JillR

Wow. This is weird stuff. While reading this stuff I kept thinking that some people act this way because they can. They act innappropriate and when called on their actions the either admit themselves to a psych unit or do something to get admitted. Then people either feel sorry for them or are afraid to call them on their behaviors and the cycle go on and on. I have had 18-20 yr olds that frequent our facility that have never worked a day in their lives and don't have to because they are disability for depression. Well, must be nice. I wonder how the nursing shortage would be if all of the nurses that are clinically depressed quit working and went on disablity. I am sure the tax payers would not stand for that for long. I may just have a bad attitiude today, but I feel that if some people were told that their behaviors would not be accepted because they are just plain unacceptable, there would be lot less of this stuff happening. I do realize that there are people out there that truely suffer from mental illnesses, but the crap others are expected to put up with from co-workers is just too much. There has to come a time that people in administration have to say, hey you can't perform your job either take a leave of absence and get help or you will not be allowed to work here. If these people either don't understand or don't care what behavior is unacceptable, then do they really have the judment required to determine other (patient) health and adequately do care planning and intervene in unhealthy and maybe even dangerous situations for the patient? There really needs to be a serious question of competency in these cases and maybe the best place to go about this would be the Board of Nursing. Only because we all know that in many facilities, a body with a heartbeat is the requirement for employment.

One April fools day, the people on med/surg decided to fill the work sheets with all sorts of patients that had weird problems, one was there for a penile implant. When I came to work, one of the nurses in ER inadvertently let it slip that the floor nurses did that. So when I came to the floor and there were suposedly 35 patients for two RN's and no LPN's and CNA's, I made the comment that unless we get some help right now I would not be taking report. They told me that they tried to get help and no one would come in or stay. I told them that I was going home that minute. The look on thier faces were priceless when I faked that I punched out and came back and said April fools! The NTG thing, I would not recommend it. I have had NTG before and it puts me into the worst Migraines possible, ( not just a HA, but on my knees puking for hours HA) you would loose a nurse for the shift with that little joke.

Layna, I guess there is always the chance that some people might be put off if you hire agency, but I know that the people I worked with were happy to have the help. We are a union hospital and there really was no problem with it. Another thing they did was get together a retention and recruitment commitee. The members were voted for by the RN's and LPN's. The five (I think) highest voted for nurses were asked to be on the commitee (sp?). This helps keep the staff and management on the same page. It also gave other staff memebers someone to go to with ideas for solving the problems. Also, have you considered hiring LPN's to take care of some of the more stable patients on your med/surg? We have a few and they are great. Do your nurses work 8 or 12 hour shifts? If they work 8, are they willing to work 12's? This may help take some pressure off, if they work less days but more hours. The only down fall we have had with 12's on the weekend staff is when ther is a call in, it is really hard to find someone willing to cover a whole 12 hour shift because the people who work during the week all work 8's. One other things, you and administration may not like to hear this but, I have found that rural hospitals, in order to compete with teritiary care centers, must offer wages and benefits that are competative with those larger hospitals. I know that many of the hospitals in the northern part of WI do not offer wages that even come close to what we get here and they are always advertising for help. Just because people live in a very rural area does not mean that they do not expect to get competitive compensation. Many people may be willing to relocate, but may not be willing to take a pay cut to do it. Just FYI. I don't know, just throwing some things out there.

Layna, I wish I could help you more. I also live in a rural area, we had extreme staffing issues, such as yours, last year and it took a toll on everyone. It was so bad that the DON and the clinical director of OR worked the floor (med/surg) on Christmas. They did use agency nurses and one stayed here as a staff nurse. WE had two supervisors, and three staff nurses all put in resignations within a week of each other. As you know, for such a small place, this is a good percentage of the RN staff. In response to this, they started a weekend plan, which really helps. Regardless, we seem to always have openings for RN's, LPN's and CNA's. Job hopping is very common in this area. Good luck and take care of yourself.

