Ioreth

I had an interview for a hospital RN job today and I'm just so confounded and anxious about it that I can't sleep, so here I am on AllNurses to get it out of my system. I tend to be longwinded when I write; apologies in advance. ((TLDR: Team interview for RN with 3 years experience. No longer accepting specific department applications. Worried I won't get the floor I applied for, or any job at all because I expressed a preference.)) I've been working on the same hospital unit since I became a nurse, and I have had several ups and downs during that time. The people I enjoy working with have mostly left for other nursing opportunities, and I am becoming more and more uncomfortable with both the hospital and its parent company. I've kept in contact with some work friends who have left to work for the other major hospital competitor in my area, and most of my specific concerns are not an issue there. I don't expect everything to be perfect, but I just need a change. There's a floor in the competitor hospital that I've always wanted to work on, so I applied to it when I saw a job requisition for that floor with the hours and shift I wanted. This is an area common to new grads, so I didn't think it unreasonable for me to apply there, especially with 3 years including charge and frequent precepting under my belt. I applied previously to this floor 2 years ago but was not given an offer. My understanding was that I had less experience than the other applicants at that time. I also did that interview 2 years ago online and fuzzy-brained, sick with the first few days of COVID (it hit me pretty hard), which the interviewers did not know about, but it probably didn't help that interview. I got a call back from the recruiter almost immediately and an interview was set up. It was to be a team interview and online. This seems pretty normal right now. However today when I logged in for the interview, it was 5 minutes past the start time before anyone else came in. Then I realized that the interviewers were all from other floors, not the floor I applied to. They told me that although there are job requisitions on the company website for each floor, they are not doing interviews for specific floors. Instead, some of the managers will attend and together they will decide where the best fit for me would be. I did my best to emphasize my preference of floor to work on as the interview progressed. Late in the interview, after I had already given my spiel on what floor I preferred, why I want to work with this population, and my "best" responses to the interview questions, the floor manager I wanted to see did come in. One of the other interviewers said she saw I wanted that floor and asked her to come in. However, she seemed annoyed to be there, didn't ask any questions, and briefly mentioned that she remembered interviewing me 2 years ago. I was rattled by that, but I think I finished the interview well. Unfortunately, the remainder of the interview questions were the more negatively oriented, the ones that seem intended to throw someone off balance, stuff like "what are your greatest weaknesses?" She missed all of the "why" I was applying to her unit. I tried to work it back in, but the interview just didn't flow that way. The whole thing was over in 30 minutes. I was told I would get a call back from the recruiter right after the interview, but there was never a call. I'm worried about this and I'm starting to run in circles in my brain. First, I am worried that my impression from the interview 2 years ago was a bad one and that this manager is just not wanting me there. Second, I am worried that the other managers will not offer me a position because I expressed so much interest in working on that floor, then I'll be stuck in my current hospital. I'm seeing the writing on the wall in my current hospital, and I don't want to stay to see what happens when it all comes down. I told my husband about this after it was over. He's also job searching, but he's in a completely different industry and the interview process is so very different. He commented that it seemed insulting for the interviewers to all be late and not even include the manager for the position I was applying for. I don't know what to think about this. Honestly, it felt like a new grad interview. The unit I work in currently is pretty specialized, but I've seen lots of med-surg, including the population I was wanting to work towards. I've worked hard to earn skills, certifications, and committee participation beyond what is required for my job. I feel like my own preferences and (admittedly limited) experience mean nothing. If this is how they are treating non-new grads, what are they doing with nurses that are far more experienced in their specialty?

I think it is more of an issue that a warm body on the floor is better than a vacant job opening. We are so severely short-staffed. I feel like I've got one foot out the door already. I've posted plenty about some of the issues in this job and they really haven't gotten better. I just can't look for another job just yet until I'm done with this class. I want the reimbursement that I'm promised, and I feel like the hospital owes me. Come mid-October will be another story. I just need to get through this until then. Also I'm trying to reframe it in my own head. I tend to think of things in terms of "what am I doing wrong?" rather than "what is wrong with the other person?" I'm working on that. I know there are going to be jerks in any job, and I will not let them keep me from the career I love. But I do need to learn how to develop the resilience to not let them get under my skin.

