problems with my unit, any ideas?

[rags]

I posted this in the graduate nurse forum but thought I would also post it here in hopes of getting advise from some seasoned nurses. All is appreciated!

Original post with grammer corrects :):

I have been working at my hospital since June and was hired on in the Family Care Unit (includes PEDS OB and PP). I worked as a graduate nurse until I failed the NCLEX the first time in late July (second time in late Sept.) and since as a CNA (for the first time ever in my life). I have actually enjoyed the experience and feel that someone somewhere thought I needed to be a CNA for a while so that I will be a more understanding RN. (Please don't crush my bubble here, It is not only a wonderful experience for me that I have taken on whole heartedly but also a wonderful coping mechanism).

I have floated to different areas of the hospital since, with only about 4 nights working in my own unit. That's 4 nights out of 3 months. I am very comfortable in all other units of the hospital and have adapted to the way things are done in each pretty well. When I got back to my own unit to work for a night (or in some cases like last night... part of a night) I feel a bit out of place. My unit does not normally have CNA's, just the one that is Unit Secretary 4 days a week. The RN's are pretty self sufficiant as a result and we have had some issues with know who should be taking VS and such, but that has been worked out. So I thought anyway.

Every unit has been very positive toward me and seems to be very appiciative that I am there and pretty much lets me be on my own to determine what I need to get done. I sit in on report so that I know who is on strict bed rest, has a foley, on strict I&O's, etc...

I'll try to keep this simple (honestly, I WILL try). On Tue. night I was left to work on my unit in FC. I was very excited about working with my own crew again and tried to anticipate their needs from what I remembered needed to be done while working as a GN. I took vitals on the pt's I was allowed to (L/D and NS seems to be off limits for some reason) when I came on after report was done. I have always been in the habit of charting (done on computer) as soon as I am done and I report anything out of the norm or any needs I cannot meet of a pt to the RN I am under for that peticular pt. They usually just shrug their shoulders at me and say, yeah, I know and don't appear to be concerned, which is fine. I am just the messenger and I understand that. So, on Tue. night I cleaned equipment, cleaned and restocked warmers and del. carts after deliveries, put together charts, helped care for NB's in the NS that was full of gagging babies (can't figure out what was up there, must have been something in the milk ), called new borns to admitting, set up the circ room for an AM circ, did a couple of hearing screens and a midnight weight, got a newly post-partum mom up the first time & also changed her bedding, prepaired a room for an early am C/S, ordered labs on NB's and delivered the cord blood etc... I think you get the picture. It really gave me a good feeling to have the RN's coming to me saying, "Oh, you already did that?" or simply finding me doing what they were going to tell me to do. I felt I had anticipated their needs and that was the best way for me to be helpful on a floor not used to having a CNA. Apparently work performance on my part was not seen by the RN's in the same way.

When I got to work last night I was first floated to another unit and one of their RN's was floated to mine. Around 11:00 I was to go back but nobody informed me of this until after 11:15. I was helping an RN get her hourly BS and VS on a pt with the Dr. present waiting for the results, then I charted it before going to Family Care. I was later told I should have left the pt room and called them to let them know where I was. I admitted it would have been helpful and I even thought of doing that, but felt it would be appropriate to put the Dr. on hold (who was waiting at the bedside) while I did so.

While I was writing down the patient load and finding the information I felt I would need from the cardex I was handed a list of things I would be doing, and at what time I would be doing them, from one of the RN's. It felt strange, kind of like I was a new CNA off the street that had never taken VS or I&O's before and was in need of direction for some reason. It also had on the top a message saying that I would do hourly checks on all pt's and chart it. I felt this was a bit too much and not normal procedure! I could not find a good reason for me to open every door during the night and look at patients on a unit such as ours. PP mom's are usually stable patients, I can not chart on or care for Laboring moms or usually even the new borns (their rules) and they were doing their checks anyway (were they not?). I was answering call lights and doing their VS and I&O's as well. But... I did it. I was told to by my RN's and that is what I did. I might also add that one of the RN's did NO charting until after she gave report to the next shift. The same RN had me do a weight on a 10 year old at midnight that she had already done when he was admitted a few hours before. I didn't realize this until around 0500 though when she charted it in the computer. I thought, "why did she have me get that poor child up and do it again if she had already done it?"

