This is why I am an anxious wreck...

Piglet08 · Jan 19, 2012

Hell, I'd be a nervous wreck, too. I've worked places where I felt safe, and places I didn't. Whether what you describe is "nursing as we know it", I can't answer. But I wouldn't have been in this career as long as I have if I'd had to stay someplace like you're describing. Maybe I've just been lucky.

anotherone, BSN, RN · Jan 19, 2012

I have had shifts just like this. It only helps when staffing is based on acuity. Primary nursing is so much better because of this. If it was primary nursing it would be more difficult to justify one nurse getting 3 fresh post ops but management can cover it up with " there is an lpn to help you. " Nothing will change unless the whole thing is restructured.

nursemike, ASN, RN · Jan 19, 2012

I've had some nights, lately, when I've felt I had more than I could manage. It seems to me that a shift as bad as you describe as a rare (once every year or two) emergency, or a string like I've been having of bad (but not as bad as that) shifts, might be tolerable. But a place where you pretty regularly feel circumstances are unsafe probably won't be a lot worse off with one less RN.

anotherone, BSN, RN · Jan 19, 2012

You are not over reacting. No one wants to be labeled as an incompetent nurse etc so these consitions continue. Things improved slightly on my unit when pretty much the whole staff revolted. when it was just one or two complaining things kept getting worse and worse. eventually most of the staff left and those who stayed went to top nursing and medical managment about unsafe staffing etc. If this was a one night fluke vs a constant thing makes a big difference.

CathyRN06 · Jan 19, 2012

I'll tell you what I would do. You work with the nurse who has the transfer and inform her of WHEN you can take the patient. You're right, you are responsible and if you can't give safe patient care then you can't accept that patient at that time. You are allowed to schedule and prioritize care so that the essential assessments get done in a timely manner for these patients. Sorry that your supervisor didn't answer your page - have you talked to your manager about it? The more you tolerate it, the worse it becomes.

By the way, you can do this in a spirit of cooperation, "what's best for the patient" kind of attitude. Tact goes a long way especially if this is not the norm in your hospital. Think of it this way: if you had refused the patient at that time, your supervisor might have made an appearance to your unit! :)

I'm assuming here that it isn't the norm in your hospital and I ran into that once. When we first started "scheduling" our transfers and admissions, there was a bit of an attitude from other units. Eventually they respected us and it did become the norm in the hospital. It's part of professionalism and perhaps you'll have to be the one to start it in your hospital.

gorjos · Jan 19, 2012

Cathy, you are right. That is not the norm where I work. I should have not accepted, though I am not sure they wouldn't have sent the patient anyway. Just going by what I have witnessed. Experience is a cruel teacher sometimes. Unique situation, but not unique in that I was left to dry when I needed help. Hence the anxiety.

MomRN0913 · Jan 19, 2012

I'll tell you what I would do. You work with the nurse who has the transfer and inform her of WHEN you can take the patient. You're right, you are responsible and if you can't give safe patient care then you can't accept that patient at that time. You are allowed to schedule and prioritize care so that the essential assessments get done in a timely manner for these patients. Sorry that your supervisor didn't answer your page - have you talked to your manager about it? The more you tolerate it, the worse it becomes.
By the way, you can do this in a spirit of cooperation, "what's best for the patient" kind of attitude. Tact goes a long way especially if this is not the norm in your hospital. Think of it this way: if you had refused the patient at that time, your supervisor might have made an appearance to your unit! :)
I'm assuming here that it isn't the norm in your hospital and I ran into that once. When we first started "scheduling" our transfers and admissions, there was a bit of an attitude from other units. Eventually they respected us and it did become the norm in the hospital. It's part of professionalism and perhaps you'll have to be the one to start it in your hospital.

Totally agreed. Do not take all the patients within minutes of eachother. They can hold on while you get each one admitted and settled.

A little assertiveness with out being b!tchy can go a long way,

changeofpaceRN · Jan 19, 2012

I can't imagine how you felt but I can certainly understand your anxiety. I was in a situation like that a few times too. I came to the realization that it is MY license on the line and I don't play around with people's lives. If you are not getting the support you need from your workplace, consider your options. I considered mine and went into case management. Now, I'm a manager and work from HOME. Now, I LOVE nursing whereas before I was going to quit and never go back.

