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post COVID chaos??

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by nursemomma nursemomma (New) New Nurse

Situation: I am giving my 200% every shift and am still getting my butt kicked! Trying to decide whether to break my sign on bonus after being here a year. 

Background: I work in a big level 1 trauma center, 50+ beds. We had major staffing cuts after COVID, so nurses are doing nearly everything in the ER...phlebotomy, EKGs, lines, transporting, toileting, cleaning rooms, etc. etc. Nothing is stocked, so the 10 seconds it takes to hand a patient a urinal turns into 10 minutes just to find one. I used to LOVE our team nursing model, but now we only have 2 nurses per team most nights...that means that when my teammate gets pulled into a 1:1 situation, it's not unusual to manage 7-9 patients for hours at a time. Most of our floor nurses were laid off or left, so it's common to board 75% of our patients in the ER with a 14- hr wait time in triage (in other words, patients are angry, hateful, and hopefully not dying by the time they get to you). Family is not allowed back, so they are constantly calling with complaints as well. I have 4 yrs nursing experience but am relatively new to a department this big.

Assessment: All things considered...I still have some compassion left and try to be professional. I have been told that I am a strong nurse and help orient new staff. BUT, I can tell the workload is wearing on me, and it's getting harder to not drag it home. None of my family members work in the medical field, so it's either frustrating trying to explain what I go through at work, or lonely when I can't talk about it.

Recommendation: Pretty sure I need a change?? I'm starting advanced trauma training soon, and I don't know how much more extra work/depressing deaths I can handle. Have any fellow ER nurses run into these "post-COVID" problems in your department?! Did I just choose a hospital with poor management? Is this typical chaos for a big trauma center (aside from COVID), and I'm simply not cut out to do this long term?

Edited by nursemomma

speedynurse, ADN, RN, EMT-P

Specializes in ER, Pre-Op, PACU.

Yes. Our volume has picked back up but management will not increase our staffing. Meanwhile, staff nurses continue to resign due to the “new normal” work conditions and the positions aren’t filled. I left one ED because I feel like it wasn’t safe patient care.....now I am in the same situation post covid.....needless to say I am anxiously waiting for my new job in the preop/PACU environment starting in a few weeks. I need a break from the ER.....badly.

On 9/1/2020 at 5:54 AM, nursemomma said:

We had major staffing cuts after COVID, so nurses are doing nearly everything in the ER...phlebotomy, EKGs, lines, transporting, toileting, cleaning rooms, etc. etc.

All of this was pre-covid around here (just to give you some perspective-- which I think is important because the propensity for *literally impossible* demands is not at all covid-related at its core). All of what you describe has been enacted due to efficiency fantasies in various places long before covid.

Also, some places actually do have dangerous overcrowding and lack of resources and other places just restrict resources for direct care, preferring to expend them in other ways.

 

On 9/1/2020 at 5:54 AM, nursemomma said:

Is this typical chaos for a big trauma center (aside from COVID)

Generally, yes. Although yours sounds especially dysfunctional for whatever reason with your ED wait times and your patient boarding times. You don't have enough beds upstairs or something.


How many ED visits annually? Or what are your typically daily numbers?

 

 

speedynurse, ADN, RN, EMT-P

Specializes in ER, Pre-Op, PACU.

On 9/1/2020 at 5:54 AM, nursemomma said:

Situation: I am giving my 200% every shift and am still getting my butt kicked! Trying to decide whether to break my sign on bonus after being here a year. 

Background: I work in a big level 1 trauma center, 50+ beds. We had major staffing cuts after COVID, so nurses are doing nearly everything in the ER...phlebotomy, EKGs, lines, transporting, toileting, cleaning rooms, etc. etc. Nothing is stocked, so the 10 seconds it takes to hand a patient a urinal turns into 10 minutes just to find one. I used to LOVE our team nursing model, but now we only have 2 nurses per team most nights...that means that when my teammate gets pulled into a 1:1 situation, it's not unusual to manage 7-9 patients for hours at a time. Most of our floor nurses were laid off or left, so it's common to board 75% of our patients in the ER with a 14- hr wait time in triage (in other words, patients are angry, hateful, and hopefully not dying by the time they get to you). Family is not allowed back, so they are constantly calling with complaints as well. I have 4 yrs nursing experience but am relatively new to a department this big.

Assessment: All things considered...I still have some compassion left and try to be professional. I have been told that I am a strong nurse and help orient new staff. BUT, I can tell the workload is wearing on me, and it's getting harder to not drag it home. None of my family members work in the medical field, so it's either frustrating trying to explain what I go through at work, or lonely when I can't talk about it.

Recommendation: Pretty sure I need a change?? I'm starting advanced trauma training soon, and I don't know how much more extra work/depressing deaths I can handle. Have any fellow ER nurses run into these "post-COVID" problems in your department?! Did I just choose a hospital with poor management? Is this typical chaos for a big trauma center (aside from COVID), and I'm simply not cut out to do this long term?

