Orientedindependent

Hi all, I've been working in a surgical ICU for the last 18 months. It's a well known fact the leadership team on this particular ICU is bad, but silly me coming from an inpatient but non-ICU background wasn't aware of this at my time of application. Just your usual stuff that makes it bad, punitive assignments, picking favorites for job progression and challenging sick assignments, speaking up leads to repercussions with your schedule being changed to awful turnarounds between nights and days. I came into this unit with a few years experience in med/surg, charge trained, higher 'nursing level' etc. Nitty gritty: In the most recent months I've switched to a contract to work a specific split of days/nights between a specific window (i.e., only nights, only weekends Friday-Monday, etc). I'm still a FTE, but for school reasons could not take the constant flipping of shifts and asked my manager for this route which he agreed to. In my institution our leadership team has specific responsibilities; one does scheduling, one oversees staff education, one does auditing, one does care coordinating. They're all best friends of course, they like to sit in a circle in their office when the unit is falling to piece and talk about the staff they don't like (according to our APPs who share their office). I recently got my schedule in which my shifts have been changed to outside of my mutually agreed upon scheduling window for each week. I'm contracted to only work xyz shifts, the leader who does the scheduling is aware, she was in the meeting with my manager where this contract was decided. I got moved anyway, which I'm unavailable to work because of school commitments. So I sent an email to her (none of these people are here working when I work because they only work two days a week) and have yet to get a reply (despite the fact she has replied to other people I'm working with on the same day who also sent her emails). I'm not even sure she is allowed to do this since the contract outlines when I am available to work. If worse comes to worse, yes, I can switch my schedule, but this shouldn't be happening. Second, I'm being held back from progressing with no documentable reason as to why. In order to progress where I work and take on more complex patients there are classes we have where you are introduced and educated on the different devices that we get transferred here. In the past I have been unable to attend these classes due to scheduling issues (meaning that I was scheduled to work on the days the classes were being offered). Once or twice I understand, staff is needed. But this has happened far beyond the point to be considered coincidence. Also, staff who just started but happened to be friends with this particular nurse leader are now FULLY device trained, despite having no surgical ICU experience. I asked if I found coverage for the few hours if I could attend the classes and was told no. I didn't think to ask further at the time. There are now two classes coming up that I am available on and yet I'm not in the class. I sent an email asking if I could be in it, and was told no. I want to address this with the educator face to face and ask why but she only works weekdays so it won't be until later this week. I would probably understand why if there was a reason behind it, but to the best of my knowledge there have been no issues with me and my care. It drives me nuts to see a new grad with less than a year of experience under their belt after orientation being able to get device trained while I can't and am being kept in the dark as to why. I'm aware 18 months is not a long time at all for an ICU career, who am I to be asking for this job related progression but if a new grad is allowed to do it I definitely should be able to as well. These are just two incidents that happened to me, there are a number of different things that happen on a regular basis that concern me about this unit. New graduates are taken off of orientation two months early when they clearly aren't ready and then put a huge strain on experienced staff to not only care for their own patient but the new graduates' as well. Weekends are always super well staffed because the nurse leaders are on call yet there are weekdays where we have half the number of staff we need in order to safely run the unit, and these are the days no nurse leaders are scheduled and we don't have anyone on call. Nurse leaders will schedule themselves for 12 hour shifts on the floor when really they're teaching clinical on the unit across the hall for another institution but apparently that counts as their required 'on the floor' hours. While writing this I'm starting to wonder what is the point? Should I even speak up and say anything or try to fight to progress in this unit? Is it worth it? So many people have left because of the incidents they've had with this particular leadership team and their treatment of staff. I don't want to get into details too much because I want to stay anonymous, but I wonder if this isn't even worth my time. Not to mention my speaking out against the education coordinator will likely result in repercussions in my patient assignments and work schedule. Is it just time to consider another place?

