sjlang

Good luck to you, and bravo for speaking out. We've got to change the system/healthcare culture or die as a profession. Your situation brought back so many memories and feelings in me. I was also an ICU/PACU nurse in Arkansas. The chief surgeon (and source of income for the hospital) had everyone so intimidated that no one, including the DON would stand up to him. He would curse the nurses in front of the patients and family members and threw temper tantrums frequently. One surgeon threw an instrument during surgery, breaking the glass in one of the OR cabinets, and the crew just acted like it was a joke. This was typical behavior. My aunt was admitted to the hosp. w/ a blood sugar of 29, but no one on the floor realized she was admitted, and she was alone for hours without so much as a peek at her. She managed to finally call me to ask for help, saying that she felt "really weird" and was afraid. When I was in ICU as a patient, my nurse didn't stick her head in the door until 11:45 one a.m. I know, because I was very coherent. One of my patients was having a massive MI. When I reported that his blood pressure and O2 sat were falling, he was having Cheyne-Stokes respirations, was barely responsive to sternal rub, the color of a purple plum, and having frequent pvc's, the surgeon told me to send him to ASU for a barium enema as ordered. (Thought he needed some vagal stimulation to help out his arrythmias, I guess!) I kept calling and informing and documenting and finally was allowed to contact his primary care doc. Within minutes, the PCP was there ordering the appropriate tests, admitting him to ICU. The damage was too great by then, tho, and I heard that he died several days later. The DON threatened to fire me for refusing (politely & following the chain of command) to give a med contraindicated for the patient (black warning box), and ordered at two times the correct dose, in spite of the pharmacist and the drug company saying that I was right. They didn't want to upset the doc, who said that I couldn't take care of his patients anymore after I said that I couldn't conscientiously give the med. I was left as the only person in PACU w/ fresh surgical patients in spite of the national standards requiring two licensed personnel. I tried to change the system using everything I knew, but nothing worked. When I asked the surgery crew to be at least within earshot, they would agree. I would learn later that they were all at the other end of the hosp. in the cafe, & I was alone with my patient(s) behind two sets of double doors, and the call lights didn't even work! Ever tried to ambu bag someone in laryngospasm by yourself and call for help at the same time? I did a lot of praying, but nurses shouldn't have to rely on prayers and hope! These are just a few of many similar memories. I was out of nursing for several years, but have been thinking of going back. It scares me to death. I would really like to start earning a living again, but the situations I've been in have made me wonder if there is any place that even tries to follow standards, or if I'm still up to it and knowledgeable enough after my absence. I've taken a refresher course and am doing a lot of reading. Have any of you gone back into nursing after several years? Should I try a different degree/occupation? Any thoughts? Schroeder, please let us know how it goes in your new facility. Obviously, you've touched a sensitive spot in many. I feel for you. Take care of yourself, whatever that means. Your patients are fortunate to have you.

Thanks for the "dose" of reality. I'm afraid that you've got the right client, dose, etc. I'm hunting, too.

I am looking for work elsewhere. I'm just trying to figure out what that might be doing. Although I was an excellent nurse in the past, I'm afraid that after 8 years my skills may be rusty, and I know some equipment, standards, and practice have changed. I'm studying, but lack confidence. Any thoughts?

I have been out of nursing for over 8 years due to health problems. I'm well now and after a struggle of finding a fit after my long absence, I decided to try a job with adolescent offenders that requires more therapeutic relationships and conflict resolution, paperwork and supervision than the critical care skills I had used in the past. I have taken the academic portion of a "refresher course" and am finishing a 100-hour preceptorship with an excellent (agency) nurse in the facility that offered me the job. My problem: I'm having some serious concerns about the organization. (1) The handling of meds is sloppy, to say the least. I don't know all of the legalities of what they're doing, or not doing, but it isn't safe. (2) The non-nursing staff "orders" the nurses (who are supposed to be supervising) when they think that clients need medications to help them control their behavior (basically chemical restraints, although they avoid the term), or when they think the client should be on precautions. One worker became very angry a couple of days ago when the RN refused to follow the worker's demands because it was not warranted in the nurse's judgement. While any nursing job requires independent judgement and conflict management skills, this seems like a way of life here. (3) The DON quit (over politics?) after I started. Her replacement has been an RN for less than a year and seems to be more interested in pleasing her new boss than protecting her or our licenses. She's doing things that my preceptor and I consider highly disturbing. Also, my preceptor has a history of coming in early or staying late to help out at this facility, but when she asked if she could take off an hour or so early because of some pressing issues, the DON gave her a very sarcastic and rude reply instead of professionally stating that it wasn't possible. (Something like, "I don't know why the f*!@ not!!! .....No.") (4) We run out of supplies. I understand that even the docs haven't been paid in months. The turnover is high, even for nursing. It's a small place, but almost all of the nurses are agency nurses, because everyone else has left that could leave. The more I see, the more worried I am. Many basic nursing skills aren't done here, so my preceptorship hasn't prepared me for more clinical nursing. I'm also not sure how I feel going back to that. My last job was a nightmare where my DON said that national standards were developed by people in ivory towers and didn't apply to us. I felt that I was witnessing negligent homocide or dangerous situations every day, and every avenue that I pursued to correct the situation proved to be a dead end (pun, unfortunately accurate.) It was a small rural hospital with no where else that I could reasonably drive to with my family situation. Sorry this is so long, but if you have any advice, please help. Part of me loves nursing (in theory, and the clients :) ), but in real life I want to run from it. I haven't found other options for making a living with my training/education/experience. I have a BSN, was top in my class, and was a very conscientious ICU and PACU nurse with certification. Thank you for "listening." Please help if you can.