As a unit manager, it seems as if everything is my responsibility. It is almost as if people expect me to be three places at once (which, of course, is impossible). Everyone seems to think that I should attend to their requests RIGHT NOW regardless of what else I have going on and the urgency of each task. If I don't respond to their requests immediately, they have no problem expressing their frustration with me.
A couple of these situations occurred today. I had a couple of Care Conferences scheduled (which are basically routine meetings to discuss resident progress, plan for discharge if appropriate, etc). Unfortunately, during both of them, other urgent situations came up. Medical issues requiring immediate attention (one patient's surgical wound was worsening while another one was experiencing a sudden onset of shortness of breath). Regardless of the fact that these issues required my undivided attention, I was scolded by several coworkers that demanded I attend these meetings regardless of how critical these other issues were. One of them stated that it was important for all staff to "do our due diligence," while another one stated that I needed to attend this meeting no matter what, even though, in both instances these meetings were for residents who were currently medically stable.
After delegating some work to the floor nurse, I was able to attend one meeting, but not the other. Despite the seriousness of the one situation, which required my full attention, my coworkers still expressed displeasure over me not prioritizing a routine meeting discussing ostomy care over someone experiencing a medical emergency. I explained to them that I would be happy to follow up with questions the family may have later on, but I needed to attend to these patients first. They weren't satisfied and resorted to calling in my co-manager to the meeting instead. I am sure they reported me to the DON as well.
I am wondering if anyone else has been in a similar situation and what your response to your coworkers was. After all, it's not as if I can schedule my emergencies at convenient times.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
30 minutes ago, londonflo said:
The patient still needs to monitored and supported..not done and dusted
Completely agree, but once you do a decent assessment and know they’re sick enough to be on the bus for the ER, you have the unit aide make the phone call, EMS will come pick them up, and then you’re done. No need to spend hours and hours at this drama. Assess, analyze, delegate, and get out of the way. It’s not all about the OP.
once you do a decent assessment and know they’re sick enough to be on the bus for the ER,
Being short of breath is a very scary experience. I would sit with the patient to help them remain calm. Getting anxious and creating an increasing HR will increase their demand for oxygen.
3 minutes ago, Hannahbanana said:
you have the unit aide make the phone call, EMS will come pick them up, an
I did not know a unit aide could call for the EMS. Would they know how to describe the symptoms the patient is having?
I do have to say staying with a patient with a PE (providing support, comfort and assessment) is more important than any meeting I have attended. To me it is all about the patient
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
3 minutes ago, londonflo said:
I did not know a unit aide could call for the EMS. Would they know how to describe the symptoms the patient is having?
I do have to say staying with a patient with a PE (providing support, comfort and assessment) is more important than any meeting I have attended. To me it is all about the patient
How long would anybody sit at a bedside for a genuinely serious problem? Making a phone call is a perfectly delegatable action. Lay people call EMS all the time. “911, what is your emergency?” “This is SuzieQ on 2North at the Sketchy Care Center in Springfield. My nurse said for me to call you for a patient transport to the ER for bad acute breathing problems.” “OK, we’ll be right there.” Nurse sits reassuringly with patient all the while (BTW, Just how does she know it’s a PE?)… if she wasn’t able to call from the patient room on her own cell or the patient room phone, in which case all she needed do is pull the call bell and tell whoever answers what she’s just done, tell them to watch for the boys and girls in blue, and let the Patient Safety Committee know she’ll be at the meeting soon.
I stand by my opinion that once EMS arrives the patient’s out the door in minutes and this whole drama is a very short one-act play, not Hamlet. Like I said, done and dusted. Further delay would indicate that either it wasn’t such a big emergency after all, or that the rescuer role was just too juicy to walk away from.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
I got a notice of a post saying she never worked in a hospital that would call EMS for an ICU or ER transfer. I can’t find it now, so sorry about not giving credit where due.
Well, neither have I, but the OP works in a SNF, and they call EMS for hospital ER transfer all the time.
Completely agree, but once you do a decent assessment and know they’re sick enough to be on the bus for the ER, you have the unit aide make the phone call, EMS will come pick them up, and then you’re done. No need to spend hours and hours at this drama. Assess, analyze, delegate, and get out of the way. It’s not all about the OP.
