Sheez! She's back and venting AGAIN!!

[missrose]

I am a travel nurse.... this is my 14th contract.

Today, my unit manager called me into her office and offered to cancel the remaining three days of my contract. (GASP!!) Yes, she gave me the option of completing three more shifts, or cancelling. I declined to cancel, of course. I listened to her concerns, and I apologized and explained myself.

I am a brutally honest person. While I am very aware (and proud) of my skills as a nurse, I am also very aware of my short-comings... I sometimes (only in extreme moments, I swear!)have difficulty keeping my mouth shut when I feel my patients aren't getting the best care they deserve. I am not very diplomatic. That is why I am not a good charge nurse, nor do I aspire to be one. I am a floor nurse.

Recently, I had a patient who wasn't doing well. I called the hospitalist and he showed up within minutes. I was busy.... so very busy. He wrote orders and placed the chart in the "orders rack", where the unit clerk and Charge Nurse would then enter the orders in the computer and transcribe the orders so that they could be administered. The problem was I didn't get the order.... until four hours later!! When I went looking for the chart, I found it STILL in the "orders rack", not yet entered or transcribed. I was very upset and I said with complete exasperation, "This order was written FOUR HOURS AGO!! And it's a "NOW" order! This system doesn't work!!" Well, the unit clerk (not our usual experienced clerk, but a "float" from another unit, took my words personally and left the nurse's station in tears. I had no idea I had upset her, let alone that she was crying, until about half an hour later when the charge nurse came up to me and said, "You made my unit clerk cry." Bad timing to inform me of this... so I said, in an annoyed tone and again, I am being brutally honest here) "What?! I made her cry? Gosh, I didn't realize I was so powerful I could make someone cry! It wasn't her fault! The doctor didn't flag the chart with the little red tab indicating "NOW"! This system doesn't work and I am just frustrated and I should make out an Unusual Occurance Report for "Delay In Treatment" but I DON'T HAVE TIME!" And I walked away. The fact is... this was NOT an unusual occurance. Their system of transcribing orders frequently results in unnecessary delays. I realize this is a serious observation, but it is the truth.)

So... When the unit clerk returned, I apologized to her and told her that I was not upset with HER... but with the system and the doctor's failure to flag the chart. I apologized to her twice. I was very sincere. I felt terrible for upsetting her! I felt much worse for my patient, who thank God, experienced no ill effects from the delay.

My co-workers have expressed their appreciation of my team efforts. When asked by a co-worker, I will gladly attempt a difficult IV start, even if I am terribly busy myself, even though it's not my patient. I will take the time to search out that beeping IV machine and fix the problem, even though it's not my patient. I'll take another nurse's pager so she can break for lunch, even though she's not my designated "break budy" but her break buddy is overwhelmed.

But I will not look the other way when someone else isn't doing their job correctly. Even if it's a doctor. Little flags on the chart!! Just push the tab over!! Make your intentions known! Help us all do our job by pushing a little tab!! Sound petty? Well, it's not!! How simple can it get? (yes, I said all these things... quietly.... but emphatically.... but in earshot of the charge nurse, I readily admit. I felt exasperated.... I felt like crying myself!)

So back to the unit manager's office.... When called into her office and asked about the situation on Tuesday, I explained the above scenario to her and she said, "I heard you say that you only have "four shifts left". I am willing to call your company now and cancel your contract." I told her I didn't want that at all and that my frustration comes from not being able to deliver safe and quality nursing care because I find their system frustrating. I assured her that I would complete my contract and be less vocal with my frustrations. I sincerely apologized three times in about 10 minutes. I also told her that I don't feel I am bringing negativity to the workplace, but that I am actually being infected by the negativity of my fellow nurses. (Oh, she didn't like that... and I regret those words... kind of... because while true, a bit too honest?)

Ohhh..... I have never NEVER experienced this kind of .... oh what's the word I'm looking for.... MAYHEM on a nursing unit. I can't fix it, I can't change it.... though I must tell you, that my suggestion for changing their method of documenting their blood sugars and insulin administration has resulted in a facility-wide change!!! How's that for wonderful contribution?! Woo Hooo! change is gooood!!

Thank you for letting me vent.... again!! I guess the million dollar quesiton is.... what does one do when a doctor writes a "Now'" order but doesn't flag the chart correctly? I get too frustrated! Must be my OCD! OCD can be a good thing sometimes.... SOMETIMES! Agreed?

[SuesquatchRN, BSN, RN]

missrose, I have to say that I really admire your ability to take criticism without becoming annoyed and defensive. It's a quality I lack.