I completely agree. Unfortunately it seems where I am more nurses will not be added unless our scores improve. I checked my work email today and I had 4 emails about HCAHPs and how our scores were "less than satisfactory", therefore upon returning to work we will all be focusing on improving those. Frankly we are so short where I am I don't have time to focus on true patient care because I am balancing admissions, discharges, AMAs, and a patient awaiting an ICU bed on a medicine unit. I know, I know I need to switch specialties but I promised a certain time commitment to this floor when I was hired and I intend to keep it, as it's only a few months but even in the few years since I was hired I cannot believe the amount of change I have seen in the patient population and the focal shift to HCAHPs. It is frustrating.

I still haven't even heard for an interview.

I called last week and they said that the admissions committee is still meeting and acceptances are still being sent out. They couldn't give me anymore information than that.

It is apparent to all of us who work in healthcare that a change is needed. Working in a larger hospital for a few years now I have seen the effect that surveys for satisfaction, customer service education for healthcare staff, and scripting have done for our profession. Let me give you a hint: it's not pretty. Having worked at a couple hospitals now, both as a student and then as a nurse, I see a disturbing change in the type of care given and then behavior we now see from patients. I work in an urban setting, this definitely impacts the type of patients I see as more often than not, they are frequent fliers from nearby neighborhoods. In school, we are taught advocating, therapeutic communication, etc for patients. Then we get to our job orientation and that is replaced with 'JUST GIVE THEM THE PICKLE!!! LOL'. Followed by staff being given a pickle pin to wear... Really? We have a botched system that evaluates reimbursement on my ability run around and be yelled at for not bringing in a PRN medication 15 minutes early because your pain is suddenly 10/10 despite the fact you were sleeping 5 minutes ago, or that your ginger ale doesn't have enough ice. Patients now believe too that because they are surveyed on their satisfaction, threatening to leave the hospital they are currently in for another hospital will get them what they're requesting so diligently. My response? Please do. It's unsettling too that new nurses now, instead of focusing in their training as a new graduate on the important things like how to manage a critically ill patient, they are learning how to time manage drinks and pain meds with a 5-6 patient assignment. The awful thing is multiple times a patient will be decompensating and the new nurse gets pulled out of her own patient's room with that situation to attend to the non urgent needs of another patient. I get some of this is teamwork, but some of this is also the change in attitude of what healthcare is for patients. But it's unacceptable to tell them to wait. How is it appropriate to evaluate us and our reimbursement on whether the hospital stay was satisfactory? You know what's satisfactory? Getting better and going home. You know what hospitals are for? Healing. Not narcotics galore, free sandwiches, and free tv. And yet now, we are all mandated to take a class on customer service, smiling, scripting our conversations with the dissatisfied patients and family members threatening to sue for not giving dilaudid to a sedated 20 yo. Please tell me how this will benefit me in our next Code Blue. Nursing has changed and it is sad.

I wouldn't say it's weeding out so much as preparation. There's a reason there are required scientific and difficult pre reqs for nursing school, it's to challenge and prepare you for the actual hardcore work that nursing school is. When you get to nursing school, they're not 'weeding out', they're simply educating you to be the best you can be. Another part that you need to understand is that as a nurse once graduated you need to be able to think quickly on your feet. In some ways taking the hard classes and pushing yourself regardless of it being a nursing class or not is preparation for that. It's not fun, but it's realistic. Finally, I did graduate within the last five years and while I do agree the programs are certainly challenging, the only changes they have made are to adapt to changes outside of their control (i.e., NCLEX testing, expanded nursing responsibilities, more autonomy depending where you are). They need to prepare their students as best as they can, and yes, that makes it more difficult for some. If you are struggling with the prereqs I would urge you to consider part time to feel out how nursing school goes. It's a whole different ball game. At least you are able to take your nursing classes separate from prereqs/liberal arts, some of us had to take micro/AP2/art/sociology/etc in addition to maternity/medsurg/pharm/patho in a semester.

I applied late November. Called Friday, they said I'd hear sometime in February. But I'm just surprised seeing as so many have gotten interviews already.

Has anyone heard of getting in here without interviews? I've been lurking for awhile both last years and this years threads related to SBU's FNP program... Some had interviews while others didn't. Why is that? I applied but haven't heard a thing about an interview. I'm 6 hours away