Nytenurse

Interesting, I had my first code a couple of weeks ago, They call it Code 30. We are a teaching hospital so like 50 people show up. Surgical residents, medical residents, respiratory, nursing coordinators. It was my patient and there was no room in the room for me. Thank god it was a private room. I gave the nursing coordinator the information on the patient that I had. last vs, mental status, diagnosis. The nice thing about all those residents at least one or two of them had him as a patient. Then I was told to just go tend to my other patients. I think their theory behind this is that it is so stressful on the nurse whose pt it is they have them do next to nothing. The pt didn't make it. What bothers me and I don't know if this is just how it is everywhere, but there wasn't any debriefing afterwards. Like did I do everything ok? Was there anything I could have done differently? Actually if I should have done something differently I would have been told already, my hospital has no problem telling you what you did wrong.

I feel like the wool has been lifted from my eyes. I have been comtemplating my current situation and with the help of those who have responded I feel a little better. While I am still afraid of quitting my job and finding something else (even something better) I am determined to get something positive out of this. Like I think I said before, or maybe thought, I have the I and Os down to a science. The dr's come in a 6 am and I like to have them done for the day by then. (Which is chronologically confusing because its actually the next day, you know what I mean. Why do they consider the 7-3 shift the first shift anyway? Is this all over the world or just my neck of the woods?) This is who the documentation is for anyway. I've always prided myself in having that done for them. I am determined also to make my boss see me in a positive light. If someone has pointed out my deficiency (like the i and o's etc) I will point out my good points. Maybe she honestly doesn't know the good that I do. Like I said this is the first time that a pt has complained about me and now I know where I went wrong. Yes, I think I was beginning to get task oriented instead of pt oriented. You have no idea how powerful that statement was to me. I was starting to become the very thing that I entered into nursing to counter. I always intended to put the pt first and I fell away from that. The pca's and epidurals can wait a moment. Comfort first. I can't believe that I missed that, sometimes it takes someone from the outside looking in to point out the obvious. I wish that I could also talk to the pt and tell her what I've learned (although that may not be wise either) Supposedly, although I have no proof, she was a registered nurse, somehow ended up with a lot of money, hires private duty nurses to take care of her and her new hip so she doesn't have to go to physical therapy, did I mention she was only in her 50s? Well, I'm getting back to bitter now so I'll stop here. Learning from my mistakes as usual. Thank you all for your help. Sincerely, Nytenurse

part 2, regarding the i and o's. I showed her the check system that I do now inorder to make sure the i and o's are always documented on. I showed her every note that I take and told her that at the end of my shift I check every chart to make sure that this is all done. She said that I shouldn't have to do this and that I should just ask the lpn or ca what their intake and output was. Well thats all well and fine but if they don't put it on the chart, if they forget to write it down but know what they put out or whatever isn't that the same thing as not doing it at all if its not on the chart? this happend just the other day. An lpn told me how much the pt put out in her foley. She didn't write it in the chart I somehow missed checking this one and the next shift called me at home and asked me what it was so she could write it in. She understands what I am going through and thinks its ridiculous. She has been very supportive. Most of us are supportive of each other. We realize that nursing is a 24 hour job and that not everything can be gotten to in 8 hours. We have each others back so to speak. I know who followed me the day in question regarding my i and o's. It was a float nurse. She didn't document on a pt that day and I brought this up to my nurse manager who said that she knew about it and spoke with her. She said that she also spoke with the lpn and ca. This is not true. I already spoke with them. She didn't even realize that one of the pts not charted on was the lpns and a member of her staff and should be spoken to directly. Is there a worse feeling knowing that your manager is lying to you and you can't do anything about it. My only options are to stick it out and be entirely miserable for 6 months or quit. That means starting over in a new hospital, new orientation, waiting for benefits. As a single mom I don't know if thats wise. I have a lot of thinking to do. In the meantime it may not hurt to look into other hospitals. I know that I may run into this again, but to turn my back on post ops, on pts who don't have a private aide to stand outside another pts door and wait for me to come out? Pts who have dementia who cant ring the call bell? I had one pt who was pressing the morphine pca button thinking it was the call bell because the place where she was from, that was what the call bell looked like. Please keep telling me what your experiences are with people like this. What you have done, whats worked for you. Your experience is very valuable to me. With all thats happened. I can see why having a union is important. My hospital has been good to me in that they have given out bonuses to us to say thanks for hanging in their through the nursing shortage. Every bedside rn got 1500 dollars. lpn a little less. After taxes it was like 800 but it was still nice. The benefits are great. I guess. I don't really have anything to compare it to. Agency nursing is looking really good right now. I am so sad thinking about staying there for another 6 months. I feel so trapped. I feel that there is no one at the hospital that I can trust to talk to about this. Thank you all for being there for me. Sincerely Nytenurse.

