Why would anyone kept doing this?

blondnursey · Jul 15, 2009

so where was averybody else? thats what other staff is for. to help you.

no cna's around to help? other students?

the best advice i ever got about prioritzing was to ask for help BEFORE i was in over my head.

i am all for helping everybody, but not to the point where my job isnt done at the end of the day or a patient isnt safe.

its a team effort. when you have the whole wing, you will also have your support staff. use them. work together.

and i have never ate a new nurse .....:)

catwoman66 · Jul 15, 2009

It is unfortunate that some nurses "eat their young" and that some are codependent. When you get out on your own, hopefully, you will find one that will help you learn. What they are teaching you in nursing school is how to pass your boards; that is all. When you get out in the real world, you have to learn how to actually do your job. It is very frustrating at times with hospitals cutting costs and staff, etc. One of the things to look at when evaluating a potential employer or job is staffing. Do your homework; find out what their average patient load is and how much help you will have (nursing assistants). What is acceptable will vary depending on what area you are working in. For example, in ICU, you would not want to have more than 1-2 patients. On a med/surg floor, I don't think it is safe to have more than 5 patients, although I myself have has as many as 9. I no longer work at that facility. :down: In long term care, the nursing assistant ratio becomes much more important. You will ultimately be the only person protecting your license. Staffing numbers are the key to doing that. In the situation you described with the confused patient, this is what I would have done (not saying you SHOULD have done this...you don't know these things yet, because you are new at this..so that is why I am telling you...this is not criticism at all ), I would have tried to assess WHY the man was confused. Is this senile dementia? Drugs? Stroke in progress? Mental illness? What is going on with him? Then, I would have absolutely made him my number one priority. :up:You are very right; if he had fallen and broken his hip, you would be responsible. I would have a responsibility to keep him from hurting himself. After I determined why he was acting this way, I would call the doctor and ask for medication/sedative to prevent the man from injuring himself. If it was senile dementia, then I would ask if I could give him some ativan. If this was a drug related thing, or alcohol, he needs to be in the psych unit or behavioral health. They will physically restrain him there if need be, or have him one on one with a staff member, so I would ask for an order to send him there. If I had no idea what the cause was, I would simply tell the doctor that the man is going to fall and ask him what HE wants you to do. Then, I would document the new orders and/or response after you document that you did notify the doctor. If you are still stuck in the same situation with no improvement after talking to the doc, I would call the nursing supervisor and tell her what took place. At that point, you as the staff nurse have done all that you can do, and it is now HER responsibility to take the reins. I would also document my conversation with her. Then, I would go and try to catch up on the rest of my work. It is true that you have to set priorities, however, it sounds like you were doing that, but your instructor should have been giving you some guidance on what to do next. Sadly, many experienced nurses shy away from teaching, because the salaries are so much lower. So, some, NOT ALL (no nasty comments from nursing instructors paleeze!), but some nursing instructors have very very little real world nursing experience. Last but not least, once you get out on your own, it will be a rocky year, and then it will get better, and easier, etc. It all amounts to figuring things out and solving problems. That is what you do 90% of the time when something outside of the routine comes up. Why would anyone keep doing this? I do it to get paid. I do once in a while feel like I am making a difference in someone's life and I really like it when that happens, because I like to help people. However, the reason I stay in nursing is because I get paid to be doing it. I know they teach you not to say that in nursing school too. :icon_rollNursing school=fantasy land in more ways than one! Good luck!

neatnurse30 · Jul 15, 2009

You are asking the right questions. One of the nursing students at the end of the first semester quit the school saying: "I'm not the maid ", she was actually smart to realize fast what she was getting into, just few clinicals opened her eyes very quickly. Me and my other friend kept going, even though clinicals were horrible, but we thought that it will be better once we pass the licence. So we passed and got excited and got jobs. Now after 3 yrs or so, my friend had about 3-4 different nursing jobs, hated all of them and quit. She's looking into other jobs. I still work on the floor part time, and don't like it at all. One of my other friends, who is in the last semester of nursing said she never thought you have to work so hard on the floor. I see nurses come and go, changing jobs, hoping for better conditions on another floor or in other hospitals, only to find out, that pretty much everywhere is the same. Only those who work outpatient I know are relatively happy, or case managers who don't have to touch the patients.

