I thought I'd update you guys on my work situation.
I'm working nights for February & March, I love it! I even picked up some OT. The night shifters are so amazing & helpful. It's not that nights is easy, I know I have an amazing crew to fall back on if I need help.
But, 3 day shifters are giving me issues.
My former preceptor is still a royal thorn in my side. I had to give her report one day & woof! Giving report is my WEAKEST area by FAR! So I gave her report & the patient was suppose to be on TPN. She asked me why it wasn't going. After I finished giving report to the other nurses she called me to the patient's chart & rudely said it's in the patient's chart so why doesn't the patient have the TPN going, huh? Again, I didn't know. The prior nurse who gave me report didn't tell me why. She isn't like that with anyone else. I oriented under her so I watched her give & take report.
Day shift nurse #2 is totally petty with me. Will roll her eyes at me, make snide comments & such.
Finally & most recently is day shift nurse #3. She is orienting a nurse to our floor. I didn't know that we don't pass our ascoms over until we give report. That was never once told to me. So when the orienting nurse came on the floor I handed him the ascom to hand to the main nurse, not thinking it was a big deal. Well when she saw this she came after me. She starting yelling about how it was wrong, that nobody did that to me (uh hello, YES!) & (this is where it gets hairy) if I do it again she will make work hell for me. I remember that part bright as ******* day. But apparently when my boss asked everyone it was pretty coincidental how "nobody" heard her say that. What the ****?
I did go to HR & she gave me the typical HR spiel. I don't know if I want to continue this or not. I know they say there shouldn't be any repercussions but I'm not stupid. HR also told me I couldn't transfer because I've only been working for 3 months.
I'm also wondering if it's me. Like, did I do something or say something? I have ZERO issues with anyone else at work.
I hate working acute care for so many reasons. This just adds to that list. I need insurance so I can't just quit. If I have to work until my husband can add me to his, I will. Then my plan is to go PRN. Plus I miss my kids so much.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
That is unfortunate, but lesson learned: call the doctor, even if you will get chewed out.
I used to work nights on med/surg and it was pretty standard to call the doctor if it was something that couldn't wait until tomorrow or needed to be clarified. TPN would definitely qualify as going without TPN for even a day could cause serious issues (dehydration, hypoglycemia leading to brain damage, etc).
That being said, your coworker behaved extremely unprofessionally, and I'm sorry you went through that.
Yeah, now I know. I'm never depressed but this job is making me really depressed. Something needs to change.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I agree.
This reminds me of a situation that I encountered when I was working acute care. I came in for a day shift and took over a patient admitted with fever, neutropenia and G-tube cellulitis from a nurse who was newly off orientation. The patient was ordered for double IV antibiotics, one was vanco which had been started in the clinic before admission. We shared a computer system with the clinic so in one view of our eMAR, it showed the dose that was administered there. However, since the admission was a "separate encounter" when the patient was admitted to the floor and the inpatient team wrote an order for vanco q 8hr, it automatically timed the first dose for now. Let's say he'd gotten a dose at 3pm in the clinic and now it was 5pm. It was something like that. So the default schedule for the meds would have been 5pm-1am-9am. The nurse who admitted the patient (a very experienced nurse) charted "not done" for the 5pm dose because the patient had just received a dose in clinic and then went to reschedule the next dose for 11pm. I believe that what happened is that because the next dose after she charted the 5pm dose not done was due at 1am, it had the date of the next day attached to it and when she re-timed it to 11pm, the system put it at 11pm the next day. The night nurse who took over did not notice that she did not give the child one dose of vanco in her 12 hr shift despite the fact that it was ordered q 8hr or that she wasn't giving vanco despite giving the benadryl that was ordered as a pre-med.
