The toxic work team

“Nurses eat their young!”

Have you ever heard that before? To my new nurses out there, you may not have heard it yet but you will. To my experienced nurses, you’ve probably heard and experienced this first hand.

What exactly does that statement mean? How is that statement meant to be taken?

Honestly, to me, when I hear that statement I instantly hear “no one treats nurses worse than other nurses.” That mentality is what leads to a toxic team.

My current coworkers are amazing, I cannot say that about a previous place of employment, however. It was the true definition of a “toxic team”. The older or more experienced nurses there took pride in “eating their young”.  At that time I worked with a team that spent more time criticizing my every move and looking for mistakes than teaching me what I need to know as an inexperienced ICU nurse. There was a nurse that took PRIDE in the fact that other nurses were afraid to give them bedside report! It did not matter what you did. You could have coded a patient 3 times that shift, just come back from a repeat head CT, after emergent OR. This team member would question you on why the room is messy or why the 1900/0700 (depending on the shift) med was not given. img_1898Really? REALLY? I JUST SPENT 12 HOURS TRYING TO KEEP THIS PERSON ALIVE AND YOU ARE WORRIED ABOUT A TYLENOL NOT BEING GIVEN?

I asked other coworkers why this person was like that, and that’s the first time I heard “nurses eat their young”. Not only was this the answer but it was also given with a “justification”. Nurses that believe in this motto try to explain it as giving you, a nurse, a “real world experience”. They want to “break you in”. They want you to understand that the “NCLEX” world isn’t real. They want to toughen you up and make you a “better” nurse. They have countless reasons for why they are a bitch. It is NOT ok! There are plenty of ways to help a nurse develop and constantly being toxic is not one of them

I finally got sick of the crap so I went to my nurse manager. Her response? “Give them the same crap back. Stand your ground.” Not what I expected her to say but exactly what I needed to hear.  I did just that. Whenever this team member started with their shit I shut it down. Quickly. It did take a few times but ultimately this young nurse did not get eaten.

If you are a senior nurse please take a moment to remember a few things: There are ways to ask questions during report about an uncompleted task without being accusatory. There are positive ways of giving feedback to a nurse that may be lacking knowledge in an area. There are positive ways to help the “baby nurse” to transition from the NCLEX world to the real nursing world (and it is a big transition). Basically, there are ways to address issues where a nurse may not be up to par without being an asshole about it.

If you are the baby nurse please understand that you do not have to accept this toxic behavior. You can speak up, and you should. You don’t have to be confrontational. If you are not comfortable speaking to that nurse directly, address it with your nurse manager. If your manager chooses not to address the behavior then just know you are *probably* working on a shitty unit and you should *probably* start looking for a better place of employment.

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Hello nightshift, goodbye normality

I am a nightshift nurse. I have been my entire nursing career. It’s what I am used to and it’s been great for me. Key word: been. I used to love being a nighshifter. You couldn’t get me to work a dayshift if you paid me extra. 

That’s changed. I’m old now. I’ve been a nurse for 7 years, that’s like 21 years in human time. Nursing ages you, quickly. I’m tired. I’m always tired. That’s the problem with nightshift, it goes against your natural rhythms. I’m not supposed to be up wiping ass at 0241 in the morning and yet here I am doing just that. I can’t just have one shift off in between nights anymore either. It’s impossible for me to get anything done because I’m so exhausted that I sleep the whole day away. I’m lucky I live in a house and not apartment because I cannot tell you how many times I have been up cooking and cleaning at like, 2330 at night as if it’s normal. When I have a stretch of days off, I fall back into a normal rhythm, up during the day and down by 2200-ish. That first shift back after a stretch off is BRUTAL. It’s getting harder and harder to adjust back to the nightshift life. I think I may be reaching the end of this “nightshift nursing” thing. Then again, my mouth is far too vulgar for dayshift so… 

Story time no.4

I’m driving home from another night shift of shenanigans but what’s new. 

I have recently made a conscious decision to start drinking more water throughout the work night. I did not make the conscious decision to pee before leaving work 😒.

