Soooo, I quit

[TX911]

I've posted here quite a bit but have been here in awhile so I couldn't log back in for some reason. Anyway:

I've worked ICU for the last year. I was a paramedic for years, transitioned to RN and got a job out of nursing school in aforementioned local ICU. Throughout this year we have been understaffed, stretched to 3:1 ratios EVERY night, even when caring for CABGS, valves, heads, etc. Didn't matter what it was, you had three every night.

So the night before last, I had a 8 hour old CABG, a 21 year old dying from complications of cystic fibrosis with the family all in the room wanting information (looking to have some sort of control over a bad situation I imagine), and a schizophrenic pt admitted post status epilepticus that I cannot see from my pod with the 2 aforementioned pts in it. I told charge that I could not see the SE pt, had this heart, and that the family needed some attention with the CF patient. No dice. "Everyone has three again, I don't have anyone else to take the heart." I told them I'd get through tonight but I wasn't doing it again (we all say the same thing every night and yet we all come back.) I get through the night with minimal incident.

So the next night I come in, have the same 21 CF pt, a new GI bleed on bowel prep with a hgb- 6.9 getting blood, and a new admit HTN on cardene and getting peritoneal dialysis q 4 hours and is just generally very needy. I can't give this guy the attention he wants, my poor lady with GI bleed keeps messing the bed, and the CF family is still very frazzled. So I get in a groove finally and get some things lined out when I happen by more GI bleed's room and she raises her hand. She tells me she's messed the bed again. I say no problem, just now? Then she proceeds to tell me "No, about an hour ago. I didn't want to bother you, you just looked so busy." And right there ladies and gents, I was done. That was it for me. I told her that no matter what, if she has an accident to hit that call light and I will make sure someone comes immediately (we don't have PCAs regularly either, did I mention that???) . I then proceeded to tell charge that she needed to call someone in because I was done. She tells me that there is no one to come in, so I said fine, I'll finish tonight, give report to oncoming in the morning, but they can consider this my last shift. A year of this garbage is enough.

True to my word, I finished the night, gave report to oncoming, said goodbye to my pts, and approached the "director" and asked her if she wanted to do this here or if she wanted me to go downstairs and talk to the honcho. She gives me this disappointed look (like your mom does) and says, "no I'll take it." I hand her my badge and walk out. In my younger years I would've probably gave her about a 20 minute tirade in front of everyone about exactly what I thought of her and her units staffing practices (the 3:1 ratio is deliberate for "productivity" numbers, though they've been lying through the last year telling us it would get better.)

So, today I feel bad about not giving notice and I know that it was unprofessional. I know that and I'll wear it. But at the same time, in that same situation, finishing the shift and not tearing through the director was all the professionalism I had left in me. I feel cleansed, but at the same time disappointed in myself to a degree. Partially for not blowing my lid at her and partially for not giving notice. I've worked since I was 14 years old and this is the first job I've ever had that I couldn't go back to whenever I wanted. I still talk to my old oil field bosses and I'm headed back to my previous ambulance job full time. So I'm going to mentally chalk this one job up as the exception to my professional history and not the rule. I feel that it was my fault for not gritting my teeth and bearing the two week notice, but I have no plans of ever going back there again or ever working for a hospital that that company owns. I will miss my friends there dearly but I just couldn't stomach it any longer.

The problem is now that as far as nursing goes, that job in ICU was my only experience and now on applications I have to check not eligible for rehire (I'm sure.) So I guess my best bet is to just stay a medic and be honest when it comes to what happened.

Anyone ever have anything similar happen?

[TX911]

Actually it wasn't a challenge at all. I got a contract at a CVICU in a level 1 trauma center within a week, while I was working on the ambulance. They apparently valued my many years of experience transporting critically ill pts on IABPs and such as well as my 1 year of in house CVICU experience.

Oh and fyi, the company I worked for got sued into oblivion about 3 years ago due to a defamation suit and then again in January of this year for a wrongful termination suit. All their HR department is allowed to verify now are start and stop dates. They can't even say whether you're eligible for rehire or not. They can't say anything at all related to your employment whatsoever, except start and stop dates. In house policy. This is per the HR head after I'd spoke to a legal representative regarding my eligibility for rehire being based on not giving two weeks secondary to a "dangerous and/or hostile" work environment. I was more or less just interested in what i needed to put down on applications and ended up getting quite a lesson from a legal representative who suggested I pursue legal recourse should they give a "not eligible" reference. Both travel companies I spoke with as well as the unit manager at the hospital I'm going to said the same things.