When I came in the next morning, I immediately noticed that the patient had an active order for IV vanco but that the next dose wasn't timed until 11pm. So I asked the off-going nurse "what's going on with the vanco?" and she had no idea. She hadn't noticed it at all because it wasn't timed for her shift. I didn't want her to feel like I was throwing her under the bus because she was a new grad just off orientation but this was a big deal. The child went 17 hrs without getting a dose of a q 8hr med that was needed because he had an active infection and an ANC of 0.
Just like it's a big deal that the OP's patient didn't get TPN all night. I have had some of my home TPN patients get readmitted to the hospital with severe hypoglycemia because of errors at home where the home nurse or parent accidentally hit the wrong button on the home pump which led to it not starting the program over and running KVO all night or mixing up the pumps (some of our patients run their PN and lipids separately either because of how small they are or because they're on an investigational lipid) and running PN on a lipid pump that's rate is like 5 mL/hr. If you notice an error with a TPN order, like that's it's missing a rate, you don't just not hang the TPN all night. You must clarify the order, even if it's the middle of the night by the time you notice it. That the patient had IV fluids running isn't a reason not to call. Maybe the nurse was rude in the way she called the OP's attention to it, or the OP interpreted it as rude, but she was right to point out the error.
Yeah, that is pretty bad. What's ANC?
I can see where I went wrong. But what's weird is she wasn't a finger stick, you would think she would've been.
No, that nurse who pointed the mistake out to me was my former preceptor & was rude. She was never like that to anyone else during report & I asked a fellow orientee & she wasn't like that to her.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
It is deeper than day vs night workers. Change is not easy for anyone. People are comfortable with the usual. You are disrupting that usual . You have to be taught, learn and hopefully not make any major mistakes. It is not your fault, it is a system failure because you are supposed to operate as an experienced nurse, who has been given plenty of time to learn and absorb, the material. However the reality is you have not been given sufficient time and the conditions have not been favorable for you to learn. After I got my bachelors degree, I planned to stop going to school but I am back in school to go higher in my education. What keeps me going are the conditions of nursing. Thankfully, I have been able to balance school, work and home. Not knocking people who take 1 class a semester but I did the BSN in a year and a half. People thought I was crazy for doing it so fast but I know where I am headed and I needed to hurry up and finish the BSN so I can go on to get a higher degree. I plan to work for myself one day. I did the bachelors when I started my new job on a oncology med-surg floor. I didn't have med-surg prior so it was a huge learning curve. I worked on this unit for a year for the experience but after I decided to do psych. I will stay with it and transition into another role where I can still do psych. Only complain or report if it is absolutely necessary. You will burn a lot of bridges and nurses are running in circles to escape some of the craziness of nursing so chances are you will work for someone who is not your boss now later on in life.The people you see where you are at now, you will see at another job. You may need a reference. It is a big wheel.
It is day vs night because the night shifters are actually helpful & have yet to be one once of cruel to me. Have I messed up on nights? Yes. But there's not the drama of dayshift.
I never said anything to my NM about my preceptor the whole time I was on orientation. Nor did I say anything to my boss about the pettiness of that other nurse. But the straw that broke my back was when that last nurse yelled & threatened me all for giving her orientee the ascom. I only went to HR to see if I could transfer, I didn't want to start an investigation because I knew I would be painting a target on my back. I already emailed HR to tell her not to start one.
I can see where I went wrong. But what's weird is she wasn't a finger stick, you would think she would've been.
No, that nurse who pointed the mistake out to me was my former preceptor & was rude. She was never like that to anyone else during report & I asked a fellow orientee & she wasn't like that to her.
A patient that has TPN ordered would require glucometer checks. Perhaps, they are in the standing orders? If not, get them ordered when the TPN is finally up and running.
Critical thinking takes awhile to develop. Isn't it great that you have us? :)
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I want to thank everyone for their advice. I have decided that I will go down from FTE to PRN whenever it is possible (probably in 3 months). Everything that is happening at work combined with not seeing my children much is making me depressed. It's bad enough my husband is gone for months at a time, I don't want my children thinking their parents are ignoring them.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
A patient that has TPN ordered would require glucometer checks. Perhaps, they are in the standing orders? If not, get them ordered when the TPN is finally up and running.
