The past week has been awful...Vent

[beautifulb]

I can't remember when work was so bad. It feels like things are just going so wrong that I don't even want to go in anymore. It first started a couple weeks ago, during the night shift, when my CNA (who had 2 pts more than I did) and I had a falling out. I was finding my pts lying in soiled linen, linen damp with sweat, filthy pillow cases (pet peeve), without water, not being repositioned. And she wasn't busy. She had a pile of magazines next to her that she was thumbing through, went out for her cigarettes, gabbing the night away. When pts would want something to drink she would roll her eyes and say "well, I'm going to the bathroom first." Finally at 6am, when I still had a ton of charting to do, I became frustrated and said to her that I was unable to perform all of my nursing duties and do hers too. I was telling her this when another CNA was there in which she said in a tattle-tale voice that she would tell the nurse manager that I didn't like doing pt. care. I was mortified. Here I am busting my butt all night and then at the end of the shift telling me that I am not helping. This is from the CNA that I was not even working with. These 2 CNAs and I have been close, exchanging Christmas presents and seeing eachother outside of work, although it hasn't been that way for the past year. These are CNAs that have been working at this hospital for years and need very little delegation. I was so upset.

About a week later (I am sorry this is so long), it was my turn to float. They told me that I was going to the ICU. I told them that I have never had experience in an ICU, never even stepped into the ICU ~ any ICU. They told me that they are really nice and will give me the most stable pt. I was scared. The nurses that come back from floating from the ICU tell me that they had pts with vents, drips, A-lines ~ all things that I know nothing about. Finally someone said, exasperated, that she would go and basically she stomped off the unit. A few days later, a mass e-mail came out from our nurse manager saying that everyone needs to float, we need to take our turns, and that the charge nurses are not required to float. The e-mail seemed kind of angry and I felt that it was directed at me.

Finally, a couple days ago, I had a terrible shift. My pts weren't really that sick but they had a ton of complaints, about everything. Messages about requests for pain medicine, IV alarms, etc. were not being told to me. Physical Therapists were following me around to other pts rooms telling me that so-and-so had to go to the bathroom, were wet, etc. The med passes were just not ending and just when I thought I could see the end, something else would happen. Nothing that I was doing was right. I was so frustrated and so overwhelmed and finally I just broke down and cried - the whole day.

I feel so defeated. I feel that no matter how hard I try it is just not good enough.

The phone rang this morning and it was the hospital calling me. I am sure it is my nurse manager but it could have been staffing. I haven't checked the message yet, in fact I am dreading to.

[chris_at_lucas_RN, RN]

I'm so sorry!!!! {{{{hugs to you!}}}}

I felt my eyebrows go up a little bit when you mentioned that you basically have two CNA's ganging up on you, and that you had been close with them in the past.

There is a thing in the military where you don't socialize with people outside your "group." Officers don't socialize with NCO's don't socialize with enlisted.

It isn't about being nice or being judgmental.

It is all about discipline. If you are an officer, and you need to give an order to an underling that you socialize with, a) you are going to try to soft pedal it maybe and b) that person may feel very comfortable telling you what he or she thinks about the order.

You cannot have that in a life and death situation in a war zone, for example, and I suspect you are seeing what happens in a hospital setting.

I think you have to have a good relationship with your CNA's, of course, and you need to treat them with respect, but if they aren't doing what they are supposed to, you have to address that as well. If they have an issue, they have an issue.

A thought about ICU. At least you would have had other nurses there. You could let the charge know you were way short on experience, not to get an "easy" patient necessarily, but because you are going to need to depend on the other nurses for help. Usually they are happy enough to have someone there to help with the meds, turns, whatever, and you would have had some experience in ICU.

It doesn't sound like you said "I'm not going." It does sound like the other nurse (the stomper) maybe had some kind of issues and doesn't know how to leave things alone without resentfully fixing it herself. (That's just my take on it, could be waaaaay off.) So that would be her problem.

As to the memo, maybe it was inspired by that event, and maybe it wasn't. In any case, it applies to everybody. Next time, tough as it may be, you might just go there and if you cannot do what you are assigned ask for help--I suspect you'd do that anyway.