Before I switched jobs, I couldn't sleep, I would cry before my shift, get into fights with my husband because I was so bitter, angry and anxious. It wasn't fair to myself, my kids or anyone else. It was the best decision I ever made. Perhaps a different unit would be good for you.

nurse2shop4 · Jan 19, 2012

I can feel the anxiety building up in me when I read this. It is so typical to have days like this on the m.s. floor. I found out a long time ago that as a nurse we have to specialize in some specialty nursing to get true job satisfaction. Trust me it is not over-reacting on your part at all. :nurse: :heartbeat

ayla2004, ASN, RN · Jan 19, 2012

Ive hadsomany shifts latley were i'm treding water trying to get from handover to handover without anything bad happnening to my patients. I know that only some prioty care is getitng given. However my who ward feels liek it too much. I work a neuro surgical ward(floor) have 7-9 patients with trachey, Log=roll, EVD. fresh from threare of stepdown from critical care.

it is mad and unsafe and i cope as best as i could.

we hada ward meeting yesterdya were everyone said it was unsafe and out ward mamager will take a staff nurses workload to see how it feels. maybe we will get 2 nurses per patient team then.

We now have hourly rounding 4P, with asking the patient if we can get them anything and letitng them knwo we will be back.. msot staf canot do this as we don't have time we try to enure they are ok and have everything so that they are comfortable.

CathyRN06 · Jan 19, 2012

If they do send the patient anyway, then you write an incident report if the relationships have deteriorated that far. Usually there is a space on the incident report for explanation and you can explain your rationale, putting the patients needs over yours in your explanation. Words fail me here but I think you get the jist.

Eventually the "norm" will change but you may have to be the one to initiate it, and also the one that takes the crap for it in the beginning. Just be professional, listen patiently to their tantrum and tell them you don't like it either but that's the way it has to be on your end. Tactfully and patiently is the key here. Expect it because it's going to happen but know that you'll be giving the best care that you can and remember it's your responsibility to act as patient advocate.

Also, I was thinking - regarding the 20mg of morphine given. PACU rarely keeps them over an hour and if that patient were going to ICU or step down, that dose would be acceptable but to send a patient to a med-surg floor after given that much in such a short time is not kosher. Just because it's on the protocol list does not mean it should be given taking into consideration where the pt. would be transfered to. Of course respiratory depression would happen. I'm not saying the patient didn't need it, just that the transfer should have been to another unit for monitoring even for a few hours.

There are different acuity levels in hospitals - one ICU or step-down isn't like another. Some ICU's in rural or community hospitals would be equal to a step-down(or even med-surg) in a trauma 1 center. Yet we become accostomed to a 1:2 or 1:3 ratio when in fact, it isn't necessary. Therefore, the nurses resist. I've been there also so can understand.

Mind you, it might take 6 months to 12 but the sooner you change things, the sooner you won't feel this way at the end of the shift.

One last thought - I'm not advocating refusing patients just because you are busy or.....just because. You're still running your butt off but you're following the protocol for new surgical patients. You could also start keeping track of the time it takes you to do each of these tasks for these patients and then ask management where the extra man hours are coming from....again, hard to put into words but hope you understand what I'm trying to say.

All of this is based on safe patient care - remember that. It's not how the nurses are feeling so stressed (which you definitely would be) or that you're running your butt off (and you are) because in their eyes, that's what you're suppose to be doing. All explanations have to relate to safe patient care.

Kapish?

Don't feel bad though about that shift. Sounds like you handled it fantastically. Sometimes we don't know the alternatives open to us and this is one good reason this board is so important.

Just one more thought - do you ever get direct admits? That is one admit you can't "schedule" for lack of a better word at the moment. ER nurses (who I was) always keep the unknown in mind - what would happen if you had one (a direct admit) at the same time? Happens and there is nothing you can do about it at the time because they're coming regardless. Would have been even more of a disaster and another reason to be assertive and an advocate.

Good luck to you