It wasn't "hours and hours" but between assessment, making arrangements for transfer, and actually having the patient leave the building, it did take over 30 minutes, the same length as the meeting. Ambulance was late, wanted a report from a nurse (not an aide), and spent 10 minutes questioning us before they finally took him in. Nothing about the situation was about me at all, it was about making sure a patient got the care he needed
OP, you sound like a strong nurse who cares about her patients. However, I do agree with the general consensus....you are spreading yourself thin. Your bedside nurses and your charges SHOULD be able to take care of these emergency situations. As others had stated, if your nurses are no competent to do so; training and education needs take place. As a nursing director, perform a leaning assessment of your staff and make education available for them. What you are doing is not sustainable and is not helping your staff.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
14 hours ago, SilverBells said:
It wasn't "hours and hours" but between assessment, making arrangements for transfer, and actually having the patient leave the building, it did take over 30 minutes, the same length as the meeting.
Oh, so all this drama was over in 30 minutes? Gotcha.
I agree c all the PPs (on this and your other breathless threads) who say you and your staff need leadership training in roles and delegation. Otherwise…. lather, rinse, repeat seems to be the plan.
OP- Just curious, are you the only RN on the unit and the other nurses are LPNs? Also, is there an RN supervisor on for the house during the day or just unit managers?
I'm an LPN formerly spend about 10 years in SNF. I worked days. In my facility I would have been the one sending the patient out for respiratory distress. Our unit manager would not typically get involved. She was very supportive, and if she knew we had multiple issues unfolding at once (trache needing suctioned right away, people with their trays in front of them needing insulin, IV pumps alarming, patient on the floor while this patient is in respiratory distress etc) she would lend a hand when needed.
In my experience these facilities are very serious about these meetings. We had no unit manager for months at a time and floor nurses had to attend. An LPN had a really rough day, multiple urgent situations, admissions, falls, someone needing to go out, you name it, and said she was not going to make it. They tried to insist and she said no, she wasn't going, she had to attend XYZ patient care issues. They fired her at the end of that day for insubordination for refusing to go. I had to drop everything multiple times to get into those meetings. It must have something to do with MDS/reimbursement/making money I assume.
Sounds like you need clarification as to company’s expectation of the role of manager. It is appropriate to want to make sure the patient gets the best care and is safe. However, if as a manager, emergent situations cannot be handled without your involvement on a routine basis, something is wrong. Maybe you need more qualified staff. Maybe the staff you have need more training. You will run yourself exhausted if you have a system where every emergent situation has to run by you. And the staff will allow you to handle as much as you want. But you also have your own administrative work to do that they can’t help you with.
You need to be able to have staff below you on your team that you can trust, so that you can spend your time directing the choir, so to speak. I hope that you can find the middle ground. I wish you all the best, these situations aren’t easy!
To the OP, were the annoyed co-workers nurses? It baffles my mind a nurse would expect you to prioritize a meeting over a medical emergency (I'm not sure I'd consider the wound change an emergency that couldn't wait for the nurse assigned or wound care nurse to take care of) but the worsening SOB definitely is a priority (imo).
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 6/24/2021 at 6:53 PM, SilverBells said:
I will say that I have received phone calls at 2AM for nurses needing to know what to do for patients having chest pain, shortness of breath, abdominal pain, etc.
Why? Is there not a registered nurse in the building at all times, beside you? Are there not emergency protocols to be followed?
Why are you the only person on the whole payroll who can handle anything? Your employers are laughing all the way to the bank. Your subordinates throw all the turds in your lap. And no one respects you. Whose admiration and accolades do you think you're accruing while you slave for about $5 an hour?
Did you eat your children in a former life? Just what is it you think you need to atone for?
Hannahbanana, BSN, MSN
1,265 Posts
Completely agree, but once you do a decent assessment and know they’re sick enough to be on the bus for the ER, you have the unit aide make the phone call, EMS will come pick them up, and then you’re done. No need to spend hours and hours at this drama. Assess, analyze, delegate, and get out of the way. It’s not all about the OP.