I wish I had said that to the nurse that left her phone at the desk. I told her she wasn't to do it again. Patient abandonment was certainly at the forefront of my mind. It is fairly common practice to walk a patient to the front door without handing off other patients for that brief time. It is typical to tell others where I'm going and keep my phone on me. When I'm charge, I usually will hold another nurse's phone while they walk a patient out because I know reception is bad down there.

I know both of them know how to do this, because that is how I trained them. Unfortunately, it isn't policy at my hospital. Charge can get in trouble for not clearing the room after a discharge in a timely matter, but the primary nurse isn't held accountable. I very much wish we had this policy.

I have a love/hate relationship with bedside shift report. Positives: Patient is involved in their care plan and its a good way to involve them in their goals for the day. They can also answer positively on the HCAPS questions about beside shift report. It's a good time to do a safety check on drips, PCA handoffs, wounds/incisions, bed alarm, trip hazards, etc. I don't do a full assessment but I will usually ask them about pain (PT and OT come early for my unit and I don't want them to refuse therapy) and if they have any immediate needs. If the answer is bathroom, then I'll promise to return first after my reports, and then I do just that. Ticks them off a bit sometimes, but most understand. Negatives: The dreaded bathroom request. The nurses that do a full assessment. The patient that won't shut up. Often there are things that we do need to talk about (unrealistic pain expectations, temper tantrums, altered mental status, family issues, declining condition, labs/results not yet disclosed by physician, etc.) that can't be spoken about frankly in front of the patient. I've seen nurses that insist on a full only at the bedside report just leave these things out, and it is inappropriate to do so. I think the ideal would be a report in a private place outside the room to cover the basics and necessary info that is needed to start the day, then go to the bedside to do a meet and greet with a safety check and wound check. This may take slightly longer than just at the bedside or just away from the bedside, but it gets the best of both worlds.

I think there are two facets here. As LovingLife stated, there's likely a misunderstanding of hospital flow and these nurses chose to protect themselves from getting admits by hiding their discharges. I am usually a floor nurse, not charge, and it would never occur to me to attempt to hide a discharge. However, the thing that makes me wonder about bullying is that for the two nurses that hid their discharges, this is a continuation of similar behavior on days that I am not charge. Both women are cliquish, they have coworkers they like and coworkers they don't like, and both have decided that they don't like me. This bothers me, but I don't have to be friends with all of my coworkers. However, it is becoming more and more difficult to have a simple collegial relationship with them. For example, both women refuse me (but don't refuse others) to help with witnessed wasting of medications, narc count at the end of shift, turning and 2x assist with patients, "code browns", or really anything else I can ask for. Both women will have catty remarks when I am speaking to someone else, remarks that are intended to embarrass me. Both women have withheld information from me that could cause problems, never something that would impact patient care, but always things that would leave me embarrassed or unprepared. Catty remarks and withholding information were certainly the mode for the day I was charge in the original post. I don't know if this is related, but I did precept both of these nurses. Both had trouble accepting correction. This wasn't with a difference of opinion on technique, but major patient safety issues that is spelled out in policy, stuff that would result in an incident report (and no I did not write them up when correcting them). With the younger of the two, she was rebellious with all her preceptors. The experienced nurse had a shorter orientation, so I may have been the only preceptor. I also never correct an orientee in front of a patient or colleague, but always in private and in a way that doesn't make them feel like a "bad nurse" but that things are done differently here. I am not ready to leave this job because I want to get reimbursed for a class I am taking right now. It goes against my grain to leave a job because of a coworker. But I am starting to dread being on shift with them. I can generally ask for the help of others when I am a floor nurse, but when I am charge I can't avoid them. Also we've lost a few full-time charge nurses recently and another 1 or 2 will be leaving soon. The fact that I will be charge more often going forward is inevitable.

