Saturday, July 15, 2017

Sooooooo frustrated!

Excuse this post as I am using it to vent my frustrations.  The last 2 nights I worked have been awful.  Not because of the patients, but because my hospital purposely chooses to shortstaff us.  It isn't just our floor, it is the entire order to save money.  But at what cost?  Are they trying to overwhelm us?  Do they truly care about patient satisfaction?  Because it doesn't seem like it when they change the staffing ratios, increase the patient load and give us absolutely no techs and add on 980938091431 more responsibilities to of which is as of the last few months, we have to draw blood.  

They got rid of nearly all the lab techs - we are only allowed to get help if we are unable to get blood after 2 attempts.  Sounds easy...but it is time consuming.  We aren't even allowed to have a cart of supplies nearby in case we need something.  For each and every draw, we have to gather our supplies in the med room and hope we have brought enough.  Again, sounds basic...until you have like 5 or more blood draws in a shift.  Then we have to get our super slow computers working along with a specific printer just for the labels.  Which half the time the printers don't connect with the computer, so it's like another 10 min or more rebooting the computers and hope they sync.  Then the time it takes to look for a vein, get all the supplies ready to use, calm the patient and hopefully be successful on the first stick.  It literally takes 20-30 min or more to achieve this.  Now times that by 5 or 10 draws on a equals hours spent just drawing blood.  Meanwhile the lab techs get a cart with all the supplies and a little hand held computer/printer all in one thingy and they are in & out in about 5, maybe 10 min if it is a difficult stick.  Plus they are really good at finding veins quickly.

Ok, that is rant #1...because if anyone knows anything about nursing...we don't have extra time to spend on that task.  

Rant just feels like there is no respect for nurses.  Of course we have a select few patients who truly appreciate our services and don't take advantage of our caring nature.  More than ever, it is the opposite.  Some patients act like you are their personal servant....demanding, yelling, ignoring questions, etc.  Family members can also be that way.  They expect food and room supplies just as the patient gets.  I had one last night ask if they could wear a hospital gown when they slept. gowns are for hospital patients.  Not for family members to use as pajamas.  They request food to be specially made to meet their requirements.  Night shift doesn't have a cafeteria open.  We have premade stuff...sandwiches, soup, jello, glad we are even offering, but don't get mad when we can't cater to your specific diet requests.  

It also feels like administration has no respect for us.  We, nurses, get blamed for whatever doesn't go right.  If a lab isn't drawn on time, if a test hasn't been done, if a doctor orders the wrong med or doesn't order the right ones.  Just during report alone...we get interrupted by ER staff trying to give us report on a brand new admission - right in the middle of shift change.  I still don't understand why they can't put a hold on admissions between 7 and 7:30.  How safe can it be for the nurse getting this patient who gets dropped off during shift change?  We have no techs to help get the patient settled and what if the patient isn't stable?  We are supposed to stop report and go get the patient stabilized.  So what about the nurses who have been there for over 12 hours and just want to give report and get out of there?  And even if the patient is stable, they are now mad because no one has been into their room within 5 min of arriving to the floor.  So much for patient satisfaction scores.  We also get interrupted by different departments during shift MRI or CT scan or stress lab.  We get interrupted by the monitor techs telling us a lead is off on the monitor.  We get interrupted by doctors deciding to call at shift change.  And yet we are supposed to get a complete update on all of our patients within 15 min so the staff that is leaving can clock out on time.  How is this safe??  How is this realistic??  

Rant #3....rude doctors.  Thankfully there are not many at my hospital because this hospital does not allow the doctors to run the hospital like my last one.  At my last hospital, doctors could yell at you, belittle you, embarrass you, hang up on you or even not call you back without any repercussions.  I still remember our chief of staff telling us that if a doctor is rude to you...take them aside and remind them that you are someone's daughter, mother, sister, etc and that you are a human being.  Excuse me??????  How is that ok behavior?

