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 hospital...in 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 nurses...one 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 shift...it 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 #2...it 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.  No...hospital 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, pudding....be 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 change...like 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 crazy...how 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.  

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???  

Whoaaaaaa

I haven't been on here since MAY???  WHAT???  I am so sorry...(if anyone is still reading my blog).  Time has literally flown by.  

Let's see...where do I begin?  CDU....I love it!  Talk about less stress and aggravation.  Although a month after we opened, we reverted back to basically a PCU unit because the doctors were fighting over who could admit to our unit.  They had to have a bunch of studies and meetings and after about 2 1/2 months, we are back to CDU status.  The patients for the most part are much easier to care for (and more normal).  They like to sleep at night, they are alert & oriented and the majority are not drug seeking.  There are always a few that slip thru the cracks.  I literally had a patient a couple weeks ago that the doctor advised her to stop doing crack.  No joke!

Oh...another update from CDU...the manager is one of my best friends...lol.  She is the nurse that left with me from the last hospital we were at & started our new venture at this one.  She opted for the admin route while I am sticking with bedside.  I just have no tolerance for meetings & b.s.  I only want to work my 36-40 hrs a week & be free the rest of the time.  She is on call 24/7.  I couldn't do that no matter what the pay was.  It is nice though having her as a manager.  Plus our unit is small & our staff gets along great.  Absolutely no drama & we all have each other's back.  It really is a nice place to work.  I will enjoy it while it lasts.  Only 25 more years until I can retire...yay! 

And yet another hospital update...the manager from my old unit - the one that was way too much of a micromanager.  Well, she no longer works at my hospital.  Enough said.

Puppy update...Timber is now about 70 lbs.  She has grown quickly.  She is adorable...very energetic.  If I can figure out how to post a pic on here, I will.  

Me update...I have somehow managed to lose about 50 lbs in the last couple of years.  I didn't exercise or eat better to lose this weight...I just ate less of the junk I usually do.  However, I have now joined Weight Watchers (mostly because my hospital gets me a big discount) & managed to lose 5 lbs in 3 weeks.  Doesn't make sense because I cut out 70% of the junk & started exercising.  I know...taking it off slowly is better, but I am sick this week & unable to keep up my healthy eating or exercise & I gained all 5 lbs back.  Ugh!  I'm not going to let it get me down.  This is a journey, not a race.  Gotta get rid of this cold & get refocused.  I am determined.  And thanks to instagram...there is tons of support & incentive & recipes.  I still have a long way to go...but I am going to get there.  One day at a time!

What a difference...

What a difference a month (or so) makes!  I just finished up on my last shift as a PCU nurse this morning.  I start on Tuesday in a brand new unit in my hospital...Clinical Decision Unit aka 23 hr observation.  I've always wanted to try this & by luck of the draw...I am now in a position to do that.  Luckily the person putting the unit together was the manager that hired me at this hospital 5 years ago.  Yep, been 5 years there already.  And best of all...I won't be starting alone on the new unit...cause 6 of my coworkers are starting also.  Needless to say, our current manager isn't happy we are all transferring.  We all need it though.  The hardest part about leaving my unit is saying goodbye to my coworkers who are staying there.  I feel for them because that unit has gotten so unbelievably difficult.  The workload is tremendous & it doesn't look like there is any end (or help) in sight.  I just worked 3 nights in a row & I am exhausted (and woke up with a sore throat...grrr....go away!).  

I cannot wait to try something new.  I know this will be totally different...much more fast paced as the patients cannot stay in this unit longer than 23 hours.  And the fact that they can get up & walk to the bathroom all by themself.......ahhhhhhh...makes me happy.  That's all it takes to make me happy these days...lol.  Oh & bonus points if they aren't diabetic because my hospital has gone bananas trying to master keeping blood sugars under 170 at all times (even when a patient is getting Solumedrol).  When they first started, they were making everyone hypo...not good.  I think it is impossible...especially when a person who has a good control on their blood sugar via medication & we take them off all that & throw them onto an insulin sliding scale = disaster.  

On a different note...the puppy is getting much bigger.  She's 5 months old now & has gained about 20 lbs in the last 2 months.  She gets along wonderfully with my dog Shay.  They are really cute together.  I didn't think Shay had it in her to be buddies with another dog, but I have been proven wrong.  :)

Well...hmmmm

I swear I don't know where the time goes.  The last 5 years have literally flown by.  It was 5 years ago that I had had enough at the last hospital I was at & I started over at my current hospital.  At times it feels like I have been there forever, but most of the time I think there is no way it has been 5 years already!  So many staff has come & go...yet I'm still there.  Sometimes I wonder why...because it has gone from admin having no real involvement in our jobs to admin being complete control freaks even down to the words we are supposed to say to our patients.  All because of a government satisfaction survey.  I'm not gonna rant about that right now.  Just don't feel like it.

In other news, I somehow got talked into getting a puppy.  I don't know why I agreed.....well, she is simply adorable...but a puppy is like a newborn.  SO MUCH WORK!  I had it made with my 6 yr old dog who does no wrong.  I now have a 3 1/2 month old german shepherd/rottweiler mix named Timber (yes, after the Ke$ha song...it's going downnnn, I'm yelling Timberrrrrr).  75% of the time she is good.  The other 25% is still a battle trying to housebreak her & she is the biggest drool monster I've ever seen.  I have never had a dog drool while anxious.  When I put her in the crate when I have to leave the house...she drools non-stop.  Like basically gives herself a bath in all the drool she creates.  But it is even worse in the car...she drools & then eventually gets sick.  Needless to say, she only goes for car rides when absolutely necessary.  Like today...for her second set of shots.  Drooled everywhere...looked like I gave her a bath before taking her to the vet.  So embarrassing.  I'm hoping she grows out of this.

