So mad at my nurse manager I could spit!

[Zoomer]

I work the 7p-7a shift in critical care. On friday night we were pretty short staffed with several nurses having to "triple" (take 3 patients). I was in charge and had my own assignment which is something the nurse manager has told us wouldn't happen. We are supposed to be out of staffing in order to help throughout the unit and make assignments etc... At the beginning of the shift we had 5 patients that were tele overflow patients and it is common that if a nurse has a tele patient then he/she can take 3 patients. However due to the fact that we had to make beds for critical patients we moved 3 of those patients out and then had some very sick patients. Durring the shift we got 5 new critical patients. The nurses I worked with were great and we worked very hard. The nursing supervisor told me at the beginning of the shift that the day shift for Saturday was very short, only 5 nurses at that point for the 20 patients we ended up with. Well, the supervisor called and begged and was able to come up with 3 more nurses although 2 of them could only work 8 hours. She called the nurse manager to inform her of the very bad staffing and asked her for input. And this is the part that made me so mad. My nurse manager told her, " That is not so bad they can handle it. I was there until 11 last night the patient assignment is manageable"

Now the manager was apparently in the hospital meeting with one of the other staff members but not once did she come out to the floor. I didn't even know she was still in the building. What gets me so angry is that she didn't know a single thing about the 5 new patient we got or how sick they were. She didn't even call me to ask if I thought the assignment for days was manageable. At the time the supervisor told me about her comments I was trying to help a nurse with a patient whose heart rate was 200, at the same time I was trying to answer a doctors questions about his patient and deal with my own patients. I tried paging my manager but she never answered me. I am still steamed over this. This woman has been our manager for less than a year and has been heard to say "this is not a real ICU".

What should I do now? I am tempted to complain our nursing VP about this. Or should I just talk to the manager to let her know how upset I am?

[Jolie, BSN]

Your manager's conduct was inexcusable. She put the safety of patients and the licenses of her nursing staff in jeopardy. As a former nurse manager, I can tell you that it is not always possible to conjure up the needed staff, but to fail to address the situation at all, and refusing to come to the unit herself would have (rightfully) been grounds for dismissal where I worked!

Despite the fact that she acted irresponsibly, I encourage you to maintain professionalism in addressing this issue. I believe that she should be contacted first and spoken to in private. Write everything down, including patient numbers, acuities, staffing ratios, brief descriptions of the patient crises you were forced to address, physician comments regarding staffing, family comments, care left undone because of inadequate staffing, etc. It may also help to remind her of her 24 hour accountability for patient care on the unit, whether or not she is present. Tell her in plain English that that means she will be sued along with the staff nurses if anything untoward happens because she failed to adequately staff HER unit.

If your private meeting does not net the desired results, then go on up the chain of command.

Good luck to you, and I'm sorry for your situation.

[Jolie, BSN]

Forgot to mention that the Risk Manager may be of help to you if your nurse manager doesn't respond to your concerns.

[CritterLover, BSN, RN]

i think that you are justifiably upset over your manager's reaction.

however, i don't think you should go to the nursing vp. what i think you should do is take a day to gain some perspective. we often say things we don't mean when we are upset, and we don't "argue" our cases very well. at least i don't. once you have thought over the situation, i think you need to go to your manager, and calmly explain to her why you are upset, and that it was inappropriate of her to make those comments when she didn't know the patient acuity at that time. i also think you should put your objections into writing. then, if you don't get a satisfactory response from your manager, would be the time to go to her supervisor.

please, though, do go to your manager this week. all too often i see nurses take this kind of treatment with the martyr attitude, and they are not helping anyone, least of all themselves or their patients. but if you wait a day or so, i think you will be more objective and better able to relay your concerns.