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?

[fronkey bean]

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.

Its good that you recognize that your tone was inappropriate and you apologized. However, even after a sincere apology, it takes awile for the negativity you injected into the situation to clear. You should have taken the chart to her and said calmly "I really need these orders put in right now so these labs can be drawn" and then made sure the labs got drawn. That being said, we've all lost it a time or two. Don't beat yourself up about it, just try to be calmer next time. Just think of all the time you'll save. You won't have to do all the explaining and apologizing you had to do to make this situation right!

[canoehead, BSN, RN]

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.

Preach it, sista!

:angryfire

[SarasotaRN2b]

Well, to the OP, I can understand your frustration. As an unit secretary, it can get crazy especially if you are a float; however, if the duties were outline to secretary about what she would be responsible to do...well then she should have. Personally, I believe that if this was something that required stat orders, the MD should have given the chart directly to the unit secretary or charge nurse. While in a perfect world, it would have been preferable to totally be cool and calm about it, that is not the case. The fact that the OP saw that she may have come off frustrated and upset, she apologized and learned from it. What can be better than that?

Kris

[RyanRN]

So did the Unit Clerk get called to the office too? 4 hours is too long for picking up

ANY orders - "now" ones or not? (gonna bet not)

WHO would be held completely and totally responsible for any negative outcome of this patient? (only you)

The doc will just say he did put the little red flag up "it must have falled down". You know he's off the hook. (reality check)

I feel your frustration and have been there. However, blowing off steam in the middle of the unit does tend to set a negative atmosphere in any workplace. And you are the outsider, in this case.

Maybe privately speaking to the charge nurse about some of the real problem issues you see would have been better. As you said it did help with the insulin coverage - so they proved they will listen.

Anyway - you sound like a conscientious worker who is willing to really 'hear' what is being said to you and make changes. I'D WORK WITH YOU IN A HEARTBEAT!!!!

[RyanRN]

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.

And the fact of the matter is THEY COUNT ON IT!!!! They may or may not realize that the nurse has NOONE to 'count on' but themselves!!!

[Evangeline2000]

And no, as a traveler, I am not allowed to enter orders. I'm not even allowed to write the ordered meds on the MAR! That is soley the job of the charge nurse. Begged them to let me, but nope. Not their policy.

I was just reading over the thread and saw where you said you aren't allowed to enter the orders, but rather, the charge nurse is supposed to tend to that.

Sounds like the home team dropped the ball.

I guess they figured cancelling your contract early was the easiest way to deal with the situation.

I agree with the others that getting exasperated isn't a great idea, but we're all just human, after all. I wouldn't beat myself up too much about it, you sound like you have a really great attitude towards work and other people. Even though you got frustrated, you stayed and did your job.

I still think there are problems there on the unit that need to be addressed, as well as the unit clerk running off the floor and the charge nurse not entering the orders.