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...

Thank you all for the responses. It helps to know that I'm not the only one that finds this situation alarming. I don't know why I hadn't thought about reporting it to the state. I will be looking into that. In my hospital though, I have frequently voiced my concern about this lack of testing to anyone who will listen, my manager, my manager's boss, the focus groups concerned about RNs leaving the hospital, the infectious disease department, anonymous quarterly surveys, and even the suits that round once in a blue moon. None of my proddings have gone anywhere. One of our Trauma surgeons recently died from Covid of an unknown source. I know of at least 2 other physicians that have died in our mid-sized hospital. We frequently have staff out with Covid, and I myself have had it twice, both times from surgical patients who were thought to be Covid negative but never tested due to lack of symptoms and both had been on our floor for several days. (On a related note, both of these patients became symptomatic later, both transferred to ICU, and both eventually died.) This is a Level 1 trauma center in a large midwestern city, and we have over 350 beds and 16 surgical suites. And we have not stopped or even slowed elective surgeries since the early months of the pandemic. Though the Other hospitals have. This is a very old hospital and in dire need of updating key areas, including PACU which is a single open room. I don't know how they isolate PACU patients for other infectious diseases. I know from an RN that recently transferred from my floor to peri-op that they are using the same precautions that were used pre-covid. For a while, they were using N95s when intubating/extubating only, but they no longer do that either. I enjoy the work I do, but it isn't my forever job. As I said earlier in this post and in others where I talked about possibly moving on, I would like to move into working Oncology and eventually in-patient Palliative care and/or Hospice. Right now I'd be happy just getting away from my current employer.

I'm glad your hospital is giving you a good incentive to pick up extra shifts. My hospital tried something similar, but it was so convoluted and poorly written that few people take advantage of it. Basically, the employee has to commit to working extra shifts 2 weeks in advance and they have no say in what day the extra shifts are scheduled. It really doesn't help the short staffing due to call-offs at all, which is what we're mostly seeing right now. Also, the pay increase doesn't really amount to much "because we're already getting overtime and the base pay from working more". My hospital also tried doing a retention bonus this year, but the way they rolled it out was an insult. They offered RNs $15,000 if we sign a 3-year contract. If we leave for any reason, then we have to pay the full $15,000 immediately. The taxes on that money would just be lost, and there was no provisions for leaving due to illness/injury or if the employee or spouse had to move for the military (lots of military in my area). I don't know of anyone who actually took that deal.

Part II: What to do next? I have posted many times about being dissatisfied with this job. I'm still a fairly new nurse, so I've stuck it out, the devil you know and all that. I am so close to being fully vested in my 401K, which will be this August. I'm also close to finishing my BSN, which I am getting partial tuition reimbursement. I wanted to finish those before moving on. On some level, I feel like the hospital owes me after the BS I've dealt with here, so I want to get all I can get from them. I'm also a little scared of looking for another job. I hate, hate, hate the job search and would rather just be settled. I don't expect the Other hospital system to be perfect or even better, but I know that they are better in at least the specific areas that I am frustrated with in my current hospital. I've had a horrible manager and a better manager, so I know that my next one could be either. I think I'm also a little psyched out from the last time I thought about jumping ship. I did land an interview in my preferred area of nursing at the Other hospital, but I did the interview while sick with Covid at home isolating and did the interview online. I didn't get the job but I did get the "we still liked you so feel free to apply again sometime" letter. That was over a year ago, so my nursing skills have improved and I now have a bit of charge experience, but I don't think my confidence has improved. I have also thought of just quitting now. If I did that, then I would finish the BSN then start applying to the other hospital. My family finances can take it, though it would delay some of our goals this year. This option "feels" better, but it leaves me even more anxious about actually landing a job I want. I'm also afraid that the next place will be worse in some other way. I know nowhere is perfect, but what if I have a good thing and don't realize it. Well except for the blatant avoidance of Covid testing. I think this worry comes from when I was floated to a more medically oriented floor and I felt way out of my depth. I have an interest in oncology, but I know that the learning curve there will be steep after working with mostly surgical patients. This may be exhaustion and anxiety of the unknown talking.

