Why do we put up with it? (sorry, longish)

Rabid Badger, BSN, RN · Feb 17, 2007

Okay, so I had kind of a rotten shift the other night. One bad shift wouldn't be so awful if it wasn't for the fact that we had nothing but bad shifts for most of December and January. Then we had a couple of nice weeks, and it seems we are back to unmanageable again. Why do we as nurses, in a field with a huge amount of liability (in a very litigious society), allow this to be the norm?
I was so busy last night (3 - 1130), I did not have time to check my charts until 11pm. Upon doing this, I found 2 med orders that were never taken off. We have been having problems for weeks now with our computer MARs - one time orders that are in our pyxis are not showing up on our to do list on the computer. In the "olden days", I would have had the order transcribed onto a paper MAR by the UC, so I would have seen it. Anyway, this pt had a K+ of 3.0 and was supposed to recieve K-Dur "now" at 1400. He never got it. Then, at 1500, another pt was supposed to get dulcolax suppositories x2 "now". Keep in mind that I am in report until 1530. So I guess that's why I didn't know about the orders till late. I took care of them, but I was pissed. What if that had been something important? Another nurse I work with said that, if it was something important, I would probably have known about it, but maybe not. And the nurse I followed must just not have seen the orders, because she is usally very good.
The main reason that I was so busy was my little houdini. She was in a posey and bilat wrist restarints, and she screamed bloody murder all night long. She managed to get out of the restraints at least once and hour, and even though the ANM could hear her, and knew that I was drowning, she would not go into that room. I flat out said, "I'm dying here." She said, "so is everyone else." Yeah, that's a good way to deal with the situation. I repeatedly asked for a siiter. I had given this little tiny lady 4 of haldol IM, seroquel, 2 prn doses of zyprexa, and a mg of ativan per PEG. It didn't touch her! But she did wear herself out...she was starting to nod off about 2345 - 15 minutes after I was supposed to be gone.
Are your hospitals like this? Where you have to take pt loads that you can't handle alone, or you have nobody to help you, or you constantly stay late every day (most of the time I am finished on time, but I have to wait for the next shift to get out of report)? I work for a good hospital. We keep winning all kinds of awards. It's insane. We aren't union, and it all feels very hopeless right now. I'm sure I'll get over it, but I still think that bad shifts should be the exception, not the norm. I didn't get my BSN to be constantly worried that I don't have enough time to provide adequate care to my patients, and be run off my feet and miserable every night. It jsut feels like there is nothing I can do about it! I like my job! I like my pts! I like (most of) my coworkers! I just feel that we are all being abused by the system now, and it doesn't feel like it's going to get any better.
Aaaaahhhhhhh okay, vent over!

I'm union, I think it makes a big difference. That being said, I have exactly those hell shifts too. Our ward is difficult to staff and we get many sick calls. Management seems to work in complete opposition to the staff, in pushing more and more complex patients onto a tighter staff ratio.

I personally don't put up with it. A few things I do to cope:

1) incident reports, tons of them

2) reports to the union

3) written (recorded) complaints to management

4) ensuring your unit manager and charge nurse are aware of your unreasonable assignment and that you require help. Ensure that you are making it loud and clear that you feel that the situation is unsafe.

5) we still work by the old system, transcribing our orders by paper, often ourself, on top of the busy assignment. MAKE A HABIT OF CHECKING YOUR ORDERS EVERY TIME YOU WALK BY THEM, even if they are not flagged. I walk past the charts/med room every few minutes, and I am anal retentive about checking my charts to ensure nothing is missed. My patients are far too sick for an order to go missed for four hours.

6) Chart chart chart

7) resign if nothing else works. Nothing speaks louder than your staff leaving in droves.

Remember, you can't expect others to advocate for you. You must advocate for yourself and advocate on behalf of your patients. It is your responsibility. If that order is missed and something happens to the patient, you are responsible, unless you take documented steps outlining your concerns and measures.

And if you think you don't have time for documenting this stuff, realize that it MUST BE DONE. Nothing else will save your a$$.

