Should I quit my job (long post)

Okay guys, I first need to vent and have a long rant--then I need advice.

I'm a registered nurse working on a cardiac floor at a local civilian hospital. For the most part, I like my job and I like the people I work with.

Unfortunately I have a problem.

Over the past two months, things have been getting progressively worse. I've had higher patient loads, the people are sicker, and since the hospital is a business, they're reducing costs by making due with less nurses for the same (or more) work.

It's not always bad--in fact 3 out of 4 nights go just fine, but some nights suck the life out of me.

The bad part is that we're moving into a new wing along with the ICU next month. We'll have more patients, they will be higher acuity, and we will do it with the same number of staff--just a worse version of what we have now.


Last night was a good example. I felt sick, but I didn't call off. I thought that since it was the first Monday after Christmas, I figured it would be busy and I would be needed. In fact, I've put 2 extra shifts in over the past two weeks. When I get there, they've taken our "extra" worker and put her on another floor. Then at 11pm, the charge nurse sent home the travel nurse that costs the hospital more money, even though she knew I felt terrible.

From 6:45 pm till 9 am I worked my @ss off. Emergency phone calls to doctors, prepping patients for STAT procedures, literally runing from room to room dealing with all kinds of patient problems. The kicker was that I had to put up with a PA this morning who never returned my STAT pages from the night before and feels fit to criticise me because I contacted the MD instead.

/ubbthreads/images/graemlins/icon23.gif
I normally don't have a problem working hard, but when I have a more than full patient load and I feel that it's compromising my patient care, I get pissed. I think of it as taking advantage of both me and my patients. They're (or their insurance) is paying top dollar for care, and a lot of them are not getting it.


I've been thinking for a while about quitting. Nothing I say or do can change this 'business." I think back to when I worked in the ICU for the Veteran's hospital--so far it was my favorite place to work (unfortunately the nearest one is well over an hour way so I can't really work there). Care was given according to care needed and I could do my job without sacrifice.


Now advice time....

I keep thinking about my time in the Army and what my wife did in Iraq. She's still a Captian in the Army Nurse Corps and she really loves what she does.

Army nursing has many benifits.
Pro: Better pay (my wife makes twice what I do), student loan repayment, opportunities for advancement at a much faster rate, (she's a head nurse), lateral movement into various high-tech positions that will take years to move into in the civilian sector (flight nurse), knowing that I'm helping the people who are helping us, and govt. regulation.
Cons: I am told were to go and what to do, but that happens now. I also stand a very good chance of going to Iraq. I could be killed or worse.


What to do, what to do. /ubbthreads/images/graemlins/confused.gif

I really like nurses. I appreciate what they do immensely. Also, it seems that nursing is a high-demand field. I think you could get a better job somewhere else - military or civilian.

It sounds like your tradeoff is about relocation. I will discount the effect of your leaving on your patients - the hospitals will do what they need to do make do and maybe a few nurses leaving will force them to improve their business model about health care in the long run.

In a dense health care market like Los Angeles, there would be many employers looking for nurses within a reasonable distance and you could just look for a better offer in a competitive market. If that's not one of your options in Fountain CO, then your choice is stay and suffer or move somewhere to a better job. The military is one option for moving (they'll tell you where) or you might consider finding a job first and relocating to meet it, hopefully in some place where there are more health care employers to bid up the market and provide future options.

Or maybe they'll sweeten the pot for you when you tell them you're leaving. But I wouldn't mention that until I had the next job already lined up.

Good luck. My wife was a nurse in CC ICU and I know from second hand observation it is an undervalued job...

As an old ER/Med Surg nurse, I feel your pain!!

It's why I left nursing and became one of those PA's that give you so much grief! (Not really, my nurses love me because I still do all that nurse stuff like clean up after myself, make sure no sharps are left, start my own IV's, give shots, etc.)

But the situation you face is being played out a million places. The VA isn't the best answer, because even their funding is slowly being cut, so the changes will affect them to eventually.

If you are a BSN nurse, the military is an option. I'm trying to figure out how your wife makes more than you do. The last time I checked, RN's were in the 25-35 dollar an hour range. (We pay our office RN's 25 an hour.) That works out to $50-70,000 yearly without overtime, and thats quite a bit more than military nurses make until they reach 05 or so.

The shift of the burden for care to fewer nurses is something we should all be concerned about. There is ample evidence that outcomes significantly decrease in quality when nursing staff is cut, the question is where does that become cost effective?

You face a tough decision, one which your union and staffing people need to address!!

Best of Wishes!!