So here I am, at the rest stop (because my commute is 1 hr 15 mins and 75 miles one way) peeing in a fly ridden restroom. That’s not what bothers me. I just saw a woman walk out of a stall, walk past the sink without washing her hands, and just walk right on out of the bathroom. 


So, you’re just not going to wash your hands? No? Oh, ok. 

I walk out behind her to see her at the vending machine getting a bag of chips, because nothing tastes quite as delicious as Doritos and bacteria… 

Story time no. 3

You ever have a patient situation hit you hard? It’s happening to me tonight. 

We have a patient going down to OR for organ harvesting. The patient had a severe fall with non survivable injuries. The family had the heart, the soul, the strength to say yes to organ donation despite the sudden death of their loved one. 

It’s hard to watch. It’s hard to see the children say their last goodbye’s. It’s hard to see their tears. It’s hard to listen to them thanking us profusely when we should be thanking them. It’s hard knowing that this is the last time they will see their loved one, connected to IV’s and intubated. It’s just painful. 

I know that this patient will bless someone else’s life. They aren’t dying in vain. I just wish they weren’t dying at all… 

The end isn’t always the end

I learned a lesson not too long ago. The end is not always the end. I got to see this first hand more than once.

A few months ago we had a trauma, pedestrian-vs-motor vehicle, that came to our unit with severe head trauma. The patient had a head bleed along with swelling. The CT scans did not look good. The MRI didn’t look any better. The patient and family were refugees from a war torn country, they spoke little English. The team began having “the talk” with his family. You know that talk, the one where they are pushing for the DNR because the patient is not expected to have any quality of life. Yeah, that talk.

The family would have none of it. We managed to stabilize the patient. They got the standard trach/peg combo. The doctors continued to speak with the family about the quality of life and the family continued to hold out hope. The patient ultimately managed to be transferred out of the hospital into a long term care facility. We were pretty much under the impression that they would just waste away in a nursing home, with no improvement in neuro status.

The patient came back to visit us, along with the family. The patient still has noticeable deficits but was able to fully communicate and even thanked us for our care. We had given up but they didn’t.

dont give up

More recently, our unit had a very sick vascular patient that coded during their surgery. The OR team got them back and immediately brought them to our unit (STICU). They coded again, the second code was worked for an extended period of time and then the team called it. They died. And then they decided death wasn’t really for them and their heart started beating again… spontaneously… after the code was called… while the team were having a moment of silence for the patient.

The medical team spoke with the family and let them know that even though the heart is beating, the patient has been “down” for an extended period of time and neurologically there is probably nothing there. The family decides it’s in the patient’s best interest to make the patient a DNR. The family begins saying their goodbyes and leave in expectation that the patient would probably code again within the next few days. Everyone is pretty much preparing for this patient’s end of life…

gointothelight

Except the patient…

That night, they opened their eyes to painful stimuli. Then it turned into opening eyes to name but no purposeful movement by the next day. By the third day or so they just woke the fuck up and tried to self extubate! All of us were pretty much like:

heart attack

They were completely alert, oriented, and by the end of the shift able to write questions on a piece of paper. Needless to say we were all kinds of confused, surprised, and impressed. We ended up nicknaming the patient “Lazarus”. Are we going to Hell? Yes. We are all well aware. I have a time share there.

The patient had a rough course. They were intubated, extubated, and reintubated multiple times before finally being trached and pegged. However, as I am typing this they are alive and are being prepped for long term acute care out on the floor. That’s right, the patient that we basically pronounced dead is instead going to LTACH soon.

These moments have taught me that it is not over until the patient decides it’s over. It has also taught me that maybe I shouldn’t give up so easily. My miracle patients are showing me there are still some things that we in medicine don’t understand. We don’t know it all. I am glad for that.

 

Gambling Addiction is NOT a Poor Person’s Addiction. Meet Melinda L., An RN…

Nurses know how to take care of others but we sometimes forget how to take care of ourselves

"Holiday Recovery Starts Here~A Bet Free, Sober, & Clean Blog~Sharing Hope in Recovery One Day at a Time"

imageedit_1_6172885164 Courtesy of InRecovery Magazine

“My name is Melinda and I saved lives for a living.”