As to the CNA's, I think I might do my dressing down in private so you cannot be overheard by the other little twit and risk them ganging up on you. And I think if they display that sort of blatant irresponsibility, it is time to write them up. Skip the chat, make it a formal complaint. You don't have the power to discipline them, but your NM does.

And if they don't like it, there are certainly other jobs out there for them, right?

Meantime, you are having some bad days. Take a little break, do something very nice for yourself, get some hugs from a dependable hug-giver (you don't need any rejection right now, no matter how minimal), and keep on nursing.

I hope this is the worst you will experience. You aren't alone.... you have something like 100,000 of us here, with you.

[rn/writer, RN]

Go check your message and come back and tell us what it was. You came to the right place to get a little TLC. Sounds like you're on the edge of burn-out and that really needs attention.

Have you spoken with your nurse manager? Are you documenting problems so you have a record of the CNA's inadequate care? It's the pits when you find yourself at war with a co-worker, but you can't just look the other way.

Maybe it's time for a change to another unit/facility. Or maybe that's too drastic and there are other, less radical changes that would help you to regain your wits and your perspective.

I hope your message was an okay one.

[Jo Dirt]

You know, I'm a new grad RN and just started in home health. I thought this would be a low stress job (unlike the hospital) but it is turning out ot be a nightmare. They send me out to these houses to do things I'm not comfortable (or competent) enough to do, and when I protest the boss hands me an instruction sheet and tells me how easy it is.

On top of that you still have pi$$y family to deal with and the monotonous tedious details of paperwork.

[rn/writer, RN]

You know, I'm a new grad RN and just started in home health. I thought this would be a low stress job (unlike the hospital) but it is turning out ot be a nightmare. They send me out to these houses to do things I'm not comfortable (or competent) enough to do, and when I protest the boss hands me an instruction sheet and tells me how easy it is.

On top of that you still have pi$$y family to deal with and the monotonous tedious details of paperwork.

Man, oh man. Home health is challenging enough WITH a year or two of experience. I can't imagine going in cold, with no med/surg training under your belt.

You are really taking some big risks by putting yourself in this kind of situation. It might work if you had a super supportive manager who was willing to spend some extra time helping you to get up to speed. But handing you instruction sheets and expecting you to make it all work is foolhardy for HER, even if she isn't too concerned about you.

Seriously, I think this is a dangerous proposition all round. You, the management, and most of all, the patients are dancing at the edge of a cliff.

Please, consider finding another more structured type of job where you can have some time to learn and grow as a new nurse before you put yourself in a position where you need to have experience and on-the-job wisdom to fall back on.

I'm not at all trying to be discouraging. My main concern here is that you worked too hard to get your license to risk it on a job that is not meant for new grads. I'm surprised that your agency hired someone just out of school. It makes me question their agenda and their integrity. You deserve better and so do your patients. The best new grad in the world still needs to learn the ropes before going into such a solitary job.

I hope you will look for something else before you either burn out or run into serious problems.

Please keep us posted.

[beautifulb]

Thank you for your responses. I think you are right, I am on the edge of burnout but I just don't know what to do about it. My job is close by, I have been there for 3 yrs. (which is a long time for me ~ I was a traveler and was never anywhere long), I like the flexibility of the job, and I don't know if I want to leave. I think I just don't know what I want. I am a first time mom to my 11 month old and I am having (still) a hard time adjusting to everything.

Chris, you said some excellent things. I wasn't looking at things in that light.

I got the nerve to check my message. It was staffing wanting me to switch tonight for tomorrow day.

[Antikigirl, ASN, RN]

Oh yes, sounds like a few weeks I have had...except for the ICU part. I am agency, but working for this one hospital...and they know I am not trained for ICU so they won't put me there to float. WHEW!

CNA's...I have worked with so many and absolutely adore them! However, I have had my bad apple CNA's too (and RN's!).

In one case I asked a CNA to get a temp on a pt and she threw a fit! Okay...off to a empty room with her I went and told her "hey, we all are stressed...but I don't want you to be so stressed that you loose your job for not doing something. Please lets just be a team and help eachother. Besides...I really don't want to play the "RN CARD" (slang for being her superior)...when we can just talk about things and get them back on track."

That worked wonders...I made sure I pointed out that it was a stressful day/week, everyone was feeling that...reminded her she could loose her job for not doing her duties...made sure she felt like a human being and a team member...and a little reminder that I was her RN, but still willing to talk to her first and handle things that way.

