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!
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!
Don't be embarassed about crying. We've all done it at some point or another.
I can relate to your experience- the constant cutdowns, wear you down, you are human, unfortunately for some reason in nursing folks want to knock you down when you are already there! As for not respecting your NM-been there, trust me just fake it for now-go back apologize for being unprofessional thank her for the corrective action and inquire about how she feels you can better your job performance:bow:. You don't want to tick her off-you need her on your side to transfer or future job reference-it's your first year, just take these negative events as learning experience-and move on to the next challenge, you sound as if you are determined, so just do what you gotta do to get to your career goals:yeah:
RN1982
3,362 Posts
Don't be embarassed about crying. We've all done it at some point or another.