Urgent Advice Needed

[CRV]

I need some advice. I'm a new LVN grad with just 6 mths experience in telemetry/medsurg hospital floor in Texas (12 hr day shift). Last week I

was assigned a total of 6 patients of which 1 was going through alcohol withdrawal

symptoms, 2 were total care and another was very disoriented & out of touch. At the start of my shift the 1st pt managed to get out of 4 pt restraints and tried to leave the building approx 6 times. To make a long story short, this guy was restrained a total of 3 times by 3 nurses and each time managed to get loose. A posey vest was used on the last attempt but it failed as well. Well this pt was so disruptive (despite q 2 hr sedation meds given) that the management and nurses were all over the place trying to get this guy back in his room This pt took up all of my time and everyone was aware of it. This pt was supposed to have been transferred to PCU where he could be watched closely but wasn't d/t no beds available. The mgmt already had knowledge that this pt had been combative and troublesome. Well needless to say I had my hands full. I was overwhelmed and everyone knew it. I worked a 12 hr shift, never sat down, ate or had a drink of water. Management handled the situation poorly. They did not care about the safety of pt's, staff or me. This pt created havoc throughout the hospital. I am so upset that things were handled so badly by mgmt. They left it up to me to deal with the problem. To make matters worse the charge nurse decided to add a new admit to my already heavy load. I no longer want to work for this place. All of mgmt was aware of the situation but did nothing to help resolve it. I'm afraid that by complaining they may find it best to keep it quiet and find a way to get rid of me. I am just starting out and need them as a reference. What should I do? Who do I voice my complaints to? What is the chain of command. Is there a nursing assoc or regulating agency that can guide me thru this situation? Please need your advice. Thank you in advance.

CRV

[walk6miles]

It comes down to one basic premise: SAFETY - SAFETY - SAFETY!!!

Yours, the patient's and the patients in the surrounding area.

I would go up the chain of command - alll at once - then, find another position and leave!

Places like that have patient deaths, patients leave and roam around in traffic, occasionally a patient dies within the premises. They NEVER change because it boils down to that almighty DOLLAR!!

Save yourself grief and heart ache - RUN!

Best wishes and prayers for you!

[TazziRN, RN]

Your state BON may be able to answer your questions.

Let me ask you something: do you really want to use as a reference a facility that lets you put your license at risk?

[maolin]

What a nightmare! In hindsight, I would have invoked safe harbor when the weight of the assignment became clear, and especially when given an admit. That would have demanded the attention of your CoC and your license would have been under protection should the unthinkable happen and harm came to any of your 6-7 pts. It unfortunate to have the need for such a law, but a small comfort that Texas nurses have the protection with Safe Harbor.

http://www.bne.state.tx.us/practice/safe.html

I hope you have a few days off to rest and recover after a shift like that. Good luck to you!

[Daytonite, BSN, RN]

i have to tell you that i worked on a stepdown unit where we often had an assignment of similar patients where each rn/lpn team had 10 patients assigned to care for. so, the situation you described was not sounding unusual at all to me. i'm wondering a lot of things after reading your post because i don't think you've told the entire story. first off, you are asking for urgent advice, yet this incident happened a week ago! what's happened in the last week that suddenly made this an urgent situation?

as i was re-reading your post, one thing was standing out to me. you are constantly mentioning that "management" knew what was going on, that they handled the situation poorly, they did not care about your safety and "management" did nothing to help resolve your situation. yet, no where do you mention that you did anything to inform "management" of your situation. i was a supervisor and manager for many years. i didn't necessarily know what difficult situation was going on with each individual staff nurse who was on duty unless it was brought to my attention or i made rounds and inquired from each staff nurse how their shift was going.

so, i have some questions for you. just who are you referring to as "management"? a charge nurse, team leader, unit manager, supervisor? did you inform the "management" that you felt like you were drowning and needed help? no where in your post do you mention that you were ever given any kind of response to a request for help which is another reason that makes me wonder if you asked for help. assuming your "management" was aware of what was happening with you, they have the ability to assess the overall situation of everyone on the unit and get you some help if that is feasible. but, they have to be aware of the problem first. did you say nothing and just continue to try to keep up with the situation? you can't assume that the people around you knew you were upset, overwhelmed and needed help. you have to tell them. i'll grant you that it would be nice if someone had come up to you and said "can i help you with something?" i'm wondering why coworkers would leave you to flounder as you have described. were they having their own difficulties with their assigned patients as well? sometimes when coworkers are also busy with their own patient problems they are not particularly astute as to what might be going on with others around them.

honestly, the way you describe the situation doesn't sound like "management" knew what was going on at all. when you say "this patient took up all of my time and everyone was aware of it" and "they left it up to me to deal with the problem" makes me think that your people thought you were handling things as best you could.

i think that before you do anything that you need to get more information and facts about what was happening on the unit. i would talk to the nurse manager about this first. tell your side of the what happened. let him/her investigate the situation. be prepared to listen to what you are being told because the manager is looking at the larger situation. i think it would be inappropriate to contact the state board of nursing about this.

you are angry and upset right now. i have to tell you that we had shifts that went like yours on our stepdown from time to time. i also worked on a unit that had 4 alcohol detox beds. patients who are detoxing and having dts are very time consuming. their confusion and disruptive behavior can come on within minutes. this makes it hard to assess staffing needs. a detox patient can be docile one minute and an hour later turn into a raging bull. had i been in your situation, getting no help from coworkers (you didn't mention anyone offered to help you nor that you asked) i would have been bugging the charge nurse or my unit manager, or whatever manager was covering the unit if the manager was absent, and asking for help. i would have kept calling all the way to the nursing office if i had to until somebody came to explain why that wasn't going to happen. i have to tell you that having been a supervisor, had i assessed the situation and felt you needed assistance, i would have started looking at the rest of the hospital nursing staff and if i had to, would have started sending nurses from various units for an hour at a time to specifically sit with your detox patient. but, that is how i would have handled it.

something else that you probably don't want to hear is just my own opinion based upon having worked for over 5 years on a very busy stepdown unit myself. these units are not appropriate as a first job for new grads. they require a nurse to have very good skills in organization and prioritizing. new grads just don't have that skill and it takes more than 6 months to develop them. yet some facilities are short staffed on telemetry and stepdown units and they will take on any warm body that agrees to work it. these units claim a lot of casualties among the new grad group. you might have to ask yourself if this is the kind of organization that you are working for.