my "floor nurse mentality"

[Anagray, BSN]

I have to get this off my chest because I did not sleep all night and I am obsessing over it.

I worked on a busy med-surg for 2 years, now I've been in the ER since April, preceptor was very pleased with my work ethic. I came off orientation in July and made sure to tell everyone around me that if they felt i was doing something wrong to let me know right away.

In the past few weeks i was working with another RN on a team where we would take on 12-14 patients as they would show up. I found myself overwhelmed and at times I can only take on 5 patients, especially if one (or 2 ) of them is ICU. I spoke up to other nurses and said that i felt like i am not carrying my load - one CN said "relax and take your time".

Yesterday I was really upset because CN # 2 slams me with EMSs reagardless of what is going on with my other patients. Because of this my patient on cardizem drip dropped his pressure and I was not there to catch it - i had 2 EMSs back to back.

i approached CN #2 and said that i am unable to keep up with the pace she is setting for me. To that CN # 2 replied that I have a "floor nurse mentality", that I am not focusing on what needs to be done, that I need to go back on orientation with a preceptor, that people are complaining about me, etc.

I was completely crushed, I asked her why noone has come to me and said something - neither my co-workers nor management. She had no answers.

I feel like a complete failure and I don't even want to go back to work.

It is possible that i do spend too much time with my patients..so what do it do about that? How do I approach this issue?

Do i just walk in the room, make an assessment, draw labs and leave within 4 mintues without getting the whole picture?

how do you plan your care in room?

thanks

Nat

[Tweety, BSN, RN]

I can't answer because I'm a floor nurse, however, these questions should have been answered by your preceptor the first time.

It's a low blow to say "people are complaining". I would meet with the manager and tell the charge nurses concerns and that you would like to meet with this CN and get specifics. A blanket statement like that isn't helpful without specifics on how you can improve.

It's quite common to get overwhelmed at first and you did the right thing by going to charge nurse saying so.

Good luck.

[Altra, BSN, RN]

Are you sure we don't work in the same ER? There's a lot of support where I work except for one charge nurse, and this just exactly the kind of unhelpful thing she would say ...

I agree w/Tweety -- talk to someone to get specific feedback. You need to know if there was a better way to specifically handle the patient load on that particular day, or if there is a larger area of concern.

BTW -- I'm repeatedly told that even for an experienced nurse, it will take 1-2 years to feel completely comfortable in the ER. Shifts from hell happen -- I refuse to believe that they are always entirely the fault of the nurse.

:flowersfo

[loricatus]

I am so sorry about what you are going through and can totally relate. I wouldn't be surprised if we work at the same place. IT IS NOT YOU WITH THE FLOOR MENTALITY. This CN was using anything she could think of to justify HER POOR PEFORMANCE. You cannot be in 2 places at one time, no matter what she says. It is she that is endangering the patients. If you can handle 5, with 2 ICU patients, you are doing very well. You told her that you had a critical patient and was overwhelmed with what she was throwing at you. That ICU patient needed your attention-look what happened when you tried to accomodate the CN. CN #1 was correct-relax and do what you can do. Refuse to see patients and take report on patients that are added to your load when you are in situations like you just you described. Charge nurses like these need to learn how to do their jobs correctly. It is not the decision of the CN whether you go back to having a preceptor-the NM makes that decision. You should suggest that the CN goes back to 'school' to learn how to make a good assessment of the patient and the situation-a little real world managment and customer service training wouldn't hurt either.

Sorry about the tone in this reply. You touched a button because this is the very thing that is ready to cause me a nervous breakdown :angryfire:angryfire:angryfire:angryfire:banghead:

I, personally, will be starting (on my next shift) the same type of passive-aggressive thing back to the charge nurse that tries to deal it out to me.

[Kidrn911]

I was told once that all I do is sit around and have the Paramedics care for my patients, that all I do was delegate. This was about 3 months after I was praised by management that I was doing a fab job and was told that I was such a team player always helping out others and so forth.

What changed? Let's say revenge. The paramedic that complained about me was mad at me for hurting his ego. The first day he was off orientation "I kicked him out of triage". not really, but that was his story. He was there to help me, but he kept screwing things up. For instance he would document in lbs and Farenheight, and such. I would have to go back in change it. That was just the minor stuff, there was more. I finally confronted the charge nurse and asked if I could have help from someone that knew our triage system. I didn't have the the time to train him, since he should have already been trained in orientation. It was during RSV and Flu season and had a line about 20 patients that still needed triaged. I wasn't doubting this man's ability, but I was doubting that he knew how to triage our system.

