I'm a new nurse, in my job for just a year now working on a med/surg floor. Being older than my co-workers and having previous work history, I tend to be more adamant about some of the rules and ways things should run.
My most experienced co-worker ( on this shift) has 20 months experience due to the high turnover here: 100% at 2 years is the current according to recruitment.
Anyway, I was made charge a couple nights ago and things were just insane as usual. We were running short 1 nurse and we were getting slammed with admits. 5 in the first hour plus an AMA and an irate family to deal with because day shift had neglected to tell them they could'nt leave until the pt urinated - pulled their cath @ 1900.
I had 5 patients: one with SaO2 @ 63%, one getting 2 units PRBC's with Lasix and fluid overload and one with 9/10 pain and we were out of meds as usual.
My co-workers were in a similar bind with their crazy night.
The Unit secretary calls and says I'm getting an admit. I said it was wrong and the assignment sheet was made up differently, she told me that too bad I was getting it anyway the House Supervisor wanted that room.
I called the House Sup and refused saying we were completely overwhelmed and would not accept the pt. His response was to tell ER to put the pt in the room and I would call later for report.
In other words they dumped the pt and left! Further they never even told me the pt was there. I got really pissed and I even called the NM at home. Understand, Admin is only on duty here 0730- 1530 , we have NO admin here on nights weekends or holidays.
The NM's answer was I don't have enough time management and everybody runs short and we all have to deal with it.
As to having no meds from pharmacy - a regular issue here - she said that I need to address the issue and I should also confront the Unit Secretary to tell them they don't assign duties.
It's always the answer here: Deal with it & You do something about it.
The last year has been entirely like this: 5 & 6 hours to get meds from pharmacy, no stock of different doses so we have to give 6 or 12 pills for a dose, we spent two days over memorial days with no tylenol because we were out of stock and the always standard answer from Admin that we need to deal with it.
Anyway, I'm bad, I got really mad and threw a chart at the desk and was rude to the house supervisor.
Now I'm not afraid of firing, after all they've had staffers threaten homicide and they don't get dismissed, but I am afraid for my licence and the likelihood of bad references for a new job.
Recently they gave poor reviews to two staffers to keep them here and they were very blunt to them saying that they didn't need to leave so they would not get positive evals.
I do have a foot in the door at an agency for various PRN & contract work. Should I cut and run? Give notice and go?
Is it like this everywhere? The hospitals I did clinicals at in school sure seemed better.
you can't be made to work during your break! If you have to get up and do anything (even just answer the phone) they are denying you the break the law says you must be allowed to have. So if you do have to do some work during your break,request reimbursement. Where I work we can fill out a form if we've had to work through lunch. If it would be unsafe for you to leave your floor page your manager or supervisor to watch your pts while you are gone.
you need to grab the other job and get out of here. they always pass the buck and eventually you will get let go for something, as they dont seem to care, about the workers or the patients.
NO, all places are not alike. If I were you, I'd give my two weeks and hit the happy trail. There ARE places out there that actually care for their nurses. If it's feasible, try finding a magnet hospital to work at. While not without issues, for the most part, they are great places to work!
I work nights, and on the RARE occasion when one of us takes a dinner break (or any break) we can't be off the floor, there's not enough coverage if something goes wrong. We lose a half hour of pay for a mealtime we just about never get, and it's written in our policy that on nightshift, it "may be deemed necessary" for breaks to be taken in the breakroom on the unit instead of being allowed off the floor. And they wonder why it can be hard to fill night spots...
It doesn't matter what hospital policy says, they can't overrule federal law, which states that you must have 30 uninterrupted minutes for lunch, and since you are not being paid for it it is your time to use as you see fit. If you are interrupted, charge them for your lunch. If six nurses per shift don't take lunch, or allow interruptions that's 42 hours a week for 12 hour shifts and 63 hours a week for 8 hour shifts that the hospital gets for free. More than a full time nurse a week the hospital saves in salary. (And we all know that even in the smallest hospital six nurses per shift skip lunch because something is happening in their dept. Whatever depts.) How much time have you given away? Enough to pay off a bill, or have a vacation, I'm sure. Do the paper work, charge for your time. We have to learn to value ourselves before we can insist they value us.
I'm a new nurse, in my job for just a year now working on a med/surg floor. Being older than my co-workers and having previous work history, I tend to be more adamant about some of the rules and ways things should run.
My most experienced co-worker ( on this shift) has 20 months experience due to the high turnover here: 100% at 2 years is the current according to recruitment.
Anyway, I was made charge a couple nights ago and things were just insane as usual. We were running short 1 nurse and we were getting slammed with admits. 5 in the first hour plus an AMA and an irate family to deal with because day shift had neglected to tell them they could'nt leave until the pt urinated - pulled their cath @ 1900.
I had 5 patients: one with SaO2 @ 63%, one getting 2 units PRBC's with Lasix and fluid overload and one with 9/10 pain and we were out of meds as usual.
My co-workers were in a similar bind with their crazy night.
