewhere.
Anyway, any suggestions appreciated. It seems that they do not realize that by assigning me to these other tasks, I may lose my skills in writing SBARs and even my ability to write in complete sentences.
Specializes in Psych (25 years), Medical (15 years).
Your entire post was a good read, SBE, but I chose this line on which to focus:
10 hours ago, SmilingBluEyes said:
The skillset is different, not inferior.
When I worked psych at Wrongway, the skillset was definitely inferior, medically speaking. Not so much on geriatric psych, as many of the patients had comorbid statuses, like HTN, IDDM, dehydration, etc. plus/and/or chronic conditions.
However, all the other units, child, adolescent, and adult were required to complete a daily SBAR on every patient. Perfectly healthy patients admitted solely with psych diagnoses were supposed to have fall risks, VS, labs, IV and O2 status, etc. completed.
The vast majority of the SBARs on the psych units were a joke and a waste of time. I recall one nurse merely filling out the patient's name, date, and putting a smiley face under the notes section.
Interpretation: "No problem".
MN nurses were to initiate the daily SBARs, and when I worked units other than geriatric psych, when and if I had the time, my note section would say "slept" or a glyph and the word "prob". (see above interpretation)
When I brought up the virtually useless psych SBARs at a unit meaning, the manager's response was,"Yeah... the director's working on that..."
Eventually, I stopped initiating or filling out SBARs completely. If a patient had a medical problem, I'd be dang well sure to proactively intervene and document extensively, making sure the oncoming nurse was well aware of the patient's status.
"But we're supposed to give shift report from the SBARs!" some nurses would say.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
On 1/27/2021 at 9:05 PM, SilverBells said:
In other words, this is another change I am not thrilled with because tasks I am being asked to complete are not my areas of strength and I am being given fewer opportunities to complete the activities I do well at. Once again, I feel I would do a much better job in the admissions role, which I have offered to learn, but continue to be denied that role because for some reason they’d rather assign me elsewhere.
Anyway, any suggestions appreciated. It seems that they do not realize that by assigning me to these other tasks, I may lose my skills in writing SBARs and even my ability to write in complete sentences.
Here we go again. Your posts continuously reek of entitlement. If you being assigned these other tasks makes you question whether you will lose your writing skills, especially writing in complete sentences, then perhaps you need to just quit ?♀️ I hope you don't expect your staff to be so flexible considering you yourself are struggling and complaining about it at any given opportunity.
Specializes in Mental health, substance abuse, geriatrics, PCU.
23 minutes ago, Davey Do said:
Your entire post was a good read, SBE, but I chose this line on which to focus:
When I worked psych at Wrongway, the skillset was definitely inferior, medically speaking. Not so much on geriatric psych, as many of the patients had comorbid statuses, like HTN, IDDM, dehydration, etc. plus/and/or chronic conditions.
However, all the other units, child, adolescent, and adult were required to complete a daily SBAR on every patient. Perfectly healthy patients admitted solely with psych diagnoses were supposed to have fall risks, VS, labs, IV and O2 status, etc. completed.
The vast majority of the SBARs on the psych units were a joke and a waste of time. I recall one nurse merely filling out the patient's name, date, and putting a smiley face under the notes section.
Interpretation: "No problem".
MN nurses were to initiate the daily SBARs, and when I worked units other than geriatric psych, when and if I had the time, my note section would say "slept" or a glyph and the word "prob". (see above interpretation)
When I brought up the virtually useless psych SBARs at a unit meaning, the manager's response was,""Yeah... the director's working on that..."
Eventually, I stopped initiating or filling out SBARs completely. If a patient had a medical problem, I'be dang well sure to proactively intervene and document extensively, making sure the oncoming nurse was well aware of the patient's status.
"But we're supposed to give shift report from the SBARs!" some nurses would say.
Phooey!
And now, back to our program...
We must work for the same system. When I was in psych we had a report sheet for each patient that was designed like yours for a medical floor. Labs, IV's, I/O, X-ray, etc. It was so silly, the reason we used it was "it's always been here". Finally we got a new manager that tossed those suckers out and redesigned one tailored to psych.