The man started dating one of the new princess nurses, that didn't at the time know nursing to save her life. I had to explain what SQ was and how to do it. She wasn't a new nurse, just new to the unit.

Thus complaints came afterwards from them too.

[gonzo1, ASN, RN]

The ENA standard is 4 pts per nurse, unless it is fasttrack or such. There are ERs where you are expected to have many more patients, but I and most of the ER nurses I know stay away from those because we can not provide safe care with that many patients.

It is not uncommon for myself and my experienced ER friends to be overwhelmed even with just 4 patients if they are bad.

Do not be ashamed of the job you are doing. What this charge nurse is doing is trying to pass off the blame for her ineptitude.

It takes at least a year and a half to be even half way competent as a ER nurse. Cut yourself some slack.

Read some of Suzannes Gordons book about how hospitals dump on nurses and then try to fault us for what ever goes wrong.

And get yourself some Liability Insurance too if you are gonna stay in such a bad place.

Come to Illinois, we are building hospitals, have ERs to staff and most are 4:1.

Give yourself a hug

[sumas8]

I agree- if you are handling 5-6 pts including ICU pts on drips you are doing very well. Does your ED have differently staffed areas for 'main' patients and acutely ill patients or are they combined and all staff cares for them? If your ER's system of assigning incoming patients is putting other patients at risk, it is a SYSTEM or MANAGEMENT problem, not an individual nurse problem. Over the past few years as my dept's pt volume has skyrocketed, we have developed a "lead" position (initially an RN but now due to staffing can also be a senior nurse's aide under the guidance of the triage RN). The lead nurse or NA keeps a written record of which 'team' and RN gets each patient (the staff develped their own 'flow sheet') with the triage times and we rotate through each RN in turn. Any ED with common sense does not want to give one nurse 'back to back' ambulance patients, especially higher acuity ones (of course when you get many ambulances in a row, you may end up getting one soon after another, but everyone else would have gotten one also). I would document incidences such as these, especially when patient safety is affected.

I would bring my concerns through the proper channels (charge nurse, nurse manager,etc.) and have the concerns in writing. Every hospital now has quality assurance depts., risk management, etc.

We have a 'patient safety network' where you can write up any problem that affects patient safety. It is on the hospital internet and then whatever dept is involved must reply and try to fix the problem.

It is a non=punitive system intended to prevent/fix problems.

Also, we like people who have a complaint to be part of the solution.

Can you look at your system of how incoming patients are assigned and perhaps offer a solution if it is somewhat arbitrary? Base it on patient care and safety issues and you cant go wrong.

Speak to management and/or unit educators to find out how you are doing. As a charge nurse, we discuss and know who the staff hates to get report from and who is not carrying their load.

If your department and management is as small minded as it sounds, you may be better off working elsewhere. You sound like a good conscientious nurse who would be an asset to another place that would value your work. Sometimes you have to find the 'right fit'.

There are better places out there!

[Anagray, BSN]

Thank you all so much for your support, it really means a lot. I am meeting with my manager today and I will tell her my side of the story. I have another job offer at the agency and many of my co-workers from med-surg have already left to another hospital. maybe it is the hospital that is a problem in general.

thank you! I'll keep you updated.

[Anagray, BSN]

an update. i met with my manager today who apparently had no feedback about my "poor performance" from anyone besides CN # 2. I spoke with other nurses on the floor regarding what happened and turns out that most of the staff has problems with CN # 2 and even one of the doctors was unhappy with the way she runs things.

I feel so much better about everything. I will still have to work with her, but at least now I don't feel like the worst nurse in the ER.

thanks again for your support.

[JBudd, MSN]

Good for you for going up the ladder. There's always a sour grapes type around. If there is someone on a card drip in our ER, there is no way the nurse is expected to take 5 more patients, the charge is supposed to back her up and cover the rest of her assignment.

Never believe a horizontal complaint by only one nurse! Your preceptor knew you were ready, trust the one who really knows your work. :flowersfo:flowersfo

[teeituptom, BSN, RN]

I dont care what kind of nurse you are, where you work, or whatever.

You can only do one thing at a time. Doesnt matter who you are.