The Unit secretary calls and says I'm getting an admit. I said it was wrong and the assignment sheet was made up differently, she told me that too bad I was getting it anyway the House Supervisor wanted that room.
I called the House Sup and refused saying we were completely overwhelmed and would not accept the pt. His response was to tell ER to put the pt in the room and I would call later for report.
In other words they dumped the pt and left! Further they never even told me the pt was there. I got really pissed and I even called the NM at home. Understand, Admin is only on duty here 0730- 1530 , we have NO admin here on nights weekends or holidays.
The NM's answer was I don't have enough time management and everybody runs short and we all have to deal with it.
As to having no meds from pharmacy - a regular issue here - she said that I need to address the issue and I should also confront the Unit Secretary to tell them they don't assign duties.
It's always the answer here: Deal with it & You do something about it.
The last year has been entirely like this: 5 & 6 hours to get meds from pharmacy, no stock of different doses so we have to give 6 or 12 pills for a dose, we spent two days over memorial days with no tylenol because we were out of stock and the always standard answer from Admin that we need to deal with it.
Anyway, I'm bad, I got really mad and threw a chart at the desk and was rude to the house supervisor.
Now I'm not afraid of firing, after all they've had staffers threaten homicide and they don't get dismissed, but I am afraid for my licence and the likelihood of bad references for a new job.
Recently they gave poor reviews to two staffers to keep them here and they were very blunt to them saying that they didn't need to leave so they would not get positive evals.
I do have a foot in the door at an agency for various PRN & contract work. Should I cut and run? Give notice and go?
Is it like this everywhere? The hospitals I did clinicals at in school sure seemed better.
Frustrated and burning out!
fizz2nurse
Leave. Leave now. And file a report with JCAHO and the labor board and whatever agency oversees hospitals and pharmacies in your state. You owe it to yourself to save your license and to the patients to report this hospital situation. Both you and the patients deserve better.
Tuff thing to remember is that that hospital serves that community and those patients and loved ones need you... It sounds like a small hospital. I think a change needs to made but it needs to start at a manegment level! Talk to head of the hospital, CEO, If that isnt working for you threaten legal action starting with reporting work conditions to the state.. You can leave but someone else will step into your place and it will continue... Those patients need you wether you are there or not! Do it for the patient!
I think a change needs to made but it needs to start at a manegment level! Talk to head of the hospital, CEO, If that isnt working for you threaten legal action starting with reporting work conditions to the state..
This is good advice but I would not advise approaching management. They have already shown that they are not above unscrupulous practices to keep their nurses. They would just think up an excuse to fire her. I've had it happen to me -- if management doesn't care about nurses or patients, they will play dirty.
She should not threaten legal action, just report the facility to the state, with documentation, on her way out. That will help the patients more than anything.
Run Toto, run..... this will be the first of many. Take a position doing something else, some where else. You answered all your questions. Yes, hospitals are short staffed....but it is never a reason to endanger patients! The patient should have been held in the ER or the supervisor should have come up and admitted the patient herself, and stayed to help. Sounds like a dangerous place to work. I'd have lost it too! I've had my share of hissy fits too, but I found it does not change. If this is how the unit is on a regular basis, run, don't walk out of there. Be sure to share your experience with human resources, and administration at your exit interview. Pave the way for the next "nurse victims". Good care is out there...go to the light!
Yes, I do think throwing a chart out of anger as you did was out of line, even given the situation. But the more important thing is that I believe there are things you can do to handle the situation better.
1) Don't yell. And don't threaten. Usually when we nurses threaten things, we don't follow through. Often the louder you yell, the less people hear what you are saying. And don't get emotional (even though I know this is such an emotional issue for all of us nurses). Usually you can pursuade/intimidate/ get people to listen much more effectively when you use a calm yet firm and very collected tone. Instead of threatening, simply let them know their response to your concern will be documented, and that you will begin the process of taking it up the PROPER chain of command.
2) Gather documentation. Just as you would gather your data before you call a doctor, you have to gather your documentation before you call an administrator (or a lawyer for that matter!). This includes copies of incident reports (both from yourself and possibly related ones from your peers if you want to prove it is not an isolated incident.
3) Report who you need to report to JCAHO, CMS, your state's labor board, & especially the NM & ER nurse to your state's BON. Do this before you climb the chain of command very high (as soon as you can prove administration's response was negligent). Otherwise, the administration will most likely talk you out of it (as they did to another nurse who posted on this thread). Also, then if administration retaliates once you have reported these things, you can easily prove it was retaliation, & the BON or JCAHO will go after them even more. And HR will probably tell your manager they CAN'T fire you, because of the legal risk to them after you have made such a report.
