Rough night, but I survived, apparently.

[ixchel]

I'm about four months in on my very first nursing job, wide-eyed and terrified of every little new symptom that presents in my patients. I'm on ICU step-down, and my first couple weeks off orientation were blessed by charge nurses giving me gentle assignments. I guess we've moved on from that, and really, that's fair enough considering it's not fair to give a heavier load to everyone else for my benefit.

We usually have a 4:1 ratio, but a nurse filling a staffing need was scheduled to leave right after her HS meds were passed, so we got an extra patient each. My initial 4 patients were okay. Two were low maintenance, aside from one being convinced she was going to die. She actually had a chief complaint that would have been discharged to home from the ED but she had a Dysrhythmia that made them decide to admit her. One patient was a known seeker who messed up on her fabricated chief complaints and said something that got her admitted. So really there was nothing wrong with her, but because of what she said, she bought a cocaine detox ticket on my floor with a giant list of tests she refused over and over again. She was lovely. The fourth patient in my group was the most obese woman I have ever seen who may have been a GI bleed but no imagine in the hospital could see her organs or intestines due to her girth. Her heart rate was scary, though, as was her BP. I spent a large amount of time on the phone with the MD about her. Such is life.

Then I got the 5th patient, a brand new admit with an obvious, raging infection, but no one could figure out where. I got her after she was admitted by another nurse. Based on her etiology, it could have been a few places, one rather benign but the rest really scary, and more likely by her radiology. She seemed like she'd be okay on our unit, but as the night went on, her status declined and she was transferred to ICU a half hour before shift change.

This was my most challenging shift yet in terms of patient load. By leaps and bounds. Thank goodness two patients were low maintenance. With some firm boundaries, the seeker settled herself down somewhat except an episode where she became unresponsive for about a minute and a half (probably self medicated when no one was looking). These two others, though..... They were both competing for the one empty icu bed.

What really did me in.... People dropping the ball and just generally being rude. It's frustrating to know every second I'm there, I help, I try, I speak with respect and compassion to the people around me, always. We have two aids, similar in stature and name, and I called one the wrong name, and boy did I feel badly (and apologized) after. This person is generally a rude person, dismissive, irritated anytime you ask for help or what she got for vitals or blood sugars. Generally, she's a difficult person to work with.

As soon as I walked away, I heard her and several people start talking about me, making fun of my newbie mistakes and getting a good laugh at them. A friend who said to never join conversations like this one because it makes people turn on you, was actually quite happy to volunteer moments of weakness I'd asked him for help on because I thought he'd never do anything like that.

Then I got to enjoy the aids not actually doing parts of their jobs that are actually license threateners for me, as the RN. Obviously it's the nurse's responsibility to ensure things are done, and done accurately, but man we should be able to trust support staff to do their jobs. The two patients they did this on were my two unstable patients (skipped vitals on my GI bleed and glucose on my probably septic pt).

And lab. Ohhhhh, lab. Lost blood twice and then took 90-120 minutes to result stat draws several times. I got locked out of my computer login and spent my precious few quiet minutes waiting on hold for tech support and eating about 1/3 of my lunch.

This hospital is normally a well-oiled machine. On this night? Not even close. I'm thanking my lucky stars that the hospitalist on for the night knew I was trying so hard just to get things together and respond accordingly. We have a couple of MDs who are not at all reasonable to deal with on nights and have no problem being cranky at the nurses who are trying to take care of the patients on the floor. This guy is patient, helpful, understood I was under pressure, too, and was happy to sit on the phone when necessary to help and get orders in quickly. The rest of the place (except the cranky people) are typically this nice, this helpful.

But on this night? I felt left out in the cold. I felt frustration. I felt betrayed. I felt overwhelmed. When I clocked out, I felt amazing and proud for doing it all, and knowing I did it right. It was a triumphant moment for me, truly. But why did it have to be so much harder than it should have been? I mean, really.

On my way out the door, the manager walked in, and for the very first time in my professional life (which spans many years before my nursing career started), I complained about coworkers. I was just so frustrated. I'm glad I did it, but hate that it was even necessary. The attitude of the one aid is not okay. Skipping assigned tasks is not okay. The gossiping of staff members about their coworkers is inappropriate. The failings that I experienced with the lab were unacceptable. It was so frustrating. It had to be reported. If only one of those things happened at a time, spread out over weeks, then I likely would have just said, okay, it's a bad night for that person tonight. But it came from all directions. It was a frustrating battle.

So that's it. My night. I survived. Apparently.

[ixchel]

(Comment deleted.)

[firstinfamily, RN]

You need to give yourself a pat on the back for getting through such an ordeal. Team work, that is what it takes and if certain staff are not playing with the team then it needs to be addressed. It is not about who did what, but about working together to accomplish the goals for the patients. Not having vital signs done on a GI Bleeder is totally unacceptable. Not getting a glucose on a patient perhaps not as tragic but, still. If you clarified with the tech what you needed them to do then there should be no questions. If the charge nurse has assigned the techs to the patients there should be no question as to who does what. If this is a constant problem then the manager of the unit needs to know. It sounds like there needs to be some shaking up of staff. I abhor gossip and those who participate in it. There are staff like this no matter where you work, you do have to develop tough skin but also you have to confront the gossipers(sp) bullies etc. that you work with. Just be an adult, that is all that is required. You do not have to be rude or confrontational, if you do not participate in the gossip at any time and can honestly say that, then use that to address those who do. "How would you feel if I was talking about you when you did--------------" The only other thing to do is to walk away, be the grown up and walk away. WE have discussed about forming friendships at work and how sometimes this is just not possible. That may never happen. But what does have to happen is team work to get everything done on this shift and to prevent any patient decline. I have only had the privilege of working with a wonderfully responsive team maybe twice in my 30 plus years of nursing. There are some people who just work great with each other, we knew who was doing what without even saying it,we worked together like a well oiled machine and I do envy anyone who has that working environment. It is harder to find today, not sure exactly why. Hold your head up, they will most likely say something to you about reporting them to the manager and you need to be prepared for that. Plus, realize that there are always going to be bad nights, no matter where you work. Night shift usually is less staffed than other shifts and patients do have problems at night!! AS long as you are getting support from your manager and they are aware of the issues you will do OK. It will take time to make it all better, and you do not want to be the squeeler all the time. Lay low for awhile and just do your work. Sounds like morale is at a low and that takes time to bring up. Good luck!! It is harder to bring a unit up out of a down-turn than it is for it to go down. See if you can suggest some team-building exercises or projects that they will participate in-----yes it is possible and does not take a lot of time or money.

[ixchel]

Thank you so much for that. My manager was receptive, and I feel like she would be the type to ensure any response she would have to the situations would not focus the attention on me. She's pretty amazing, really. I've enjoyed working with her so far. She also said that the employee-specific feedback I gave her, she has heard from others, so it's likely that I won't get heat from coworkers.

I like the idea of team building exercises. What kinds of things have you seen done in the past?

[Nola009]

Well, you got through it and hopefully things will get better. Sure they will. I agree that it's good you told your manager of the hostility. Their nastiness needs to be addressed.

[jadelpn, LPN, EMT-B]

Be proud of your critical thinking skills. Sounds spot on. You may have to do your own vitals and FBS, maybe incorporate into your hourly rounds.

Do not internalize what your coworkers say. Stay completely out of it. The manager is aware, and hopefully will do something about it. It is far easier to sit at the nurse's station gossiping about the perceived shortcomings of another nurse than to get off one's duff and help.

Have and nurture a life and friends outside of work. But be mindful going forward.

Best wishes