My niece went to her prom tonight.  She's a junior.  I can't believe she's 17 & going to prom.  I still remember when I went.  Sigh, time sure does fly.

What the ???

What the heck...where did the last 3 months go???  Wow...got some catching up to do.  Basically...nothing's changed...lol.  Well, except for my attitude.  I've decided I'm going to look on the bright side & to try to understand things from a different point of view.  ANDDDDDDDD I'm not going to allow work to stress me out.  I leave it all at the door now & I am happier than ever.  

I mean...what good does it do to fight against all the changes that I cannot change?  Nursing is no longer a healthcare career.  It is customer service...plain & simple.  Sure, we give meds & we do dressing changes & we try to teach out patients how to live a healthy lifestyle...but any nurse that works in a hospital knows that all that we learned in nursing school comes second to trying to please a patient & their family so that we get a good survey after they go home.  Because the only thing that matters is their perception of how clean & quiet the hospital was.  Why fight it?  I'm good at customer service.  It's part of the reason I connect so well with the majority of my patients.

The past couple of weeks I've had to take care of heroin addicts, crackheads & alcoholics.  This was definitely not what I pictured when I was in nursing school.  And I must say it is the hardest type of patients to care for....because they do not care about themselves & all that matters is their drugs & the me, me, me attitude.  I had one spitting on the floor the other morning.  I looked at her like WTF??? & told her to stop it.  She knows better, she just doesn't care.  And then she'd whine "no one cares about meeeeeeeeeeee."  She ended up leaving AMA (against medical advice).  I just don't have a high tolerance for this.  

We are sort of creating this attitude though.  We cater to their every need...and don't get as much as a thank you.  I don't know, maybe I say thank you too much.  Something as simple as a waiter refilling my glass of water will warrant a thank you from me.  At work, I run my ass off for 12 hrs & it still isn't enough.  But remember my first paragraph...it isn't going to stress me out anymore.  I can only do what I can do.  I will continue to try my best to make someone's night a little better.  And when I go home...it all stays behind in the hospital.  I'm not taking that stress home.

Nuff said.  Moving on.  I'm still with my guy.  I tried to end it...a few times.  He doesn't go away...and I don't mean in an annoying, stalking type way.  We work through the issues & right now things are pretty good.  Who knows what the future holds.  I'm not going to worry about that either.  Life is short...enjoy each precious day.

That CEO of the other hospital I posted about in my last post.......she got fired.  Big shock...lol.  I haven't heard much else about that hospital lately.

Our employee survey....the results were not as great as they hoped.  Another big shock.  Nothing has changed...they still continue to short staff us on purpose.  They call it productivity.  Yeah, ok.  Sigh.

The Gators were the worst ever this year.  Luckily, my alma mater, UCF is doing great!  GO UCF!!!

Not Much

Not much to really say about work lately.  Why?  Cause I've only worked the equivalent of one shift in the last 2 weeks.  I called in sick last week...for 3 days in a row.  And this week I was only scheduled for 2 shifts....I got put on call Tuesday...only to be called in at 10 pm.  Ugh...and to ICU.  It turned out to be ok.  I can guarantee you I'll never be an ICU nurse though.  It just isn't for me.  And I went to work Wednesday night & my charge nurse called me at 10:30 & said "Hey, do you want to go home at 11?"  Uhhhh, heck yeah!!!!!!!!!  It is rare that this ever happens any more & the stars had aligned cause I didn't carpool that night either.  My paycheck isn't gonna be pretty...but my peace of mind is skyrocketing.  

I don't know if other hospitals are doing this...but my hospital admin is obsessed with controlling blood sugars.  I mean to the point that we are making practically everyone hypoglycemic by morning time.  So they switched it up, but it is OCD I tell you.  To the point that on some patients we are doing accuchecks every 2 hours.  We don't have any endocrinologists that come to our hospital.  I think without an expert in the field, we will never be able to come up with something that actually works.  So instead, we will poke & prod & over-medicate these people...just to make admin happy.  In the past, they actually had us giving insulin to those with a blood sugar of 121 or higher....at bedtime.  Ummmm, I don't think anything under 150 at bedtime is anything to worry about.  They are going to sleep & not getting breakfast until 8:30 am.  Over 15 hours since they had dinner.  Sigh.

On a bright note...college football is back.  Go Gators!!!!!!

I have decided to end things with my guy.  I just don't feel I'm a priority in his life...sooo see ya.  He won't go away though.  Wish me luck.

The other hospital in the area that is our competition is having some real struggles.  They have decided to cut the nightshift differential in half.  That's basically a $10,000 pay cut for each night nurse.  Admin states they have to...in order to meet the budget.  Mind you, the CEO gave herself a $120,000 raise though.  So instead of a million dollars, she makes $1,120,000.  Is that not insane?  And the hospital is going downhill.  No wonder we have been so busy the entire year.  I hear hospital morale is non-existent.  That's sad.  They are also laying off 400 people....but giving the doctors $500,000 bonuses.  And that is after acquiring a doctors group for $50 million.  I will never work in admin.  I just can't screw people over like they do.

We had our employee survey last month.  They say a record number completed the survey...93%.  Can't wait to see those results.  I hope people were honest & not brainwashed with all the meetings we had about it.

And on a final note....it's nearly fall!!!!!!!!  Which means pumpkin everything!  Yum!!!!!!!!!!!!!!