So what this experience has taught me is that no one has to put up with that crap, ever, and I was an absolute moron for taking report on three pts. It was unethical and immoral for me to do so and it won't ever happen again. The pushover I was for a year is what I'm ashamed of.

[kakamegamama]

Hey---you have integrity. That is good. Ease up on yourself a bit. Congrats on your new job. Keep up the good work. And, I am so glad to know that there are still nurses like you "out there".

[morte, LPN, LVN]

samadams point is that a lot of the communication takes place outside the workplace. The head of the xyz hospital's HR dept belongs to the same club as the head of trs hospital's HR dept. etc

[paradiseboundRN]

That may be true but don't these department heads have better things to talk about than their employees? IMHO many nurses that go on to management have narcissistic personalities and would rather talk about themselves.

[Esme12, ASN, BSN, RN]

Actually it wasn't a challenge at all. I got a contract at a CVICU in a level 1 trauma center within a week, while I was working on the ambulance. They apparently valued my many years of experience transporting critically ill pts on IABPs and such as well as my 1 year of in house CVICU experience.

Oh and fyi, the company I worked for got sued into oblivion about 3 years ago due to a defamation suit and then again in January of this year for a wrongful termination suit. All their HR department is allowed to verify now are start and stop dates. They can't even say whether you're eligible for rehire or not. They can't say anything at all related to your employment whatsoever, except start and stop dates. In house policy. This is per the HR head after I'd spoke to a legal representative regarding my eligibility for rehire being based on not giving two weeks secondary to a "dangerous and/or hostile" work environment. I was more or less just interested in what i needed to put down on applications and ended up getting quite a lesson from a legal representative who suggested I pursue legal recourse should they give a "not eligible" reference. Both travel companies I spoke with as well as the unit manager at the hospital I'm going to said the same things.

So what this experience has taught me is that no one has to put up with that crap, ever, and I was an absolute moron for taking report on three pts. It was unethical and immoral for me to do so and it won't ever happen again. The pushover I was for a year is what I'm ashamed of.

:ancong!: I am so happy for you!

[Esme12, ASN, BSN, RN]

samadams point is that a lot of the communication takes place outside the workplace. The head of the xyz hospital's HR dept belongs to the same club as the head of trs hospital's HR dept. etc

What do you think those meetings of "Nurse Executives" are all about? I remember how stunned I was when I first realized what the Organization of Nurse Executives talked about during dinner.

[Guest343211]

Actually it wasn't a challenge at all. I got a contract at a CVICU in a level 1 trauma center within a week, while I was working on the ambulance. They apparently valued my many years of experience transporting critically ill pts on IABPs and such as well as my 1 year of in house CVICU experience.

Oh and fyi, the company I worked for got sued into oblivion about 3 years ago due to a defamation suit and then again in January of this year for a wrongful termination suit. All their HR department is allowed to verify now are start and stop dates. They can't even say whether you're eligible for rehire or not. They can't say anything at all related to your employment whatsoever, except start and stop dates. In house policy. This is per the HR head after I'd spoke to a legal representative regarding my eligibility for rehire being based on not giving two weeks secondary to a "dangerous and/or hostile" work environment. I was more or less just interested in what i needed to put down on applications and ended up getting quite a lesson from a legal representative who suggested I pursue legal recourse should they give a "not eligible" reference. Both travel companies I spoke with as well as the unit manager at the hospital I'm going to said the same things.

So what this experience has taught me is that no one has to put up with that crap, ever, and I was an absolute moron for taking report on three pts. It was unethical and immoral for me to do so and it won't ever happen again. The pushover I was for a year is what I'm ashamed of.

Dude! Major congratulations! You did have things turn in your favor, but be advised, this is not often the case. But in general principle, I agree with you.

About the wrongful termination, well, perhaps it really needed to be done. So many places get a way with SO much, it's not funny. At the same time, the honest statistics still don't show much promise for the bulk of wrongful termination suits---BUT, maybe this is finally starting to change with nurses.

I'm not a litigious person, but there are times when a stand clearly has to be made.

[That Guy, BSN, RN, EMT-B]

I've often been told that new grads should not start out in ICU, even if you have prior critical experience such as being a paramedic. Perhaps you could have found your groove in nursing better starting out in a more acute med-surg floor? Just a thought. Sorry to hear that you had to burn your bridges like that.

No. Just no. This person obviously has the background to handle this kind of situation. 3:1 with the load he describes is down right dangerous no matter how superman you are. He did the right thing. Something most of us wish we could do.