Bill

there is another possibility: try a different area of nursing.

i was in a similar boat as you: overworked.
i was surgical/ICU float. i once ended up on 3 different units on the same day! though i loved the work, the workload was at times unbearable. i truly feel your pain, brother.

so i went into an area of anesthesia, working for the acute pain service. i set up, troubleshoot, maintain, etc patient controlled analgesia pumps, epidural pumps, intrathecal pump trials, intrapleural pumps, peripheral nerve caths, etc.

it is very focused, and a fairly elite job, due to my tremendous autonomy, and the high risk (to patients) nature of my work. (epidural hematomas are no fun!)
we are a small service, with only about 12 people in the entire University of Michigan hospital with this training.

small service means that staffing can at times be tough, but in general, you can get your work done while keeping patients safe and happy.

wanna know what is really cool about my job? NOBODY, and i mean NOBODY gives me orders except Acute Pain Service MD's...and i have a fair amount of power.

you know those a$$hole surgeons, that like to slam nurses, and make them cry? welllllll, Bob doesnt play that crap.
i have thoroughly enjoyed ripping MD's "a new one" in retaliation for their mistreatment of nurses (including myself).
i am nicely backed up by my docs...as well as the head of anesthesia. i take no crap from anyone, and my Fellows treat me very nicely, because they know if i call in sick, they may end up staying up all night answering pages.

oops...went off topic!

burnout sucks!
not trying to "play up" the role of nursing, but people have NO idea how incredibly stressful nursing is--both mentally AND physically. i know of few jobs where a person often has to choose between eating and urinating.
we are slammed by everyone from food service to docs to patients and even other nurses.

yet, most nurses absolutely kill themselves trying to take good care of their patients: bladder infections, plantar fascitis (me), injured hips/knees (me)/backs, dehydration, illness due to stress/poor diet, etc.
a good nurse is worth their weight in enriched uranium.

anyway, take care,
Bob

What you say is SO TRUE, Bob,

When I find good nurses a cherish them.

The biggest problem with nurses IS nurses. As an old, wise nurse told me when I was a newbie nurse, "Nurses Eat Their Young, make sure you're not somebodies next meal!"

I laughed at the time, but found out just how cruel nurses can be to their own too many times to count!! It really is "What have you done for me lately?"

PedalinBob makes some great points, other avenues are open, don't forget to explore them!!

Bill

Well, my mom is a nurse and I can kind of understand. She has started working at a veterans hospital not too long ago and all I can say is I wish I could do something to ease the pain she goes through with all the work. The lack of nurses in this country is only getting worse. One nurse having to care for some many patients is ridculous. The first months someone stole her purse and belongings. On top of that, she gets a lot of crap from the older more experienced nurses. Sometimes it makes me want to barge in the hospital and strangle these disgusting people. She first thought about moving to another hospital to work but she stuck through. She tells me she loves helping people and nothing will get in the way of that. I know I didn't help but I hope it works out for you!

Bwates: 25-30 an hour--not here. The pay here is terrible. Even with my weekend and night differential, I'm not even touching your $25/hour mark. My BSN and business degree and prior experience mean squat around here.
With call offs and other cost saving mesures from the hospital, based off what I'm getting per month, I'll be netting approx 32-35K this year post tax. My wife (with all the allowable military pay allowances) is getting between 55-57K this year after tax.
With 5 years in, she's an 0-3 and a head nurse--I'm a lowly cardiac nurse who will take another 4 years before I even hit day charge nurse if I stay civilian.

Union--people in the hospital (not on my floor) have been fired for trying to start a union in the past. It's really union unfriendly here in Colorado. /ubbthreads/images/graemlins/mpr.gif



The thing about the military is that since we already live just off Ft. Carson, it takes less than a third of the time to get there than it takes me to get to the north end of Colorado Springs.
I had serious thoughts about going Army Nurse last year when we were living in Texas (I had been a 12B combat engineer before college) but the Iraq thing was in full swing and my wife was over there--kinda dampened that thought.


At my wife's holiday banquet a few weeks ago, I talked to a number of Army medical professionals. They seemed to have more comradarie and be a generally nicer group than what I work with now.
A few high ranking officers even went so far as to offer to talk to the department heads of the ER and ICU for me. Although I like cardiac care, it's every tempting and it does fit in with my career plan.




Thanks for your thoughts guys--it's always nice to know that I'm not alone here. For those of you appreciating the work of nurses, thank you--we often don't hear nice words of appreciation.