When I was finished doing VS on all pt's I was passing the nursery that had a very upset baby in it and no RN, so I went in to calm the NB. Not 2 minutes after I went in there one of the RN's came in and said, "if you aren't done charting you shouldn't be in here holding babies. I'm just warning you because there has been a lot of drama about things not getting done or charted." I used this opertunity to ask questions and find out the reasoning behind the list. It would seem that the RN's didn't feel I got anything done the night before except hold babies in the nursery (only one of these RN's was on the night before and took her own delivery tray try to soak and cleaned her own warmer and delivery cart while I was in the nursery alone with the above mentioned NB's. It took her all of 15 minutes) and the statement was even made that "everytime we look for you, you are nowhere to be found" this was from a nurse I have worked with all of 3 times since I started there and simply isn't true. If I am going to be leaving the floor I ALWAYS tell someone. I admit I smoke but it does not effect my work. I have maybe 3 cig. in a 12 hours shift and NEVER if there are things needing to be done!

During the night I also found out that they feel I am taking up an RN spot on the schedule and that leaves them short handed. One even mentioned to me that it must be tough and that I must doubt myself on everything since I haven't passed the NCLEX yet. I responded with, "No. I don't doubt myself at all. I just need to figure out the NCLEX, but I think others here do and that's a hard one to swallow". She responded with, "Well, I'll be honest with you. I do that. Since you never worked on nights as a GN we just think, how scary is she? Why can't she pass the NCLEX". I will add that I have a lot of respect for this RN because she will actually talk to me as if I am older than 2 years old and is up front with me at all times. Well, after all this I received an email from my boss this morning and she wants to talk to me. I honestly am not sure if it is about this or not, but assume it is.

I just don't know what to do. I spent most of the night fighting back tears and doing everything in my power to not quit. I don't bring my personal problems to work (which are difficult and many at times) and I remain professional and try my best to give quality pt care and respect to all the RN's I work with.

I do know I need to get my license, I need to pass the NCLEX and then prove myself to them. I can retake it in Nov. but don't know if I will have the $335 to pay for it by then. The $8/hr pay cut was a huge set back. I am stuggling to just pay my bills on time now (have to find another $200 by monday even ). AND... we have been trying to buy a home for the past 3 months as well and that has only added to the financial pressures (they want the $500 for the appaisal by Tue. I realize maybe we should be trying to get this property right now but it something we have dreamed of for the 20 years we have been married and we have fought so hard to get everything moving since Aug!

I am not a spring chicken. I have been in ugly situations with fellow employees before but this feels different. Nobody has ever treated me like I was not a quality worker and made comments to me of that nature. I guess I am like a fish out of water here.

I am sorry this is so long. I just really don't know exacty how to handle this. My boss can be a little scary at times and I never seem to know what mood she is going to be in on an issue. I am the new kid on the block so don't expect her to take my word over the others. I don't think my job is exactly on the line because she did ask in the email today when I was going to test again. I am NOT doing it because she is pushing me to this time (which was the case the last 2). I will wait until I am ready. (which my plan is the end portion of Nov.)

Does anyone have any suggestions for me? I hate to whine but this is giving me a serious headache that even excedrine won't get rid of!!!

[purplemania, BSN, RN]

Your message was way too long to read every word but the impression I got is you are not happy where you are and don't know why. Just do your job and don't let someone else's attitude get you down. The job does not require you to be liked by everyone. Ask your boss or a trusted nurse for guidance, but do not ask everyone on the unit and talk about it ad nauseum. That will make you sound like a whiner. As for finances. If you don't have the money to buy something don't buy it. You may have to make a choice. Do what is best for you, not your co-workers. Ask for money for Christmas. Sell something, even blood. Take lunches to work. You can be creative. Just keep your goal in mind and think of how good you will feel when this is behind you. Think of it as a learning lab. Good luck!!

