RNOCN2311

Okay, need some help and direction here. I have a staff nurse who, to say the least, is poor (not dangerous). Her communication skills are minimal - harmful. Mind you, she's not harmful to the patients because I oversee everything she does, but it's exhausting. It's almost like having a nurse in training who thinks they have 20 years experience and making mistakes. Example of my staff nurse: Pre charting (on her patients but when she leaves the department someone else signs of the IV .... error out her charting and re chart), charts physician verbal orders as matter of fact not order and worst of all she fails to have a physician sign the order/instruction/notification. Now I hear you all gasp, but let me tell you, removing this nurse is NOT an option for various reasons (not by my choice). How on earth can I reach her?? I check the charting for the day because I check the daily charges and at least 3 times a week I find something she should have notified the physician or had a signature on. Its truly making my workload ten fold. Upper management has the power to remove her but do to her health conditions won't and seems to think it's okay for me to be the "bad guy". Any suggestions? (other than finding a new job). Now if my only job was to oversee her, fine, I'll do her work and mine, but I over see 10 employees, manage staffing adjustments, check daily charges, forms management, P&P....etc of a nurse manager and function as a Nurse Partner for 3 physicians (keeping track of all the patients care, needs, treatments, etc.). Any suggestions would be greatly appreciated before I loose my mind.

Same, but Chemo induced can only be given for 8 weeks after the last chemo cycle and Hgb can't go past 10. CRF is 12, with labs monthly and every 2 weeks with a change..... etc. Our hospital had a "pay back" due to changes in payment guidelines so we have to rule out any other cause of anemia.

Well hello there again, The nurse who was giving me problems must have heard something in her evaluation because she actually (just once though) gave me an update on a patient. I was almost shocked. I thanked her afraid that if I didn't she wouldn't feel it was worth it. Of course, she chose a time when I was in the middle of 3 things, so truth be told.... I can't recall what the update was.... but it was a step in the right direction. :)

I shutter even typing the word. For those in outpatient oncology, how is your department adjusting to the ever changing guidelines? Our clinic basically treats everyone as Medicare....... and you know the hoops. Of course, when they find something that works, they have to mess with it.

For anyone wishing to get into oncology outpatient the best skill you can bring is adaptation. You are a case worker, dietitian, pastor, IV specialist, educator, triage nurse, able to apply your clinical knowledge for insurance approvals..... jack of all trades basically.

Hi Joe, I have never spent much time on a med surg unit, outside of 20 years ago. Prior to oncology I spent my days and nights in an ER. But, for me, oncology is a very holistic nursing. I do outpatient so I have a doctor on the unit at all times for easy access, but we do alot of telephone triage that you won't get on a nursing in house unit. Outside of hanging chemo and dealing with end of life care I'm not sure how it would differ in an inhouse setting.

Oh and for some reason, the cell phone has disappeared!!! Maybe she just forgot it today, but she made not one call..... !!!

Hi Katnip ( a very cute name), I'll give them a team building rope alright.... lol. I will keep trying to let them be on their own. It's hard when the physicians look to me when there are errors, missed orders, etc. My boss has actually started the write up process and given one of the nurses the "step up or step out" speech. This particular nurse admitted she has been not pulling her weight and relying on me to fix her mistakes and not functioning well. Now, I've heard it before..... but I'm always willing to give them a try. It's just a tough spot to be in. I've distanced myself from the "personal" aspects of the day and tried to remain friendly and approachable. I figure I have a bit more in me.... not ready to give up, but I'm getting close. :)

I was promoted to Charge/Clinical Resource Nurse of a small outpatient oncology clinic 6 months ago. I'm working with my peers in a different role. They, to say the least, are good people with bad attitudes. Some like to tattle on eachother, feeling I'm not addressing situations as fast as they would like. Some like to hide in a corner, do what they want to do and not be help accountable. The previous person in my position was horrible, she randomly picked on people to the point of harrassment, handled situations with acting out and threats that got no where. I've tried to treat them as I'd like to be treated, focus on patient care and have given each of them their own areas to oversee.... one does new charts/chemo orders, one readies charts for the day, one handles all incoming consults, etc. This one thinks that one is not doing what they think they should or wants to boss the other's in my absence. I was forced to a 4-10 working shift so they have one day to man up and do their own things, but it turns into pushing eachother around or ganging up on one person. I truly feel like I'm babysitting! I, of course, have my own boss who I have to get the OK to make any changes and don't have disaplinary ability at this point so pretty much my hands are tied. When one nurse in particular is having a bad day or a personal event she uses me as her scape goat to the other staff...... I'm not being nice to her, even though I'm not doing anything different. Another one is addicted to her cell phone and runs out of the clinic to chat all day long..... I've asked for a cell phone policy and been told there is one, but I can't enforce it till upper management addresses the issue first. I've been asked to oversee performance and charting (due to an audit a few years ago that showed the previous charge's poor charting) but when I give things back and say, don't forget your stop time/initials/etc. I get "everything I do she says is wrong", which is not the case...... I try to say, "oops, I forgot" when I make my own errors in charting so they see I know they are just forgetting and dont' make a big deal about it. I've asked that pre-charting stop (one nurses terrible habit) and that no one chart for someone else, but remind them to complete a chart. It's maddening! The other day I had my evaluation, glowing, but the "how can we help them to be team players...... look inot what they expect of a charge person". I've rattled my brain all weekend (my days off) to find any way to change it. Outside of them realizing i'm not just "pe.. in the wind" when I say something, I have no clue. I'm overworked myself, but assist in clinic, answer questions, handle most of the patient phone calls, as well as charges, billing, assignements, difficult IV sticks, assist in all areas of our department. I bring atleast 2 hours of work home a night and go in early and stay late. I'm slowly feeling like no matter what I do, it's not right and trying hard not to give up and stop careing. I love what I do, I'm good at what I do, and if I left the place would fall apart (not arrogance, but the doctors have told me I'm the glue and complain when I have a day off). I have asked my boss for more staff/more enforcement of the rules/direction/assistance/etc.... Help!! I feel like I' banging my head against a brick wall.

