RyanRN

If my patients' pressors run dry I ether do pharmacys job and mix my own or they die, If there is a spill on the floor or needle boxes are overflowing on the counters ether I do houskeepings job or someone(maybe me) gets hurt, If my patient needs turned, cleaned up, watched ether I do the N.As job or my patient suffers, If the docs want a stat Xray, central line kit, labs- if the unit clerk doesn't enter it I have to or my patient is at risk. As a nurse I have to do everyone elses job when they don't or my patient suffers or worse- I'm not willing to let a patient go down the tubes to make a point. And the fact of the matter is THEY COUNT ON IT!!!! They may or may not realize that the nurse has NOONE to 'count on' but themselves!!!

So did the Unit Clerk get called to the office too? 4 hours is too long for picking up ANY orders - "now" ones or not? (gonna bet not) WHO would be held completely and totally responsible for any negative outcome of this patient? (only you) The doc will just say he did put the little red flag up "it must have falled down". You know he's off the hook. (reality check) I feel your frustration and have been there. However, blowing off steam in the middle of the unit does tend to set a negative atmosphere in any workplace. And you are the outsider, in this case. Maybe privately speaking to the charge nurse about some of the real problem issues you see would have been better. As you said it did help with the insulin coverage - so they proved they will listen. Anyway - you sound like a conscientious worker who is willing to really 'hear' what is being said to you and make changes. I'D WORK WITH YOU IN A HEARTBEAT!!!!

Thoughts: Team up with CNA or another RN from your unit - do her pt., then yours! Helps with the 'uneasy factor" and gets the job done quick. For best 'best' hints - ask an experienced/helpful CNA - their knowledge is priceless. Families *love* when their relative and linen are clean and sparkling. Some patients (my mother) never wanted "someone washing her", she was an elderly, private person, and embarrassed. Give them the opportunity to do what they can themselves - I've seen some just run in, take over, and railroad the patient - mainly because of time factor.. Not good - or kind. Truth is sometimes it's just not a "priority", esp. in ICU. Do the best you can when you can. Not often - there are patients that truly need a CAR WASH (always tried to come up with some gagit that would do that - and make me a million bucks! Never happened. Good luck - all things become easier - the more you do it!!!

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I cannot believe you have a 45 days wait period. "Force" this issue if you have to. This may not be life-threatening, but it isn't exactly a 'wait and see' surgery either. If I had a choice of paying back the thousands this will cost or pushing a little harder to have Medicaid cover - well you know! You'll be a working nurse soon (emphasize "working") and your 'pay back' to the system will be for the next 25 years. Go for it and good luck to you.

LauraKo ,nowhere here did I see anyone state that one type of nursing was 'more important' than another. Rather, the point was well made that nursing consists of many "different' areas. That old refrain "a nurse is a nurse" has been imposed on us by the purveyors of health care business as far back as I can recall. It may be good for business but it just simply is not true. If you feel comfortable shifting from area to area then that is about *you*. It's *your* gift and does not automatically mean that nurses are not 'flexible'. Nothing could be further from the truth. Our daily setting and job demands extreme flexibility but working outside our knowledge zone is dangerous. Would be a folly to agree to do so. I am not comfortable working with and being responsible for a balloon pump and I won't allow that patient to suffer for my lack of expertise. And YOU shouldn't want me to be the nurse for your family member who has one. And you don't me birthing no babies. As someone else on this board stated they went to a specific area of nursing for a specific reason (NICU r/t injury) now, would we rather not have that person in nursing at all rather than letting him do what he knows he can do best! Hogwash! You know a well as I do that the profit margin rules in hospitals. Of course they want to move us around like chess pieces rather that spring for extra staff.(MandinMS floating to THREE different places on one shift - using us a pawns!) I often wonder what their response would be if told "Ms. Nursing Supervisor you will be "supervising" maintenance today, they are short. Or, Mr. MBA Accountant your MBA expertise is needed Computer Dept. today, get going. Or Mr. DON, the DON of our sister Nursing Home is out sick you'll be covering her this week! They have got to get a grip. The old adage A NURSE IS A NURSE just doesn't get it anymore. babsRN since you consider your staff "professional" for putting on a 'game face' and floating (and making themselves liable in any untoward situation) I would hope you would consider me 'professionally assertive' for not doing the same. I know my limitations. While I consider med/surg one of the hardest areas to work, I do understand that a PCU nurse would handle that more effectively than am ICU/CCU/ER nurse - who's job has a completely different focus. One last thing, it would be a cold day in Haiti when I floated over a per diem, pool, or part time nurse. What other advantage do I have for being a full time employee? None that I know. All that said, I AM a team player, I DO understand the predicament, I DO jump in to help - BUT so am I very tired of laying down and letting everyone walk all over my back. Old age, do you think?

In a case like this I'd definetely fill out a Protest of Assisnment form - whatever your hospital has. You're taking a big chance by not doing this should an untoward event happen. CYA. Just an observation: I find it ironic that anyone who has to work under these conditions STILL gets to take the heat when patients and families (even nurses as patients) complain that their hospital stay was less than ideal. We all hear the horror stories - and yet the position we are put in never becomes a valid 'reason'. We all just want it all!