Agency and travel nurses may be one way to go. I would not implement MOT or mandatory on-call schedules either. In this day and age, expecting mandatory anything above and beyond what the employee had agreed to may (and probably will) put you in a worse staffing situation than you are already in. Remember nursing positions are a dime a dozen and if you go ahead and initiate mandatory OT or on-call, you may just see a mass exodus from your facility. Also, you can not expect these nurses to give you all this OT, for the same reasons that you are having problems doing it, family time is becomming increasingly important to people, and rightfully. I have always believed that you can not expect an employee to do something that you would not do yourself. Unfortunately, staffing is not the staff nurses problem, and it sounds like they are all getting burned out by this situation and are looking to you for some kind of solution. Having experienced this myself, I have found that the staff nurses will fill in for only so long and then will stop doing so because they feel that by doing so, it doesn't give management any incentive to hire more nurses. This is why nurses are so against MOT. They feel like many times facilities use MOT so that they do not have to hire more employees. I would be really careful as to not let your facility get that kind of reputation. I agree that a volunteer call staff may be at least part of the answer as long as you make it worth their while. If you make the offer really good, you may have more people signing up for call than you need. Why can't you utilize the prn staff more? If you don't have prn staff, maybe that would be an option. In my facility we have what we call the manager on call. There are four of them and they each have one week per month that they cover call for emergencies. That way none get really burned out, this may be an option. I started as a night 7p to 7a charge nurse in Oct and we have only had to resort to calling in a manager twice on my shift. However sometimes just having the opportunity to call a manager and consult with them about staffing helps, as then I have a fresh point of view on how to handle the situation. I only call them into the hospital if absolutely need be and the staffing is just not safe without their help. I hope some of this helps. You sound like you are really getting burned out. I hope you take some time to take care of yourself. I also agree with an above poster regarding closing beds, if the staffing is not there. You may have to postpone some of the elective surgeries in order to provide safe staffing.

WOW!! Sorry about that everyone, I guess I really needed to vent.

We are beginning to hold patients, not for our own facility, but when we need to send patients to another facility because we have no ICU. I don't mind it so much, because I understand what all of you are dealing with, and what I have does not compare. But our doctors have no idea. They are always telling me to get these patients going because "they need to be in an ICU". I try to explain that there is not way we are going to get an ICU bed for this patient any faster than the recieving facility will allow it because they probably have patients backed up in their own ER waiting for beds. The docs look at me like I am from outer space when I tell them this. One even had the gall to say to me "I will see about that", as if I am making this all up. I just said "you do that". But he must never look into these things, because we then turn around and go through the same conversation the next time I work with him. It's like a freakin broken record. THEY DO NOT LISTEN, and they don't believe me. The other day we were trying to set up a transfer to a facility 30 miles away that offers the same level of care that we do. The transfer was per patient request. I could not find an ambulance to take th transfer and when I did the amb could not come for another three hours. This doctor wanted me, actually demanded for me to call a critical care transport team to come 80 miles and take this stable patient 30 miles to this hospital, I told him to call himself, that I would not do it. The next doctor asked nicely if I would call, I explained why this was an innapropriate request but stated that I would call for him (only because he was respectful), well guess what thier reply was. When the manager came in that morning, we had a long talk about requesting critical care transport for a patient that only needed two basic EMT's as he did not even need an IV. I was livid. I am the only RN on nights and I have no tech, no unit secretary. Just me. I don't have time for this. I have had it. I am ready to come to one of your hopsitals and take those 10 patients waiting for beds, than have to deal with doctors that have no idea what is going on with nursing. They are rude and have a major knowledge defecit and think they are just too smart to have an RN tell they just can't get an ICU bed this minute. I have had it. By the end of that shift I was ready to shell out a good portion of my savings for someone who knew just what to do with a human, a concrete block and a large body of water.

I ditto what CEN said.

I have a chronic condition that causes this, I can't remember what it is called. This had bothered me for years until I saw an ENT, he diagnosed it and taught me ways to help with the irritation. It still bothers me at times, but at least I know what is causing it and how ti keep it to a minimium. Good Luck, I know that this can be very iritating.

Krista, Don't let this bitter, mean person push you out of a profession that you will be wonderful in. You have just experienced the nurrse eating their young phenomenon and it sucks. By letting this nasty person intimidate you (by letting her know she intimidated you) you are allowing her control over your future. We had a couple of these nurses from hell in our clinicals and one very smart instructor told us that when we work with nurses in clinicals we are seeing how things should be done usually, but sometimes we have to look at it as "this is the kind of nurse I don't want to be". It's a learing experience either way, although not a very pleasant one. Brandy had some very intellegent comments about how this person is problably not very confindent and is just showing her ingorance. Don't take it personal when others do this to you, this is their problem, not yours. Do not allow them to make it your problem. Sometimes the best way to diffuse a bully is to call them on thier bluff, unfortunatly sometimes this makes things worse. your best bet would to completly ignore this person at all costs. You only have to be there for 5 more weeks and then you will be on to bigger and better things. At my school, we had to do an evaluation on each clincal area we were sent, my class did not hesitate to mention by name those that were the bullies and those that practiced questionable nursing practice. If you are given this opportunity, do not hesitate to use it, these tools are there for a reason. When the facility gets the results of these evals, thing usually change real fast. Please hang in there, I remember wanting to quit three or four times each semester, but I hung in there and am grateful i did. Good Luck. Jill