I'm not in the medical field, but I can understand the feeling of being marginalized, screwed over, taken advantage of, un-appreciated, paid crap, even though what I do is critical (business critical - though I'd like to see how many people I'd give heart attacks to if the core systems I run failed, and I think the chain reaction will result in a few). It is always "the business first", "the bottom line first". They've even threatened to outsource me. Well, by all means, please do. If they can find anybody else who will take the bullet, by all means great, I want to be there to watch. The last person who replaced me ended up causing far more of a trainwreck. /ubbthreads/images/graemlins/crackup.gif /ubbthreads/images/graemlins/hahaha.gif

Well, I had a veteran who served 25 years with a MNC in a very high powered management position who told me "People, process, profit" - place the people first because without them, NOTHING in the business happens. Without people, a business is an empty shell. Almost nobody seems to realize this. For without the people, there will be no process.. and no bottom line.

It's a really tough call when it comes down to "stay or quit" and that's always a universal problem.. is the grass always greener? Will things really be better? Or is this the best I can look forward to? I ask myself that every day, and remember a time when it didn't always have to be like this. It sucks when organizations like these get in the way of people who are truly committed to making a difference.

But what keeps me going is that it isn't just a job, it's a calling and I know it is the same for many of you folks. Stay strong. We'll find a way. flownosaj and others - thank you for doing what you do.

Competency with critical care is a big hurdle for the majority of nurses, and you should exploit it as a valued commodity. I'd suggest following pedalinbob's advice and consider a lateral move to an anesthesia-related nursing job. Some docs will employ a nurse in the same manner as a PA to assist them in the office (handling phone calls, helping to assess or educate patients, etc.). If you get along well with some of the docs, you may want to extend a feeler.

If you have the time and motivation, bwaites' suggestion of additional training (yay, more school!) is an excellent idea - consider CRNA certification or PA school.

ER nursing can lead to rapid burnout, depending upon the nature of the medical center where you work. How many times do you want to hear some crackhead yell "***** when'm I gonna get my Demerol and somethin to eat?!!" (the crackheads around here call men "*****" too /ubbthreads/images/graemlins/rolleyes.gif )

With your business degree, you could even consider working for the Dark Side - a health insurer. I didn't say it was a palatable idea, just an alternative...

My wife burned out on an inpatient Neuro floor about 12 years ago and made a lateral move to the OR. It was an excellent career move. The bull$#!+ from "@$$hole surgeons" (as pedalinbob so eloquently put it) is one of the quirks of the job, you just have to have a thick skin. For some reason, the male OR nurses get it less, at least from the male surgeons...

I didn't want to do civillian ER--I've seen way too crazies and junkies on the floor already. If I do the Army ER, it's usually active troops, dependents and retirees--maybe an occasional crackhead, but not the same stuff I see in a metro hospital. With ED or ICU, I could transfer to flight nursing or anesthesia for a while before I move on to management. And the thought of field nursing is always fun.

I like school. In fact, if someone's willing to pay for it, even better. /ubbthreads/images/graemlins/smile.gif The Army has a CRNA school. They also have a program that pays you to get your nursing masters.


Except for the occasional deployment, risking my life and being at the beck and call of Uncle Sam, the Army doesn't seem too bad...
The question is, a year from now will I be regretting my decision, regardless of what it is.

/ubbthreads/images/graemlins/banghead.gif

CRNA might be my next step as well.

they have decent hours, and the pay is excellent--at least here at my hospital.

many open doors to ya!

Bob

The truth is that although deployments do occur, military nurses very seldom get injured unless they make a mistake off duty and go somewhere that is "iffy".

How many of the injured/dead in Iraq/Afghanistan have been medical people?

One of our surgeons spent a year over there, treated lots of sunstroke, and only did surgery about once a month.

The nurses work harder, of course, but the risk of life and limb is different than if you're a regular jarhead or dogface.

I still think you're being underpaid where you are, check the online listings for nurses, they all are significantly more than you are making!

Bill

i'm coming late to this thread /ubbthreads/images/graemlins/wink.gif But on behalf of the people that you take care of let me give you the thanks that they might not always think of, or be able to give you /ubbthreads/images/graemlins/smile.gif You know you're making a difference to them, even if it would be nice to be recognized for it once in a while.

It's amazing how a few people in charge can take a difficult job and make it virtually impossible just by creating a bad atmosphere which infects the day for everyone else. It sure sounds like some bad apples in your hierarchy somewhere have created a place where you're miserable, and I doubt that it's only you thats suffering there.

I'm only involved with the health care industry through marriage (my wife is a doc) But I am privy at least to her thoughts and frustrations at things. She is SO thankful for good nurses and especially for the more training and responsibility that the ones in the various units. Without good people at the bedside she'd spend an awfully lot more time in the hospital in the middle of the night and her patient outcome would be much worse.