my dear friends, you have been very supportive to me through this and your support is again needed. I was written up for an incident that occured the other day. This is what happened: They way our floor is divided we have a 28 bed floor. 2 rns and 2 lpns and 1 asst. This is then divided into 7 pts each for each rn and lpn. The rn covers the lpns resulting in 14 pts total responsible for. On this night we had (we meaning the lpn and I) 10 pts that were post op. They had had surgery that day. All were elderly with cardiac conditions. 1 pt who was my direct meaning that she was one of the 7 that had me as their nurse only, had a private aide with her, this aide came out to me and told me that she needed help repositioning this pt. Now this pt has been a difficult pt in that she feels that she is the only pt on the floor. She expects everyone to drop what they are doing and tend to her immediately. I explained to her aide that I had post op pt that I needed to see first and that I would be there as soon as I could. She came out again and said that she needed to see me. I told her again about the post ops that I needed to see first. Then she came out one last time and asked me if she could have a pain pill and that if she could give it to her. I said that no she couldn't but I would be there as soon as I could. Of course this wasn't good enough and the pt called the night supervisor. This resulted in my nurse manager writing me up for not delivering care when requested. I explained to her the necessity of needing to see post op pts and what their medical history was. This did not matter. If I had dropped everything and saw to her I would have been delaying care on someone else. I have not learned yet how to be in two places at once. Because I was written up I cannot leave this floor now for 6 months. I am stuck on this floor for 6 months. I had the director of nursing present at this meeting and she stood by the nurse manager. Is there anything that I should have done differently? I told them that I am really unhappy with the way the floor is run as a whole and what are they going to do to make me happy there. They told me it is not their responsiblitly to see to my happiness there. I was every inch a professional at this meeting. It didn't matter that this was the first time a pt complained about me. It didn't matter that I had a pt who was very good friends with the head of the hospital who was so happy with my care his family baked me brownies to show their appreciation. I feel that being kept on this floor is a fate worse than death. To hear them say that they don't care if their employees are happy or not, to know that they will risk post op pts for a pt with pain. This one pt, no one could make happy, every shift has had a hard time with her. My manager knows this, it was told to her by the other shifts. Part of me feels like she got wind of me wanting to leave and in order to keep her floor staff she wrote me up so I can't leave. Like I said this is the first time this ever happened. It is the first time a pt complained about me. The first time I was unable to get to someone in a timely manner. The first time we had 10 post ops on the same night. All had either epidurals or pcas that the lpn couldnt touch. Who will make sure that the setting are right if not me? no one.

I think that everything happens for a reason...signs are all around us if we choose to see them etc... It just so happens that last night at work one of my patients was an RN in our OR, she was happy to talk to me at length about it and it sounds great! After some soul searching I think that this is best. My nurse manager and I will probably butt heads forever if I stay. I think that it is best for all involved. Especially me. Sad thing is some of my coworkers are just as unhappy, being victims of her before. A couple have left, and I know that I won't be the last. I hope the higher ups will see what the common denominator is here and why she can't hold on to her staff. Thank you everyone for your advice and support. You have no idea how helpful you all have been. If I get the job in the OR though, I'll have to change my name. No more full time nights for me. Again Thanks... Nytenurse sleepy girl.

I am the last shift to chart on the flow sheets. Soooo, you gotta be blind to not see the missing documentation ahead of me. Regardless, I am getting pretty meticulous about my charting. The last thing that I do before I walk out the door is check all the charts one last time. Just a quick scan. So far so good. I am keeping a work journal, lots of positive things, also if I do leave I will have something to counter anything negative that may have been said. Ready for this? Pt satisfaction is going to make up %40 of our evaluations. Can you believe it? I work nights! On post op pts! Who are on MSO4 and Dilaudid and Percs! Half the time I am shooing out imaginary birds! They don't remember me from the night before let alone when those surveys go out. I've taken to writing my name in big letters on the dry erase board and the shift that I'm working. Maybe when they are more awake and lucid they will say oh yeah, I remember her... Yep, love my job. The ER and the OR are looking really good right now.

Thank you all so much for your replies. You have given me much to think about. Here is what I have so far and let me know if I'm on the right track... Once bitten, twice shy. Wanna bet it will be a really long time that I ever miss charting I/O's? I definately will be checking over everything, I don't want to give her a leg to stand on. I have already started the work journal, sadly to say, I already have several pages. We have a pretty new staff, new grads etc. It can be overwhelming. You have opened my eyes to a lot. Worse than my nurse manager, though, would be a day in court. I will be documenting my ass off, I think that with a little tweaking I can do this. As far as communicating with her I really have to prepare myself. The advice and support that I have gotten here has really lifted my spirits. Thank you thank you thank you!!! Sincerely, nytenurse zzzzzzz

I have recently been targeted by my nurse manager, I have been an RN for a year now on her floor and she has been on me like white on rice the past couple of weeks for the most petty problems. One bad night I forgot to document the I and O's and she proceeded to tell the shift following me to let her know if there is anything that I'm not doing and that she may put me back on orientation. Does anyone have any advice on how to deal with someone like her? She doesn't seem to notice the more important things that I catch that hasn't been done by other shifts. For example a post op pt that should have been on telemetry and was sent to a regular med-surg floor, IV rates that a wrong, pts not getting needed medications when ordered stat on the previous shift, recognizing "silent MI's" and a fib vs tachycardia. I follow a new grad sometimes and you don't want to know the stuff that I find that isn't done. I work nights and the I and O documentation for the day ends with me, however all the shifts are poor documenters when it comes to I and O's and when you are prioritizing in the face of too large of a pt load, very sick pts and what have you the I and O's are sometimes missed by all. You can get a basic idea that yes this pt has sufficient Intake and Output but not necessary by the cc. Anyway it seems that she is more concerned with this right now than anything else. I used to love my job, but now my stomach hurst all the time and I'm having headaches. I am so caught up with watching my step and my aides and lpns that I'm afraid that I will miss something more important. I usually have between 5 and 10 direct pts and cover the lpns 5-10. If the lpn misses documenting the I and O's she comes to me only and doesn't speak with the lpn or nurses aide, they are still memebers of her staff and I feel that she should speak with them as well. Has anyone ever experienced this before and what should I do? Is it possible to love what you do but hate your job? Thanks for hearing me.