Welp. The time has come, sort of. I've finally reached my breaking point with this place. Charge did it. It's not that people are giving me shit, or that I can't handle the pressure (well, maybe partially), so much as it's really brought to light how insanely fucking dangerous a place this is to work as a nurse and I don't feel okay doing it anymore. It's almost okay sometimes as a staff nurse. Yeah, your patient acuity is crazy and most of us probably have more on our plate than we can handle at any given time. But at least there's a limit to how many they can make us take. Charge and triage? Forget about it.
We do not have the resources we need to take care of all these people. And we haven't since I started here. Every year it gets worse. They keep telling us to hold on, that we'll do this or that, and it will get fixed. And okay, great, we don't have to hang Levophed on a fucking dial-a-flow anymore, am I supposed to be impressed at this progress? There are still good nights. But the bad nights are becoming the norm. And it's not alright anymore. It's seriously just not okay that I look at the tracker and consider it a "good night" if the waits are in the single digits and I don't have to scroll down to see how many people are in the waiting room. The conditions here are setting us up for failure. With as sick as our population is, someone is going to either die in the waiting room or go home after waiting to be seen forever and die and it's going to be all of our asses. Not the people in suits who keep making excuses about why we have so many holds all the time and why we never have any staff. Not even my manager who's been begging them to do something. Us. The nurses. We're the ones that are going down when this happens. And maybe when it does they will finally do something about how this place runs. But our lives are gonna get ruined in the process.
I've felt so loyal for so long, because I really love it here. I really care about our patient population. Among the ridiculous hood foolish behavior, there are some really sick, sweet, hardworking people that really need good nursing care and are really grateful when they get it. I actually genuinely like my manager. And damn it, my coworkers. That is the hardest part. They have kept me here for so long. Worrying about leaving them here with a bunch of people who don't give a shit. About who is gonna teach the baby nurses how to work on a team and how to deal with the crazy shit and how to deal with all the messed up stuff they feel in the first year or so. I absolutely adore these people. About who my charge nurse buds are gonna put at triage on the nights they have a quarter of the rooms they should and they need someone who's only gonna call about the really sick people. They have reached out to me and held me up when I was at my wit's end with the crap this place dishes out. It's like having a second family.
But ultimately, I can't do it like this. I can't continue looking these patients in the eye and telling them it's acceptable to wait to be seen for 10 hours with chest pain and a cardiac history. And can't keep sending these people I care about more ambulances when I know they're already overwhelmed. I can't continue to be part of an environment where I don't have the tools I need to be successful and practice safely. I worked so hard to get my license. I'm not gonna lose it for the dignity of staying on this sinking ship. I feel like I can't do anything good for these people anymore, and it's breaking my heart. I'm constantly anxious days after I'm in charge or triage, because I it's gonna come back that something bad happened on my watch. I feel like crap for days on end thinking about how sub-par the care I'm able to give these patients is when I want to be doing so much more. I'm generally having nightmares about being at work after I get off a shift. It's gone past being a tough job at this point- it's crept into my entire life.
So I'm looking for jobs. I'm gonna stay in the ER. Preferably one that's still busy, but one that isn't a total shit show in the way it operates. I'm sure I'll still be here for a bit, and even then that I'll still have stories. I just can't take the way things are here anymore.
I have been there.When it starts to seep into your dreams, you know it's time. After you have been at the next job for about 1 month you will come home and look around at your normal, happy life and realize you should have left sooner. Good for you for making the change. Management really could care two beans for us nurses. Get while the gettin's good. There are always jobs for great nurses. Don't let anyone tell you otherwise.
ReplyDeleteI have been working in our ER for the past 16 years and every year we keep thinking that it can't get any worse. Management just shrugs their shoulders and does nothing about the conditions. I agree with you about triage--it truly is scary sometimes and you have to talk yourself out of panicking. About 1 week ago we had a middle aged man come in with chest pain and nausea. He had a cardiac history. As per usual he was put out in the waiting room after an EKG. A couple of hours later the staff could not find him to do bloodwork and it was assumed that he had AWOL'ed. He was found in the bathroom and it looked as if he had been down for at least an hour. I hate to say it but I am surprised something like this hasn't happened sooner! Where is it going to go from here.....