Hi, I've worked with many a p-a nurse in my 20+ years. Truly the only way to get a tiny bit of respect from them its to give it back to them. I know it's hard, but if you kind of call a bully on the carpet, they are usually shocked. What you have to be careful of is don't choose a situation that in turn makes you look bad. Management that give the "you should talk to her/him..... we all need to get along" are just doing what they can (I'm now in management) but it really isn't an effective approach. A good ole, "get over yourself" when you get a smart remark might help. Good luck!

I'm the charge nurse of a outpatient oncology clinic and let me tell you, it's a thankless job! I worked side by side with the staff for 8 years (I've got 10 in the department working with newer staff members), and dispite my work ethic, building "team" processes that the former charge person lacked I am finding that the resentment factor is a hurdle that I can't seem to get over. I do the please and thank you, good job, and truly appreciate the staff in every way. I try to keep them informed, ask suggestions for processes that are being changed and make sure every one knows a change is coming before it's implemented. I have one staff member with a terrible call off history..... though I always ask if she's feeling better after one of those 4 day weekends she gets. One is diabetic and is poorly regulated and flys off the handle at will. No matter what time I send her to lunch, it's the wrong time, she won't go as scheduled, sugar to high and not eating today, but an extremely poor communicator and never say "I'm feeling I need to eat..... I need to eat at this time.....". She has more seniority in the system but not in our department and I truly think no matter what I do or say she will have problem with it. I take an assignment even though my phone rings off the hook, I manage 4 doctors patient follow ups, make rounds, do charges for deparment and physicians, forgo most lunch hour or take 10 minutes so everyone gets to lunch and generally am the "answer lady" for anything the other staff aren't sure what to do with or don't want to deal with (phone calls from patients). Needless to say, I'm more of the Nurse Manager than a charge nurse. I'm pretty much ready to resign my position, but know the other nurse can't handle the decision making of the charge person, so I can be paid a small pentence for it or let her be paid and me still make the decisions. My biggest hurdle is management. Make decisions, but don't implement them on your own..... the good old fashion let them get the credit for my ideas. I really don't care who gets the credit, but back it up when you implement it. I hear, "this is stupid... why do we have to time our entry.......excuse me for forgetting", and no support from management in the disapline. I can make the decisions, but can't enforce them. Any ideas on how to get support from upper management? Our Nurse Manager is more hands off, out of sight, 5 hours a day instead of 8 kind of style of over seeing. One more day like today and I will resign.

I also went to oncology nursing after taking care of my father. Seeing things from his perspective gave me a different look at nursing. I'd been an ER nurse for 11 years. As frustrating as it can be when your flying around the department trying to fit all the treatments in, then fitting in a patient needing hydration of a blood transfusion when you have no rooms and a reaction in one of the rooms so your entire plan is shot to heck, I've never been so appreciated in my career. These patients facing death are appreciative for each thing and truly make it worth while. Oh, I have my moments when I think what am I doing, but then one of my favorite patients will smile at me and its all over. You have to be able to lose patients too. It's all part of the process.

I also work outpatient and we have 8 rooms and 4 nurses, we currently don't have "assignments" so, if everyone is on their game we get the 2:1 but yes we also could have a lot of other events going at once.

In our oupatient treatment area it's 8 room with 3 nurses, one assigned calls, consults, scheduling, etc. which gives us four total and staggered day shifts. We have primary assignments but on average it's 2-3:1 depending on what's being given. Our Rad onc is 3:1 also with one RN seeing what is needed for the day with 3 rooms for exams.

I've worked in the OR, and though it does have it's knowledge base of importance (tasks, infection, positioning, etc), it can not prepare you for oncology. Labs are labs, most importantly is the standard WBC, H/H, Platelets, and diff, to start with but it's the drugs that are the tricky part. Take a look around the ONS web site, google chemotherapy (side effects). It's a different type of nursing. If it's like our inpatient oncology floor, your actual chemo patients will be small compaired to the med/surg patients. If it's a large instituion with a designated oncology inpatient area..... you'll learn as you go and if you're sharp, you'll learn that the patient is usually more important than the drug anyway. It's a very scary time for the patients & families and they are looking for your comfort, confidence and support. It's very holistic nursing.