Tension with Management

[NeuroNurse101]

I've been working on a Neuro/ tele step down unit for almost nine months now and I cannot take it anymore. When I was first hired, I informed the director of my goals and how I wanted ICU and she was completely on board, said I would be evaluated in six months. Unfortunately, that director left and now we have a new one, who could careless about my goals.

When I was on orientation, I met a CRNA who said I could shadow her, I went to the OR director, she agreed and said that I only need an okay from my director and that it would have to be on my days off, which I was completely fine with. I reached out to my director multiple times and ways (email, notes on her desk, voicemail) and no response, then I finally saw her. I work nights so it was difficult to run into her but I did and told her I have been contacting her in regards of the shadowing. She said she knows and that she thinks I need more experience first. I said to her, I need more experience to shadow? And she said yes, I need more time.

I used to constantly remind my manager of how I want to be in ICU... I don't mention it at all anymore. I feel so trapped, I can't help but cry as I'm typing this. Working on this floor has been difficult.

Every time I'm called in the office, I know its because I did something wrong, I never get a good job. All of the ICU nurses that come to my floor keep telling that I'm the best hire and would be a great ICU nurse, the charge nurses on my floor tell me that too. My manager said to me that her and the director were considering me for ICU but that was months ago and clearly a lie because they just hired a bunch of new ICU nurses.

My manager has called me into her office, accusing me of having a potential drug problem because pharmacy said that I've been pulling and returning too many narcotics, but nothing was missing and the count is still accurate...

Last month, my manager and director had a scapegoat meeting with me, trying to blame me for a patient's death. The patient should've been in ICU, not on the floor and I followed the facility's protocol and informed the charge, nursing supervisor, and doctor. No one did anything, so what was I supposed to do? But they wanted me to do a presentation on what happened at a staff meeting. I sent an email stating that I would not because it is unprofessional.

Last week, my manager told me to either present or get written up.

I spoke with union representatives and fellow coworkers regarding the matter. Everyone is stunned and doesn't really know what to do because they've never heard of such things happening but it is, to me.

Ever since I started working here, I've been having anxiety, panic attacks and chest pain. My doctor put me on Xanax because it was getting so bad... I also started seeing a therapist. I'm so paranoid going to work, thinking something is going to happen and I'm going to get in trouble.

Sorry for the lengthy background.

TL;DR... I applied to PACU, CVOR, MICU and CVICU at my facility. I've been working on a neuro/ tele step down unit for nine months. I'm on a two year contract. In order for my applications to go through, I have to complete a transfer form, which requires my manager's approval.

There is already so much tension, I don't want to rock the boat further but I also can't take it anymore. I'm the youngest nurse in my hospital and it feels like management treats me this way because I am young, my charge nurse and colleagues agreed.

What should I do?

Thank you all in advance.

[Ruby Vee, BSN]

You've only been working in your present job for nine months. A year is probably the minimum for a new nurse to transfer to ICU. There is no reason why the ICU would want to hire a new grad with only nine months of experience. Perhaps they were considering you for ICU and were waiting for you to have a full year of experience first. Perhaps you were being considered for the ICU, but the ICU passed on you because you had been pestering your manager about wanting to work in the ICU instead of concentrating on learning everything you can in your current job.

I suspect that management isn't "mistreating" you because you're the youngest nurse in your hospital (how would you even KNOW that?) but because you are demonstrably immature. You've demonstrated a failure to take any responsibility for your part in a patient's death -- no one is perfect and there is ALWAYS something we can learn from a bad patient outcome. Even after forty years at the bedside, one can learn something new. You've been insubordinate in refusing to do the presentation. You've demonstrated poor judgement in removing and replacing narcotics from the Pyxis. Are you not fully evaluating your patient's pain before pulling narcotics?

From your manager's perspective, she needs to staff her unit. She doesn't really care that your goal is the ICU or that you think you should be in the ICU already. I'm fairly certain that no one promised you an ICU job after six months -- they only promised you that you'd get an evaluation feedback after six months. I doubt anyone lied to you about that. You're supposedly an adult now -- doing a good job is what you're supposed to do. Adults don't usually get a whole lot of "attaboys" for just doing their jobs. They get called into the office when they aren't doing a good job. That's just the normal course of business.

Anxiety, panic attacks and chest pain are not normal. Please check into some counseling and learn to manage your emotions. If you think ICU is going to be less stressful than neuro stepdown, you are very mistaken.