I was an ICU nurse and a nursing supervisor at a hospital where I had been employed for 27 years. I had earned respect, accolades and a good degree of success in my career. There are people alive today because of actions I took and decisions I made, often in a split second, to save their lives. With all of this success, I could not for the life of me stop gambling or think I could stop any more than changing the tides of the ocean.

Believe me, I tried.  In the local bookstore, I found rows and rows of books on alcoholism, drug addiction, overeating, overspending, over-sexing, over this, over that. There were entire sections dedicated to the innocent enablers who unwillingly allowed the “overs” to continue their destructive behavior. There were no manuals…

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Resting bitch face

I have resting bitch face, also known as RBF, and it’s terminal.

I have been told in my annual evals that I need to work on my “non-verbal communication”. Translation: “fix your damn face woman!” I blame nursing for my RBF. You probably have it too.

I am not only responsible for collaborating with the family of my patients, but also with the interdisciplinary team. Have you ever had to deal with a family member that insists that you know that their “cousin/sister/brother/daughter” works in health care, as if it is going to change how you care for their family?  It happens faaaaaaarrrrrr too often in the ICU. Typically my reaction is this:

waka ok

I am glad that your cousin is a CNA in a nursing home. Really, I am. However, this is an ICU and things are a tad bit different here. My other favorite is when I have to talk to one of the residents about something I need ordered, and instead they want to peacock around and tell me why they don’t think it’s necessary DESPITE the fact that the attending has already agreed that what I want for my patient would be beneficial. Once again my facial expressions look something like this while they are over-explaining things:

nene eye roll

Look, bruh, I know what hydralazine does. I know how it works. I am asking for it because I need to control his BP but his heart rate is like, 58, and maybe metoprolol isn’t the best idea. AND I ALREADY ASKED THE ATTENDING ABOUT IT WHEN HE WALKED THROUGH THE UNIT DOING HIS ROUNDS, just give me the damn meds!

Yeah. I have yet to figure out the whole “poker face” thing. Seven years of nursing and I will still look at you like you’re stupid.

So, to my new nurses, just know that if you don’t have RBF, you will. It won’t be on purpose. One day someone will say or do something so dumb that you just can’t hide your feelings. It is normal. Just about every nurse I know either admits to having RBF or has had a coworker with RBF. It just sort of happens. Don’t beat yourself up over it.

Story time no.2

It’s a work night. I’m charge. Typically I’m a black cloud. It’s the usual. One hour into my shift we are hit with two admissions. No biggie, we have the staffing for once! 

One of the new patients to come has a potassium of 7… Up from 6.1 two hours earlier. They are a renal patient on T/Th/S dialysis normally. They received their full four hour treatment on Tuesday and have been NPO for OR today. No one is really sure why the “K” is so high. So of course I can understand why they would prefer the patient be in an intermediate or intensive care unit to get emergent bedside dialysis. The step down is full so they came here. No problem, right? WRONG.

The patient’s significant other is PISSED

They want to know why they couldn’t just dialyze the patient on the floor where they were. Renal nurse and doc explain the significance of the high potassium, the possibility of a potentially fatal arrhythmia, you know, all the bad shit related to elevated potassium and why they need continuous monitoring right now. 

The S.O. is still pissed. 

Why?

They don’t like the room, we don’t have anywhere for them to sleep. 

Yep.

Forget the labs. Forget the safety of the patient. The room isn’t to their liking… 

Several seats… you need to have several seats… 

Story time no.1

I’m at work because it’s a Saturday and why the fuck not 😒.

We have a patient that has been screaming ALL NIGHT LONG. They were recently extubated, recently as in dayshift. For some reason NO ONE thought to get a follow up ABG. The RT decided to get an ABG tonight for shits and giggles. Values as follows:

pH 7.546

PCO2 37.4

PO2 44.3

Bicarb 31.7

O2 sats 86.5


Oh. *Maybe* we should do something about that! 

Guess who ended up reintubated…