Rabid Badger, BSN, RN · Feb 17, 2007

This is the way nursing is because it is a predominately female occupation and we 'care giver' moms won't ever stand up for ourselves. God forbid our little patients should be left unattended while we organize and get better conditions for all. And god forbid we should actually stand behind and support those few souls who are gutsy enough to put it on the line and start the process for organization. WE DO IT TO OURSELVES, LADIES!!!!

LOL, I'm the loudmouth gutsy one on the ward. I have noooo problem calling out the medical team and managment etc. I consider it a necessity for advocating for your patients.

Calgon-take.me.away · Feb 17, 2007

You only had 6 patients???I work in a LTC, all 3-11 shiftand have 25 patients to myself every night. In additiion, we have noone to answer the phones, talk to the families, take care of pharmacy when they come in, feed at least 2 patients each, round with the MD's IF they come in, take all our own orders, write them, notify pharmacy and EACH family for any and all med changes, even if it is a Tylenol order. We too have our share of patients that sundown as soon as the dinner trays are picked up. Each CNA has 14-20 patients to do PM care for. I have to supervise 5 CNA's who by the way, work their tails off. I have IV atb'S to run, line dressings to do, lines to flush. Then we have the patients that decide they are going to be combative. We do not have the "advantage" of hitting them with the Ativan, Seroquel, Haldol that you all have access to. We have a no restraint policy in place, so the only thing we have here available is putting them up in a tray geri chair and dragging them with me as I do my med pass. But, I have been doing this all my nursing years and would not do anything else. You seriously hit them with all those meds?? iS there not a policy about chemical restraints?

Hoozdo, ADN · Feb 17, 2007

You only had 6 patients???I work in a LTC, all 3-11 shiftand have 25 patients to myself every night. In additiion, we have noone to answer the phones, talk to the families, take care of pharmacy when they come in, feed at least 2 patients each, round with the MD's IF they come in, take all our own orders, write them, notify pharmacy and EACH family for any and all med changes, even if it is a Tylenol order. We too have our share of patients that sundown as soon as the dinner trays are picked up. Each CNA has 14-20 patients to do PM care for. I have to supervise 5 CNA's who by the way, work their tails off. I have IV atb'S to run, line dressings to do, lines to flush. Then we have the patients that decide they are going to be combative. We do not have the "advantage" of hitting them with the Ativan, Seroquel, Haldol that you all have access to. We have a no restraint policy in place, so the only thing we have here available is putting them up in a tray geri chair and dragging them with me as I do my med pass. But, I have been doing this all my nursing years and would not do anything else. You seriously hit them with all those meds?? iS there not a policy about chemical restraints?

Why would you not do anything else? What do you do if you have two geri chairs to take with you while you pass meds?

Rabid Badger, BSN, RN · Feb 17, 2007

You only had 6 patients???I work in a LTC, all 3-11 shiftand have 25 patients to myself every night. In additiion, we have noone to answer the phones, talk to the families, take care of pharmacy when they come in, feed at least 2 patients each, round with the MD's IF they come in, take all our own orders, write them, notify pharmacy and EACH family for any and all med changes, even if it is a Tylenol order. We too have our share of patients that sundown as soon as the dinner trays are picked up. Each CNA has 14-20 patients to do PM care for. I have to supervise 5 CNA's who by the way, work their tails off. I have IV atb'S to run, line dressings to do, lines to flush. Then we have the patients that decide they are going to be combative. We do not have the "advantage" of hitting them with the Ativan, Seroquel, Haldol that you all have access to. We have a no restraint policy in place, so the only thing we have here available is putting them up in a tray geri chair and dragging them with me as I do my med pass. But, I have been doing this all my nursing years and would not do anything else. You seriously hit them with all those meds?? iS there not a policy about chemical restraints?

Wow.

Are you kidding? You seriously cannot compare 6 high acuity medicine patients to LTC patients. There is a reason you have half a ward to yourself. Same reason rehab patients have such a low ratio. Because there is considerably less to do!

And yes we do chemically restrain, and physically. Next time you have a 30 yo year old 250 lb male who is HIV pos, Hep C pos spitting blood in your face and kicking 3 staff and 4 security guards, threatening to kill you, while you have another patient bleeding out 3 litres in 5 minutes in the next bed, ask me again if its ethical to restrain.