Sorry - the 14 hour wait.....hmmm....probably not the safest. I thought a 6 to 8 hour wait was bad. Yeah, that can make things challenging and unsafe.

cliniquenurse

Specializes in Emergency. Has 13 years experience.

I love the SBAR format of your post! 

Everything you said is relatable and unfortunate; the mere presence of your post is a testament to your professionalism and compassion.

My guess is you don't have a union; if you do please contact them and explain the situation - you pay fees for things like this. 

Talk to your fellow nurses and see how you and management can move forward that is safe for patient care and important for staff retention, morale and the like. Managers come in all styles but their purpose is a properly functioning department. Happy and appreciated nurses is critical to a well flowing department.

If all is fails I recommend holding yourself to the appropriate standard in the given circumstance. For example, if you typically chart very thoroughly, chart what you need to communicate the facts, simply paint the picture and protect your license - a minute shaved off charting is a minute gained somewhere else.

For the patient you've assessed is kind and not critical, let them know, it's really crazy, you're important to me, but things may take longer than we'd both like due to census, etc. Setting up realistic expectations for to realistic people takes some weight off your shoulders. 

Deciding to leave is a big decision, regardless of finances. Weigh your options, see if the grass is greener on the other side. Since there is no medical person at home, connect with your colleagues as often as possible for the comradeship and understanding. Love yourself for what you do and understand it is hard times, it really is; you're doing the best you can, but it's hard. 

6 hours ago, JKL33 said:

All of this was pre-covid around here (just to give you some perspective-- which I think is important because the propensity for *literally impossible* demands is not at all covid-related at its core). All of what you describe has been enacted due to efficiency fantasies in various places long before covid.


How many ED visits annually? Or what are your typically daily numbers?

 

 

Thank you for the reply! I was indeed hoping for some perspective. I started orienting just a few months before COVID “hit,” but I was also new to the state/hospital/ER that big, so it felt really crazy at the time. I’ve heard several nurses who have worked in our ER 10+ years say they have never seen it this bad, which makes me wonder...

We have plenty of beds upstairs, just no floor nurses to take the patients. Argh. Currently, I think we typically see 200-220 patients come through the ER per day. 

1 hour ago, cliniquenurse said:

I love the SBAR format of your post! 

Everything you said is relatable and unfortunate; the mere presence of your post is a testament to your professionalism and compassion.

My guess is you don't have a union; if you do please contact them and explain the situation - you pay fees for things like this. 

Talk to your fellow nurses and see how you and management can move forward that is safe for patient care and important for staff retention, morale and the like. Managers come in all styles but their purpose is a properly functioning department. Happy and appreciated nurses is critical to a well flowing department.

If all is fails I recommend holding yourself to the appropriate standard in the given circumstance. For example, if you typically chart very thoroughly, chart what you need to communicate the facts, simply paint the picture and protect your license - a minute shaved off charting is a minute gained somewhere else.

For the patient you've assessed is kind and not critical, let them know, it's really crazy, you're important to me, but things may take longer than we'd both like due to census, etc. Setting up realistic expectations for to realistic people takes some weight off your shoulders. 

Deciding to leave is a big decision, regardless of finances. Weigh your options, see if the grass is greener on the other side. Since there is no medical person at home, connect with your colleagues as often as possible for the comradeship and understanding. Love yourself for what you do and understand it is hard times, it really is; you're doing the best you can, but it's hard. 

I really appreciate the advice and encouragement - thank you! I feel like “the grass is greener somewhere else” attitude is one of my faults, so I’m really trying to stick this one out and hope it improves. It’s such a hard decision knowing when to say “enough is enough” though! I am definitely trying to take a second look at my charting and see how I can save time there. It just makes me nervous when patients come in angry from triage, threatening to sue the hospital before you even have a chance to care for them. Fun times 🙂 

6 hours ago, cliniquenurse said:

If all is fails I recommend holding yourself to the appropriate standard in the given circumstance. For example, if you typically chart very thoroughly, chart what you need to communicate the facts, simply paint the picture and protect your license - a minute shaved off charting is a minute gained somewhere else.

Agree with this. I would chart the bare minimum that is prudent, especially in lower-level and/or stable cases. Hit the highlights.

Who is caring for all of these boarded patients? That's another one of the scarier aspects of this. You in the ED are supposed to be providing admission- or obs-level care to them while you're doing all of this other work for the incoming patients?

I don't know...there is major dysfunction going on there. I mean, there are several different ways to attack the kind of problems you describe, but in order for things to be as bad as they sound it would suggest that they've tried none of them. Or that they're not even working on it.

Leaving would be reasonable if no one is responsive to taking sort of emergency corrective measures.

What are the basic details of the sign-on bonus?