So technically we become a cross between a NA and a Tech with continuous monitoring, distant assessments and second guessing. What about our experince, will it count? I mean if you have some off campus people just sitting there ready to act on any minute change in status without first hand input won't it lead to overkill? For example, if I have a guy with uncontrolled hypertension, assess that, use my judgment and PRN treatment(IF I feel it necessary, only I know if he's upset, anxious, excited, in pain etc.) I'm gonna keep a close eye, not jump in too fast, wait for a nice mean and a 'feel'. Are these guys gonna be calling me every 5 minutes or let me make the judgment call? I hate to poo poo everything new, but I don't have a handle on whether this will turn out like they think. You do though. Keep us posted.

All the above suggestions are good. One point, I see NO reason why you 'tactfully' have to handle this situation. Just say and do what you have to - right is right and this loser knows darned well what he is doing is wrong. You are being manipulated and intimidated. Lay it on the line in no uncertain terms.

"------Well, there was no identifyable C-Diff runny stool smell. I was disappointed :-( ----" - So sorry you were disappointed Mario, ewwwwww!!! LOL. Hate to disagree but you will, in time my friend, be able to smell that smell and disinguish it from all others. Just like the ever-pleasant, hard not to notice GI BLEEDER. We have this little machine where I work, it plugs in next to the patients beds who smell up the unit. It emits almost no odor yet somehow works to eliminate the distastefuls aromas that abound. I'll check out the name of it and be back with it asap.

LOL SHAY and ERNURSRE My husband, a Correction Office, says 'CALL 911, call adm. and state clearly, either he goes or I do". I used to argue the 'nursing mentality' argument with him, now I consider him right! We live in America, noone has the right to abuse us! PS, "that's what you're paid to do" is BS, I'd put money on the fact that YOUR taxes are paying for his hospital stay!!!!! (I hate when that happens cause I always want to have a SAY in how I spend my taxes)

Boy, did I ever get sick and tired of being stopped during working hours to give acuity ratings. I once told my manager "12". She asked what I meant by that, "well there are 12 patients here and that's all the staffing by acuity rating you need". She wasn't happy, but knew darned well I was right! The ratings went by the wayside after that. We ,too, are staffed by numbers. A bit worse than you, though RNinICU, just today our 13 bed unit had FOUR nurses and 2 nurses asst. Scary, scary thought but happens over and over - letters of protest or not. I do agree with you that we at least have to keep signing those protest letters each and every time staffing stinks. Our RN's get tired and say it doesn't do any good and they are right. But I feel documenting the ongoing problem is essential and we need to keep a record of our poor situation. Hard to convince overworked, exhausted,downtrodden people who have taken the abuse and given up. Most stay because they are on their way to retirement and would no more consider moving to another hospital EVER. One is as bad as the next in their opinions. Couple of comments: I feel for the more experienced staff having a difficult time getting their much deserved time off. There should be another way and I don't have an answer. I think the "floating" issue is just as important as the "mandated overtime" and "pt./staff" issues and should be yelled about from the rooftops. The "nurse is a nurse' mantra from adm. is baloney and they need to be made to 'think out of the box' for a change. No one feels comfortable floating, we weren't hired to be pawns for miserly CEO's. We are educated, have specialties, should have a say in where we are willing to work - this isn't 19th century England and we are not serfs. JeanneM your idea is certainly a start, we need a major upset in that area. You don't want me, a Critical Care nurse, to be birthin no babies, that's for sure. I like Agency Nurses, I am nice to Agency nurses, I totally agree that when they sign on to work, say, in CCU, that is where they will work or they get to leave. BUT, there has got to be a happy medium for loyal hospital/company employees. Where in the heck does this leave us? Something about all this I can't lay my hands on, like we are forced to deal with the best of both evils and noone really is a winner. What is wrong with working for the 'company' for your entire professional career then retiring with some level of comfort. If we ALL go the way of agency (which I think just may be the wave of the future) then we ALL become 'self employed'-as most do not pay vacation, pension, health-and we have effectively wiped out one major type of nursing (which by the way, I think the hospitals will love as they save bundles of money ,can cancel you on a daily basis. Noone has any allegiance and I fear things will deterioate) Just some food for thought.

Trouble with only 'helping out' when floated, is that most of us don't have that choice. And you can't operate beneath your license. For instance an RN cannot work as an LPN. You are fully responsible for everything under description of the RN license. We don't have that support from managment. It still boils down to them against us and 'their' licenses are not on the line. Once asked mine if he was going to court with me should I make a mistake and get sued. No answer. That says it all.