Critical thinking takes awhile to develop. Isn't it great that you have us? :)
Sorry you are having a hard time. As others have stated it is not because of acute care, day v noc etc., its just the way some people behave. It is hard when you are new and you just have to grin and bear it, eyes open, mouth shut, and just get through it; at least until you gain some experience and then it will get better!! As far as HR goes, I would not contact them any further. If you have a severe grievance I would talk to the manager and just keep your own personal documentation. For the TPN, as others have stated you should have called the MD or at least asked for clarification from your Charge and documented that, for the pt and for your own CYA (this could be considered a med error). Consider it a live and learn situation for next time and move on, everyone (even experienced nurses) make mistakes. I would try to avoid those nurses who have a problem as much as possible, but when not possible just keep calm and carry on. You will get through this and be a better preceptor to others later!!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I'm only on nights Feb & March. I wish I could switch permanently but there are not open spots.
Yeah, there was an active order, it was scanned in & everything. It turned out there was no rate. So all that attitude for literally, nothing.
I totally know they will, you have so much on your plate & even though we are there for 12 hours it doesn't feel like enough time.
I know, she's older than me but emotionally she's stunted.
Ascom is our work phone thing. Yeah, I went to our boss & my boss interviewed everyone who then denied she said that. Why would I make that up? Right after that happened I was venting to a male dayshift nurse about what she said & what happened. So did everything just not happen??
I spoke to HR about everything that has happened but I don't know if I want to pursue this any further because I'm afraid of retailiation.
Really? You don't get along with someone and that means they're emotionally stunted? Perhaps the problem isn't with all of those other nurses; perhaps it is with you. After all, YOU are the common denominator here.
The TPN was your mistake. The RNs may be responsible for checking it and hanging it in your facility, but it was up to you to make sure you understood the order, that the order was complete and that the TPN was hung when it was supposed to be. If this is the FIRST time you've made a major error like this one, perhaps the "attitude" was over the top. But since you don't seem to be taking accountability for the error, perhaps it's not the first time -- and in that case, I can understand the attitude. A nurse who has precepted you probably has a better idea than most about how prone you are to errors and whether or not you take responsibility for them. Although -- and I hope you note this -- the fact that you didn't like the nurse's attitude does not mean that she was in any way in the wrong. She may or may not have been rude -- I wasn't there -- but you do seem to create a lot of drama.
The fact that you vented to a dayshift nurse (what does gender have to do with anything?) does not mean that said dayshift nurse witnessed anything other than you venting about a coworker he has known for far longer than he's known you.
Given that you've already been to HR with what amounts to petty complaints and a failure on your part to get along with your coworkers, you've already set yourself up for retaliation. It seems as though the attitude problem is on your part.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Really, you again? Dude. Stop. It's 3 nurses I have an issue with NOT the whole floor. So no, it's NOT me. **** off dude. How is it ME when I'm working nights and have ZERO issues with NO ONE! NO ONE!!! Not a nurse, aide or doctor! NOT A ******* PERSON! So **** OFF DUDE!
If you have "zero issues with no one", you're having issues with every single person. That, and the totally uncalled for drama (and profanity) in your response here makes me pretty sure it's you that has the problem.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I need to start doing that. It's great advice! They just catch me so off guard & I'm so tired of being treated like a toddler that I just give up. I can't tell you how many times I've cried on the way home. I haven't done that in years!
If you are so tired of being treated like a toddler, stop acting like a toddler. The dramatic, profanity laced posts and the way you're acting on this board gives me a very clear idea why you're having so much difficulty getting along with your colleagues.
OrganizedChaos, LVN
1 Article; 6,883 Posts
Yeah, now I know. I'm never depressed but this job is making me really depressed. Something needs to change.