I live in an army town, so I know a lot of people involved with the military and there are some really great people here. But I'd still think that joining up would be a rather extreme measure. First I'd try asking around different departments at your own hospital. You might find that elsewhere there are some wonderful folks in charge that make it not only bearable to do what you love, but actually reward it. It's amazing how a little recognition can make even the hardest work seem a lot easier /ubbthreads/images/graemlins/wink.gif

My wife would tell you to find a department there where they recognize your value and your abilities. There are people there somewhere that will be thrilled to have someone with your skills.

Good Luck!

I just need to vent some more so ignore if you don't want to hear more whining and self-introspection:


I almost handed in my two week notice yesterday--I was not in a good mood at all by the time I was ready to go home.
Same situation--Short staffed, only one aide. I started 9pm meds at 8:20 and still didn't finish till after 11 due to various problems.
Two patients had to be placed in restraints--one in 4 points. Neither of these two were my patients, but I was there dealing with it just like everyone else on the floor.
I'm just happy I'm quicker than both patients--I missed a slap to the face from the woman and a kick from the man. Two other nurses weren't so lucky--one was kicked in the chest and one got a glancing blow.

I do have to say here that I would like to take the time to thank the makers of IM injectable anti-psychotics and major tranquilizers. Neither patient remembered a thing once the sun came up /ubbthreads/images/graemlins/rolleyes.gif


While doing chart checks at 3am, I find that a patient has not recieved any IV antibiotics or steroids since admission because the orders from ER were missed when they were admitted nearly 24 hours ago. Gee, I was wondering why his feever wasn't going down and his lungs sounded like crap...
it most likely was missed because the night nurse when he arrived was overtaxed to begin with and entering in the orders herself--it's hard to catch your own mistakes.


To make that morning even worse, the night charge told the day charge about a comment I had made. We couldn't find the only functioning piece of equipment for a sheath removal at 0100 and we had already looked in most places it could be. I said to call the day charge and ask her where it was since it was not where it was supposed to be and it's not our responsibility to play hide-and-seek with cruicial equipment.
The night charge said that it was 1am and she didn't want to wake her up over this--I said, "fine, then I'll call her." I was half serious, half joking, but still pissed we were going to have to hold manual pressure for 20 minutes on a femoral artery because of this.
(Anyone who's tried to obliterate/occlude a femoral artery by hand for 20 minutes can tell you that your hand is useless for nearly an hour afterward.)

No call was made. We did manual pressure and I forgot all about it an hour or two later.

As I'm finishing morning report and getting ready to go, the day charge comes up to me, smiles the "I know something" smile and said "I heard you wanted to wake me up at 2am."

I tried to laugh it off and said "it was more like 1am, but yeah, I figured you weren't busy." I could tell she wasn't exactly amused, but she wasn't pissed either. I further told her that people call me all during the day when I'm sleeping, but at least I appreciate the attention. /ubbthreads/images/graemlins/smile.gif



The point of this is I now know that I can't say anything around these people--It'll come back to haunt me.
________________________

Now news from the past two weeks:

I spoke with some fellow employees two weeks ago about staffing. I'm not alone in feeling that it's often an unsafe environment and it's just a matter of time before something bad happens.

We spoke to the charge about it and she feels the same way. She spoke to the unit mananger on our behalf. Same story we were told last time--the manager and the night supervisors feel that we're adequately staffed according to the charts.

It will take something big to change their minds from thinking like accountants to thinking about care. Just one person (me) can't do it, but at least I can get off the sinking ship before it takes me down.

______
So, what did I do about it so far?

I've gone to the ICU at the hospital on the military base just to check it out. It's kind of 1985 if you get my drift. Old building, old technology.

I spent an hour talking to ICU staff, the head nurse and the head of critical care services.
Do you do computer charting? "No, but we can get labs and do email from it."
Do you have form printed patient Kardexes and flowsheets? "No, but we've got a white sheet for meds and a blue sheet for the other stuff."
Tell me about patient load and staffing? "It's usually 1:1 or 1:2 and the acuity level is nothing like the ICU patients at your hospital (trauma)--we're not equipped for that."
Carreer progression? "I'm the ICU head nurse and I'm only 32. We've got a couple of positions that are being filled by travel or agency that will open up soon." /ubbthreads/images/graemlins/smile.gif

I also spoke with an Army Healthcare Recruiter twice. She's not telling me anything I didn't already know.
______________________

Part of me says run from my current job (not a career) and never look back. I know that unless there is a major shakeup nothing is going to change and I can only fend for myself.
I still have the same concerns about the military as before but it's not really so bad. The next move after here will most likely be to a major medical center (due to my wife's progression), so the hospital will be more high-tech.


