1RN4Christ

You are assuming I spoke with the manager. And yes, as I claim, there is only one. Policy states there has to be two at all times (manager included). I did not call the manager. Let's stick to the post.

I'm done with this post. I'm not sitting here being nasty or condescending. I admitted what I could have done differently and I was asking a question to merely be more OBJECTIVE. Not judgmental and rude! Religion has NOTHING to do with this and you that are so quick to point the finger forget that we are all human and fall subject to the same faults/failures.

Before I called the board (to ask the question, not report anyone), I did look at our policies (which were incredibly vague). Maybe I should have asked my manager first. At any rate, I was trying to become more informed on the situation before proceeding further. It would have been better to ask the RT directly but if you only have one for your small hospital (other than the charge), I am not going to pull her away from ER/ICU, whatever, to ask. I can find her another day. I don't see any issue in doing my own research.

I understand what you're saying, but you don't get that the RT charge is at a separate extension altogether (their office). I called the dept. extension expecting to get the RT that was working on the floor. Let's not make assumptions or project into the future. I just wanted an answer to a question, not get somebody in trouble, which is why no one was mentioned, or the patient, or the day. It was a generalized question that I wanted an answer for, and in turn, give that RT the benefit of a doubt before I took things a step further (if even necessary).

Regardless of what you THINK I was doing, I was not trying to throw them under the bus. I was not going to name anyone specifically, just ask a generalized question. As I said, I'm just trying to gain a better understanding. There is nothing wrong with asking questions. No one has to be named in order to get an answer.

I forgot to mention that I called their department several times to inquire and no one answered. I was not going to page overhead for something like this. I also asked around and no one thought what was done was appropriate, so I went to a reliable source.

Don't get me wrong. I appreciate the role of the RT, they are an incredibly valuable resource for nursing and the patients and we are all a team. I do not have the luxury of rounding with RT's...in fact, we do not round at all, and I wish we did. It is important to know if it's over-stepping because I do not want any confusion regarding information given. It looks bad when nursing says one thing (after communicating with the physician) and RT says another. RT and nursing need to communicate closely regarding the patient's status. Giving inaccurate information can create a mess for nursing and upset among clients and their families. That is all I am trying to avoid. We are a team, need to respect one another's roles and should be on the same page.

I also work in small rural hospital where I do not have quick access to the RT department (as they float everywhere) and often need to be paged. I was going to ask. I'm not trying to get anyone in trouble and did not report this person. As I said, I am just trying to understand the role they have, better.

Just a question. I'm just trying to have a better understanding of the role they play. They are not with the patient all day long, nor do they have direct interaction with the physician.

Also, is it appropriate for them to initiate the discussion of hospice?

Hello! Quick background then a question... I overheard an RT giving lab work, values and their own interpretation of how this played a role in the patient's diagnoses to a patient's family member. Now, I guess I can see an RT discussing ABG's and maybe even a CXR, but CMP and CBC? No. I think this is over-stepping. Anyone know for sure? Or have experience as an RT? I called the board in my state and they said "interpretation is wrong." Then I was referred to the web site that was not very helpful. I don't think they should be reviewing these results with the family, period. I think that question needs to be referred to nursing, or better yet, the physician. Any thoughts?

Strange indeed. I work in a rural hospital on a tele/med-surg unit with an occasional peds patient. A hodge podge of cases.

Yes, I AM an introvert! Good guess ;-) I like the pastoral care idea as I am constantly forgetting. Our pastors do regular rounding but sometimes they are definitely needed more! I'm learning to establish more boundaries. As an example, when people ask me for coffee while I'm doing an assessment, I will tell them breakfast will be up soon with coffee and that if they still need it, I will bring it after I'm done meeting with all my patients. That seems to go over well and they understand. It feels a little strange saying "No" or "Not right now" as people are VERY demanding, but it makes me feel better knowing I have some control and I can only do what I can do without having my hair fall out or losing my sanity. I do delegate...when I first started the tech that sent out the pages wouldn't actually send them as I had requested. I finally figured that out. She was an advocate for CNA's and did not like nurses asking them to do things (delegating is part of MY job as I'm not super-human). I didn't make ridiculous requests. After speaking with my manager, he straightened this out. Sometimes, I still have issues with the CNAs not doing tasks and not telling me - this is irritating. I don't ask much and am constantly telling them to let me know if they need help. There's a select few that give issue... Anyway, I'm finding my voice, slowly but surely after 2 years! Agh! Thank you for your input.

I am going to be more assertive and speak with my manager. I've made comments in the past about how I can't handle another patient being added to my already difficult load or how I need help, but am still given this additional patient and do not receive help. I will be more vocal, in a tactful way, of course.

Your comment is very encouraging. I do need to say something. After speaking with another co-worker, she said she has heard night shift say before "Insert my name is very good with that kind of patient. She is so calm and does a good job so we'll give them to her." I immediately thought the worst. I guess, in part, b/c I have overheard a day charge assign a night nurse a difficult patient just to be mean. It would be nice if these sorts of praises were actually shared.

