eriksoln

Funny. A friend of mine went from school to ICU, sited patient ratio and "more respect from management" for it. He lasted about 7 months and is out of nursing now. Last I hear, he became a counselor at a youth group home. The thing about crash carts on M/S units..................hilarious, but sad too.

I remember one of my clinical instructors talking about how the old idea of nurses who could go anywhere and do everything is slipping away. More acute patients, more technical equipment, deeper/more complex rules and policies, more complex treatment plans............all make every nursing field it's own specialty. Problem is, despite the increasing challenges that face nursing, decision makers are more interested in reducing staffing than they are in meeting said challenges. Unless a certain quality parameter is mandated of them, they won't meet it. Nursing has become specialized enough that yes, if you expect your staff to float here and there, you should have training in place that makes said floating safe for the patients. If you expect M/S nurses to go to tele floors, give them the low level tele. classes so they are not completely clueless. Want your ICU nurses not to be scared out of their wits of less acute unit ratios........maybe don't have pt. ratios that stretch even your most experienced M/S nurses to the brink. But, this costs money. And, it's easier/less hassle to just let the staffing be unsafe and point the finger at the nurses when the system fails. Why bother with all that.........I mean, we are here for billing insurances, not for good health.................. I feel for the OP. I can't say for sure what I would have done in her shoes because I'm on the other end of the spectrum. I can say certain things are out of my scope of practice if they take me from M/S to ICU. If I were in her shoes, I probably would have gone, done the best I could, and if anyone complained followed with a simple explanation that "I've never done M/S nursing, I'm not going to be able to perform the role like a well oriented/experienced nurse. I'm willing to help and do my best, but my work isn't going to be top notch. This isn't my specialty." My guess is, they would have given her a lot of dirty looks and clicked their teeth at her, but not fired her.

It wasn't an unsafe assignment though.........it just wansn't comfortable for you. There is an ocean of difference between "unsafe" and "comfort". Your complaints fell into the "I am not comfortable" zone, not the unsafe zone. What were they asking you to do that you were not qualified to do? A cardiac gtt. that you are not qualified for? Any equipment that required certification that you had to use? What? Your complaint was that it was too many patients. To juggle more patients requires time management and hustle, things you should have already mastered as a travel RN. You can not in one sentence say you are qualified to be an ICU nurse and in the same sentence pronounce you can not do M/S nursing. Thats the way RL nursing is. It's the "ivory tower" thought process at work. Not saying its right, but it exists and you will have to have encounters with it as a CC nurse. It is assumed that, since you can handle "X" acuity level patients in the ICU, you can also handle the lower acuity patients on a M/S unit. That is how the decision makers think. This is not accurate, as my OP pointed out, but it's how the people signing the checks see it hence, right or wrong, you'll be dealing with it your entire career. Giving "that's too many patients" as a reason to refuse an assignment will get you fired every time. And no state BON is going to accept that or back you up. That's one of the fallouts of CC nursing.

That, in effect, is the decision you have to make. If you feel it is unsafe.............you must make the call and stand your ground. Hospital supervisors and admin. are not going to watch out for your license for you, and if something happens, they have no problem throwing you under the bus for it ("Well, she should have known better than to take the assignment, where is the autonomy in her practice if she accepted the assignment?") I must add though.........when you get pulled, you don't get oriented. How would you be? They don't know you are going to have to go there till that night, so the only option is to "orient every nurse on every unit just incase". Not going to happen. People barely get oriented to the units they call home much less.............. Its not any different for staff nurses. I get hired on a unit, get oriented to it and work there till my 90 days is up and I can float. When my probation is up and I can float..........when the day comes that I have to.........I go to w/e unit they need me on. I have not been oriented to it. I can only simply go there and make the best of it. Not being oriented to a specific unit is not grounds for refusing to work there. On the other hand, if you assess dangers in your assignment outside of your scope of practice...........thats a different story. But you didn't even go, so you can't say that. Your only argument is that you are not used to that many patients. You say: "I am not oriented to that unit and am not equipped to handle a patient load of 9." They hear: "Thats too much work, I'm not going to do it." At least, if you don't even go to see what your assignment is like, thats how they take it. As a travel nurse, I refused to float only one time, and it was the exact opposite of your situation. They wanted me to go to a heavy cardiac unit, and I was strictly M/S at the time. I went, listened to report, and found out I was given many patients on cardiac med. drips, and one was new onset a-fib. I called the supervisor, told her I was not taking the assignment and I could be found on my M/S unit if the problem were fixed and she needed me. I didn't get fired, not even written up. But that is because I could state what the dangers of the assignment were and why it was beyond my scope of practice. What on the M/S unit was beyond your scope of practice?

