Too Sensitive?

[jserrano]

Hi,

My job has been really stressful lately and there have been multiple times within the last few months that I have cried at work! Actually literaly cried at the desk! I am a charge nurse in labor and delivery at a fast growing hospital(but we are relatively small for our area doing just under 200 births a month). We have recently gotten a new director who is trying to make changes for the better. But I feel our unit is more overworked than most labor and delivery units. To try to keep up with the growth they have hired a lot of new nurses(some straight out of nursing school) and had an internship program for them. But since most of our night staff is new I am one of the "older" more experienced labor nurses there which means I have to be the charge nurse almost every shift.( I have 6 years L&D experience.) I feel so stressed out with all these new nurses and the constant pressure to "staff down". And I am so embarrased to be crying at the desk! (anyone have any good ideas on how to tough up and not cry like a freak at the desk, thanks) Just wondering how many patients you typically have each in L&D and how you split up the patients, etc. Right now we are expected to do 2 laboring patients, or one laboring patient and see evals(we do not have a seperate antepartum unit or triage unit) If possible all the nurses should have 2 patients each, (which can be very difficult when it comes time to push with a primip, because everyone is so busy there is no one to watch your other patient during your delivery) There are times when we bring in all these elective inductions to make the dr's happy even though it takes all the rooms and max's out all the nurses. (heaven forbid someone should actually go into spontanous labor) More frequent than not lately when busy I will have 3 patients and be charging with no one to call in to help. The charge nurse is expected to take a full assignment and do staffing, deal with complaints and help the new nurses. We used to do one to one patient care with an unmedicated pt, or a patient on magnesium, or during pushing and delivery, but now that seems to never happen. What are you thoughts on this, should I consider another hospital? I hate to loose my senority and start over but my job is so not as fun as it used to be. I am a hard worker but this kind of overload is breaking me down!

[babyktchr, BSN, RN]

What you describe, sadly, is probably more like what goes on in a majority of the hospitals across the country. I know in my little neck of the woods (100 births/mo) we get into some pretty sticky situations where there are way more patients than there are nurses. I am lucky in that my direct supervisors are great about finding help with no questions asked. My hosptial supervisors however do not share the enthusiasm. Many times I am told "there is no one to come and help you". ARGH!!!

AWHONN has clearly defined staffing ratios. Perhaps your management needs to be reminded of them. When I am in a jam, and out of standard, I am sure to "write it up", for tracking with risk management. That way if there is a problem, then there is at least documentation that staffing was no adequate (and administration was aware)

You are not alone in your frustration honey. Many many times I have wanted to scream in the middle of the unit if one more patient shows up leaking fluid. Perhaps a chat with your director...share your concerns..ventilate a bit. Maybe she will hear your frustration. If not, then maybe consider a move if things don't improve. Its hard to work when you are miserable.

Good luck to you.

[Soup Turtle]

I actually make myself cry at home sometimes just to get all the bad feelings out. When I do this, it's a lot easier to stay composed at work or anywhere else I have to be composed. It does sound like you have it rough. I hope things get better or you find a happier place to be.

[NurseNora, BSN, RN]

Bach's Flower "Rescue Remedy" comes in a spray bottle that looks like breath spray. Some people find it helpful although there is absolutely no scientific basis for it. Found in health food stores.

I kept telling my Director that I didn't want to be in charge all the time and there was always talk about orienting some other nurses to charge, but it didn't happen until I had a nervous breakdown and had to take a 3 month leave of absence. So, as usual, no one got oriented to charge, they just got charge experience. At least I now get a break once in a while because there are now those other nurses who have experience. (By the way, the breakdown was not job related, although the job stress didn't help)

babyktchr's suggestion about AWHONN standards is a good one. Document it whenever you go over (yes, it's more work you don't have time to do, but it's one of the few things that may help you). Send it to your director, with a copy to Risk Management, every time you exceed standards.

In an area as busy as yours sounds, the charge nurse should not have a patient load so that she can be free to do triage of new patients, relieve staff for breaks (I can hear you all now--Breaks? What breaks? We never get breaks! But your state labor department has rules about that and you are legally guaranteed them, at least sometimes.), be the second NRP person in a delivery, watch a nurse's other patient while she's assisting with an epidural (1:1 is the standard) or pushing with a patient (also 1:1 standard).

Good luck

[deehaverrn]

That sounds soo much like my hospital, its scary that its happening all over. The thing is that despite what they might try to portray to the public, the bottom line is money! And if they can do it with less staff they will. Don't be fooled into thinking that the hospital cares about the patients or the nurses!

After almost 20 years of being one of the charge nurses, I told my manager that I simply couldn't do it anymore. I mean, I never got any credit when we somehow managed to pull through on shifts that were woefully understaffed. But when anyone had a complaint, my manager was right on my tail! When I had four triage patients and all the labor staff was 1:1 with their pts., I asked two of them to cover each others deliveries (they were both experience RNS), they reported to the manager that I didn't help them..this was despite the fact that I had no break no meal and was baby nurse for 4 other deliveries that day in addition to my own assignment and being charge. Then another day, I was in tears myself after being harassed by a physician because her elective induction was still in triage. She wanted to know why I hadn't called her off if we didn't have a bed..despite the fact that I start at 6'30, and the pt had arrived at 6:45 so the night chg. would have had to do so...as well as anticipate that this person who was scheduled for ripening would be dilated enough to start pitocin, and that so many people would arrive in spontaneous labor, AND that we would have two admits from high risk that needed to be dellivered!! Every room was full, including three post partum rooms that we had converted for labor, moving those moms to our overflow unit. I had no more beds or staff, all of us were working as hard as possible, and I had staff (who wanted breaks and meals), doctors (who wanted their pitocin started yesterday) and patients (who didn't like having to stay in triage with its small room) all giving me grief and the supervisor wanting me to take med-surg overflow on my high risk floor.

At my place, when you are in charge , it is of triage, labor and delivery (including the OR and PACU areas), postpartum, newborn nursery, and highrisk ob floor. Its crazy..and for all that (sometimes 90 pts in a shift), you get paid 75 cents extra an hour...I decided that the stress was not worth it, and it was the best decision I ever made in nursing.

Unfortunately, now that I've blown out my back, I wish that I had changed jobs completely. I have 20+ years here though which means a lot of seniority, and now that my back is shot, i'm not sure i'd be marketable anyway. My advice to newer people is to change professions...seriously. Because being in constant pain is just not worth it. So if you have the chance ..change. If you really want to stay in nursing, move to an area thats not as stressful ( i always tell my husband that he will outlive me cuz this stress will surely cause some problems as I get older). Even since I hurt my back, he says that he can see how my face has changed, with lines at corner of my eyes, between my brows, and slight frown lines under my mouth. A year ago, I had none so I don't think its just age, pain ages you..I really can't emphasize enough, that it surely has not been worth it.

[jserrano]

wow, (deehavern)you do sound like you are in the same boat as me! I think I might have written you before about your back? What kind of back injury do you have? I had a microscopic discectomy-(for a ruptured disc L4-L5) the best decision of my life, and have been pain free since-ran 2 miles today!!!!

Anyway we had this big staff meeting at work(the first in 6 months) and then a charge nurse meeting(which I didn't get to attend since i was working that night and in charge) but I did break into the meeting to talk to my boss and present a case study(my current problem of the evening)! It was great to show all the charge nurses in the room the whinning I usually have to put up with and all the issues i was having already! Anyway thanks for everyone's comments, it saddens me that you all know what I am going through but also makes me feel better that there are some people who can understand this stress!!!!