Wanting to Quit my Covid-19 job

londonflo · Jul 28, 2020

On 7/28/2020 at 5:41 AM, Bbang said:
Only 1 tech for a 32bed floor and each nurse regularly takes 6-7 patients.

On 7/28/2020 at 5:41 AM, Bbang said:
house super pulled 2 of our nurses leaving us with all nurses with under 8mths experience (our team leader had the most experience with 8mths). We ended up having 15 admissions from the ED and it was such a hell night.

Maybe I didn't catch this right but you started out with 17 patients? and then 15 were admitted with Covid? I can understand why the 2 nurses were rescheduled since you had a little over half of your census. Was there any talk of pending ED admissions? But did you call the Supervisor when 15 more came? How was it decided who would take which patient?

It sounds like a horrible night. You may need to check the plans with the charge nurse when RNs get reassigned or try to refuse an ED patient. I once overheard an RN do a great job with explaining why the unit could not take another patient from the Admission RN. I do think nursing students should have some content on "negotiating" with bed placement whether they can take an new admit at the time.

On 7/28/2020 at 5:41 AM, Bbang said:
And I still feel new so a lot of these I labs I don't know the significance of and I don't have enough time to sit down and learn the importance of them.

I may get grief from this but additional learning can be on your own time. Plan on labs for your CEUs. Starting getting a list together of topics you want to focus on.

fawnmarie, ASN · Jul 29, 2020

Thank you for doing what you do! I hope it gets better. I wish I had something more valuable to add. I'm a psych RN and I think you're amazing to do the job that you do, with only 1 tech for 32 patients and not enough nurses. Keep your chin up, stay strong!?

RuralNurse · Jul 29, 2020

This time is really difficult for so many healthcare workers. We are being bombarded on every side, stressed to our max and overwhelmed. We feel like we are not doing enough. Keep your chin up. One of the best pieces of advice I was given was take it one step at a time. Use the prioritization skills they taught you in school. Focus on one task at a time, work quickly and effectively to tackle that task then move on to the next. Keep something with you that you can jot down notes for charting later. Our ER nurse will put a piece of tape from her knee to her hip and keep notes when things are crazy.( this won’t necessarily work while in Covid gear) Let yourself cry. When you cry it releases endorphins. Don’t try to keep everything bottled up, it will only make your stress build. Be honest with yourself, your coworkers and the house supervisor when you are struggling and need help or you can’t take any more patients at the moment. Where I work we assign patients based on acuity. We all take turns with admits. To avoid one nurse getting several admits while the others haven’t admitted any. On night shift we pull together and tackle the admit, each taking a certain part (meds, initial interview, ect) to lessen the load.
Right now I doubt there is a single healthcare worker that isn’t overwhelmed and struggling to fight against Covid. Just remember we are in this together. You’ve got this.

Bbang · Jul 29, 2020

On 7/28/2020 at 1:29 PM, londonflo said:
Maybe I didn't catch this right but you started out with 17 patients? and then 15 were admitted with Covid? I can understand why the 2 nurses were rescheduled since you had a little over half of your census. Was there any talk of pending ED admissions? But did you call the Supervisor when 15 more came? How was it decided who would take which patient?
It sounds like a horrible night. You may need to check the plans with the charge nurse when RNs get reassigned or try to refuse an ED patient. I once overheard an RN do a great job with explaining why the unit could not take another patient from the Admission RN. I do think nursing students should have some content on "negotiating" with bed placement whether they can take an new admit at the time.
I may get grief from this but additional learning can be on your own time. Plan on labs for your CEUs. Starting getting a list together of topics you want to focus on.

This was this particular charge nurse's first time being charge and with only 8mths experience she felt like she didn't know what she was doing. Can't blame her, I would feel the same way. She tried to deny the supervisor when they took our second nurse, but there's only so much you can do. She honestly just started crying when supervisor called and one the nurses with 5mths experience offered to go so it wouldn't be a big deal.

It's difficult because it feels like we don't have any staff, and when we do it's all new people, so we're all learning.

Regarding to educating off the clock with labs, normally I would agree and your point is valid, but it is hard to be motivated to learn outside of work when work is kicking your butt every shift.

londonflo · Jul 29, 2020

36 minutes ago, Bbang said:
This was this particular charge nurse's first time being charge and with only 8mths experience she felt like she didn't know what she was doing. Can't blame her, I would feel the same way. She tried to deny the supervisor when they took our second nurse, but there's only so much you can do

I wasn't criticizing you. Your job is plenty tough. I just was trying to wrap my head around the 15 admissions. Nobody could handle that well! Sounds like choices that overloaded your unit were made.