Last night I received a patient who was in pain and all the doctor ordered was Tylenol.  Seriously?  So I put a call out to the doctor and she calls back.  The conversation started like this... Dr: "I just want you to know I am on call until Monday morning and I need my sleep."  Mind you, it was a little after 11 pm on a Friday night.  So her on call began at 7 pm.  She goes on to say "I would appreciate it if you didn't call me."  As if I was calling just to say hi.  I am in the room with the patient in pain and he is moaning and yelling in the background.  So I remind her who she just admitted to my floor and how he is in a lot of pain and all she ordered was Tylenol.  She "reminds me" that the patient is an older gentleman (as if I had no idea) and that she doesn't like the idea of giving him anything strong.  Ok, that I get...but Tylenol is not going to reduce his pain at all.  So she goes on to order Dilaudid....DILAUDID.  That is one of the strongest pain meds we have.  So much for being concerned of his age.  Then she goes on to say that if I have any further needs, to wait until I have figured out everything I need and then call her.  WHAT?  As if I had no idea why I called her in the first place.  

She is the only one lately that stands out as being rude.  Last week I had my secretary call a primary doctor and this is who was on call.  I had never spoken to her before last week...but I tell her why I'm calling, she gives me an order and then I ask her name because I need it to write an order since she is too lazy to put the order in herself.  She yells at me "Now we have a problem."  What?  I don't have time for this drama, can't you just tell me your name?  She says "You don't know who you called?"  I told her the unit secretary placed the call because I am taking care of patients at the moment.  Does she actually think we just sit around filing our nails, drinking coffee and watching soap operas while we call doctors?  She can't simply say "my name is..." like any other normal person would do?  In the time it took for all her questioning, she could have said her name 50 times.  And it's an easy name to understand!  Not like she'd have to repeat it or spell it out.  Sigh!

Rant #4 My easy walkie talkie observation patients are not so easy anymore.  Why?  Because they give us every type of patient now & 50% don't even belong in observation status.  We get confused patients, we get drunk patients, we get nursing home patients who won't be able to return to a nursing home or rehab until they've spent 3 days at the hospital.  We are 23 hr observation.  Not 3 day observation.  Doesn't sound like that big of a deal except we (my unit) get penalized if a patient is there beyond 23 hrs or if they are turned into an inpatient stay.  How is that OUR fault?  Why should WE get penalized because a doctor didn't make the right choice when admitting a patient?  As a result.....we no longer get an extra nurse, our unit secretary is cancelled often and we get absolutely no techs........because we need to save $$$ after all these penalties.  How is that fair to us?  You would think they'd go to the doctors and tell them to figure out a better criteria before sending a patient to 23 hr observation status.  Or perhaps the doctors should get penalized every time a patient they send to us goes over the 23 hr observation time.  Then they'd be a little more inclined not to give us patients that are obviously in need of being in the hospital longer than 23 hrs.  

The reason I am ranting is because the last 2 nights have been awful.  Again, the patients themselves are not what I am complaining about.  If anything, the majority have been quite kind and patient.  I went into work 2 nights ago and as usual started off with 5 patients.  Two of them were to be discharged, but dayshift was too busy to do it.  That's fine, I understand because they are shortchanged also with staffing.  Another was inpatient status...not a big deal.  And the other two were brand new admissions with nothing done.  One of them was a direct admit.  I don't think direct admits should even be allowed.  Everyone should go thru the ER....things get done down there in a much better process than coming directly to the floor with no lab work done, no tests done, no IV done, no meds ordered, etc.

So I'm starting off my shift overwhelmed before I even get done with report.  Who is my priority?  The people wanting to go home?  The people that just got there?  The patient in pain?  The patient needing assistance to the bathroom?  Who gets my attention first and in what order?  Add in phone calls and family members and meds that need to be on time and lab draws that need to be on time.  How am I not supposed to feel stressed out?  And is that really how we want nurses to feel while they are taking care of sick people who usually are stressed out also?  I manage to get the two discharges done by 9:30.  Again, thankfully they were very patient and not in a hurry to get out of there like most people are.  Still though, I felt like a failure keeping them there until 9:30 when they were discharged at 5 pm.  It's not a good feeling to not be able to meet their needs as quickly as possible.  Although with what I had been handed at shift change...that was as quickly as I could get their discharges done.  One of my new admissions was fine....the other, well, she was just there for a medication to be administered.  Of course it wasn't something I could just give and send her on her merry way.  We had to pull an order set and make sure she met all the criteria.  Then we had to get the doctor who sent her as a direct admit to come to the hospital because the "consent" he signed did not include the patient's signature.  He started to argue with me over the phone.  I didn't have the patience for it...I handed the phone to my charge nurse because I had plenty of other stuff that had to be done.  Eventually he gave in...because simply signing a consent and sending her over does not meet the criteria of a patient giving consent.  So something that should have only taken a couple hours at the most ended up taking over 4 hours.  Again, the patient was fine with it taking longer than necessary, but I felt like I wasn't meeting my patient's needs.