I had to attend my first depostion just a few weeks ago. It was from an accident that I responded to as an EMT about 5 years ago. I just used my notes. Since you may not remeber the exacts of the case, the only real way to do it is to refer to your documentation. This is why documentation is so important. If this a suit against you, good luck. If it is a suit aganst someone else, like an insurance company or something, don't worry, you only need to tell the truth as stated in your documentation. Answer yes and no as much as possible, don't speculate. Don't worry, it's not that bad.

First of all carole, I love your perspective on nursing and nurses. I have never thought of it this way. It's a great way to see things. Adrena, I felt that way all the time when I first started. I still feel that way at times, it is normal. Find a mentor. Someone who has not forgotten what it is like to be a new grad and not afraid to admit that they still feel like that at times. I had two terriffic nurses I could look to that supported me, and were not afraid to tell me that they still feel lost at times, even though they did not show it. I felt that I could ask either of these two great ladies anything and they would not treat me as if I should know that already. They both understood that you could not possibly remember everything you learned in school and that ther real learning comes after you get out of school. They were great supports to me and thye have both moved on to bigger and better things. I miss them tremendously, especially on the days that I am charge for the whole darn place, then I think...what would they have done. They both saved me from giving up many times and instilled in me the confidence to ask if I am not sure, and not feel stupid for doing so. And Linda and Linda, if you are reading this. Thank You!!!!!!!! Jill

Wow, where did that attitude come from tee? Feeling a bit insecure are you? Because that is exactly how you sound, like an insecure, uninformed person who thinks that Medics are not able to think, reason and make decision. You really need some educaion about this subject. Okay, now to the point. Medics and EMT can have a very productive role in the ER, that is if they are working with RN's that will respect them for the knowledge and capabilities they do have an allow them the time, mentoring and support they would need to succeed. I do not feel that medics should independantly take on patients, however, they would be very helpful with patient care. They know emergency care, they know what to look for and what should be done about many different problems. They are very good at prioritizing, thinking outside of the box and have great abilites to be inovative. Team them up with an RN and you could have a great team for a patient. They could perform some basic assessments, give some medications. They know trauma, are terrific at stabilizing broken limbs, c-spine. They know that they do not give meds without first know about the med. Contrary to what this tee person might think, they do know how to read and know when they need to find information they need to treat a patient effectively. Another thing, yes they have protocols in the field, but anyone who workd ER, knows that rarely does anyone present with textbook cases, so they medics need to make decisions on what protocol to use and when to stray from protocols. They need to make informed, snap judgements without the benefit of having the docs there to oversee what they are doing out there. We do not have paramedics in our ER, but we do have ER techs that must be EMT-Intermediates. They give meds that they have been signed off on, or that has a written order and the dosage is checked by the RN. They assist with suturing, they teach crutch walking, apply dressing and bandaging, assist with casting. They help with the paperwork, do vitals, insert IV's and foleys, do blood draws if needed. All of this is delegated by the RN. Add all of these thing up and it really free's me up for assessments and critical patients. Treat them respectfully and there is nothing they would not do for you or the patient. Treat them like they are just another nursing assistant, don't expect much from them. They have skills and knowledge way beyond what I have written here, but I think you get my point. Should they work independantly in the ER? No, they do not have the educational background and licence to do so. But they can be great assets to any ER, if done right and they are not treated like they are some kind of ignorant inbred scum that should bow to the RN's. If that is the case, you might as well not bother. It would be a waiste of their skills, knowledge and time to bother working in an ER with that kind of attitude.

The autonomy I get in the ER is that I order it, do it and then tell the doc, now that is autonomy. I don't see any less respect coming to to female RN's than to the male RN's in our ER, but I think that is because we work so closely with them. It is a really good relationship back there. But then again maybe I like it so much because of all of the testosterone. Jill

I agree that this does not sound like much of an orientation, especially since it's your first position in an ER. I work 4 days a week and had two weeks orientation, which I felt was fine, but I had been floated there before and had at least some experience in our ER before. I guess it depends on how comfortable you are, there are times that I have questions, but I have great supervisors that are willing to answer questions and come and help if needed. 10 patients for a 3-11 shift does not sound bad, or is it 10 at a time, that would be a bit harder but do-able. Do you have tech's? if so then delagate what they are capable of doing. Good luck and I hope everything works out okay.