Charge Nurse Headaches

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One of the main things that I hate having to deal with as a charge nurse is the managerial side when it comes to my staff.  Most of the time, they’re a breeze.  We all get along relatively well and function as a cohesive unit more often than not.  Sure, there are personality differences, style of nursing differences and the differences of how people deal with crises, but for the most part we’re a pretty easy-going well-adjusted group.  Until you do something to piss someone off.

I had such an episode last week that left me fuming.  Luckily, my ride home cooled me off a bit, but even now I’m still pissed about it.  It was all about a staffing decision.  For some reason, our census had been low.  Like really low.  Frighteningly low.  Low enough to where we were having to decide on 3 nurses and an aide or 4 nurses and no aide.  This includes the charge nurse.  Lucky for me, my day shift counterpart knew my preference and went with 4 nurses and no aide.  For the first time in eons, the aide got canceled.  Compared to the rest of us getting canceled once a pay period or more, it’s nothing.  If we had gone with 3 nurses and an aide here’s how it would have broken down:  2 nurses with 4 patients each, me with 2, plus being in charge of 2 units (us plus our obs unit), plus unit secretary and being relief for the telemetry tech’s lunch, breaks and bathroom trips.

Maybe comparatively it’s not that bad, but for our unit, it is a lot of work.  Additionally, we had no one available except myself to admit, and by our staffing guide, we didn’t qualify for another nurse until we got 2 more patients.  It could have been very bad indeed.  So we went with 4 nurses. I was CNA, charge nurse, secretary, tele tech breaker and jack of all trades.  It worked beautifully.  We even had a couple of admits and things still went great.

The next night the situation was the same.  Again, the same choice was made.  The same aide got canceled – but she was able to pick up hours in the ED.  So after 2 nights of plenty of shit (literal and figurative) she comes up in the morning and starts laying into me.  She’s complaining she was canceled, that she’s the only bread-winner in the house, what right do we have to cancel her – all legitimate issues.  But then she says, “I’m going to talk to the union about this.”

You see, the nurses at my facility have chosen repeatedly to not be union, but almost all of the other staff, including CNAs are.  I’m all for working things out and trying to explain what happened, but when you threaten me with “going to the union” that’s just not cool, I turn off.  So I say, “That’s your right.  We made this decision based on nursing judgment to go with 4 nurses instead, based on the needs of the unit.  Besides Derrick (our manager) is backing us on this.”  I was calm.  I was pleasant.  I was brusque.  And I walked away before what I was truly thinking came out.  That would have been something like this:

“You’re pissed that you missed one night of work?  Big fucking deal!  We’re missing at least a shift a pay period, sometimes more.  And believe me, having the extra nurse was far more helpful than you could ever be.  Can you give meds?  Can you take off orders?  Can you admit a patient and settle them?  No, no and no.  I chose to do it this way to better support my nurses, to ensure that we had a safe environment for our patients.  So go ahead, run crying to your union, Derrick’s got my back.”

But I didn’t.  I kept it in.  But I’ve thought about it too much since then.  But I still know I made the right decision.  Why?  The nights we had no aide, I passed meds for the nurses who were busy, I put in orders when they couldn’t, I watched tele while my tech (ab)used the bathroom, I did all the things that a CNA can’t (won’t) do.  The thing that sucks is that she is one of my better aides and still she would be pretty much useless.

In spite of all of this, I’ve been tore up inside.  Doubting myself.  Worrying that maybe Derrick doesn’t have my back.  Worried that maybe I made the wrong choice.  And pissed that I’m so worried about it all.  I haven’t been back to work since so I don’t know what has come down the line, but I know I’m at the bottom of the hill and shit does roll downhill.  But I guess that’s why I make the big bucks…

And as for other headaches, let’s just say, when your other 3 nurses are the weakest on the unit and there is nothing you can do about it, is a headache all it’s own.

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Management Conversation

A couple of weeks ago the CEO of the hospital and the Nurse Administrator, my boss’s boss came by for their annual night shift tour.   They were delivering donuts and hot apple cider in celebration of Halloween.  Hot apple cider?  What are we?  Amish?  How about some nice fresh good coffee, not the swill they try to pass off as coffee in our joint.  But something good, like Stumptown or  *shudder* Starbucks.  But they came around, made small talk.  The CEO looked like he was part of the Living Dead, shambling and not really talking all that much, I mean he was completely out of his element.  He was on an un-remodeled floor and out of his office, in the middle of the night, go figure, he was a little out of his comfort zone.  He had probably heard tales that night shift nurses eat administrators, which I can’t confirm or deny, so needless he was scared.

But this isn’t what I’m truly talking about, just laying back story.  I had a meeting with my manager the other morning.  Just a sit down, chat, see how things are going.  She mentioned that her boss had talked to her about the other night.  Evidently her boss had said to her that it seemed that, “we had a lot of people sitting around for that time of the night.  I looked at her and said, “When they came and delivered donuts and stuff, right?”

“Yep.”

“If I remember correctly, it was the first time many of my nurses had actually sat.  And it’s not like they’re not doing anything, odds are they were charting.”  I said.

“I know that,” she said, “I know you guys work hard at night, and that it was probably that you guys happened to be at the station at that time.  She said that it was harder to find people on the other floors that night.”

“Yeah, because they were hiding.” I came back with.

She continued, “She says there were 11 people on the floor,”

“Yep, there were 7 nurses, 2 aides and a MHT for our token psych patient.” I interrupted with a grin.

“I’m not pointing fingers or anything, but now can you kind of see how the pressure is being applied from above?  I’m just saying we need to watch our productivity and hours.”  she finished.

This gets me on so many different levels.  In fact, when I walked out, I was pissed, almost ready to storm the Ivory Tower of Administration to kick the living shit out of the folks who think we don’t work at night.  Then I thought to offer them a chance to shadow us at night, but realized that the night they would shadow would be the most mellow easy night in the books.  Then I thought about sabotage, sending porn to their email, or dropping of a bag of poop (preferable encrusted with MRSA, VRE from a C.Diff patient) on their desk, but I realized this is what I get for joining management.

Yes, the busy-ness level is different at night.  The LOL who during the day was, “Sweet, pleasant  and a breeze to deal with” becomes the screaming demented demon from Sundown-land who spends hours attempting to cause a Never event by climbing out of bed.  Folks who spend all day looking good and on the mend get tired and start to go downhill when the night shift arrives.  It is a different kind of busy.  I know that many people think that most of what we do at night is sit around, gossip, play canasta, surf on-line, generally do nothing.  Some nights I will admit, some of this is true (I suck at canasta), but those are rare.

I remember the night in question.  We had a good half-dozen bed alarms, on each side of the hallway that would go off every 30 minutes or so.  We had the patient, who admittedly were behaving themselves and considering they had a sitter, that was great.  I had two patients of my own, nearly every one was full.  We had spent nearly an hour trying to track down the right surgical resident to call for orders on a patient we thought might be having a stroke.  I skipped bed rounds to stay and help out, and also because I only had one bed.  Everyone had at least one patient that required total care, isolation precautions, extra re-orientation or all three.  It wasn’t the busiest of nights, but it had pretty much been non-stop since the word “Go.”  And truthfully, when the delivery truck came around, we were sitting down.  Charting.  Signing off MARs.  Doing chart checks.  Waiting for a doctor’s call.  We weren’t just sitting around.  We were working.