She and I got along great after that! It doesn't work with everyone...but I was happy it worked for me :).

As far as management, you may want to schedule some time to talk to a administrative nursing staff and explain how you feel and your wish to make things better for both the facility and you! I find if you use key words like 'continuity', 'teamwork', 'facility', 'patient care', 'job satisfaction', 'patient rights', or quote the facilities mission statement and make things very positive...like you really really want to keep working there...things turn out better then you think...and shows you are a proactive nurse on the team for the facility!

Good luck to you!

[mtngrl, ASN, RN]

beautifulb-

You were right to question being floated to ICU. I think that is plain dangerous if you are not familiar with vents and such. I would have said no I am not comfortable with going to ICU and that patient safety should be priority. Sorry you have been having a rough time. Hospitals are good at making nurses cry and burned out. It seems you are really stressed. Maybe you could look and see what other jobs are out there. Don't get stuck in a miserable job....you can't be a happy mom to your child if you are upset from work. Or could you work part-time? Hope things get better!

[TallGirlAni]

I think you are right for not going to the ICU, where you had no experience. In our hospital, the ICU nurses float out, but no one floats in. If you had acccepted the assignment and something went bad, then you would've been blamed for accepting an unsafe assignment. It is important to stick to your guns in this case because you are protecting patient safety, as well as your LICENSE. Don't let anyone bully you or hang YOU out to dry. If your NM wants you to float to ICU, then you should be able to go down to the ICU for an orientation to the unit until you are comfortable accepting "the most stable patient." For all you know, the most stable patient could be on his or her way downhill...fast.

I can already tell by your NM's email that this is a person with poor leadership skills, and do you want to work under someone like that?

As for the CNAs, they are testing you....trying to bully you. I am a new grad, and this happened to me in the past few months where I started my new job. I wrote the ones up who tried to bully me, who were insubordinate, etc. I stood my ground, and two of them would not even look at me as I passed them in the hallway. Eventually, after a few weeks, these CNAs were the ones who became the most useful to me during my shift. Even though we all realized that we weren't friends, we did have to work together, and I was not going to play their games. I have had no trouble since then. Knock on wood. I have learned that there are times that one must be assertive, while not being aggressive. With that being said, I am always appreciative of the help the CNAs give to me, and I treat them as a team member......a very valued team member.

I have had nights like the one you described, in which I just wanted to cry. My list of things to do was growing, and a patient or two started to go downhill. I am lucky to work on a shift and floor in which I could go to the other nurses and let them know what was happening and if they could help me out in getting the work done. Since, I am always asking other nurses if I can help them when I am not as busy, they are very willing to help me in my need. If you do not have this team approach at work, you may want to start by finding a nurse or two that you are working with and start helping each other out. Don't be afraid to ask, I am not. I know when my head feels like it is going under, and that is the time in which I start asking.

If you feel like this is a no-go where you work, then you may want to look for another job. No job is worth the unhappiness and everything that it leads to. If you are a good nurse, then you can make it in many other places. And you will be welcomed and appreciated in most other places you work. Good Luck in your path.

[beautifulb]

Yes, I have been thinking. I may need a new place of employment despite all of the positives of working there. I am going in to work tonight and I am quite sure that I will end up in the NM office before I go home. (Maybe I shouldn't where my bright yellow outfit?) Anyways, I am almost looking forward to going in b/c I can use the advice that you all gave me and I feel strong tonight. We will see how it goes. Thanks for listening.

[ebear, BSN, RN]

Dear beautifulb,

Bless your heart, girl! Many issues here. Be sure to document these events with dates, times and quotes and leave this documentation at home.You are held liable if you accept an assignment that you don't have the skill sets yet to accept. The nursing administrator should be very familiar with this standard. As far as the CNA issue, if you are an RN you are responsible for their patient care or lack thereof. Don't let them intimidate you. It's difficult to address if they've been there forever and think that they are beyond reprimand, but it is an achievable issue. Please look into some assertiveness training courses for nurses. It's very unfortunate that the nurse manager is not a good resource person (apparently) but there is someone above her head if you can't get resolve from her. Follow the chain of command and keep your head up!

ebear