[NeuroNurse101]

To be honest, you seem like you need counseling. You are just spewing negativity, not constructive criticism. And if you actually read, I am in therapy. I was recognized at my hospital as being the youngest RN, that's how I know. I learned protocol and the patient's death didn't regard me, the nurse practitioner admitted the patient shouldn't of been on the floor and also stated I did a good job and my part.

Please, get your own emotions together and seek counsel before you decide to comment and spread your unnecessary negativity, says a lot about you. Good luck.

[Castiela]

So you probably aren't going to like my post either. Here are my thoughts reading your post, I've made a new line for each paragraph as my tablet won't let me copy and paste.

*I agree with Ruby. Evaluation for ICU is not a job offer/ guarantee you will be offered a position for ICU in 6 mos

*Its a common train of thought that nurses should have a couple of years experience before becoming a CRNA/NP. I get your enthusiasm, and I get that it is your free time. However my I kind of agree with your director, you are learning to become a nurse. It's important to develop your fundamentals and my impression is that your director wanted you to direct your energies there.

*depending on how frequent/ the content of your emails, I could see how your director could get annoyed with you trying to push for ICU

*are you getting called into the office for mistakes often? What kind of mistakes? I rarely see my manager much less get a good job from them. I suspect I am not alone on this relationship with my managers. If you are getting called into the office frequently for mistakes, wouldn't it make sense that the director/ manager is hesitant to advance you to ICU? It's always nice to hear from coworkers/ ICU nurses that you'd be a great nurse in ICU, but can you honestly say you would be? They only see a part of your practice. I Imaging your manager/ educator are more aware of your weaknesses? Who knows, maybe they were considering you for ICU but your mistakes made them want to give you more time to consolidate

*i can't really comment much about the narcotics. There are ways to divert while still having an accurate count. I'm not accusing you of this. I believe they track the number of narcotics each user takes out and compares it to what the majority of the other nurses have taken out each month. I don't know how your hospital works,

*i also wasn't present when your manager talked to you about this patients death. I know sometimes our hospital takes events like this and turns them into a learning situation. Maybe your manager wanted you to do it as you were the closest to the situation and could identify holes in the system? Generally, our educator leads this/ makes a presentation. Without knowing how your conversations went, I can't make a judgment if this was to embarrass you or to learn from it. I wouldn't say it is unprofessional to make you do this, just not really in your job description.

*im glad you are seeing a therapist. Anxiety attacks are terrible. Transferring units may be the best thing. However, are you sure critical care is the right place for you right now? How would your anxiety be caring for two unstable vents? Are your foundational nursing skills strong enough to work in an environment where your patients can decompensate?

I recognize I have a slight cultural bias. Only nurses with 1.5-2 years are considered for critical care, and only after a 10 month advanced certification in critical care with a 2 month bedside practicum in my province. I understand things are different in the states

I would just give the transfer form to your manager, explain you don't think you're a good fit for the unit, but not expect to be transferred into the critical care areas.

[Penelope_Pitstop, BSN, RN]

Constructive criticism and positive reinforcement are not the same thing. People tend to confuse the two, but "good job" is not constructive criticism.

You aren't going to be pulled into the office for positive reinforcement, so my suggestion is abiding by "no news is good news" in regards to interactions with management. If I were you, I'd put my pride aside and ask how to improve regarding my present job before even considering finding a new one.

[NeuroNurse101]

I don't dislike your comment actually, you are not being completely biased and are giving me a different perspective. Thank you for your response. I am anxious because of where I am working, not because of the unit. Every time I go to ICU, where I know the staff, I feel comfortable and like I belong.

The floor just feels like a mad house, patients jumping out of bed, ringing for pain medicine non stop and yelling, and when you have five, six or seven patients like this 8 of 10 times it becomes tiring.

Reading your post, I realize my performance has gone down because I'm not happy where I am. Management, the patient population, the lack of staffing with sometimes just me and one nurse with six patients each and no patient care associate, on my floor there is basically all total care patients.

Three friends are new grads and were hired straight into ICU and getting paid more. And I am in this state where the mindset is where on the floor first then you'll be promoted, when critical care thinking and the floor thought process are completely different.

The presentation on the patient as a whole is against HIPAA, which is unprofessional. A general presentation would be acceptable, not a patient-specific.

The first time I was called in was because they were trying to keep me on day shift when I applied and was hired for nights. "My orientation was extended," with no preceptor. Management called me on a weekend, at home at 9pm and spoke to me for over an hour trying to discourage me from nights and ultimately said she would think about putting me on nights... Thats where it all begin. It conflicted so much with my schooling, my other job, my life and I was being dodged.

