Rant

[TXTraumaRN]

Ok ladies and gentlemen,

I haven't made very many posts on here yet, but tonight I have to rant. I just got home (0100) after my 12 hour 11a-11p shift. We had a fairly nice day today until about 1800 when the bottom fell out of triage and EMS both as the ER is known to do. For whatever reason, our director (i.e. nurse manager) decided to monitor our tracking/charting system from home tonight. At approx 2200, she took it upon herself to call the charge nurse and chew him out for not opening our overflow rooms; (we were already working short staffed) she wanted him to have our dedicated EMS nurse (we have a nurse who answers the EMS phone/radio and directs traffic) open up overflow rooms and take pts. Keep in mind that this particular nurse would be leaving an hour later at 2300 and would not have a nurse coming in to relieve her. :angryfireThe director then proceded to call the triage nurse and tell her that she was not triaging people fast enough.:angryfire We staff triage with 1 LVN to greet pts at the desk and 2 RNs to triage. Tonight, we got an ICU nurse floated down to help out; they put her in triage because she doesn't know how to chart in our system or how the ER flows. She got a brief 10 minute "here's how you triage" from the other triage RN. This place is driving me insane!!! This is all on top of an email that we received last week, saying that due to increased pt volume after moving into our new ER (they claim they didn't see this one coming), the staff members who work 11a-11p will now be required to work one 3p-3a shift a week to help cover. No "hey why don't we discuss this with the staff first"; no, just "this will go into effect the next schedule" that comes out in 2 weeks. Why just the 11a-11p? Why can't they rotate it so that all the shifts have to take turns working an odd shift? Oh wait, that would be fair and make sense.

[swartzrn]

Well, what was going through my head was that if your NM thought you were not doing things fast enough, then why was she taking up more time making the phone calls and having staff on the phone while she chews them out. Seems like that was time that could have been moving patients or triaging. And reading emails? Who has the time on days like you described? Also--I had the question, if there were not enough people then why didn't she come into help either and I was also wondering the same thing about the LPN as to why she/he is there to "greet" the patients. Seems like there are several problems with this picture.

I also think it's like this all over. Everybody is so short handed that the people who are there are getting rail-roaded.

[Fiesta Red]

We had a director that was micro-managing from home like that. All the charge RNs got together and threatened to quit doing charge duties if he kept it up. And we went above his head to his boss as well. He doesn't work there anymore.

Making assumptions just from looking at the tracking system is bad news. The tracking board only gives a small part of the big picture. Time to set some limits with a manager or find another ER.

[arual56]

You have my respect and sympathy. Be assured that you are not wrong in your thinking. What your Nurse manager was asking you to do was unsafe and irresponsible in my opinion. It sounds as though she was more interested in her statistical data then in the proper care of the patients. If it was her, or one of her family members, would she want them to receive that kind of "hit and miss" care? I know that we often end up in "code purple" with patients being treated in our hallways on stretchers. It is not the best solution to our over crowded ER, but it is better than having someone with kidneystones, or with a threatened miscarriage waiting in the waiting room. But we certainly don't open our hall zones if we don't have staff to cover the patients. And as far as putting the ICU nurse in triage, I may be wrong, but I think the nurse would have been better used in treating the patients rather than triaging them. I am blessed to work with a nurse manager who doesn't yell at us for going to slowly. Instead, she comes out on to the floor, or comes in from home, jumps in and gets her hands dirty taking care of patients herself. I feel for you and hope that you either get a job in a better environment or get a nurse manager that is not so focused on "her vs the rest of you vs the patient."