Seriously, come work on an acute ward for a while before you start spouting such remarks. *eyeroll*

CseMgr1, ASN, RN · Feb 17, 2007

computers usually cause as much work as they save us. but that's a matter for another thread.

when i turned in my hand-written expense report on thursday, my manager rejected it, insisting that it "had" to be redone on the computer...even though the instructions on the form stated to "type or print". it took me six hours to redo it, because of a "glitch" in the applications program which would not allow me to enter the numbers correctly. neither her or the director seemed to care that i had other work to do...they wanted it done now. it was only after the director realized the problem was with the computer program (and not me), that he finally intervened and kept fiddling with it until it finally took my numbers and correctly printed the information that they wanted. all this over nine lousy dollars which i wound up owing the department. :angryfire

TigerGalLE, BSN, RN · Feb 17, 2007

haha... Thank you Rabid... Not to say that you don't work hard in the LTC facility because I KNOW you do. I was a tech where i would have 18 patients on the same floor I work on now... The acuity is very high and I would work my butt off... SO being a nurse on this floor and having 6-7 patients is hell...

And the restraint thing.... It is for their own safety as well.. When our 80yr old pneumonia patients become so confused they need to be restrained for their own safety. I wish we had enough staff so we could just have a sitter but that just doesn't happen.

rita359 · Feb 17, 2007

Sounds like the place I work too. We must have the same supervisors or they learned from the same person as "deal with it" is a response I've had to deal with too.

SCRN1 · Feb 17, 2007

Sounds like our hospital too.

I agree with the poster who said to write incident reports. Not to try and get anyone in trouble because I'm sure the preceding nurse was just as overworked, but to CYA and to alert management that things aren't being done on time because of understaffing. If your incident reports have an area to write what could be done to prevent the error, give your suggestions there. If you can get everyone you work with to start writing these too, maybe it will open their eyes. (Maybe not.)

Chaya, ASN, RN · Feb 17, 2007

Everyone has my sympathy!!!!!! At times like this I wouldn't mind having velcro suits and sticking people to the wall..... I know I'm mean but I think we all wish it once in a while

:chuckle :roll

miko014 · Feb 19, 2007

I think one of the biggest problems is that the public DOES NOT HAVE A CLUE on how short staffed nurses are and what patient ratios are in place. The normal patient probably thinks we have all the time in the world to schmooze around at the bedside, get me a blanket, get me some ice, ad nauseum.

Amen! I wholeheartedly agree that that is a HUGE part of the problem. I always say that we need to get Dateline or 20/20 - or heck, why not all of them - do to a story about what (and how much) nurses are expected to do! Maybe if they see that, they will think twice about screaming at me because they wanted ORANGE jello, not RED!

I thought I would get flamed for that post, but it seems like a lot of you agree with me. It's not the busy I mind, it's the unsafe that scares me. I mean, I hate using restraints! I seriously cringe when I have to do it, but like so many of you have said, it's for their own safety!

I've thought about the CA thing too, and the mandatory 5:1 ratio. That's awesome, but on that horrible night that I had, I only did have 5 pts. I've had times when I've only had 4 (just because I was waiting for a transfer or admission, we never have less than 5) and been drowning, and said, "I can't take that admission right now, I can't even handle the 4 pts I have" and been told "oh, well. They're coming anyway". It scares me! If I had a family member in the hospital, I'd want to be there all the time with them! And it's not because I don't trust people to do their jobs, but I know that they don't have time to do them right!

Long Term Care Columnist / Guide · Feb 20, 2007

These are all the reasons I left hospital nursing. I took a major cut in pay, but for me it was worth it.

You and me both! Sometimes I actually have nightmares in which I'm back working in the hospital, drowning in high-acuity patients, getting yelled at by managers who have NO clue as to what things are like out there on that floor, and being told to 'suck it up'.:uhoh21: I took a big hit in the pocketbook when I switched to my current job as DNS in an assisted-living facility, but my sanity and my general contentment with life are far more important than money.