I just didn't understand how that form got approved in the first place?
MN nurses were to initiate the daily SBARs, and when I worked units other than geriatric psych, when and if I had the time, my note section would say "slept" or a glyph and the word "prob". (see above interpretation)
So an SBAR is like a care plan? That makes sense now. I am used to using it to communicate a change in status. Thank you.
The best managers I ever had were the ones who had put in their time in the trenches with the rest of us. It's important to know what's going on behind the scenes and see how health care is delivered before taking a position where you would be making decisions affecting patient care outcomes.
There is no way to do this job in a vacuum. I don't feel like cleaning up poop is a skillset that I want to develop but I do it anyway because it teaches me about dignity, continence care, skin care, pressure areas, and poop. Which is a vital indicator of what's going on with a patient.
It also gives nurses insight into the kind of work CNAs do and how to collaborate well with them in their jobs, which is absolutely essential in providing good healthcare.
I admit I just perused the emojis to see if there was one that looked like "Oh, come on, now." I will hope your last statement was an attempt at humor. I don't wish to be mean, but you are not going to lose the ability to write in complete sentences by providing direct care to patients.
Your performance in the roles that you say you want may very well be enhanced with increased direct care experience. I know there are exceptions, but if I had to pick a side I would be on the side saying that you don't need to be in charge of all the SBARs and care planning when there are patient medical needs that you aren't familiar or comfortable with. Your peers might not be most familiar with them either. But we have to figure things out; learn, grow. Help the patient. We don't get to just say we should get a non-direct care role.
It's pretty possible that your superiors have recognized your weaknesses and your hesitation/refusal to put strong efforts toward some of these things. If they think that avoidance is part of your desire for different roles then you're really facing an uphill battle I think.
In regards to the last sentence...yes, I was attempting to include a little humor in the post ? I enjoy a bit of sarcasm every once in a while, but sometimes it's hard to convey that tone on the internet. Since several others thought I was seriously concerned, though, I will state that realistically my chances of losing my writing abilities due to providing patient care are nonexistent. I've been writing for many years, so it's not a skill I would just lose by doing less of it one day.
Now, realistically, you may be right about my performance being enhanced with increased direct care experience. I do sometimes wonder if I was possibly promoted too soon in my career, despite being good at many aspects of my current position. Nevertheless, after writing my original post, I have made more of an effort to engage in more hands-on skills. I worked the cart as a floor nurse a couple of times this week (although not for the entire shift due to finding someone else to cover) and have been more active in answering call lights, assisting with transfers, performing TB and COVID tests, etc. I have let some of my other coworkers take over some of the secretarial aspects of the job since I am already quite competent in those skills.
With that said, I've had a hard time letting coworkers take over completing floor admissions or entering orders since I still find errors on their end, or at least find things that haven't been addressed yet after reviewing the patients' medical records myself. As I suspected, many of my coworkers are not completing their admission assessments thoroughly. For example, I have had several document that a patient's skin is intact when in reality the person just had surgery and has a surgical incision that they failed to document. They have also failed to provide documentation on major pressure injuries, or if they do document a pressure injury, they simply state "Resident has pressure injury on the bottom" with no description, measurements, or interventions documented. Someone was hospitalized for an infected wound because the nurse doing her initial assessment failed to identify that the wound was even present on her admission and failed to verify that there were wound care orders. Many of them are also failing to complete a Drug Regimen Review on their first day, or if they do, they finish the assessment stating there are "no issues," even though I have found several myself. Some of these issues involve failure to address possible drug allergies and drug interactions, failure to clarify the dose or frequency of a particular medication, and failure to address medications that have been prescribed with no clear indication for them. All of these "failures" have the potential to put patients at risk, but most people seem to simply brush them off. I've also found that when other coworkers are primarily in charge of entering in orders, errors are made. By taking me off of some of these tasks and giving them to others, they are not being done nearly as well. It's not that I feel that I am the only one that can do these things efficiently, as there are a couple of coworkers who also do an excellent job. I don't mind it when they complete some of these assessments or other tasks instead of me because they seem to care and put the time and effort into doing them thoroughly. Unfortunately, there are too many other coworkers that don't seem to care or are unwilling to spend any time making sure these assessments/orders are done correctly, so it is frustrating when they get assigned those tasks.