My hospital is not doing much. We get the usual EAP and free counseling up to a certain number of sessions. There's also a feel-good section in our weekly newsletter, but I find that often the tone of that section doesn't take into account the reality of direct patient care jobs. It can be frustrating to be reminded to drink water when I can't even find time to eat or pee. There was a moment during my newly licensed RN orientation that still sticks in my head. It was right before the pandemic so there were about 300 of us new grads piled in a conference room in the next largest city in my state. The corporate CEO gave a presentation then asked for questions. One particularly ballsy person asked what the company did to prevent nurse burnout. I remember the CEO's words almost exactly. "You are given X hours of PTO each year. If you use your PTO then you won't have any problems with burnout." I doubt this man had any experience at the bedside. It is also hard to use your PTO when frequently denied due to short staffing and canceled due to call-ins.

I think I just felt the straw that broke the camel's back. This is going to take some time to unpack. TLDR version is: I'm frustrated with my hospital's continued disregard for nurse and patient safety and want to leave this hospital system for the local competitor, but I want to tie up some loose ends and I'm worried that the next job won't be any better. When Covid started, the Other hospital system in town started testing all admits for any reason for Covid. My hospital did not. On my floor, patients often discharge to a rehab facility, and all require a Covid test to be done before transfer. Many, many times we have had patients Surprise! test positive for Covid when we are doing this test right before setting up transport. Edit: I wanted to add that I don't mind caring for Covid patients. We've seen less than the other floors but we have had many. I am happy to do my part in caring for these patients. However, we must know their Covid+ status to protect ourselves and our other patients. So this month, as we are now 2 years into the pandemic, we all got an email from corporate headquarters that all patients admitted to the hospital will be tested "so they can be treated appropriately". No mention of avoiding cross-contamination or protecting direct patient care staff, but I'll take it. We saw this policy go into effect last week, but it was ugly. All patients admitted from the ED were tested, but not patients admitted under observation status, even though these patients are roomed on the same floors as general admission patients. Patients were also being tested only on admission to the hospital, which meant that this test was the last thing that was done in PACU as surgical patients were to be admitted. We had 4 surgical patients to our floor that afternoon after this policy went into effect and 3 were surprise positives. So instead of moving the Covid test to before surgery (wouldn't the surgical team want to know a patient was positive?) the hospital panicked because PACU can't isolate patients. They required that PACU testing be stopped immediately. It doesn't exist if we don't see it, I suppose. I found out about this a few days ago when I admitted a surgical patient from PACU and a warning came up on my computer that this patient had not been tested. I ordered a test per protocol and let my charge nurse know that a patient had come up without being tested. I was then told to cancel the order and there's no protocol (despite the email from corporate headquarters?!), so it was an inappropriate order. My manager then let me know the changes to PACU not testing. So we are not even testing these patients after they arrive to the floor. Again, it doesn't exist if we don't know about it. I'm furious, and I am done.

Regardless of or perhaps despite CDC guidance, my hospital is recommending direct patient care employees return to work even while Covid positive "as long as they feel well enough". That is irrespective of whether they have a fever, how long it has been since symptoms started, and whether they are vaccinated and/or boosted. I am seeing signs that our Oc Health nurses are pushing back against this and trying to give employees a way to stay out, but their ability to control this situation is minimal. Symptomatic employees and employees who are still in their 5 day from + test window are to wear N95s the entire time they are in the building. A strict reading of this would be that sips of water through a shift and even a lunch break are to be done at least outside, though I've not heard of anyone challenging it yet. My hospital's response to control of Covid within the hospital and protecting employees from its spread has been dismal. This is my main reason for wanting to leave this hospital system as soon as I can line up a new job.

Fall Risk Screening and Skin Breakdown Screening (I forget the actual name of the tools at the moment) that have to be done every 12 hours I assess their fall risk by assessing their strength, compliancy, and how they move; not this stupid tool that I generally don't fill out until late in the shift. The skin I assess by looking at the patient and how often they shift their weight. I'm sure these tools are useful for the inexperienced, but for those of us that have been doing this for a while, it is a waste of time.

I've had covid twice, likely different variants. The vaccine is stronger protection for multiple variants. I'm not going to risk a 3rd time. I got the vaccine and will take any booster I can get.

Rock those prints! An awesome coworker of mine would wear turtles every chance he got.

I keep my stethoscope in a Bat Clip (check it out on Amazon, awesome product) on my waist so it is never around my neck. After each use I wipe the bell and tubing with an alcohol wipe. I generally do it pretty fast while I'm educating the patient on something or another (generally on how to use the incentive spirometer). At the end of the shift, I wipe down the whole thing, clip and all with Cavi wipes. I don't bleach because I've turned too many of my navy scrubs purple that way. If I'm concerned enough to want the bleach, I'm not taking my own scope in the room, and I'm using a disposable.