[brandy1017, ASN, RN]

I've heard this is becoming standard practices in many ICU's, to push for 3 even 4 patients instead of 2 patients. Without a union, all you can do is quit because they have no intention to hire more and they just want to make this the new standard to increase profitibility. It's your license and you are the one who suffers working under these unsafe conditions, the extra stress is harmful to your own health and of course it leaves the patients at risk, but if something would happen they would blame you!

I think you did the right thing. Consider getting a paramedic or flight RN for the city you work for. I know someone who was a paramedic became an RN and does flight for life. Usually city workers have better benefits and pay then private, although maybe not so much in Texas which is a right to work state right?

Good luck! Hold your head up high! Maybe your fellow RN's will take a page from you and leave and if enough people quit they will come to their senses and staff adequately. You never know. But they won't change until it starts to hurt them either thru high turnover, a bad patient outcome or if the nurses join a union. The union is CA seems great, very powerful, maybe they will organize hospitals in Texas and things will improve!

Without a union I think we are all doomed to working in crappy, unsafe conditions just so the hospital can make more money! Money is totally the bottom line these days, nothing else seems to matter to the "corp" hospital admin! The dept managers get a nice bonus if they keep the budget down so that's what motivates this penny pinching crap!

[brandy1017, ASN, RN]

to do any real good, this needs to hit the papers/blogs etc. The families of those three paitients need to know the danger their loved ones where in and why, not the hospital's spin.

A good strong effective union would fight back with media coverage and even picketing if necessary and letting the doctors know the working conditions in the hospital. Doctors usually will then add their voices and pressure management to improve things!

[Guest343211]

No. Just no. This person obviously has the background to handle this kind of situation. 3:1 with the load he describes is down right dangerous no matter how superman you are. He did the right thing. Something most of us wish we could do.

Well, apart from taking fresh hearts out of the OR, many, many intensive care units that I have worked in, will, at various times, give you 3 patients. This was even true 20 years ago. Of course there was some limit in doing that when assignments were based on the current acuity of the particular patients. They don't care about acuity so much anymore.

It's not a rare thing to get 3 patients in a unit--or to even have a fourth, b/c you have to most another person to a step-down bed, and then receive from OR or ED. These exchanges from the units need to be done carefully, and they take time--time away from the other sick patients. Add to that that you need to work together with other unit nurses in order to help them with their sick patients. I can remember working in a SICU 20 years ago where you had 3 or 4 patients, and 1 or 2 of them is grossly unstable. I remember all of us killing ourselves b/c the acuities were so high that we had to plead with someone to keep an eye out for our patients while we quickly tried to pee. I can remember getting blood all over with certain patients, having to wait patiently for surpervisor to find another pair of scrubs for me, and continuing to kill myself taking care of my sick load--all while the blood soaked down through my underwear. No, it didn't happen every day, but it happened enough--enough such that I learned that we couldn't count on someone getting OR scrubs for back-up, so we started to bring in a 2ndary pair on our own. ICU's can be dirty, messy scenes. Pt's throwing up blood, pooping out blood stool, invasive line bleeds, people with coagulopathies and bleeding from everywhere, people fighting due to coming out of anesthesia or sedation, sloppy major GI surgery wound changes with residents through the bloody damn dressings and what not everywhere. And then there is all the other happy horse stuff you are responsible for, as well as the fact that the nature of critical care means every i on every single things has to be dotted and every little t must be crossed, on someone will be on your orifice.

It can be a real pain in the orifice working in a busy critical care unit. You can get burned by others or burned out,b/c of patient acuity in no time.

Maybe it's not so bad working in a little community intensive care unit or CCU; but most of my experiences have been in major centers. Many nurses move through the units b/c they get their year or so of experience and move into other areas.

I applaud the OP for taking a stand, but I will also say, depending on the type of hospital and even regional area you work in, it does not necessarily get any better--especially now, while hospitals have pulled back from taking on the ideal number of hirings of better staffing.

If you work in a really good open heart unit that cares about outcomes and so forth, it can be a little better--it just all depends.

[Guest343211]

I've heard this is becoming standard practices in many ICU's, to push for 3 even 4 patients instead of 2 patients. Money is totally the bottom line these days, nothing else seems to matter to the "corp" hospital admin! The dept managers get a nice bonus if they keep the budget down so that's what motivates this penny pinching crap!

Too freaking true. Also, though, we got 3 and sometimes 4 ICU patients in many ICU. The difference was that we used to be able to fight it with pushing the acuity issue. Again, accuity somehow does not get calculated in like it used to.