I know there will be some nurses answering you, that you just had a bad shift or need to take vacation, and so forth. No, that won't change the things, it is what it is and it will not get better.

You have to decide for yourself what you want to do. If I knew what I know now and had the courage back then, I would quit in the first semester of nursing and not look back.Now I'm looking for non- bedside nursing positions.

classicdame, MSN, EdD · Jul 15, 2009

when you first get the feeling things might be getting out of control, that is the time to ask your instructor how to handle the situation. When you are licensed you will ask the charge nurse. If you do not get help and see an unsafe situation, then follow chain of command. That probably means calling the house supervisor (but facilities differ so you will need to know the policy for that facility). Once you have done the chain of command you have reduced your risk. This does not mean you won't get sued by the family ( who probably refused to come sit with the patient, at least in my experience). But it means you have fulfilled your DUTY and can keep your license. Any facility that consistently allows this type situation should be known as "my former employer".

llg, PhD, RN · Jul 15, 2009

I am almost done with school and having to force myself to finish. Its not the patients. Its not even the administration from what I can see. It is the other nurses.
I don't understand how or why many of you seem to keep blaming each other or putting each other down for workloads that are not manageable. !

Note that you say that it is not the administration's fault. ... You blame the nurses for the fact that they are chronically under-staffed and burned out because of it. That's a glaring example of nurse bashing by someone who says that nurses should not eat each other. It's a great example on how nurses can blame each other and "eat" each other when the real culprit is something/someone else.

Ironic, isn't it? The OP is guilty of one of the very things she is complaining about. It's a great teaching example of why these problems are so hard to solve. The responsbilitly should be placed on the administrators - responsibility for properly staffing the unit and supplying the resources necessary to do the job. Then the staff would not be so burned out and would be in a better position to help the newbie.

ChristyRN2009 · Jul 15, 2009

I'm pretty lucky in that I like my unit but maybe it takes a certain type of person to be truly happy in nursing, and you are not that person. You seem pretty bitter and jaded already, which is so sad to me. So if I were you'd I'd talk to as many nurses as possible in the hospital that you'd like to work in, maybe shadow a few and figure out if you are just having a bad impression from a student side or if you truly just wasted all these years of your life.

And with that patient, I probably would've restrained him, tried to figure out why he was acting that way and worked with the family/physician to get him medically stable and happy enough to come out of the restraints without grave risk to himself.

misplaced1 · Jul 15, 2009

Restraints? You can't just throw restraints on a person any old time you want to anywhere I've ever been. Where do you work?

Patient was medicated for agitation, other staff , superviosr informed of situation etc etc. And no I don't blame the nurses for short staffing. At all. The problem is though that nurses blame each other and are so busy trying to prove they are SUPERnurse by putting you down cause you can't HANDLE it and MANAGE you time better and PRIORITIZE. One person told me you just can't spend all your time on him. So as far as the other comment that I make him my priority, which I did, the only way to keep him from falling was to check on him, a lot. And even then I sweating bullets in between checks.

As far as bitter and jaded, farthest thing from it. Again, this is a problem in nursing I have seen in nursing that in my lifetime I have not seen to this extent in another profession. You voice a legitimate complaint and many of the other nurses yell get out, or your too bitter or whatever else they can come up with to make themselves look like a superior person that can HANDLE it and YOU CAN'T. And you should just take it as the patient needs you etc etc. I just dont see how any of this is in th ebest interests of the patient. From being in a more business oriented profession before I have to tell you that these owners/managers know that the population they are working with here will blame each other and take the fall if anything goes wrong. That is why they know they can continue to get away with this stuff. They have a great set up. They make all the money and have little accountability.

I met a person in nursing school who ended up quitting part way through. He ended up getting an advanced degree in health care management and is now working in hospital administration. When I asked him why he was giving up on nursing he said "because nurses are suckers." At the time I did not agree with him at all. But now I think I know what he was talking about. I don't like being in a profession where people I work for may see me as a "sucker." That makes me mad.

