Stressed Out!

[AWanderingMinstral]

I finally reached my boiling point today after one year as a registered nurse and, as a result, I need to vent.

I received my six-month evaluation earlier in the week and, after being praised for my maturity and organizational skills as well as receiving a 3% increase, I was asked about a particular "incident" which occurred the night before. A urology patient had adequate urinary output from 3-11p, but had very little from 11p-7a. My experience has been that output from a catheter is less viscous than that from a nephrostomy tube. As a result, while I suspected a clot, I waited until the resident rounded on the patient at 630a before it was addressed. Please keep in mind that of our two nursing assistants, only one draws blood. So, instead of having her draw 21 labs, I volunteered to empty my drains, record their respective outputs, and draw my own blood (with nine patients). So, I discovered the minimal urinary output at 515a. I opted to wait until the doctors rounded at 630a to address the issue. The resident and medical student used a piston syringe to dislodge any clot and the catheter quickly filled with 400 cc of urine. Instead of leaving their new orders - a normal saline bolus and a STAT lab - for the next shift, I completed both at 7a (when most nurses are sitting and waiting for the next shift). Well, the resident either told my unit director or the attending and I was reprimanded for not trying to dislodge the clot. This left a sour taste in my mouth.

The following day, I had a patient receiving intravenous fluids with sodium bicarbonate. I called the pharmacy at 6a for a new bag because I had about one hour left at the current rate. With nine patients (again!), I got wrapped up in other things and the patient only had about 50 cc in his bag when the primary nurse care coordinator bellowed that he needed more fluids. Because I have no respect for this individual, I was already on edge. I explained to him that I ordered a new bag, but it had not yet arrived. If he was so concerned about the patient's well-being, shouldn't HE have decreased the rate when he went into the patient's room? So, I called the pharmacy a second time and decreased the patient's rate to 30 cc. I explained everything to the oncoming nurse and all was well.

After much thought, I e-mailed my unit director and expressed my concern that she (more than anyone else) would consider me incompetent and disorganized. While she reassured me that she didn't consider me incompetent, she DID tell me not to be so paranoid. I was slightly insulted by her comment, but I let it go.

Finally, on my fourth 12-hour nights shift in a row, I received the ninth patient again. One of those patients received blood during the daylight shift and, as a result would need, at the very least, a hemoglobin and hematocrit drawn. Unfortunately, the nurse who hung the blood didn't order it. So, I did at 4a yesterday and attempted to draw the blood from her double lumen PICC. After flushing each lumen and trying four times on each, I had no success. I made the oncoming nurse aware of that in report. The same individual who gave me grief about the intravenous fluid asked why she didn't have her labs drawn and asked if I check a patient's chart to see which labs they are ordered. I explained that I entered the order and couldn't get a blood return and the patient refused a regular venipuncture. I curtly reminded him that it is the responsibility of either the doctor or the nurse hanging the blood to enter an order for a repeat complete blood count. This escalated in front of my unit director and several nurses.

Shortly thereafter, my boss approached me and asked that I, in the near future, be the "bigger person" and approach the primary nurse care coordinator. I am tired of being the "bigger person." In addition, two of the nurses that the unit director holds in very high esteem have made mistakes this week and they never hear about it. One of them left 15 mg of oxycodone for a patient on his bedside table and charted them as given at 430p. Well, the nursing assistant pulled me into that patient's room at 8p last night and they were sitting in a cup on the patient's bedside table. Isn't that nursing 101? Oh, he's been a nurse for five years. Another nurse is very disorganized and, while she told me two days ago that patients received pain medications at/around 6p, none of their medications were charted (for three patients!). So, did they or did they NOT receive their narcotics?

My emotions got the best of me and, as I explained that I'm tired of being singled out for things while other seasoned nurses are making mistakes too, I started to cry. I STARTED TO CRY! I told her that I couldn't talk anymore and I left.

I strongly dislike nursing. It is often a thankless career path. The stress and level of responsibility and liability are NOT commensurate with the salary. I have a sincere interest in helping people (as evidenced by my time in the Peace Corps and willingness to persevere through nursing school). However, I have had enough. The public is rude and I am now ALL about the money. I will only work as a bedside nurse for the highest bidder until I complete graduate school. I don't know how some of you have done this for decades. God bless you!

[RN1982]

Well...I have to disagree about the nephro tube. I know it sucks to be reprimanded but I would have still tried to dislodge the clot and if I couldn't unclog the tube, I would have called the doc right away. Not over an hour later. I think there could have been some serious implications if it had stayed clogged any longer.

But from your post, my impression is that you become a bit defensive when someone asks you why something wasn't done. There isn't any reason to be snippy. They were snippy with you, but you could have been the bigger person if you remained calm, composed and professional.

I have to ask, when you were in nursing school, what did you think it would be like when you graduated? You need not worry about what your co-workers do, focus on you and your patients.

[TheCommuter, BSN, RN]

(((((Hugs.))))) :icon_hug:

[RN1982]

I know its frustrating but I think the first year out of school is always the worst because you are just really trying to find yourself as a nurse. Perhaps med/surg or whatever floor you work on is not for you? Perhaps you need a change of scenery like transfer to ER or ICU?