Quote
one the nurses with 5mths experience offered to go so it wouldn't be a big deal.

So glad for team spirit.

JKL33 · Jul 29, 2020

So, this is completely rotten. And some aspects of it are not completely new/"because covid." Covid has made for some unprecedented stressors, but as long as I've been a nurse the solution has always involved rationing nursing care and spreading nurses as thin as possible despite schools on every corner cranking out nurses at top speed.

First, I am sorry this is how it is.

18 hours ago, londonflo said:
Maybe I didn't catch this right but you started out with 17 patients? and then 15 were admitted with Covid? I can understand why the 2 nurses were rescheduled since you had a little over half of your census.

Not even worth it to go there. First, the OP says they were also transferring patients off all night which surely freed up some of the beds to get more admissions. But more importantly, even if they did begin the shift with 17 patients, it was well known how many potential admits were waiting in the ED, it can easily be assumed that more are coming and it was known what the general shift was going to look like. How about giving this group of newer nurses some breathing room to get the 17 settled and taken care of so that they could spend the rest of the shift doing all this patient shuffling at top speed instead of cutting them off at the knees right from the get-go?

This is one of those practices that may seem more necessary right now, but the root of it is definitely not because covid. It is the spine of the nursing admin playbook.

***

Anyway...back to you, OP. What to do. Two ways I would evaluate the situation:

1) Actual patient harm: Are bad things happening. Not how you feel or what you're afraid of, but is this resulting in patient harms that must never happen. Try not to think in terms of ideals and try not to think along the lines "it shouldn't be this way." We all know it shouldn't. We'd all like to spend adequate time with patients, we'd all like to feel comfortable and good about what we've done when we leave. Put put that on the back burner for now and go into get-by mode. Your measuring stick is different. If patients are being harmed with regard to important stuff (not just they had to wait 10 minutes for someone to answer their call light), then you have to make a decision about leaving.

2) Abuse: Are you nurses being criticized, written up, talked to, threatened....over how you are getting by in this scenario? If your professional reputation is being marred, they are filling up your files with BS write-ups or constantly criticizing what you do to get by after they leave you completely stranded, that's another excellent reason to leave.

Other than that, learn what you can. You will come out stronger even if you don't have time to read all your charts as would be ideal.

7 hours ago, RuralNurse said:
One of the best pieces of advice I was given was take it one step at a time. Use the prioritization skills they taught you in school. Focus on one task at a time, work quickly and effectively to tackle that task then move on to the next.

This is exactly it. Prioritize as you were taught. If you have 10 things that need to be done and feel completely overwhelmed, simply look at your list and go to the thing that should be done first to avoid patient harm. Get it done and move on.

Don't be hard on yourself, this is NOT your doing.

I think you can do it. Put your shoulders back and your chin up, move quickly, stay positive, and get it done. Wherever the chips fall, you will have done all you could do. The results of others' decision-making are NOT your weight to bear.

? Good luck!

Susie2310 · Jul 29, 2020

On 7/29/2020 at 7:49 AM, JKL33 said:
If patients are being harmed with regard to important stuff (not just they had to wait 10 minutes for someone to answer their call light), then you have to make a decision about leaving.

I wanted to respond to this because I have a family member who would have died if the staff hadn't immediately responded to their call light. They were very recently post-op, and somehow managed to get themself into a position where they couldn't breathe, and were unable to move to reposition themself. I had only just left their bedside when this happened, and had made sure to place the call light right next to them within their reach, and had reminded them that it was there and how to use it. Thankfully they did this, and were able to utter the words: "Help, I can't breathe." Fortunately the staff responded immediately, and several staff members ran into their room to help. My family member was badly shaken up by this event.

Answering call lights immediately is extremely important. It is very important that everyone who is working with patients is aware of this. The patient may be unable to breathe, as in the case of my family member, or may be having chest pain, or another serious problem. One can never assume that a patient is not calling due to a life threatening problem. The call bell is the patient's lifeline.

macawake, MSN · Jul 29, 2020

On 7/29/2020 at 8:23 AM, Susie2310 said:
I wanted to respond to this because I have a family member who would have died if the staff hadn't immediately responded to their call light. They were very recently post-op, and somehow managed to get themself into a position where they couldn't breathe, and were unable to move to reposition themself. I had only just left their bedside when this happened, and had made sure to place the call light right next to them within their reach, and had reminded them that it was there and how to use it. Thankfully they did this, and were able to utter the words: "Help, I can't breathe." Fortunately the staff responded immediately, and several staff members ran into their room to help. My family member was badly shaken up by this event.
Answering call lights immediately is extremely important. It is very important that everyone who is working with patients is aware of this. The patient may be unable to breathe, as in the case of my family member, or may be having chest pain, or another serious problem. One can never assume that a patient is not calling due to a life threatening problem. The call bell is the patient's lifeline.