Firstly, I'd like to comment as to WHY so many competent, educated, experienced nurses are scared to death when they hear YOU HAVE TO FLOAT TODAY! There IS something to that!!! All the reasons listed for not wanting to float are valid and no one is listening! Very easy for administration to sit in their comfortable offices and dole out outrageous assigments without blinking an eye. Their focus is MONEY. No doubt about it. It would be easy, Fgr8out, if we all felt like you. We don't. We are being asked to do a job we are NOT qualified to do. I often wonder what our CEO would do if he was made to 'float' to say, Worldcom. to 'fill in' as the CEO that night!!! After all isn't a CEO a CEO? The 'basic's are just not enough to risk losing a life, harming a person or losing your license. I wouldn't want my podiatrist to do my cardiac catheter, who would? And docs know all the ABC's and basics too. The subtlies of being capable of recognizing a potential disaster takes experience. And a short orientation isn't going to cut it either. I don't want to be oriented to a med-surg floor today, after 15 years in ICU, and then be expected to function in 6 months when asked to float there, just because I completed a little check off list 6 months ago. I handle 2 usually 3 pts. in ICU and appreciate that I would never be able to handle and multi task 10 patients on a med surg unit. That's a gift. I don't have that gift or experience anymore. Asking to just help out or take a smaller pt. load because I feel inadequate just doesn't work when the 34 bed floor has 1 staff RN, 1 LPN and ME , the float! The regulars are alreadyfamiliar with more than half the patients on the floor. I know nobody and have to start from scatch. I don't like it, never will. Reverse is also true, if we are short in ICU and have 13 pts, 3 staff members and 1 med surg float how in the heck can we divide it so that she gets a more stable ratio. Someone is stuck having 3 or 4 CRITICAL patients because the stable ones have to be given away. THAT is scarry and patients suffer. All that said, I want to remind us of who is to blame in all of this, THE ADMINISTRATION. They don't hire enough nurses, send people home, keep cutting, cutting, cutting. I know all the popular complaints in the media for nursing - mandatory overtime, nurse/pt ratio, outdated salaries, etc. I think we ALL ought to start focusing on the very unsafe and frequent use of floating as administrative solution to save more money. It's my license and I'll whine if I want to.

Once had a patient A/0 on a vent who asked every single nurse and everysingle NA who came into contact with him "I need a bath please". Then told his wife he "loved the baths he got and why doesn't she bath him like that". Then SHE started 'joking' about the baths she has to give him when they get home. It went on for days!!!! YECH YECH YECH, he never got another bath from me. He was a pig.

Oooooohhh been sick since Thursday, went to work because I got up and vomited after our 2 hour call off time, hit every single toilet on the way to my floor! Must have appeared green ,my hair looked like Cameron Diazs' in What About Mary ---because ALL my coworkers told me to GO HOME (seems we don't get paid if we call sick later than 2 hours before our shift, but we DO get paid if we come in and go home immediately!, go figure). At least 5 nurses on my unit so far got it. My son is here from Philly, has had it for 5 days with severe abdominal pain, husband is having the time of his life on a Colarado ski trip, hugging the toilet, not the slopes, daughter works at Probation Dept, they have it, friend in a preschool - got it! All of LI is pooping water!! Grooossss! And looks like we are sharing the joy with Colorado. Hope everyone feels better!

deathnurse, I have used each and every drug you have mentioned and still cannot for the life of me understand the rationale for reporting which lines are infusing which drugs. I had damned well better be alert enough on my OWN assessment to know which drugs are where. I am not going to take your word, sorry, I look myself (like checking my own med even after you've checked them thoroughly and reported tome. I certainly wouldnt piggy anything where it shouldn't be. Diprivan is WHITE and obvious, I can SEE TPN etc., not piggys into that. and follow any line anywhere. What does a K rider have to do with anything? I'll send that in where it should be. You have to look EACH time you do anything and not rely on memory or report. In any case, if I wanted, I could get right up from report and after assessing and considering any 'clogs' change everything around and that report wouldn't amount to a thing. In any emergency I would NEVER just assume something is running where I THOUGHT it was, that would require LOOKING at that moment. Bottom line, my point was we pass on way too many inconcequental, unreliable, time-wasting,peripheral garbage on report. I like to get to the meat of the report, Ill check out everything else for myself.

Deathnurse, that didn't answer my question about IV and ports. I am quite serious about a reasonable rationale, do you have one.? What would make the difference, say, if I switched the D5W and dopamine from pacer to side ports and why? One should always check a pts. orders, IVs, sites and patency, so passing this on in report does nothing for me. I am in total agreement with you on the use of Cell phones, getting my hospital to take down the signs will only happen with an act of congress however.

thisnurse and desspoohbear !!!! nuff said you made my night!!! LOL

I am inclined to think those signs are there and staying there because "that's the way it always been"! We have them at my hospital also and I have often wondered just exactly WHAT kind of interference they cause? Noone can answer my question. With all the advances in these phones and medical equipment you would think it wouldn't amount to a hill of beans, but we keep the restrictive policy. I am serious noone can give me a reason. This is a little like the millions of other things we do, as nurses, just because" it's always been that way". For instance, can someone give me a reasonable rationale as to why some nurses want to know in report which IV fluids are running into which CVP port ( I get this in a peripheral line as we can determine any info on infiltrates, but central lines?) Just asking.