I have had a similar experience being charge. I wrote about my ambivalence with being charge for the first time here: I don't want to be Charge! Being charge with a 1/2 patient load or no patients at all isn't too bad. It can be intimidating to be the one holding the bag and managing beds. I still firmly believe that no new grad should be charge, better with at least 2 years of experience, but that is still a bit low. Even so, remember that the charge doesn't have to have the answers, they just have to know where to find someone who does. The reality? Charge on my unit (same as unit in quoted post) has a full load. Very few charge nurses are trained before they're thrown in because the scheduled charge is called in sick. I've seen a new grad 3 weeks off orientation made charge and was stuck with it until she quit. We have enough CNAs, but they're often floated out to other floors. I've had several times where I've had to just take care of my own patients and toss out the charge chores except those I just could not ignore such as admits and narc counts. Recently I had a day where it was just me and one other nurse with 12 patients. We both had 6 on a floor where normal is 3-4. Pure chaos. I've also seen night shifts on the same unit recently where charge had up to 7 patients. I'd have a hard time doing that on this unit even without being charge. I agree, it is really difficult to manage beds and be a resource with a full or overfull patient load.

I LOVE working 12s. Sometimes I toy with the idea of working a clinic or public health job that would have me working 8s. I just don't think I would like doing it since I would much rather work my 3 12s and be done. If you find the 8s to be troublesome, then you might just ask and see if they'd be open to you working 10 or 12 hour shifts. There might be a need for it that isn't obvious to someone new until you ask.

Things I've seen firings for: Not rounding on patients. CNA falsifying vital signs. Altered mental status while working then leaving hospital campus midshift without notifying anyone. Sitter CNA yelling at patient when patient was sleeping soundly on a night shift. Sitter was apparently upset that patient was boring and causing her to nod off. Managers canned for receiving poor satisfaction surveys when staff are upset about pandemic work conditions and changes from higher-up management. Things I've seen people not fired for: Failure to take vitals for several hours on a patient with altered mental status in post-op period, then the patient is found to be barely hanging on to life. Calling in "sick" for 2 months straight. No advance leave taken, no FMLA. CNA playing phone games in empty room instead of answering call lights, repeatedly. Attempted to hide med error with patient harm. Heparin drip was set at the 100 mL/h continuous IV fluid rate. Found passed out drunk in break room while clocked in. Gross negligence in insisting on carrying out a clearly contraindicated order (order actually had parameters which were ignored) resulting in patient harm. Bullying. Drinking PCA narcotics from the tubing after PCA DCed.

Wow. Thank you all for the excellent advice, especially on not using the scan overrides. I'm already a bit leary of pulling meds at all on an override since that one big case this year with an RN charged with negligent homicide after pulling a wrong drug overridden at the Pyxis. Now I don't want to ever skip scanning ANYTHING. Gonna re-up that malpractice insurance too... I hate that you went through this, OP. Thank you for sharing your story and I hope that things get better.

I wanted to add a few things that didn't really fit above. I also found the other noncommunicative nurse's phone at the charge station when I came back after discharging my patient. She had gone on lunch break, left her phone, but didn't tell me because I "wasn't there". I told her that she needed to give the phone to me directly or keep it with her. She gave me quite a lot of attitude for that, putting it kindly. I am always happy to hold phones for lunches, but I need to know that I am covering these patients. I never deny nurses lunches though I often can't take one myself. I'm not charge terribly often, but when I am, I don't micromanage. I do check in with nurses periodically for needs, breaks, lunches, and discharge times. I do not chart audit or interrogate them on patient care as I hate having that done to me. I only got crickets when I checked in with these two nurses. Generally, if I see that someone is struggling I will adjust loads if possible, facilitate discharges, and try to time admits to their workflow needs. Sometimes I'll even settle a patient for them. I don't understand this behavior at all. If it matters, one is a just past new grad, the other is very experienced but newish to this unit.