I think that JKL33’s advice is spot on ??

I’m pretty confident that both JKL and OP realize the importance of the patient’s call bell.

Being able to respond to every call literally within seconds requires adequate staffing. Going by OP’s account, that doesn’t seem to be the case on her floor.

Susie, your family member who was very recently post-op belonged on a higher acuity/better staffed floor than the one OP is describing. I’m sure that OP and her coworkers are doing the best they can with the resources they’ve been given, but a floor staffed with four nurses where the most senior one has eight months experience (is this total nursing experience or floor/specialty experience OP?), doesn’t sound very safe.

While it would definitely be ideal to be able to respond within seconds to every patient call, how do you suggest that four nurses and one aide manage that with fifteen admissions and who knows how many transfers/discharges, and still manage to get anything else done?

From what I’ve seen, you often write posts from the patient’s perspective or from the perspective of a patient’s family member. I understand the concern you feel. I, like most of us, have also had loved ones hospitalized. But do you have any actual advice for OP to make it easier for her to be an effective and safe nurse in circumstances that quite frankly to me, sound far from optimal.

JKL’s advice is helpful. OP is understandably overwhelmed. No wonder, since the floor appears to be staffed by new/recent grads with less than one year experience each. OP needs advice on how to prioritize in this situation. It’s a situation that management has created.

When JKL asked if ”actual patient harm” has occurred, I’m sure that would also include a scenario where a patient with acute respiratory distress had had their call unanswered and deteriorated as a result of that.

OP, it sounds like a rough shift. It would likely have been tough even for nurses with many years of experience but they’d at least would have had time honing their prioritization skills and perhaps found it easier to see the ”big picture”.

As far as learning off the clock, I can understand if it’s diffucult to find motivation when you feel exhausted and not supported by management. But the learning isn’t for management. It’s really to make you more confident and skilled as a nurse, and it benefits both your patients and you as our job tends to get both easier in the sense that you experience less negative stress (have more tools available in your nursing tool box) and oftentimes more mentally stimulating with further knowledge and understanding.

In order to find the energy to do anything after long and taxing shifts, I have always relied on exercise and sometimes just slow walks through nature, or just sitting down and contemplating the beauty of a sunrise. Find a way to de-stress that works for you, then perhaps you’ll find the energy to tackle more studying.

Take care!

TPowellRN · Jul 29, 2020

Excellent advice and appreciate your awesome support for this young nurse.

JKL33 · Jul 30, 2020

Mea culpa; my whole point down the drain I guess. Immediately answering call lights is extremely important. Giving a septic patient their antibiotics is extremely important. Giving all patients their medications is extremely important. Starting IVs/PICCs etc. to deliver necessary medications, hydration and nutrients is extremely important. Immediately attending a patient in acute respiratory distress is extremely important. Immediately attending any patient in any kind of acute distress is extremely important. Prudently and methodically performing medication administration rights is extremely important. Providing oral nourishment and hydration to patients is extremely important. Holding pressure on something hemorrhaging is extremely important. Maintaining patient dignity is extremely important. Accurately documenting a patient's care is extremely important. Addressing the concerns of patients and loved ones is extremely important. Preventing patient falls is extremely important. Noticing a change in condition is extremely important. Conveying changes in condition to the patients' providers is extremely important. Reviewing labs/test results and generally being aware of what is going on with a patient, all patients, is extremely important. Accurately conveying information during a care hand-off is extremely important. Assisting with an emergency intervention/procedure is extremely important. Obtaining accurate vital signs and monitoring them is extremely important. Obtaining blood sugars and treating them as necessary is extremely important. Immediately responding to alarms is extremely important. Monitoring for medication effects is extremely important. Making sure your patient isn't pregnant before sending them to x-ray is extremely important. Assisting patients with toileting is extremely important. Turning and repositioning patients and other measures to prevent skin break-down is extremely important. Accurate assessments are extremely important. Providing oral care is extremely important. Responding appropriately to patient agitation or violence is extremely important. Answering the phone is extremely important. Relieving patients' pain is extremely important. Communicating with patients is extremely important.

I'm just getting nicely started with actual extremely important things...and haven't even mentioned any of administration's "emergencies" yet.