ReplyDeleteI hear ya. I was looking at travel nursing sites today, planning for a change. Not that it's much better elsewhere, but it's got to be better than where I am.
ReplyDeleteWhen is the sentinel event going to occur that wakes them all up? And then, eventho we all know how bad it truly is, it will be blamed on those who are least responsible for the shit storm the suits have created.
I wish I knew the answer. Good luck to us all.
Everyone who works in ER relates to this. What management and hospitals don't realize is that nurses are going back to school in droves working to get out of the hospital.
ReplyDeleteMakes me wonder who is going to take care of all these patients in the future.
Exactly the reason I have gone back to school to get my master's and transitioned into teaching. Still nursing, but WAY less stress. I do feel a little guilty, because like you, I love my job and my co-workers (for the most part) but it's just not worth it anymore. We can only do so much before something's gotta give. Management will NEVER get it, so let them worry about the consequences when all the talented, smart nurses leave the hospital. I do feel sorry for the patients because they are the ones who will ultimately suffer the most.
ReplyDeleteThe ER I left had a little magnet hidden by the charge desk that said "The only difference between this place and the Titanic is that the Titanic had a band." So true. I don't regret leaving, but I do feel guilty for leaving all my coworkers in an even shittier situation. Still...you've got to protect yourself at some point.
ReplyDeleteCome traveling with me? You know you wanna!
Exactly this. Hubs and I had actually talked about traveling until he got a fancy new job, but this dual income thing is pretty rad so we're sticking with it for now. Blergh, enjoy all the awesome places twice as much on my behalf!
DeleteWow. That sucks. I deal with this sometimes at the ED I work at, but most of the time it isn't super high acuity, so even though it's annoying to have everyone wait forever to be seen, I'm not necessarily worried about the patients' medical outcomes. I can't imagine having to deal with a waiting room full of ICU patients all the time.
ReplyDeleteI'm sure lots of ER's have problems with this. What do you think can be done about it? Would it help to find some way to funnel the non-emergent patients away from the ED to be seen elsewhere somehow (and I'm not talking about fast tracking them, I mean get them out of the damn department entirely)? What about making assisted living facilities and SNF's actually have end-of-life conversations with their patients BEFORE the situation gets dire, and then actually upholding any DNR/DNI orders so those patients don't get brought to the ER?
I feel that no matter how good any ER is...no matter how great their management is or how many resources they have..it will be super-stressful and sometimes borderline unsafe working in one until we can find a way to cut down on our overall patient population.
It's true. I'm sure where I go won't be perfect, but in this case the hold situation is so out of control that at times, we're effectively running the entire ER out of triage. Most of the non-emergent people leave during days like this, but some of the emergent ones leave also. Other places have this problem, but not this bad, and they have alternate plans in place like bringing in floor nurses to take care of the holds. We've been begging for something like this forever and they just keep telling us it'll get fixed eventually. It's seriously a recipe for disaster on a regular basis.
DeleteYUP. Pretty much why I left. Things just arent going to change there till something bad happens that causes bad press. Come join us up north. Good mix of sick people and have the resources. Pay isnt as good for nurses tho
ReplyDeleteER Doc
Whe you find your new job I would really encourage you to schedule a meeting with the president of the hospital and lay it all out. And tell him, that it might be too late for you, but you are leaving as a cause not because you don't love the hospital. Tell him he fixes things, you might consider coming back. That way,at least you can tell your peoples that you let them know exactly why you are leaving. Put it in writing. If it's that bad - then send it to the newspapers
ReplyDeleteI'm sorry. I can't imagine how difficult that is. Good luck with the job search.
ReplyDeleteYeah you gotta get out of there, cos you're right- when something awful finally happens it's gonna be your butt on the line.
ReplyDeleteI also agree with the last comment, definitely put something in writing before you leave.
I feel your pain on behalf of the seniors at my work- I'm still relatively new so I don't have that responsibility, but man when you're in charge it looks like it's a whole new world.
Good luck and I hope you find an amazing new job!
I know exactly how you feel, best wishes.
ReplyDeleteHow ironic. While reading this, a Code Blue ED Triage Lobby overhead. Bizarre. Although I do believe our hospital isn't as crazy as yours sounds.
ReplyDelete