[rags]

Thank you. Sorry it was long.

[kate1114]

I've worked with several RNs who didn't pass NCLEX the first time, and I never doubted their ability to work. They were usually very conscientious people, and many had individual reasons why they didn't pass. One went to a school with an abysmal pass rate and she's struggled with the test structure ever since. Some people just don't test well.

As for the rest, try to make sure that you are in constant communication with the nurses. Tell people where you are going to be. I would also try to talk to someone in power who seems to care. A charge nurse or a manager, if possible. See if you can find any insight to their behavior.

It is entirely possible (and I hate to see this) that you have a personality conflict with some of the people and that there are cliques in your unit. I saw this with one girl who was a unit tech. She was very nice, but her personality (a bit needy and whiny at times) REALLY angered some people for some reason. They would make comments that she never stocked right and that she was always goofing off, when I never saw a problem with her work. It might be that you need to switch to another unit or hospital.

Also about the house. This is NOT the time to get into debt. Interest rates are increasing but housing prices are falling. Don't bite off too much at once. Yes, it might be your "dream house" but if you aren't making ends meet at the moment, home ownership might be the worst thing you can attempt. Wait for the purchase until you can save up some money. Concentrate on passing the NCLEX, and then get another job. If they are treating you like crap right now, who says they'll be any better once you are an RN? And if they are, then they are two-faced people who are not to be trusted, KWIM? You don't need that sort of working environment.

[rags]

Thank you Kate1114, I will take everything you said to heart. I really don't like this feeling of mistrust from my fellow workers.

[nurse_clown]

[color=dimgray]imho i think the problem is, you are working in the same place where you were gn. that must be tough. you should consider yourself very brave for doing that. it must be uncomfortable for your coworkers too. however, you shouldn't allow them to make you feel uncomfortable.

there could be a number of reasons why you didn't pass the nclex. in my first year of college, i was diagnosed with dyslexia. so, i worked to overcome that. but, passing the exams was very difficult because i couldn't read the multiple choice questions. i knew my stuff but i crashed during the exams. also, my first year of nursing school, i was diagnosed with add. i'm not saying you have dyslexia or add. i'm just suggesting that writing the exams may be more challenging than doing the actual job. once i figured out how to read the darn questions, i wrote my board exams in answered five questions incorrectly.

is there a way that you could ask this nurse who is honest and up front with you to help you with the exam? maybe she has some insight or old exams. i'm not sure but i've come across some practice exams on the internet. put off rewriting the exam till the next time so you can study and be successful. i suggest using the "bartering" system which'll make everyone happy and build a team. you work extra hard for your coworkers and it'll be easier to approach them to help you with your exam.

oh, and don't get into the exedrine, talk a nice brisk walk instead. it gets the heart going. i always get rid of my headaches that way. especially, the stress headaches. when i first started nursing at the hospital, i had a hard time. my coworkers actually had a meeting about me and complained to the manager! i felt so sick to my stomach. i vowed to make it better. it took a lot of hard work but now i'm considered one of the more "seasoned" grads now.

[mrsalby]

I hope you are able to use an NCLEX preparation system to assist you. Does your hospital offer courses that help prepare you? Take time to do what you need for yourself and know who you are. When you talk with your manager, go in prepared and relax with positive reinforcement for yourself. Review your post...(It was long but out of respect I read it) you mention encouraging strong points about yourself and the work you performed as well as anticipating what the nurses needed and being complemented. This is your rebuttal material if the meeting with your manager is less than expected. Mention this to her and the names of nurses that made the positive comments. Smile, be professional like you know how to do. It is work and the others negative comments and feelings are no reflection on you.

It may stem from their feeling they have to increase their workload because of your inability at the time to pass. If this is how they respond to a coworker in "need" maybe you might be comfortable in another area where your efforts are appreciated and assistance may be available. Just becasue you move on to another area does not equate failure, just healthy decision making. Geez, where is the compassion in these nurses if they can't pick and encourage one of their own.