And yet, if I had said, "actual patient harm as opposed to not getting their antibiotics on time" someone would've been along to point out how dangerous it could be to not give a septic patient their antibiotics on time. If I had said, "actual patient harm as opposed to not receiving oral care" someone would've been along to say that oral care is incredibly important (VAP, etc). If I had said, "actual harm as opposed to not answering the phone" I would've been reminded that maybe it was lab calling with a bona fide critical.

ALL of these things are very important. And yet, according to the laws of nature, they cannot all be done according to some ideal (no matter how correct or "standard" that ideal is) by a handful of nurses working in the situation described.

Stand up for these inexperienced nurses (***and their patients***) who are left alone on their floor in the situation described because they had some of their last resources for avoiding outright chaos taken away.

I already advised the OP that if bona fide emergencies can't be handled in a timely manner due to administrative decisions, that is a reason to leave the position. That was one of two measures I gave for judging the OP's situation.

macawake, MSN · Jul 30, 2020

On 7/30/2020 at 3:33 PM, JKL33 said:
Mea culpa; my whole point down the drain I guess. Immediately answering call lights is extremely important. Giving a septic patient their antibiotics is extremely important. Giving all patients their medications is extremely important. Starting IVs/PICCs etc. to deliver necessary medications, hydration and nutrients is extremely important. Immediately attending a patient in acute respiratory distress is extremely important. Immediately attending any patient in any kind of acute distress is extremely important. Prudently and methodically performing medication administration rights is extremely important. Providing oral nourishment and hydration to patients is extremely important. Holding pressure on something hemorrhaging is extremely important. Maintaining patient dignity is extremely important. Accurately documenting a patient's care is extremely important. Addressing the concerns of patients and loved ones is extremely important. Preventing patient falls is extremely important. Noticing a change in condition is extremely important. Conveying changes in condition to the patients' providers is extremely important. Reviewing labs/test results and generally being aware of what is going on with a patient, all patients, is extremely important. Accurately conveying information during a care hand-off is extremely important. Assisting with an emergency intervention/procedure is extremely important. Obtaining accurate vital signs and monitoring them is extremely important. Obtaining blood sugars and treating them as necessary is extremely important. Immediately responding to alarms is extremely important. Monitoring for medication effects is extremely important. Making sure your patient isn't pregnant before sending them to x-ray is extremely important. Assisting patients with toileting is extremely important. Turning and repositioning patients and other measures to prevent skin break-down is extremely important. Accurate assessments are extremely important. Providing oral care is extremely important. Responding appropriately to patient agitation or violence is extremely important. Answering the phone is extremely important. Relieving patients' pain is extremely important. Communicating with patients is extremely important.
I'm just getting nicely started with actual extremely important things...and haven't even mentioned any of administration's "emergencies" yet.
And yet, if I had said, "actual patient harm as opposed to not getting their antibiotics on time" someone would've been along to point out how dangerous it could be to not give a septic patient their antibiotics on time. If I had said, "actual patient harm as opposed to not receiving oral care" someone would've been along to say that oral care is incredibly important (VAP, etc). If I had said, "actual harm as opposed to not answering the phone" I would've been reminded that maybe it was lab calling with a bona fide critical.
ALL of these things are very important. And yet, according to the laws of nature, they cannot all be done according to some ideal (no matter how correct or "standard" that ideal is) by a handful of nurses working in the situation described.
Stand up for these inexperienced nurses (***and their patients***) who are left alone on their floor in the situation described because they had some of their last resources for avoiding outright chaos taken away.
I already advised the OP that if bona fide emergencies can't be handled in a timely manner due to administrative decisions, that is a reason to leave the position. That was one of two measures I gave for judging the OP's situation.

WOW!! You’re on fire! Love your post.

All the things you just listed that are a nurse’s responsibility is exactly why I thought your first post was so helpful. It offered tools to make the overwhelming and unmanagable, managable. You also added clear parameters regarding what you would consider an unacceptable situation.

I think we all know that pretty much everything we do for our patients is very important. I wouldn’t be surprised if that knowledge in itself is a major source of stress for a recent grad like OP. I think the last thing she needs is someone pointing out that almost everything we do and everything we miss, has the potential to cause serious harm. She knows. We all do.

It would be great to work at UUMC * where resources are plentiful. But most of us don’t. When you listed all the things a floor nurse is responsible for, it really shows the absurdity of being assigned 7-8 patients, with the workload further increased by a high number of admissions and discharges during the shift. Since this is a Covid/Covid rule out floor, are OP and coworkers donning and doffing between every patient contact? We only have one head, two arms and two legs, we can only be in one place at a time and there are only so many hours in a shift.

( * Utopia & Unicorns Medical Center)

Wanting to Quit my Covid-19 job

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