Walk or stay and try to help "fix" the unit?

[RunninOnCoffee]

Our family just moved due to my husband's job. I have just spent a year working in a great ICU down south and then I walk into the doors of the ICU at my new hospital. This place is an utter train wreck! Management has changed hands at least 7 times in 5 years. There are no standing protocols for oh just about anything. Diprivan or pressors are not even kept on the floor, nor are controlled drips in lock boxes when hung in pt's rooms. I have seen 2, yes 2 lines labeled and dated my whole two weeks of orientation. The list just goes on. The manager told me when getting hired it was in a transition pd and she was working on improving it, but I had no idea it was this bad. Part of me doesn't want to continue the problem by just leaving, but on the other hand this place is a hot mess. They do have L&D positions across town posted which is really what I went to school wanting to do, but I really do love critical care too. I have given the manager my opinion on a lot of things that I think need to be worked on in a very nice way, but I don't know if any of it will actually happen. I am just very frustrated and very disappointed.

[nurseprnRN, BSN, RN]

If your manager tells you this is a transition time, she acknowledges she needs help. Take that as a vote of confidence, esp as she knows you came from a great unit.

For starters, how about writing to your old manager and asking for copies of some of the most important policies and procedures and protocols you used there? Show them to your new manager and ask if these would be helpful. Talk is helpful, but she's overwhelmed too, and having something in hard copy in her hand will be helpful to her, because otherwise somebody (read: she) will have to write them or research them de novo. She might even like to call your old manager for some pointers. Especially if she's new at this job, she needs support too.

Get together with your unit educator, if there is such a thing, and the unit manager, and put together a plan. If there isn't one, see if your manager will let you do some of that role. This could be a great opportunity for all concerned.

[RunninOnCoffee]

I have actually started working on getting some of those. I have already sent an email to one of the companies that we used about some supplies I think would be very useful and have a few articles on sepsis bundles saved on my computer to email her later. Unfortunately we have no critical care educator or PCC's. Our charge nurse takes a full load of patients also so there is kind of a vacuum of leadership. We have a unit director which manages 2 ICU's. When I spoke with her, rather than making complaints I made suggestions on what we could do to improve the unit. Some things I know are far out of my control, but part of me does want to at least make improvements where I can. I looked into the educator position but it requires a BSN, 5 years of ICU experience and already passing the CCRN. All completely understandable but none of which I have completed.

[nurseprnRN, BSN, RN]

Excellent. OK, so you can still give little presentations at change of shift report and help orient new people. Saying, "What can I do to help with this process?" will be well-received, especially if you can identify at least one other RN on the unit to do it with you. Baby steps.

[KelRN215, BSN, RN]

You have a manager who acknowledges things need "fixing" which is different than a lot of places. I have been in the position you describe... and for a LONG time, I was convinced I needed to stay to try to make things better. When I would speak with my manager about the issues I saw, her response was often "if you feel this way, why don't you leave?" and my response was always "If everyone who saw the issues and cared enough to speak out just left, that will only compound the problem." Unfortunately, I worked for an institution that believed itself to be perfect and didn't think it had any problems that needed fixing so TPTB were never receptive to anyone's suggestions for things that needed to change. After several years of realizing it was impossible to change their "we do things this way because this is the way we've always done them" attitude, I put my walking boots on and haven't looked back.

[tyvin, BSN, RN]

Apply to the L&D position across town...that is what you want isn't it? True, there is a sinking ship and could give steer them in the right direction, but didn't you want L&D? Apply across town and if you get a position give your 4 wk notice and start doing what your hearts really into to.

You owe them nothing; don't stay out of guilt.