These actually are GOOD night shift M/S numbers. Many facilities will have you take 12. Not a few............many. My facility goes up to 8, with the option of stretching it to 10 in the case of emergencies (happens, eh, about 5 times a month). And we still are better than most facilities in the area.

Well. You said "cancelled my contract" which leads me to believe you are a travel nurse. Truth is, as a travel nurse, you have to go "above and beyond" on a daily basis. I could tell you some stories from my days in the business that would make your head spin. It comes with the territory. Fact: Their attitude is "We want ICU nurses who can float anywhere, and you don't provide that, we'll fill the spot with someone who can." The way the supervisor at the time saw it was probably: "I'd rather keep my staff ICU nurses in the ICU, and let the travel nurse float and have a night of hell. Thats what they are here for anyway." My hospital, when everyone was going through a period of low census, issued a statement to the Crit. Care nurses stating they would float "everywhere". If you were in the ICU, unlike before, you could now go to fill in at rehab./Med. Surge./Short stay etc ect.. In the past, that was considered a waste of "expertise". But, the admin.'s attitude was "It's how we are doing it. If you're not happy with it, feel free to find an establishment that suits your needs better." More than a few CC nurses left, pretty much said "The first day this is in effect is my last day of working." They moved on, and the hospital suffered, but not as much as the nurses who moved on would have liked. Sure enough, when CC nurses were floated to less acute units................it didn't work. It didn't work AT ALL. I'll be honest with you, I worked one night when we had an ICU nurse on the unit and..........I would've just preferred to be short. I had to babysit and watch over that nurse all night. She just could not adjust to the different culture. She was used to getting calls back from doctors within 5 min., stat orders were actually treated like they were "stat" by other dept's (stat CT ordered etc), if she was behind and not caught up in the ICU people noticed and avoided giving her an admit.......not so on a M/S unit. These are all things she pointed out, not things I made up or observed myself. It simply did not work. Now, even though the facility retains it's right to float ICU nurses anywhere.......it doesn't happen. Unfortunately, you are like one of the nurses who left before the policy was initiated. They didn't like it, said so, stood their ground and........well, both sides decided parting ways was the way to go. The ones who stayed and tolerated admin.'s learning curve while they took their time realizing what a mistake they made still have a job and don't have to worry about it so much anymore.

Had to do it at a place I travel nursed at. Some days, you LOVE it, others you HATE it. The thing that decides which it will be that day: Who you are taking over for. If you are taking over for chicken little who never stops running around in circles accomplishing nothing, you will hate it. They will put off giving report forever and ever while they pass this med late, fill out this form they forgot, get this coffee someone asked for an hour ago. You end up being behind all day because you stood around waiting for them to realize the sky is not actually falling. Then, they don't have time to do it properly and any advantages it presents you with are lost.

Better that than the song that came to my mind.

Elthia. I glanced at your screen name, thought it said "Elvira" and now I have this song stuck in my head: Hmmm, wonder if that CD is on sale at Borders.

Its 20% this and 80%...........I've always thought they looked silly. Just do. Can't define why I think Vanilla tastes better than chocolate. I've always thought lab coats were silly though.

I worked at Tacoma General for 7 months, lived in "University Place" while there. Then I worked at Virginia Mason for 2 months, living directly in downtown Seattle. I'm guessing I want to go out there after I get my BSN.

Ah. I know how you feel. I miss WA. I was only there 10 months but never wanted to leave. I still think some day I will go back.

A home video rental place near me went out of business (to this day wondering why, they were so busy) and they hired an outside company to do their liquidation. There were little discounts here and there to be found at first, but nothing to exciting. They created a whole wall of videos that were designed to sell each other. The more you bought, the less you paid each. Things that were popular were not discounted at all. By the time the % off reached 30%, it wasn't even worth going into the store, the stock was all crap. I bought one video set at 40% off (not so popular TV series I love) and that was it. From what I hear though, a lot of people fell for the gimmick sales and spent a lot of money. You won't save anything much going to Borders if they do things the same way, unless you desire something NO ONE else is in the hunt for.

aaaahhhhh X-TX-RN OK What part of Texas? I drove through the northern part of it once, coming back to PA.

I can't figure out x-t-x though. I thought it meant "RN Extern"......then I saw your experience.