RANT: I hate my new job

[CrazierThanYou]

So, about six months ago, I took a job at a hospital in my county after working at hospitals in other counties that required anywhere from 1-2 hours driving time. This is also the smallest hospital I've worked at. I work in the ICU.

This hospital has a rather negative reputation in our community and now, it's glaringly obvious why. For starters, I feel like my main job is doctor-sitting. We (the nurses) spend a large amount of time running the doctors down and reminding them repeatedly to do their job. VTE prophylaxis is a big thing, as I'm sure it is everywhere, but at this hospital, it seems to THE BIGGEST thing. Yet, none of the doctors address it unless they've been reminded by the nurses several times.

Speaking of running the doctors down, I mean that literally. Other places I've worked, we have called or paged them. I really miss Arch paging. Anyway, we have to literally, walk around trying to find the doctors. On my first day of orientation, I asked my preceptor what that was about, because I think it's ridiculous. When I asked why we couldn't call she said "Well... I don't know. I've never called them. I don't even have their numbers." REALLY?

Another major focus is home med reconciliation. The meds are supposed to be entered and reviewed in the ER, then reviewed with the nurse after admission, then reviewed by the pharmacy, then reviewed by the doctor YET the doctors don't bother to do med recs until sometimes 3 or 4 days after the patient is admitted and they've been reminded a dozen times. More doctor sitting. I've had some very upset patients regarding this.

The doctors are jerks. I had one smart off to me the other day because he asked me what a patient (who had only been on my unit for about 15 minutes) had ordered for pain. I had her chart open and said (more to myself) "let me see". He says WHAT DO YOU MEAN LET ME SEE? SHE IS YOUR PATIENT ISN'T SHE?" Well, yes. But 1. she just got there 2. I don't see any value in memorizing my patient's PRN medications when I can just look at the computer/chart/pyxis and 3. she is also HIS patient and HE is the one who ordered the meds. Then later, he screamed at me because I broke the news to him that he ordered a Xopenex treatment as a one time order instead of a continuing order.

The last hospital I worked at, there had to be two RNs in the ICU at ALL TIMES, regardless if there was only one patient. This hospital will leave an RN in the unit alone if there are 3 or fewer patients. No CNA, no tele tech, no secretary, nothing. That just doesn't seem safe to me. I mean, the patient's are technically unattended if the nurse has to take a bathroom break.

The charting system is something out of the dark ages. You have to click through every single thing one at a time, whether it pertains to that patient or not. For I&O's there is no cumulative, just adding manually. I hate it. Order entries (because the doctors can't be bothered to enter their own orders) are tedious.

Our DKA order set is 5 pages long and is just bizarre compared to others I've used.

I can go on and on. Maybe I've just been spoiled at other hospitals? Anyone else have similar experiences?

Meanwhile, I'm on the hunt for a new job!

[more coffee]

My experience is similar. I went from a big city with 15+ hospitals to a small community hospital in a different state. I used to complain about my city hospital being an academic teaching hospital and the craziness of July 1 until I went to this new hospital that has no residents and only 1 doctor on the unit (I work in the ER). In my experience, the community hospital does not have the resources to improve because they are in a small healthcare system that serves a broad radius.

Look for another job and really do your research about the hospital, or setting. The beauty of nursing is that you have options.

[Been there,done that, ASN, RN]

I have been in one smaller hospital that forced us to babysit the docs. I lasted 7 weeks of my 13 week contract.

Management must feel the nurse's time is not important. While you're looking, why not get a committee together to come out of the dark ages and institute a paging system?

No doctor screams at me and gets away with it. What did you do?