After having gone to great lengths to get the night shift I was supposed to be on, management seemed to call me for ridiculous reasons. I was shown the document of when I pulled the narcotic, it was for one patient, one night that had a bunch of pain medications to choose from and decided she didn't want this particular one anymore so I returned it and gave her a different one. It was not a pattern, so imagine being called in and accused of having a drug problem for that?

Ruby Vee's post and yours are not in the least the same. Her's was judgemental and rude, didn't even attempt to answer the question. Seems like she was just having a bad day and wanted to vent by attacking someone.

[NeuroNurse101]

Where do you see pride? I'm curious.

[Ruby Vee, BSN]

Ruby Vee's post and yours are not in the least the same. Her's was judgemental and rude, didn't even attempt to answer the question. Seems like she was just having a bad day and wanted to vent by attacking someone.

I am sorry you felt that way. I put a good bit of thought into addressing your concerns and trying to explain why things might be going the way they are. I put some time into typing out a response. I was trying to help. I'm sorry you don't see it that way.

[bsyrn, ASN, RN]

Wow....Ruby gives a lot of good advice to people. Just by reading your responses, I see why you might be having issues at work.

[llg, PhD, RN]

The presentation on the patient as a whole is against HIPAA, which is unprofessional. A general presentation would be acceptable, not a patient-specific.

You're totally wrong here. Case presentations are a commonly used teaching method and considered an essential part of health care education. They do not violate HIPAA if done correctly.

[brandy1017, ASN, RN]

Hear me out and please read my whole post. While it doesn't look like your manager has any intention of letting you transfer to ICU at this time, the fact that you are being called into the office may also show that you are not ready for ICU yet. If you need xanax now on a step-down unit, that may also be a sign that you are not ready for ICU. It is even more stressful there because you are all that is between your patients and heaven sometimes!

The presentation about the patient death is pretty routine. I don't think it is meant to blame you more as a debriefing to analyze what happened and how to prevent it in the future. Most hospitals have emergency response teams that you are able to call to intervene when a patient is taking a turn for the worse. In an ideal situation they would have done so and transferred the patient to ICU. Unfortunately that is not always the case either because the Dr doesn't want to transfer the patient to ICU because they will have to come in and see the patient, but more commonly because they either don't have open beds or enough ICU nurses to take the patient.

As for the narcotics, this too is something to be aware of. I know it doesn't make sense to accuse you of drug use. Be aware most places can drug test you for "suspicion" and some hospitals have a drug free rule where you may not work if you take narcotics or other controlled substances like xanax. If that is the case it would be in the policy. It is unfair, but a fact of life that because some nurses divert narcotics we are watched like a hawk. The pharmacists or their computers per se analyze each nurse against others for pulling narcotics and controlled substances. If that history seems high in comparison to the average they may start an investigation to determine if that nurse might be diverting drugs. It's sad to have to worry about being targeted because you give the pain meds when people need them, but it is the life of a nurse these days. Don't pull a narcotic until a patient asks for one, always do a witnessed waste, always do a pain reassessment. Red flags that will trigger an investigation include pulling a larger than average number of narcotics, not witnessing wastes, not doing pain reassessments, and giving out another nurses pain meds. In fact, it was the ADU that caught a favorite nurse who'd been thru cancer and was diverting pain meds. We were all shocked!

I think you made a mistake letting everyone know your goal is ICU. Also I think you are in too much of hurry. You need to slow down, learn all you can and prove yourself. Think seriously about if ICU will really make you happy. It comes across as you have an almost irrational belief that you can't be happy until you are in ICU.

I imagine you feel pangs of jealously that new grad friends were chosen for ICU but you weren't. This is totally understandable, but I really think they are not doing the new grads any favor by starting them off in ICU! Where I work people are given the chance to switch to step down if they either don't like ICU or can't cut it at the time. Some who failed in ICU eventually tried again elsewhere after more experience and were successful at another hospital. Some decided it wasn't really for them. From what you've said I'm not sure ICU is for you, at least not at this time.

Definitely, go to the presentation about the patient death and don't take it personally. It is common practice and not an indictment against you. Speak up that your concern for the need for ICU was blocked and defend yourself. If you charted every action you took you should be in the clear as far as that goes.

I agree that 6 patients and no CNA is poor staffing and understand your frustration on your unit. I hope that is the exception and not routine. Since you have a union can you file an unsafe staffing form when they leave you like that?

Good luck and best wishes in your nursing journey!

[NeuroNurse101]

Thank you for your response!