Also, as a temporizing measure, I'd probably swing by the supply room after punching in and take handfuls and armfuls of frequently-needed supplies and throw some of each of them into whatever locked compartment you have in each room, or a common area close to your group/chairs/beds/rooms if they can be secured there.

Beyond whatever things like ^ this and the brief charting....all you can do is prioritize carefully. Better to have not-sick people mad then to have sick people decompensate. While you're with the patients you need to be with doing the things that must be done, remember to keep a positive mindset. You cannot run around with hair on fire solely because they think they don't need staff in this place. This is not on you. Just do your best until you can figure out your next move.

On 9/2/2020 at 10:39 PM, JKL33 said:

Who is caring for all of these boarded patients? That's another one of the scarier aspects of this. You in the ED are supposed to be providing admission- or obs-level care to them while you're doing all of this other work for the incoming patients?

What are the basic details of the sign-on bonus?

Unfortunately the ER nurses are caring for them....I generally have to be a floor nurse, ER nurse, and ICU nurse  at the same time. Thankfully our docs are very gracious, and the hospitalists come around often to check on us and help prioritize tasks on the boarder patients if needed. Our ER docs are generally gracious also, but frustrated that we have to spend so much time on boarders. But still, scary things get missed...I happened to catch a nice run of torsades on a boarder patient that was missed on the previous shift.....called the doc immediately and she had no idea. It honestly could have happened to any of us though, with as many patients we have to monitor. 

The sign-on bonus was specific to the ER and the contract states I have to pay back the full amount if I leave before 2 years. It’s the first and last time I’ll ever sign one, sadly. 

On 9/2/2020 at 10:46 PM, JKL33 said:

Also, as a temporizing measure, I'd probably swing by the supply room after punching in and take handfuls and armfuls of frequently-needed supplies and throw some of each of them into whatever locked compartment you have in each room, or a common area close to your group/chairs/beds/rooms if they can be secured there.

Beyond whatever things like ^ this and the brief charting....all you can do is prioritize carefully. Better to have not-sick people mad then to have sick people decompensate. While you're with the patients you need to be with doing the things that must be done, remember to keep a positive mindset. You cannot run around with hair on fire solely because they think they don't need staff in this place. This is not on you. Just do your best until you can figure out your next move.

I would love to hoard supplies, but unfortunately nurses don’t have access to the main supply rooms and we are no longer allowed to store items in rooms due to COVID restrictions. The supplies alone probably frustrates me more than anything! Supposedly they are working on the stocking issue in the ER...so HOPEFULLY something improves soon on that front. 
 

Thank you for the encouragement! I am really trying to stay positive, but some shifts just leave me feeling so ragged. I try to remind myself that my job is to keep patients alive, and not cater to the people who think they are at a 5-star resort. It’s hard to hear those alarms though when patients are yelling at me for their forgotten pudding cup 😂 

 

On 9/2/2020 at 8:00 PM, nursemomma said:

I really appreciate the advice and encouragement - thank you! I feel like “the grass is greener somewhere else” attitude is one of my faults, so I’m really trying to stick this one out and hope it improves. It’s such a hard decision knowing when to say “enough is enough” though! I am definitely trying to take a second look at my charting and see how I can save time there. It just makes me nervous when patients come in angry from triage, threatening to sue the hospital before you even have a chance to care for them. Fun times 🙂 

The grass is greener where I work in Maine.  5 patients is a lot, and unusual.  2 hour waits are long, 6 hour waits don't happen.

That being said, I still often run my *** off for 12 hours.  But not every day.

And, we face some of the same challenges, just on a different scale.  What ever it is you are used to, it feels worse when it gets worse.

My best suggestion is detachment.  There are only 12 1/2 hours in a 12 hour shift, each of them still only has 60 minutes.  You can only do what you can do, and linking your emotional well being to outcomes you can't control is a recipe for burnout.  I periodically remind myself I didn't create the staffing model, I didn't randomly require extra useless documentation, etc.  I prioritize, and my first priority is me.  For those who have worked pre-hospital, you are very familiar with the concept. The whole self sacrifice thing is a nursing thing.

 

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Make repeated and detailed reports of your shift in emails to your boss. Make sure your concerns are on record, and you'll be able to look back and say they are aware of the conditions if anything happens. It looks like you should be emailing every shift to me! Not angry emails, just FYI notes asking for guidance and other resources you could use.

Then do your shifts knowing that the patients couldn't get better care from another nurse, because those above you have made your job impossible. Let the phrase "its what the hospital has chosen" just fall off your lips. Give the complaint forms to (almost)everyone and tell them "you would be doing me a favor if you reported your concerns." Try to make it you and the patient fighting against the system instead of you vrs patients or family.

Its an impossible situation, maybe you'll get lucky and they'll fire you for documenting the dumpster fire via email. Then you wouldn't have to pay back anything, and you'd have a great answer for why you left your job.