[AWanderingMinstral]

Well...I have to disagree about the nephro tube. I know it sucks to be reprimanded but I would have still tried to dislodge the clot and if I couldn't unclog the tube, I would have called the doc right away. Not over an hour later. I think there could have been some serious implications if it had stayed clogged any longer.

But from your post, my impression is that you become a bit defensive when someone asks you why something wasn't done. There isn't any reason to be snippy. They were snippy with you, but you could have been the bigger person if you remained calm, composed and professional.

I have to ask, when you were in nursing school, what did you think it would be like when you graduated? You need not worry about what your co-workers do, focus on you and your patients.

Since I have left work, I have gained some perspective on the situation. I'm sure I could have done more for the urology patient. I tried my best at the time and that's that. That's all I can ask of myself. I learned SOMETHING from all three situations.

As for nursing school, I honestly didn't know WHAT I was in for. My only real taste came in the last eight weeks when I was completing my transition course. In all honesty, I am using nursing as a foundation for a career in public health. There IS a light at the end of the tunnel!

Thank you for the dose of tough love! :)

[RN1982]

I had to do it. Trust me when I say, I've been where you were before. You can not always be the "perfect" nurse. You have good days, you have bad days. Some days you just scratch your head and say "what the heck just happened", which was my day today. After a while, things come together, you're more organized, a bit more confident. It will get better.

[AWanderingMinstral]

I know its frustrating but I think the first year out of school is always the worst because you are just really trying to find yourself as a nurse. Perhaps med/surg or whatever floor you work on is not for you? Perhaps you need a change of scenery like transfer to ER or ICU?

I would like to try the ED, but I'm afraid of all the type A personalities. I don't aspire to be the big fish in the small pond and I'm not Flo N.

[Scrubby]

After my first year I had a meltdown for similar reasons, seasoned nurses being allowed to get away with murder and newbies treated like dirt and constantly criticised. The mistakes we make are constantly pointed out to us, yet we are rarely praised or even acknowledged when we do a good job.

Unfortunately in nursing you do need to develop a thick skin. Most of the time isn't fair, nurses are NOT treated equally and there is a lot of hypocrisy and some managers have their favourites.

Glad you are much happier now. Good luck to you!

[RN1982]

You should try it. You could get a hold of the ER manager and just say that you'd like to shadow a day in the ER to see what its like there.

[AWanderingMinstral]

After my first year I had a meltdown for similar reasons, seasoned nurses being allowed to get away with murder and newbies treated like dirt and constantly criticised. The mistakes we make are constantly pointed out to us, yet we are rarely praised or even acknowledged when we do a good job.

Unfortunately in nursing you do need to develop a thick skin. Most of the time isn't fair, nurses are NOT treated equally and there is a lot of hypocrisy and some managers have their favourites.

Glad you are much happier now. Good luck to you!

I'm (sort of) embarrassed that I started crying and I'm not sure what it will be like when I return on Tuesday night. I don't respect my unit director and some of my colleagues, but I am always professional. In the words of my unit director, [you] don't have to be friends with your co-workers. Thanks for the advice! You folks are great!

[Proud 2b Me]

I just need to get the opinnion of others; I currently work for a home care agency I have been with my patient for about 6 years. I was a LVN until I recently went back to school and got my RN. My mistake was staying in home care too long. I am having a hard time finding work as a new grad RN and all of the programs here in California that I know of are full and highly competetive. Well, the agency I work for has no opportuities for me as an RN. I asked them if they are willing to pay me an increase in salary while I am still there since I am now a RN and I was told "only If would agreed to stay on the case I am on" , which is out of the question because I really need to utilize my new

skills. I am really angry about this because there is a RN that also works this case with me and he is paid RN salary and they plan to fill my position with an RN so I really don't understand this. I have never called in sick and have been loyal . I was told the would consider small increase but they don't want to do the paperwork if I am going to leave--- but they will do it when they get a new hire:cool: I feel like I have been slapped in the face when I should be really happy to have my RN- I was looking to get some reconition you know, some experience, salary increase If I could quit and just walk away I would or should I? :typing it seems so unfair!!!!!

[RN1982]

I just need to get the opinnion of others; I currently work for a home care agency I have been with my patient for about 6 years. I was a LVN until I recently went back to school and got my RN. My mistake was staying in home care too long. I am having a hard time finding work as a new grad RN and all of the programs here in California that I know of are full and highly competetive. Well, the agency I work for has no opportuities for me as an RN. I asked them if they are willing to pay me an increase in salary while I am still there since I am now a RN and I was told "only If would agreed to stay on the case I am on" , which is out of the question because I really need to utilize my new

skills. I am really angry about this because there is a RN that also works this case with me and he is paid RN salary and they plan to fill my position with an RN so I really don't understand this. I have never called in sick and have been loyal . I was told the would consider small increase but they don't want to do the paperwork if I am going to leave--- but they will do it when they get a new hire:cool: I feel like I have been slapped in the face when I should be really happy to have my RN- I was looking to get some reconition you know, some experience, salary increase If I could quit and just walk away I would or should I? :typing it seems so unfair!!!!!

I suggest looking at the hospitals in your area to see if they offer any "nurse residency" programs or internships. I agree that you need to find somewhere to practice your skills and it won't be with the one case you have. It doesn't seem like the agency is doing anything to try to keep you so I would start looking for a new job if I were you.