What to do, what to do....I liked the Army when I was in and I can honestly say that I kind of miss it at times. It does have it's drawbacks though.

I guess I'll wait some more...


Thanks for listening guys. It makes me feel better.

Do what you can until you can't.

In the meantime search.

Try not to give up until you have another offer.

As a nurse, your skills are in high demand and there are plenty of places you could work for good money and to get the job, you just have to fill out an application. If you don't like your situation, look around. The only advice I have for anyone asking if they should quit is to never quit a job until you have secured your next job. This is not as much of a problem for a nurse, however.

Unfortunately the problems you are facing are endemic in health care right now and common in most hospitals. Nurses are needed in plenty of places besides hospitals, however. Medical practices, private industry, pharmacutical companies, medical research companies, etc.

I can't give any advice on the military question. I would personally hesitate taking a job that I couldn't quit.

"I do have to say here that I would like to take the time to thank the makers of IM injectable anti-psychotics and major tranquilizers. Neither patient remembered a thing once the sun came up."

Heh, heh, heh...vitamin H, perhaps? (Haldol...WONDERFUL stuff!)

man, i read this stuff, and can totally relate.

though my job is pretty cool, i deal with similar issues of incompetence over and OVER again.

missed orders, improper orders, annoying/incompetent docs/nurses/clerks/aides, inappropriate behavior, unrealistic expectations, etc, etc, ETC!

and i get the joy of cleaning up all that crap.

2 nights ago, a nurse was trying to get me to increase the dose of IV narcotic. the patient was positively sleepy, but appropriate, and still having some pain.
the patient was NOT using the PCA maximally: only about 30%.
i argued with the nurse that the patient needed to TOLERATE the med before i could justify increasing the dose.
further, i recommended non-narc analgesics to potentiate the narcotic.
she was under the impression that she could tell whether a patient was "just drowsy from lack of sleep" vs sedated due to narcotics.

i told her she needed to work for the psychic network, because her services are sorely needed.

i was nice during the encounter, pointing out our rationale for treatment, offerig SAFE options, etc.

the nurse just DIDNT get it!
i laid it out for her: "do you REALLY want to intubate this patient?"

i have similar conversations with PA's and docs.
so much for med school.

anyway, take your time making your choices--and dont burn your bridges.

take care,

Bob

[ QUOTE ]
pedalinbob said:
Heh, heh, heh...vitamin H, perhaps?

[/ QUOTE ]
To quote the late Rick James--"it's a hell of a drug..." /ubbthreads/images/graemlins/grin.gif It's not my favorite, but it does the job.

[ QUOTE ]
pedalinbob said:...i told her she needed to work for the psychic network, because her services are sorely needed...
i laid it out for her: "do you REALLY want to intubate this patient?"

[/ QUOTE ]
<scarcasm alert>I love those kinds of nurses. I've seen them and worked with them--they're a pleasure to work with and nobody knows nearly as much as them... /ubbthreads/images/graemlins/rolleyes.gif



[ QUOTE ]
pedalinbob said:
dont burn your bridges.

[/ QUOTE ] Been there, done that and burned myself in the process--not something I'd like to repeat but sometimes it's inescapable.


The really sad part about all of this, and what keeps making the decision difficult is that I enjoy working with most (not all) of the people on nights. I usually enjoy my area of nursing as it was why I wanted to go to into nursing in the first place, and I feel that I'm making a difference more often than not.

There are a few nights that just go great. There are, on the other hand more nights that I'm pulling my hair out by the root because of all the crap going on. I always leave in the morning saying "why am I still doing this to myself." After a few days off, I forget about it untill it happens again next week.

The kicker here is that I'm hesitant to get into any other field of nursing just yet and I'm not too impressed with the options of civillian nursing here where I live. I'd be going from one bad situation to another. I had originally planned to do this field for about 5 years before my masters and moving on to something else.
After thinking about all the junk I put up with, maybe being a CRNA wouldn't be such a bad job afterall /ubbthreads/images/graemlins/smile.gif It's not quite what I had in mind as far as career progression, but....

If there was a magnate hospital here, I'd have put my application in months ago for a similar position. As it is, I just don't feel like having a 2+ hour commute to Denver each day.

Flownosaj

One question I would have for you is "do you have plans for your family life (kids, taking care of elderly parents, etc...)?"

With both your wife and you in the military (I believe you have been in before), you would have great difficulties taking care of "civilian issues" in the event of a double deployment.

Nursing and Military are both callings that demand great sacrifices--I have real respect for you and your wife.

Best wishes for you and your wife.
-Bill