So I discharge her and get 2 more admissions.  One was very sick...very, very sick - did not belong in observation whatsoever.  And the other was a drug seeker.  Luckily the ER nurse medicated her right before sending her to the floor, so the patient knew they could not ask for any more pain meds anytime soon.  

Now it's like 5 am and I have so much charting to do because I can't sit down and chart until I am positive my patients are all comfortable and don't need anything.  I also am a nurse that tries my hardest not to stay any longer beyond my shift unless I absolutely have to.  At the end of 12-13 hours, all I want to do is go to sleep and forgot how my night was.

This is not what observation is supposed to be like.  The first 2 years of this unit being open...they enforced a certain criteria that patient had to meet in order to be transferred to observation.  The majority were low risk chest pain or in need of a blood transfusion or rehydration.  Low risk rule out stroke patients.  All were to be alert and oriented and able to walk to the bathroom and feed themselves.  Now we get anything and everything.  Like if they aren't sure what to do with them, just send them to observation.  This isn't what I signed up for.  And if it is this bad on my unit, I can only imagine what the other units are like.  And I'm an experienced nurse!  I can't imagine what new nurses are feeling like.  Or maybe they aren't phased by it because they don't know anything different than being overworked and understaffed.  

I remember watching the Oprah show years ago....many, many years ago and she talked about how something like 200,000 people die a year due to medical mistakes.  I thought that is is it even possible?  I definitely now understand how it is possible.  We are being stretched too thin physically and being bombarded from all directions with an overload of information mentally.  

I am usually pretty darn good at keeping myself from getting emotional when it comes to patients or work.  It's not to say I don't care or my patients don't think I care....because I do.  I just don't allow it to stress me out or make me cry.  Yet, the last 2 shifts I have nearly started crying.  It was overwhelming and I had to keep reminding myself often it will be ok, just hang in there.  Who else does this in other professions?  Who else has to worry that they may harm another person just because they don't have the resources they need at work or because they are endlessly getting interrupted while trying to do their job?

I have one night off and then I go back for 3 more nights in a row.  Lord help me!

Thanks to anyone that actually reads this.  Sorry for the venting, but I had to get it out.  

Friday, June 30, 2017

Long time!

I can't believe I haven't posted in a few years.  Wow...time really flies.  Let's catch up on things...

I'm still working in the observation unit...or CDU (Clinical Decision Unit)...not sure what the official name is.  It has definitely changed since when I first started 3 years ago.  We get a lot of patients that don't belong there.  Like some doctors don't really examine them or find out the real problem until they send them to the observation unit.  It can be frustrating.  We also get a lot of alcoholics and drug addicts that just need a place to stay.  I don't really think that is what a hospital is there for, but the doctors can't seem to say no.  They've moved our unit 3 times now....the last time was just yesterday.  I think it will be a good move as the last 2 moves we've had to share the floor with another unit and it was pretty miserable.  So I'm happy with this last move.  Hopefully it is our final move.

We got a new manager last October.  I wasn't thrilled with the change as the last manager was someone I've worked with for years and consider a friend.  She knows what it's like to be a floor nurse and worked to make sure things were fair for us.  This new one comes from being an educator and not the floor.  It really makes a difference when you have someone that is very familiar with being a floor nurse and dealing with patients, families and doctors.  Oh well, can't change it.  Trying to make the best of it.

It doesn't seem like much else has changed over the last couple of years.  Weird!  I feel like I should have more to write about.  Hmmm???