4) Continue to climb the chain of command. Don't threaten to do this, just do it without threatening. And don't be so afraid of retribution in doing so- this fear is what makes so many nurses victims. If the nurse manager doesn't respond, call the hospital's risk manager (usually they can be called 24/7). While management may simply be worried about meeting their budget standards, the risk manager often understands that it will cost the hospital more in lawsuit payouts than they saved in understaffing should unsafe things happen because of administrative decisions. So you may need to pitch it to management as "Safe staffing is a way to SAVE THE HOSPITAL MONEY BY PREVENTING LAWSUITS." Bring in journal articles that prove this- there are many. Give each person on the chain of command 48-72 hours to respond, and if they don't, keep moving up. Document anything they tell you in meetings, including retaliation or threatened retaliation.
When moving up the chain of command on the sexual harrassment writeup/retaliation, you should definitely go to HR and follow their chain of command. Remember that they are losing more than just you if you quit- it costs hospitals $50,000 on average to recruit, hire, and orient each nurse. So their turnover is costing them. Make sure HR & Risk management are aware of your steps.
Nurses need to stop accepting the role of victim and letting administrations' unsafe practices go unchecked. The fact of the matter is that it is the nurses, who have the responsibility to report ANY unsafe practices (including those of administration) to JCAHO & the BON that are partially letting administration go unchecked.
5) You may want to attempt to transfer to a different unit in the hospital where things might not be as bad. I know in my hospital, there are some units that are continually staffed worse than others, even though their need is often greater than others. I'm not saying you're an ineffective nurse or can't cut it here, I'm simply saying that if you're not ready to quit just yet, this is a way to try something new while still keeping your accumulated PTO, benefits, etc. And to possibly find a nicer manager in a happier unit who might give you a better recommendation.
6) If its still just as bad elsewhere in the hospital, find employment at a new hospital/ agency. And don't worry about a bad recommendation. Instead, in your interview, point to how you handled a conflict at work properly, or even accomplished some resolution- focus on how you made care safer for your patients and all the patients on your floor.
Lastly, remember that the nursing shortage is all relative. Hospitals who treat their nurses well (and there are many such hospitals out there) really don't experience the shortage as badly because their nurses know they have it good and don't leave as often. (So no, it is not like this everywhere else).
As usual another incident re: the care in our facilities today. Some nurses try but nursing used to be an art, a science, and a spirit. This seems to be gone. Professionally I would be looking for a new job opportunity. When life throws you lemons, make lemonade. It seems if people are threatening homicide there is such a problem there that it cannot be fixed, at least with t he current administration.
The ER abandoned the patient! No doubt and the boards of nursing and the ER nurses association would tell you this too. Very, very dangerous for nurses and patients. When you do leave, make the most of the exit interview. Make sure you talk to someone high up in the food chain.
Specializes in Ortho, Neuro, Surgical, Renal, Oncology.
Yes, you were out of line and unprofessional to respond in the manner you did.
I am a new nurse and start my job as an RN in 2 days. I have had the pleasure of working for my current employer for the past year and a half as a nursing student doing clinicals and as an employee (patient care technician). While things are not always ideal where I work, they are never as bad as you have described. The hospital I work for is a magnet hospital and I believe this makes all the difference in the world because we have higher standards. The patient:nurse ratio is 6:1(which is a little high but manageable). The pyxis sometimes has meds that are not loaded;all it takes is a call to pharmacy and they take care of it immediately. The main problem that concerns me about where you work is the lack of patient care. Patients have rights and clearly they have been violated. I, personally, would not want to work at a hospital with such a lack of management and professionalism, who clearly violates my rights and the rights of the patients. Do you have Liability Insurance(outside of what is offered thru your employer)? It is true that a different department may be the solution because this other department has a different director. This is not the best place for you. As for the prior suggestions regarding reporting to the JCAHO and BON; I would definitely report because if you were to just leave without taking action then the problem still exists and the consequences could mean someone's life;it is your ethical duty to report. As for reporting the incident(s) to your place of employment, I would say it's always a good idea to follow chain of command but from what I hear from you it doesn't sound like anyone can be trusted at your facility but I would still follow protocol because this looks good if you ever have to go before a board. Just know that not all places are as bad as the place that you have described. Good luck in your new career as a nurse.
Specializes in Med-Surg,Critical Care, Radiology,GI.
Your facility should have some type of staffing ratio requirements. That these are not adhered to are normal everywhere. This happens, been there myself. I personally spoke with the NM, gave her 3 months to correct the problem, and called her bluff 3 months later, when there was no improvement in staffing, left, and have never slept better. To protect your liscence, put in writing the unsafe staffing vs. pt. acuity ratios and which supervisor you notified. Each notification should include, I am required to notify you of this unsafe working environment and to document such. Your not refusing to care for a patient, you are protecting yourself. Please do not let this chapter of your nursing career give a poor light on what you have chosen. It is still the most rewarding profession I love. Good Luck
fronkey bean
491 Posts
you can't be made to work during your break! If you have to get up and do anything (even just answer the phone) they are denying you the break the law says you must be allowed to have. So if you do have to do some work during your break,request reimbursement. Where I work we can fill out a form if we've had to work through lunch. If it would be unsafe for you to leave your floor page your manager or supervisor to watch your pts while you are gone.