Should I stay or should I go

[buckgirl80]

I currently have a job at an outpatient area of my hospital taking care of patients who are undergoing a variety of diagnostic procedures and are also recovering from a variety of different procedures. With that being said, a lot has changed over the past six months on my unit and we are now taking on a much more complex group of patients. A lot of endless chatter has gone on about what type of patient we can expect next. And my manager has not tried to reassure us or relieve our anxieties regarding this. Our unit is not made to function at this capacity at this time. Many of our nurses on our unit are not trained to function at this capacity.

My current position

The pros: My current position is a 20 min drive and is the same unless I get off work during the heavier traffic, when it can increase to as long as 45 min. The work hours are from 6-330 four days a week or 6-630 three days a week, and I do not work holidays, nights or weekends. This is very important to me for the sake of my family. My manager has been very flexible and understanding during difficult times and allowed me a LOT of flexibility with my schedule. The complexity of the patients has allowed me to maintain my skills as a nurse which is also important to me. After all, I am only in my late 30s and I don't feel like I am ready to settle for an office job just yet. Due to the shortages on the unit that only seem to be increasing, I am able to work virtually anytime I am off and I can acquire additional overtime which also has a critical staffing diff of time and a half plus 2 that automatically is added on to any additional hours I pick up.

The cons: During all the turmoil of increasing change on our unit, we have had multiple frustrated staff members leave our unit over the past six months leaving us very very short-staffed. Many of our team members left with a decrease in pay because they felt the stress was just too much. Many moons ago before I started working on this outpatient unit, I had thoughts of going to a critical care unit, so a higher level of care is not something that bothers me or alarms me. However, the lack of education for these new and upcoming complex patients on our unit is alarming. The manager on my unit is very sympathetic in her talk but her actions speak louder and she is not very helpful when the staff is low and the census is high and we are in a bottomless pit. Furthermore, my manager maintains a very unprofessional stance and is unable to keep other staff members comments or concerns private which I feel is important for the unit as a whole. Her comments have costed a great deal of animosity on our unit as well as caused many people to leave. When I am scheduled to work until 630pm, nurses scheduled to work the evening shift (til 9pm) are scared to let me leave because they may acquire additional higher acuity patients after I leave they are not staffed to take on causing me to feel obligated to stay. There has even been comments made by my manager when everybody was leaving at 330pm that we "can't leave that's patient abandonment!!" I have requested to be placed on a four day per week schedule to prevent from being expected to stay til all hours of the evening. Our charge nurse recently left and went to a position within the hospital but she doesn't seem to like it the same. We have multiple positions that are available on our unit that have been available for many months due to the shortages. I applied for the charge nurse position when she left and my manager expressed to me that she feels I am not "ready" for this position due to my lack of critical care experience. However, she feels I am appropriate to be a relief charge nurse on the days when I am needed. I can't see what the difference is in one day as charge nurse versus another. Many of the relief charge nurses that are currently filling this position are also not experienced in critical care.

New Position

Through my frustrations I have applied for another job from within the group in the office and accepted the offer. I am still quite a bit unsure about the job I have accepted and have analyzed it from every angle. I have even expressed my desire to stay on my current unit in other circumstances; such as changing my work hours to 6-330 only.

The position is for a "float position" and is from the hours of 730-430 or 730-630. I was told in my interview it was my choice of four days/week or five but this has not been set in stone anywhere. I can float to many different locations which seem to be in excess of 1.5 hours of drive time (especially due to traffic) but during my initial interview I was told this doesn't happen "often." Many of the staff members whom I have spoke to on other units who have left the office say that although I was told I will not float often during my interview, they floated frequently. I am making the same amount of pay but the maximum I can make in the office is lower than what I can make on my current unit. I would be making 40 hours per week instead of 36, so I will be making more hours and inevitably making more money but not at an increased rate of pay. I will be managing the same types of patients but through direct phone call, email or text. I will be sitting all day in an office and will have little to no patient interaction. I will no longer be able to pick up any additional hours and if I was able to do so, I would not be getting critical staffing pay. I have no idea how the new manager is as far as flexibility of the schedule.

There are many different things into play here and I am not expecting to get a stay or go answer, but I would like insight as to what others with similar experiences would recommend in my situation.

[LovingLife123]

I'm not maybe understanding your current unit. What do you mean you are not able to handle more complex patients? Are they ventilated? Are you taking on too many at once? To me, complicated patients are a part of nursing. Everybody has them. Not just ICUs. Unless they are vented and on titrating drops, you should be able to handle patients. Or unless you are getting too many really sick ones, I could also see that as a safety issue.

From my perspective, change is going on in the unit, and as we all know, people don't like change. Your unwillingness to adapt may be why they told you no to charge nursing.

I'm often leaving my unit late. It's just the way it is. Things change in a split second and even the best laid plans get screwed up. Especially in nursing.

Those who can't embrace change are the ones who are unhappy in every job they have.

[buckgirl80]

The patients we are taking on are varying degrees of ICU level patients who would normally be cared for by pacu level nurses because they have general anesthesia. Our pacu is now declining most of these patients (and this is understandable) because they're forced to take on a certain level of other kind of patients. Change I agree is expected and I don't see it as a bad thing if your unit is equipped for these changes....our monitors are not even equipped with the devices necessary to manage these patients. The few (4) that are equipped are constantly being stolen. These patients may be on one or two gtts and may be getting vs every five minutes.

Many of our nurses are not trained well enough to manage these patients. I was questioned by one nurse a few weeks back about which pressure was reliable...when I saw cuff pressure vs the art line pressure, I asked the nurse if she had zeroed the art line and she said how do you do that.

We are not taking vented patients (yet) but I believe this is more related to our lack of respiratory supplies and resources.

I'm fine with change if we are appropriately trained. As for leaving late, my usual schedule of 6-630 may lead to leaving at 9 and the 9pm nurses leaving at 1am. This is because of a lack of staffing or a lack of beds in the hospital, not because of the complexity or the decline of a patient. I don't mind leaving late if it involves patients care, but all too often it is a matter of waiting to make sure there will not be additional patients to come. I do not have patients during this waiting period and sometimes, neither do other staff members.

[nutella, MSN, RN]

Why don't you apply to critical care??

It sounds like you are working in some kind of strange CDU / procedural unit.

If you like patient contact and do not wish to sit in an office, perhaps going to critical care would be better for you?

[Here.I.Stand, BSN, RN]

Yeah no, staying hours extra under threat of abandoning nonexistent pts...no. Their failure to appropriately staff is not your emergency. It is CERTAINLY not something you should expect as a nurse. What you should expect as is that someone is arriving to relieve you shortly before your scheduled shift ends, to leave time for handoff.

In critical care, your relief tends to show up regularly

[Nurse SMS, MSN, RN]

Yeah, I agree with the above posters. No to the float job. No to the current job. Find a better job.

[amoLucia]

One thing stands out to me - your direct manager may be experiencing the same squeezes that you are, and that she is UNABLE herself to do anything about it.

She's prob just as unhappy as you are, if not MORE SO. She's being squeezed from higher up and from lower down.