With that said, I get it. I can't just say that I shouldn't be expected to complete any direct care tasks. That's unreasonable. It's possible, as you said, that my superiors have noted my weaknesses. However, at the same time, it's possible they simply view me as someone capable of doing multiple tasks. I've noticed that I also have the time management, judgment, and prioritization skills to work the floor as well. I've been in this position long enough that sometimes I forget that I was--and still am-- also very efficient staff nurse.
I was an LTC nurse and I guarantee you, I did not forget about SBARs and complete sentences.
If you think about it, that is insulting to LTC nurses.
The skillset is different, not inferior.
It may not be "fun" all the time, but no job ever is.
Good luck to you. Try to keep it on the sunny side and have a sense of humor. That is what got me by, day by day, in LTC. Seniors can be so amazing to work with, even the ones with dementia.
My apologies. In no way did I mean to offend anyone or imply that LTC nurses do not know how to write or complete SBARS. I actually admire the skills that the LTC nurses have and do enjoy the residents. My last sentence was mostly meant as a form of sarcasm/humor (in a way, to make fun of myself) but sometimes the right tone doesn't always come across online.
Can someone clarify for me what is the skill in writing an SBAR? I thought it was tool for organizing a communique, but for the OP it seems to be something more complicated?
When I worked in acute care SBAR was encouraged when contacting providers, "I am calling you about Joe Blow who is having acute chest pain, 2/10. He was admitted 2 hours ago for r/o MI, his current VS are pulse 110, resp. 24 and BP 130/80 and SaO2 is 95% on RA. Current 12 lead shows NSR with elevated T waves in the anterior leads. I have given him sublingual nitro with minimal relief of pain. I recommend you see him ASAP or shall I call a rapid response? "
In my facility, an SBAR is a form that we use to notify the provider of any changes in condition for a resident or of other concerns that need to be addressed, such as unclear medication orders. They actually are not very hard to complete. Unfortunately, there are very few coworkers that are willing to take the time to write them, or, if they do, they do not fill them out completely. Many of them will simply write "resident states bottom is sore," and leave it at that. They don't include information such as how the bottom looks or interventions they used to relieve the pain, which is not helpful to anyone.
If they keep assigning you to areas in which you can not utilize your strengths in spite of your protracted discussion of same with them, perhaps you are being given a message about your standing with the organization.
Maybe, or it's possible they see me as someone that can float amongst different tasks. I worked on the floor a couple of times and can actually be a very efficient "staff nurse" as well. It's just that for some reason I gravitate more towards completing assessments and similar tasks.
Davey Do
10,666 Posts
Your entire post was a good read, SBE, but I chose this line on which to focus:
When I worked psych at Wrongway, the skillset was definitely inferior, medically speaking. Not so much on geriatric psych, as many of the patients had comorbid statuses, like HTN, IDDM, dehydration, etc. plus/and/or chronic conditions.
However, all the other units, child, adolescent, and adult were required to complete a daily SBAR on every patient. Perfectly healthy patients admitted solely with psych diagnoses were supposed to have fall risks, VS, labs, IV and O2 status, etc. completed.
The vast majority of the SBARs on the psych units were a joke and a waste of time. I recall one nurse merely filling out the patient's name, date, and putting a smiley face under the notes section.
Interpretation: "No problem".
MN nurses were to initiate the daily SBARs, and when I worked units other than geriatric psych, when and if I had the time, my note section would say "slept" or a glyph and the word "prob". (see above interpretation)
When I brought up the virtually useless psych SBARs at a unit meaning, the manager's response was,"Yeah... the director's working on that..."
Eventually, I stopped initiating or filling out SBARs completely. If a patient had a medical problem, I'd be dang well sure to proactively intervene and document extensively, making sure the oncoming nurse was well aware of the patient's status.
"But we're supposed to give shift report from the SBARs!" some nurses would say.
Phooey!
And now, back to our program...