I'm trying to process a situation I was in recently and would appreciate feedback. Sorry for the book. TLDR: Floor RNs hiding from Charge that patients discharged. Poor patient flow ensues, Charge is reprimanded for holding up PACU. Bullying or "self-protection"? I was charge with my own full patient load on this day. It is a post-surgical unit, and we started with a full house, short 1 nurse (hence my full load), and expecting surgeries. I was also expecting several discharges, so wasn't too concerned. After settling my own patients, I checked with the case manager and reviewed the discharge planning for the day. Two of the nurses were expected to have some early discharges, so I checked in with each of them when these discharges would happen so I could manage beds. Both told me they were not discharging anyone. So I started hustling. 2 of my own patients were discharging which would make being charge more manageable if I had a half load, but if I absolutely must I could take the post-op patients myself. Still not ideal. I also got working calling around other floors to see if anyone could take a stable-but-not-discharging patient. My first discharge wasn't until just before the first surgery was to come out. When I was taking my patient downstairs, I saw one of the nurses that had told me she wasn't discharging anyone. She was discharging another patient. I came upstairs to find 4 vacated rooms and no word to me when these patients had left. As I was sitting down to clear the rooms for cleaning and turnover, I got a call with a verbal reprimand from my manager that I was holding up PACU. I asked several times to just tell me when they are starting a discharge at least, but for the remainder of the day neither nurse would tell me when patients left. If I didn't have my own patient load I might have caught them rolling out, but since I was in my own patient rooms, I often didn't see them leave. This is despite my asking them several times the status of discharges and practically begging them to tell me when patients left. The day ended a mess. Instead of a "light" surgery day, the one nurse that was communicating well ended up with an overly heavy load and the two other nurses ended up with half loads. We were overstaffed for the census, and someone probably should have been sent home but wasn't. We could have taken some load off the Emergency Department, but since I was told "not discharging" then "surprise! discharge!" I was unable to take those patients. I was furious and talked to my manager several times. She told me that she spoke to the nurses and said it wasn't malicious, just self-protective and that they didn't want to promise something they couldn't deliver. It doesn't feel that way to me, but I'm not sure I can prove it was bullying. However, with both of these nurses, this is not the first time I have had issues with them, never as charge before but generally other things like catty remarks and setting me up for problems in general.

I came here to write about what I think is a nurse bullying incident I'm facing on my own unit, which I will shortly. I'm also an older in age but newish nurse. It has come and go on my unit, and most of the time I don't recognize it as bullying until either it ends or I come here to talk about the experience. I took a class on this offered by my workplace as a new grad and they called it lateral violence. That makes it seem like a big splashy thing, but in my experience, it has been much more subtle. Part of that may be that I tend to internalize criticism, so I tend to actually join the bully in beating myself up. I don't have an answer to nurse bullying right now, as I am looking for ways to deal with it as well. I just want you to know that it is unfortunately very real in school and in the workplace. As far as the age of the aggressor, I have often found it to be more experienced nurses that are either near my age and just a little younger or more experienced nurses that are much younger than me.

Thank you for the info about reporting to JCHO. It will be helpful as I figure out how to report this. We just finished our monthly staff meeting and I brought up my concerns yet again. "We've got a focus group looking at how to comply with this guidance from corporate." I asked if we may comply with the corporate policy by testing on arrival to our floor. "No, you may only ask the provider for a test if the patient is symptomatic. But remember that you can always wear more PPE if that makes you feel safer." So they're suggesting that I wear an N95 because I'm the nut that wants patients tested. I'm half considering wearing full Covid PPE each time I interact with all patients. See how that goes down.

Since I have a locker, my bag is just a large, simple purse. There's a zippered pocket for my keys and wallet. Everything else goes in the middle: lunch, drink, extra mask, pens. I really don't carry much since I have a locker at work and everything I need for my job I keep at work. Sometimes we float to other floors or the other hospitals in our system in the local area. For that, I do have a backpack that I keep a spare folding clipboard, stethoscope, shelf-stable food, trauma shears, a zipper pouch of pens, and another zipper pouch of OTC meds, hair ties, fingernail file, etc. This backpack is a pretty simple JanSport with two larger compartments and a handful of smaller pockets. I keep all the stuff I need on my person while working in one large compartment, and the other is full of stuff that would generally live in my locker. There's plenty of space for throwing my lunch and a drink on top. I'd love it if my bag had an unending supply of those plastic membrane covers for the bell of my stethoscope. I'm always losing those...