Monday, April 28, 2008

work issues

*this is not my usual mommy blog post, and I used lots of jargon-I will be happy to explain anything to my regular non-medical readers.

I don't usually write about work, there are lots of reasons for that. I have never hid the fact that I have a blog from my coworkers, and I worry about revealing too much about the patients I take care of.

Things are changing in the hospital that I work in. This is the only level one trauma center in our state, we have 1000+ beds, and 11,000+ employees. It's a teaching hospital and a small city all by itself. It seemed like the best place to start out as a new grad, that I would be where the action was, see a lot and learn a lot.

In the five years that I have worked there, upper management (president/ceo/director of nursing) has changed drastically, it feels as if no one is in charge, like the rules are being made up at will. We have had three incidents of wrong surgery site in the last year. Every week there seems to be some new policy, or procedure, or extra piece of paperwork that the nurse is responsible for. From Christmas on the pace seemed to just pick up until it was at a pace that was not possible to keep up with. All nurses where routinely staying an hour or more after their shifts to be able to finish their work. Extra beds were being placed in rooms that only had one oxygen and suction set up. We recently lost 6 good nurses. Smart, good common sense, experienced nurses. People who just decided they were done, it was time to move on.

Suddenly now we have had a huge drop in patient census. Odd since other area hospitals are not having the same issue. There is no overtime, units are being closed, including MICU, and step downs. Due to this it was decided that medical floors like mine would begin taking long term vents. Traditionally these vents would go to the RICU, but they are so full of "stable" vents that they don't have room for new patients needing beds. Apparently at some point in the past medical floors did take vents, this was before my time. I don't have an issue with learning how to manage a vent patient, but I don't think it is too much to ask that we get some training. Little things like, how does a vent attach to a patient, what do I do if it malfunctions, what do the alarms mean, what do the settings mean. It was agreed that some training would occur before we got a patient, and that the patients were to be placed near the nursing station so that we could monitor them more closely.

Of course this weekend we got a vent a patient, of course we did not get any training, of course the patient was placed as far away from the desk as possible when there were empty beds right near the nurses desk. Of course when we came on shift saturday morning we were upset, of course the nursing supervisors didn't care, of course the patients family was upset they were on a floor that didn't have the knowledge they needed to care for this patient, and wanted to be in the RICU where they always go. As we are talking we find out the patient does not have an ambu bag at the bedside, and did not travel with one to our floor, as they were told they didn't need one. So something like 10-12 hours later before that one was caught. We also did not have the appropriate trach size in the hospital. Luckily the family had brought one with them.

Long story short we had a nurse on the floor with some previous step-down experience (however brief) and the supervisors felt that she should be given the patient. She objected as she had not worked with a vent in years, got yelled at and told she had to. The nurse who the patient was actually assigned to was offended that the patient was just being taken away from her, and while the whole supervisor thing was going on went ahead and contacted the doctor and managed to get the patient moved to RICU as the family wanted.

I'm feeling that this hospital is in a decline, and I'm nervous because all of my work experience is in this hospital. I chose to work here because I thought it was the best place to be, that it meant something, but now I'm starting to worry that it will be perceived as "that hospital". I wonder if this is just cyclical, and it will pass, I hope so. In the meantime I wonder if i should make a change, or just stick it out.


WhiteCoat said...

I am hearing of similar situations at several hospitals in my area. Experienced nurses getting frustrated and leaving. Doctors start admitting their patients to other hospitals because of inadequate nursing. Hospital income goes down. More staff laid off. Thus goeth the downward spiral.
I think you would do well to get on the schedule part-time at another facility just so that you have something to fall back upon if you suddenly get the shaft at this hospital.
Maybe request that the administration send you to a formal course on managing vents?
I don't see any good outcome from them forcing you to work in an environment with which you are unfamiliar. Vents require some significant training, not an on the job "learn as you go" approach.
One patient death on a floor where the staff is not trained in vent management will be a big wake-up call for them.

Mighty Morphin' Mama said...

Wow, sounds like a really difficult and tense situation. I hope you find an answer and things shape up there.