My first year back in acute care was anything but easy. However, I was so enamored with the fact that I could not only survive, but actually thrive, in such a challenging clinical setting, that I let many potential annoyances roll off my back. I felt like a new nurse again (in the best way possible), idealistic about my potential to make a difference. And the snarkiness that I heard was part of every nurse’s DNA? You would never have heard me complain. Compared to my first acute care job, it was the ideal place to re-ignite my love affair with bedside nursing.
Six months since then, and I am singing a different tune. Not only have my migraines returned with a vengeance, but I am tired. And I feel myself becoming cynical. The lack of support from management is getting to me. The lip service we get for our “great work” feels more and more hypocritical as our staffing gets tighter and we get unjustly raked over the coals for nitpicky issues while our leaders never seem to be held accountable. The Magnet status our hospital brags about feels empty when the educational funding they promise disappears (the funding they dangled in front of us as the reason we get paid less per hour than other hospitals); the boasting they do about supporting their nurses’ going back to school feels hollow when my manager won’t even let me cut back from 0.9 FTE TO 0.75 FTE. The Clinical Ladder process that so inspired me when I started here revealed a uncomfortable truth – play the game or get left behind.
What has really stung is the evolution (or should I say regression) of my relationship with my preceptor (the nurse formerly known as “Favorite Nurse Ever”). She has always been smart as a whip, and she is an excellent nurse (and cool as a cucumber under stress), but I have started to sense a whiff of arrogance, as if she could do no wrong. As I have started to assert some independent thinking and demonstrate my capabilities, she’s seemed to dislike me more and more. When I use my critical thinking skills, she gives me zero credit. But I do something she doesn’t like and she can’t wait to call me on it. Case(s) in point…
SCENE: 1:00 am, patient has just called me to the room, feeling jittery and sick. Patient received bedtime insulin. Immediately checked pt’s blood sugar, which was in the 30s. Gave patient orange juice juice and rechecked two more times in the next 30 minutes. Blood sugar improved, patient felt better. Not the most clinically exciting scenario, but it could have had a much worse outcome.
While I was rushing to get a second round of juice for the patient, my preceptor (who was charge nurse at the time), called me over and asked if I had been to see the patient (the CNA had told her the patient wasn’t feeling well). I said yes and told her my assessment.
Charge: Well I just noticed you gave insulin at bedtime. You need to check blood sugar.
Me: I already did and it was in the 30s. We gave OJ and it came up to 78. We’re giving a little more juice and will check blood sugar again in 15 minutes.
Charge: Oh, okay.
No “Good thinking, Nurse Teeny” or “Nice catch!” or even “I’m glad I taught you so well” (hell, she was my preceptor, I’ll share the credit where credit is due).
Contrast this with a crazy shift that saw us get three admissions in the first hour (I got one of them). Fortunately for us, we had two nurses finishing up their orientation periods and their preceptors consequently had some free time. They offered to pitch in and help with admission tasks. My admission was extremely complex and so both preceptors ended up helping me with two different tasks at the same time. When they came to give me updates on what they were doing, my preceptor/charge nurse happened to overhear.
Charge: What’s going on here?
Me: This admission has a lot of moving parts so “T” and “M” are helping me with a couple things since they have the time.
Charge: Well there are two other admissions that just rolled up. How come they are only helping you? (Categorically untrue – they had already done another patient’s entire admission history for another nurse before coming to me.)
Me: Well it’s a little bit messy and they offered to help.
Charge: Well if they all converge to help you, then they’re not available to help anyone else. And if they’re doing all of Nurse Teeny’s work for her, Nurse Teeny might as well not even be here. (Not sure why we moved to the 3rd person here…)
Me: Actually, Nurse Teeny is busting her ass and they’re being team players.
And then there’s tonight. Tonight just sealed the deal in my frustration with this whole situation. Nurse Teeny, in her ever graceful ways, took a little tumble down the stairs Friday night. It wasn’t pretty. I have the bruises to prove it. And a doctor’s note that says no work until mid-week. After I got home from the doctor on Saturday, I called work and asked for the day shift charge nurse (as we are supposed to do). I explained what happened and said I was scheduled for both Saturday and Sunday and would have to call out for both, given the circumstances. Day shift charge nurse said no problem, she would note it. Fast forward to tonight (Sunday), when I had an angry voicemail at 7:15 pm, telling me I was on the schedule and where was I? I called back immediately and asked for the charge nurse, and the following ensued:
Nurse Teeny: I’m not sure what happened, but I fell over the weekend and have a doctor’s order not to work. I called out yesterday for both last night and tonight.
Charge: Well you’ve just created a mess here. Who did you speak with?
Me: [Day Shift Charge's Name - I tried not to throw her under the bus, but I also needed to make it clear that I spoke with the nurse in charge that day]. I told her exactly what I’m telling you. She said she would note it.
Charge: Well you were only marked off for last night. I don’t know what happened here.
Me: Neither do I. I apologize this happened but I do have a -
Charge (cutting me off): Well that’s just great. What a mess. Thanks for calling, bye.
No “Sorry you fell down the effing stairs, Nurse Teeny. Are you ok?” No “Feel better.” Just “You’ve created a mess.”
I’m a charge nurse too. I know how stressful it can be when your staffing gets screwed up for any reason. But I didn’t create the mess. I did what I was supposed to do, per unit and hospital policy. No need to get snippy.
END SCENES AND RANT
As you can tell, there hasn’t been much positive to post about (hence the lack of conversation). I feel disheartened when this blog turns into a bitchfest. I still love what I do, I just don’t love doing it all the time. Usually there is enough of the good to get me through the bad. And I am still struggling to figure out where I fit into the bigger picture. I not an overtly religious person, but I have always thought of my future in terms of a “calling”. It’s not just supposed to be about me. That’s usually what keeps me going through all the bullshit.
Unfortunately the shitteth hath hitteth the fan-eth.
And it’s become a big mess.