Thanks for the hugs, hehe

Esme12, I have been an RN for a little over 2 years. There is some truth to what you say... I probably do create more work for myself than needed. It's difficult to distance myself when some patients just outright express their misery to you when all you tried to do was fill their ice pitcher. How do I ignore that? I don't let my emotions get tangled up in theirs, but it does effect me because I can only offer myself for so long to listen. How do you keep your distance? I think the mounting frustration makes the mentioned load seem worse than it really is. I'm just drained.

Our hospital has cracked down on this. I used to get patients transferred to our bed from the ER stretcher and find the bottom sheet was soiled, then a new sheet had been placed on top. Or, they come to the floor still on the bedpan and the individual who has brought the patient up had no idea the patient was still on it.

SoldierNurse22, I appreciate your feedback. I will say that I am a very even-keel, laid-back person who deals with stress often and quite well. I can manage 5 to 6 patients and do so, often, but when they are all high acuity it becomes wearisome. It's not the # of patients, but the acuity that makes the workload so difficult, especially when so frequent. The point is that we are supposed to be assigned patients based on acuity. I have considered this a form of bullying, indirectly. The same night nurse gives me these assignments and even the nurses on her shift have commented to me "Why would she do that to you?" Once, I got report several different nurses on several crazy patients... My whole load consisted of confused people who were constantly trying to climb out of bed and could not do anything for themselves. Why would you assign a team like that? Why not disperse those patients?

Usually I say, "I've enjoyed talking to you and would like to visit more, but I have to go right now. I will come back and check on you." I've had the pager go off multiple times and back pedaled towards the door, and the patient will continue to ramble. Usually those strategies do not work for me. I like the tech calling for the nurse over the call button speaker. I'll have to try that. Enjoyed your post! I can relate to the "dizzy" excuse, but I'd be afraid to use that, because the patients may think their nurse is not well enough to care for them. Anxiety runs high when people are ill!

After reading "Behavior that Just Shouldn't Fly" by a fellow poster on allnurses, I decided I do not want to become the nurse that quits because of bullying in the workplace. Would you consider having a sixth person tell you over several month's time that "You always get the 'crap' patients. Someone must not like you very much" or "You always have the hard patients" or "You always get the difficult ones" as a form of bullying? I've had a pharmacist, a CNA, three nurses and a psych doctor all tell me this. I'm beginning to see a pattern in my assignments. While charge nurses are supposed to be assigning according to acuity, I recently had 3 patients on 02, those three patients also on tele, (my team totaled 4 patients) all 4 of those patients were fall risks, 1 of those was a bariatric patient with special needs, another patient was flip-flopping between hospice and aggressive treatment based on family's indecisiveness and were constantly cornering me for 30-40 minutes about what to do (I have compassion for them - I was just very stretched). This "hospice" patient was confused, combative as well and known for strangling. My other patient was post-op and a constant whiner and was very mentally draining... This is just one example of many. On top of this assignment, there was only one CNA for the entire floor. For some of you, having 5 and 6 patients is a luxury, but for me, when I get these heavy loads nearly every time I'm at work, it wears on me. I'm not happy to be there and I dread what assignment I will be getting that day. My co-workers are always visiting at the nurse's station, or online shopping or playing on their cell phones. Meanwhile, I'm running back and forth and back and forth and it never ends. When I'm in rooms, I find I lack energy to hold conversations and I just wish patients would stop talking to me so I can get in and get out. I always wanted to be the nurse to sit and take time to get to the bottom of why someone may be upset or depressed or lonely or what have you... I did that with the aforementioned load and was so completely drained. I learned one was grieving loss of a body part removed over two years ago and was very visibly angry for it but softened after being allowed to explain, the other had a wife who died several years ago, has been lonely ever since and was missing his companion... I don't know how to handle all this information some times. The angry patient and the hospice patient were given to me because "I knew you would be compassionate. They need a nurse with compassion" the night charge says. What about me? Typically I just love to love on my patients, but I'm beginning to show compassion fatigue. I just know that's what this is. How do I navigate this with my manager so I don't appear to be whining? I'm not the only one noticing my loads, so this should be ok to address, right? I've considered that my assignments may be given because the night charge nurse making day shift assignments may be trying to play on our best nursing traits, but I'm tired... I sleep later, I have less energy, I've been combating depression that is slowly lifting... I say things I normally wouldn't and become angry faster... I don't know how much longer I can keep this up. I've been praying a FT position will open up in another department so I can transfer. I don't think my career on my floor should have to end this way... I'm very diligent in my nursing, always researching and I have good rapport with the physicians. I've noticed nurses in the past that have been picked on because they are slower, or march to the beat of their own drum, or do not handle stress well, or do not play politics. I am there for my patients so I do not visit and gossip, and therefore, do not play politics. I don't want to be sensitive. Any thoughts on this issue? How would you proceed? Thank you!

LadyFree28 Thank you for trying to stick to my post. THAT is my biggest concern and something I find TRULY bothersome. Btw, there were no vital signs documented on this patient either. Not from the day of the event or the day after when she remained extremely hypotensive and tachycardic. It read Lungs CTA, HRR.

Thank you for your input!

Sorry, this response was for Guide. Still new at this posting thing.

In my case, I KNOW rather than ASSUME this physician writes notes without touching the patient. He is only on the floor once during the day and literally, what I see is what I get - and it isn't much! Thank you for the information. :-)