[k3immigrant]

i think that it's not the system that was not working good in that scenario that was pointed out, i think it was more of communication between the physician, the nurse in charge of the pt or the charge nurse.since the patient was going bad, wouldn't the nurse in charge or the charge nurse if the nurse in charge is busy speak with the physician so you'll know what he ordered & almost always when a patient is going bad, stat & now orders are expected.

i also think that getting mad or yelling isn't going to take anybody in a better place but rather will make other people feel bad.i worked with people who yell or be rude to other unit staff & i always feel bad because i think as nurses, we should be professional in dealing with situations because if we start getting mad, we stop being logical.i'm not saying that i don't get upset at work because i do but i always try to say it nicely & go by the golden rule, "do unto others what you would want others to do unto you".just my two cents....

[DusktilDawn]

You must simply stop doing anyone else's job. You must take stock of the true situation and dtermine realistic goals for care. You cannot be all things to all people. It just isn't realistic in today's workplace.

Just do your own work and allow the work of everyone else to pile up. Someone will eventually get t he message. If asked about it, just say you normally empty the trash, groom the horse, and feed the hens but you were very busy with 18 patients and didn't get to those .

Just say and do "NO". I dont' care if it means the patients have to wait longer or do without some niceties. The owners and insurers don't care. Why should you? Do the required care only and stop working 12 jobs for the pay of one - unless you enjoy being a martyr. Get tough.

Nice in theory, just stop doing everyelse's job. The problem is not that simple to solve, it's more complex than that. Although it is realistic that one cannot possibly be capable of doing all things for all people, our SBONs, state legislature, nursing organizations (ANA, et al), and the facilities that employ us heartily disagree when it comes to nurses. No one wants to acknowledge the fact that nurses can be too busy/overworked/understaffed, especially since that makes us such perfect scapegoats when things go wrong. With the exception of California, health care facilities are not even accountable for their own staffing practices when it comes to nurses, the nurse is for "accepting" the assignment. They can short staff the floor, take away ancillary support, create policies/procedures that make no sense or are out right ridiculous/impossible to follow and it will be the nurse who's actions will be questioned regarding any sentinel event that occurs. There are also some things you can't ignore or just not do, despite the fact that it may well indeed be someone else's job.

If your NAs refuse to turn patients every 2 hours or a patient needs to be changed/BR/bedpan and the NAs are never around/hidding, you can't just not do these things. Yes, you can write a report to the manager, after the fact, after you have taken care of it, and it will be up to management to CHOOSE whether or not they will even do something about it. The fact is as long as nurses are responsible for what we "delegate" we are responsible for ensuring their job gets done, hence the usual response of management to want the nurse to deal with them. Oh and lets not forget the very real fear of retaliation when the NA easily figures out who reported them. They may "forget" to inform you immediately regarding that obscenely high BP or HR, it won't be the NA questioned about why it took an hour or more for the nurse to address the issue. Your patient gets a pressure sore because you "forgot" to remind the NA, while you were dealing with your other patient who was desating, to turn the patient who's been there for 5 months and has had to be turned every day every 2 hours for those 5 months, it will not be the NA that will be hauled into court having their actions questions when the family sues. See, the nurse is perfectly capable of performing all aspects of an NAs job, however the majority of NAs are pretty clueless as to what the nurses do and what they're responsible and accountable for, both contribute significantly to issues that arise between NAs and nurses. They work on the unit next to us and still can't comprehend why we just can't do it all.

How about pharmacy? I guess you could not make those 4-5 phone calls regarding that stat medication that should have been started and I guess you could not walk down to get that medication when pharmacy CHOOSES not to send it in a timely manner. You know you may have ticked them off when you expressed the urgency of receiving that medication, so they're going to make sure you have to walk your "lazy" butt down to get it. See it's OK if pharmacy is short staffed or "too busy" because if a patient experiences an adverse outcome because of a delay in treatment, it will be the actions of the nurse called into question. Yeah, that same nurse who irregardless of whether they are short staffed or dealing with more than one crisis at the time will have THEIR ACTIONS questioned. Oh, and lets not forget that there are some places that do not have a pharmacy 24/7. Uh, yeah, you guessed it, the nurse has to do it.

You low on stock because someone didn't do their job and that department is now closed. You got it, you will have to scavenger hunt other units for what you need. Or how about even when they are open, you know it will take them hours to drop off what you need, you will still have hunt on other units for what you need. because of course they're busy and/or short-handed every freakin day. Oh, and my favorite is when they want to know the stock number on what I'm requesting otherwise we will never this item in our lifetime, uh yeah, like I have all those memorized. If they take hours to bring something specific that you won't find on another unit, and treatment is delayed to a patient it will be the nurse's actions called into question. They should just haul their "lazy" butt down and get it themselves.