Good luck and keep your chin up.

[vamedic4, EMT-P]

rags,

i'm sorry you work with people who don't respect you and doubt your abilities.

one thing i will tell you is that you don't need to "prove" yourself to anyone.

you need to worry about passing nclex, that's a given. study seriously and you'll get it - i know it. but to worry about what other people think is just a waste of time. people don't give a *^%$ about anyone but themselves, and they're usually hypercritical of others.

so what if you didn't pass on the first go round?? and?? it doesn't make you a bad person, or a bad nurse. as another poster put it...i"ve worked too with several rns who didn't pass the first go round, but i wouldn't trade (most) of them for the world.

a little self respect goes a long way. you'll get it next time.

all the best,

vamedic4

off in 1:45

[TazziRN, RN]

If they feel shorthanded because you're scheduled instead of an RN, they should be talking with the manager about that, not taking it out on you. And maybe they're upset about the work you did the previous night because you did more work than they did.

I think I'd be looking for a transfer to another unit.

[SteppinraeRN]

I read your entire post and I must say that you are a very detailed person. Could it be that you are doing TOO much, to over-compensate feelings of "failure"?

I feel your pain. Believe me. I joined this website tonight because I have just found myself fired from another job. Three in 6 months. I have no clue what is going on.

I have been a nurse for six years, a CNA forever, and a Medical Assistant as my segway.

I am starting to HATE nursing, I mean HATE it. The women, mostly the management, are absolute beyatches. One of the Nurse Managers had been there for 3 months, the other only eight months. The DON was also new, less than a year. Long term care is beginning to be nothing but a band of gypsies roving from one facility to another. My last job was working in a long-term care/Rehab facility that was absolutely nuts. They had a LPN running a floor with 20 step down patients! One wing had 34 patients, many with PICC'S, Mediports, Trachs, Tube-feedings, wound vacs, not to mention the 12 or so Medicare people that needed full assessments and charting on. The place was insane. I was going to quit, but I am not a quitter and wanted to fullfill my one year contract; they were also paying me very well. At any rate, the way that nurses treat each other, and especially the need to "eat their own young."

I am just flabbergasted by the entire nursing world. Why nurses do not pull together and cover each other's assess anymore is a mystery.

Hang in there and possibly find a "go to person" that you can talk to about what is going on at work. It is so hard to trust people at work, so be careful what you say and to whom.

Good luck and just know when you leave work at the end of your shift you were a good nurse, no matter what your formal title is now.

[oneLoneNurse]

I feel you need to get some of those great DVDs I bought to pass the NCLEX. Just passed the NCLEX after 22 years of RNing in July. Those DVDs were priceless, I listened to them here @ work and @ home.

[rags]

Thank you everyone for your input, words of encouragement, advise and ideas. I have read and will remember each and everyone of them.

As one mentioned, yes, I am detailed oriented and that is most likely the reason for such a lengthy post. My goodness, I couldn't believe how long it was after I hit the "submit" button... Call me crazy! But thanks to those of you who took the time to read it. It means a lot to me.

Update:

Last night when I got to work I found a note in my mailbox thanking me for taking vitals and charting hourly checks on the patients. It was a heart warmer. I also ran into an RN from a unit I am often floated to who told me she had ran into my boss and thanked her for allowing them to have me on their unit. She told her that I was "a real life saver" for all of them. I found the timing to be a bit ironic. Sort of. Before I was sent back to my own unit on that horrible night, I had been working with this RN and one other as their CNA. Between the two of them among their 13 combined pts they had 4 pts receiving blood and another pt with an hourly BS and VS q 2 and 3 admits. This was all between 7p and 11p before I was sent back to my unit. They were busy and I DID know that this peticular RN was expecially greatful for my help. So... that is why I say it wasn't completely wierd that she told my boss this the very morning after my own unit RN's were so difficult to work with. Again, it made my heart warm.

I guess you could say I ended my week on a good note. I am still going to walk on egg shells around the ladies on FC though, but it will be while dazzling them with kindness and STILL trying to anticipate their needs!