No doubt there may be good places to work. But seems most people have to go through the bad places to get there.

misplaced1 · Jul 15, 2009

catwoman66

I just want to say thank so much for the info of how to handle this without and comments about me being bitter, etc etc. I was upset last night when I wrote that of course.

Thank you for confirming for me that making him my number one priority was the right thing to do because my input from a few of the others students was that I should not have let anything that had to do with him let me ge behind and I differ on that. Proper meds were requested and given, still big problems. Perhaps if this was a real situation and I could have personally called the doc the problem would have been taken care of. But of course I was not. Also, I tried to involves other staff etc to help but this person needed constant supervision that no one had time to give him.

I do have a question though. If I was the real nurse and had called the doc and the doc did nothing about it. Told my supervisor and still nothing was done. Then if he fell would I still be liable? You said in your post that after taking these steps you would go on and do your other work and I suppose check on him as best you could. BUt in order to get your other work done obviously you are not going to be able to check on him enough and sooner or later the chances of him falling would be very high at least in this incidence. Would you still be liable?

sicushells, RN · Jul 15, 2009

Truthfully, you will learn how to better prioritize and time manage. It just one of those things that you need enough experience to learn how to handle. School teaches you "theory", sort of, and real life teaches you how to keep all your patients as happy and safe and medically managed as you can. I think you probably had a great learning day, and sometimes those are painful to go through at the time. You don't sound horribly bitter and burned out to me, and only you can decide whether or not you should be a nurse. You did say that you didn't think restraints would be appropriate in this situation. So, in which situation would they be appropriate? I'm not 100% sure I'd make this patient my number one priority because I don't know what your other patients needed. If the patient next door, for example, was a GI bleeder with a HCT of 19, and a heart rate of 120... well... you'd feel much more guilty for having to call a code than having to get an Xray for your other guy's hip, right? What I'm getting at here is that you can't neglect your other patients just because one is confused and might fall out of bed. That's not to say you should have ignored the problem until you found him on the floor, but there's definately a balance.

misplaced1 · Jul 15, 2009

hi sic u shells and thanks for the response

No this wasn't a patient I was afraid was going to fall out of bed. And this was not a hospital setting it was long term care. There was no maybe he will fall out of bed, he WAS getting up out of bed, taking care to get off his monitoring equipment every time. I discovered him teetering in the center of his room multiple times where I perceive he had gotten stuck trying to cross it. He also also made it to the door outside a couple times.

Its not that I don't think restraints may not be appropriate. It is just that I have not seen them used around here. Most places have no-restraint policies. They may hire a sitter if its bad enough. This person had other issues I do not want to describe here that if I disclosed would make you understand how unstable he was on his feet. I think an person that is very confused and taking off in this condition should not be left alone and I stand by that. Even though I did have to leave him alone to get something done, I don't think it was ok. Not in the unit he was on. Perhaps one could "prioritize" more and leave him alone for longer periods of time and it could be ok but they would certainly be taking a big chance. And if this person fell, in the shape he was in, no doubt he would be hurt badly.

I do appreciate your response. But when even nurses can't accept that you just can't "prioritize" EVERYTHING and EVERY patient and still have things be safe. I don't know how in the world the public could ever understand. Perhaps the issue is just too complicated. Although I do see nurses thinking they should just be able to do it all. I haven't seen other professions like this. Perhaps it is the calling thing or the nurses or angels thing. But the truth is like it or not nurses are just people. They may do and important job but in the end they are not endowed with any super powers, do not have eyes in the back of their heads or the ability to split themselves in half and go in two different directions. Just plain old humans.

And with that I am done thinking about this. As someone said a great great learning experience for me. Got that is the appropriate place in my head now and time to move on to whats happening in the here and now. Thanks for all the great responses, really appreciate it have learned a lot from you.

If anyone else responses I would love to hear your imput but probably wont respond. I am still in school you know so time is really really tight!

nuangel1, BSN, RN · Jul 15, 2009

instead of calling nurses suckers and blaming the nurses for your bad noc.you need to put the blame on the admin and hospital that short staff the floors.i have been a nurse 23 years not a sucker for anyone.