Patient needs a stat portable XR and the tech, despite knowing where to find the requistion, threatens not to do the XR because it is not in the specific designated spot on the chart because the doctor didn't put it there after he filled it out. Apparently nothing is too petty that someone won't threaten you with the well-being of your patient. See others have the ability to utilize our patients as their battle ground and their department will back them up if the there is one dot missing from one little i or there is failure to cross one little t, because as far as they're concerned the nurse should make sure that's done. As nurses, we don't have the option of denying care to our patients as a tool to coerce others, our patients health and well-being are our main concern. We can't go toe-to-toe with these people at those times or our patient will not be getting that test, procedure, care provided at that time. In the best interest of our patient we capitulate at that time, and possibly fill out a report later that will probably be ignored, or even better, WE get called on the carpet over a requisition not being where the tech wants it to be on the chart.

A lot of places don't staff units on off shifts with housekeepers and unit clerks. Despite the fact the unit goes 24/7 doesn't mean the unit will have a clerk or houskeeping does. That means the nurses (of course, the nurses) will have to answer those phones because it could be the doctor they're frantically paging or perhaps a family member calling to ask why their 10th cousin 215 times removed who is off the unit smoking for the 325th time that day is not answering the phone in their room. They will have to make sure the soap, paper towels, TP, and overfilled sharps containers are replaced because the houskeeper didn't bother to when she was there, ya know she was busy and just didn't have the time to do those things when she was there. Not replacing these items becomes an infection control issue, which you, as the nurse, are responsible for. We can't just stop washing our hands because housekeeping didn't do their job. You see, it's not suppose to be busy on off shifts, hence the lack of certain support services because apparently according to other departments and management it is not necessary. Since it's not supposed to busy, gee, I guess there should be no problem for the nurses to do it.

How about those memos from others departments sent to the nurses to remind others to do their jobs because apparently it is our fault when they don't. TO THE NURSES: Nursing staff needs to be aware that Dietary will not send up a tray unless it is entered in the computer, Thank you. TO THE NURSES: Regarding entering lab orders, it seems that nursing staff are not aware that Chem 7s cover Ca levels so they don't need to be ordered separately, even when the doctors order them separately. When they are entered separately it causes problems with billing which result in wasted time and money. Ionized Ca, of course, would be entered separately since it is not part of a Chem 7. Thank you. Perhaps they think the Clerk might get upset receiving a memo, but hey, any memo addressed to the nurses can be as snotty, condescending, and as rude as the sender wants to make it. Therefore the patient will not be fed unless the nurse makes sure the Clerk didn't forget to enter the diet in the computer. Now why would you send a memo to the clerks, who probably don't know exactly what a Chem 7 is and provide them that with information. Apparently it makes more sense to address that memo to the nurses, who probably do know what a Chem 7 is. Oh I almost forgot my favorites, the ones addressed to the nurses to make sure the physicians do A,B, and Z and all the rest of the alphabet in between. Heaven forbid the memo gets addressed to people/person that is actually supposed to be responsible for it, heck, they might read it and than make sure it's done.

Other departments will fight change tooth and nail, because they have no concept of what the nurses are there for and they refuse to see or comprehend the problem with the "why can't the nurses do that" attitude that is firmly entrenched in all departments in the hospital. As far as they're concerned how dare the Evil Empire of Lazy Nurses expect more from them. They should be on their knees kissing their feet in gratitude for what they will do instead of being audacious enough to expect even just a little tiny bit more from them.

As to patients not receiving the "niceties," the insurers may not care, but the "owners" certainly do. Nurses are threatened with termination and are disciplined over what is known as "service failure" in regards to customer service. On this very board you can find examples of nurses called in and raked over the coals regarding idiotic things such as not warming up one patients soup while they were coding another.

You can fill out all the QA/risk management reports and you can write all the reports on substandard performances you want. If you have management that ignores and refuses to deal with the issues you basically have the option to leave. You can leave but that doesn't necessarily mean your going to find pastures any greener elsewhere. Most place just tend to have varying degrees of the same issues. You're lucky if you find a place with low degrees of the issues that are most important to you.

As for OP - Try to learn to not have any real expectations of others and not depend on others. Weren't you already aware of the order if you called the doctor? You could have done it, perhaps, without the secretary ever touching the chart.

I'll absolutely agree with you here, Trudy. However it is a catch-22. If you have no real expectations and don't depend on others to do their jobs, they will obligue you and nothing gets solved. When other department/staff don't do their jobs, it impacts the nurses and affects how we do our job. Since they do not have to deal with the ramifications why would they even care. The problem as it pertains to the nursing profession, is that we're accountable for those others and we're the one's with the most to lose. If others had as much to lose as the nurses, you can bet they'd take their jobs more seriously.

[Jo Dirt]

You may have been frustrated, but what good did yelling about it in front of the unit clerk do?

It sounds more like "flying off the handle" than brutal honesty, to me. (just being honest!)

I'm guilty of being quick-tempered myself, and I know this isn't a virtue. Maybe we should take anger management classes.

You shouldn't have fussed at that woman.

[suanna]

You must simply stop doing anyone else's job. You must take stock of the true situation and dtermine realistic goals for care. You cannot be all things to all people. It just isn't realistic in today's workplace

If my patients' pressors run dry I ether do pharmacys job and mix my own or they die, If there is a spill on the floor or needle boxes are overflowing on the counters ether I do houskeepings job or someone(maybe me) gets hurt, If my patient needs turned, cleaned up, watched ether I do the N.As job or my patient suffers, If the docs want a stat Xray, central line kit, labs- if the unit clerk doesn't enter it I have to or my patient is at risk. As a nurse I have to do everyone elses job when they don't or my patient suffers or worse- I'm not willing to let a patient go down the tubes to make a point.

[missrose]

Well, by the same logic, how can a "system" make you angry enough to yell?

So therefore, because situations can cause negative and unproductive emotions, and what you do and say can impact others, and we are dependent upon many other hands to take care of our patients, yes, it would be a good idea to try to stay focused on building rather than tearing down.

For the record, because several have referred to my "yelling", I did not yell at the unit clerk or anyone. I am not a yeller, ever. But I do admit my tone was very, very exasperated and therefore, disrespectful. I did apologize with sincerity and a gentle hand on her shoulder. And yes, the best part is, I learned from the situation, but I have learned even more from reading these responses. Thank you! It is always very enlightening to read other people's take on it.

[leslie :-D]

i'm not going to tell you what went wrong.

you already know, aeb the 50 million responses.

what i will share with you, is like sue, i am very impressed w/your receptivity to criticism.

your willingness to gain insight, will only better yourself as a person and a nurse.

kudos to you.

you rock. :balloons:

leslie

[bagladyrn, RN]

You got that right. It doesn't help a thing and we don't care how you did it up north. (All the travelers we get are from the North).

Now, now, Tampa area isn't THAT far north! Not like I'm a Yankee or something!

[bagladyrn, RN]

Tazzi - it was I, not the OP who made the reference to "grabbing a doctor by the shirt". Wouldn't want them to get a rep.for something I did! By the way, that was before I was a traveler, and I did that because of his very inappropriate comments to a patient. I hauled him in and told him so privately because he was basically a good guy who needed to hear - immediately - where his action was hurtful to the doc/patient interaction. He listened and amended the behavior.

Later, as a traveler,when a doc who was NOT a good person said really inappropriate things about my patient in her hearing (racial/judgemental comments) I didn't bother to speak to him, instead I spoke to the house supervisor, wrote an incident report and passed copies to everyone appropriate there and at my company. It turned out to be a final straw with this doc and he was terminated.

I will never let the fact that I'm a traveler and a "guest" stop me from seeing that my patients receive proper and safe care! Anything else I will do the way the regular staff wants it done, but not that. Pts. come first, even if it means I won't get the Miss Congeniality award.

[leslie :-D]

I will never let the fact that I'm a traveler and a "guest" stop me from seeing that my patients receive proper and safe care! Anything else I will do the way the regular staff wants it done, but not that. Pts. come first, even if it means I won't get the Miss Congeniality award.

i would hope, that is a given.

patient safety and care should always take priority.

i'm quite sure tazzi was referring to only those ways that didn't reflect on quality of care given/received. :)

leslie

[bagladyrn, RN]

i would hope, that is a given.

patient safety and care should always take priority.

i'm quite sure tazzi was referring to only those ways that didn't reflect on quality of care given/received. :)

leslie

I'm sure she did too. Sometimes I tend to state the obvious.

I have seen people who are not very assertive though who can be intimidated into doing/not doing something because "that's the way it's always done here". Case in point: was a hospital at which the nurses accepted one CRNA's refusal to do epidurals until the pt. was at 8cms!! They told me "It won't do any good to question - he's always been that way and won't change". Guess what - with my patients, he did! And pretty soon the regular nurses saw that the method of dealing with him was effective and insisted on the same timeliness of treatment.

[fronkey bean]

LOL! No, some days I ain't no picnic! But my patients love me... and I do go out of my way to assist student nurses and grad nurses with their learning experiences, without being condescending, I assure you. And I know they appreciate it. I just have a short fuse when it comes to people who I feel should know how to do their job all ready. I don't intend to come across as belittling or demeaning. I try to be aware of how other's may perceive me. Some days it's tough, though. I'm trying. I'm aware of my shortcomings. That's a start.

The problem is that when you go off on others you cause them to be distressed which can affect their pt care. An upset, distracted nurse may not be able to provide their usual level of care. So while your pts are enjoying your company you may be adversely affecting pt care by causing stife on the unit. It doesn't matter what mistake someone makes, what right do you have to scream at someone? Continue to give excellent care to your pts but treat your coworkers w/ respect even when they aren't perfect.