What they don’t realize (or maybe they do but choose to continue behaving badly) is that studies show that being “hard” on someone when they are in the learning phase of their nursing job doesn’t make them strong but actually does the opposite, being hard makes the learner weak.
A Classic Example
Katie, a new nurse, works on a medical surgical unit with a nurse patient ratio of 5:1. Today is her first day off of orientation. Katie is given the following assignment: two patients in isolation, one patient going through the DTs, one in 4-point leathers, and one with the most difficult family members who have already threatened to sue the hospital and every doctor and nurse in the building. Most of her experienced co-workers have four patients; many who are stable waiting for discharge.
As an ethical issue in nursing, is Katie being set up to fail?
What helps new nurses become competent?
New nurses become competent when they feel confident in themselves. Confidence equals competence. The best way to help new nurses gain confidence is to give them the easiest assignments, fewer patients and provide a constant vigil of support. We need to do this until we see evidence that the new nurse is gaining confidence in his/her skills. Once confident, slowly add more complicated patients to their assignment.
Just like in Katie’s situation, who ultimately pays the price for the “hazing” of our new nurses? Our patients ultimately pay the price. As a nursing ethics issue, we have a responsibility to our public to ensure that we are doing everything we can to ensure that every new nurse has the skill set necessary to provide high quality care. Period. Remember, confidence equals competence. Stop the hazing, stop the violence and start the supporting!
Came to work an hour early ready to start my 12 hour shift. It was about 12 patients at the beginning of the shift, within an hour we discharged four leaving us with eight patients leaving room to get ten admissions throughout the night. ER was packed so I know we were going to get slammed with admits.
Staffing was a mess as usual and we ended up being short staffed. At least every thirty minutes to an hour somebody got a new admit so the previous admit assessment or charting was not complete. Call lights stayed going off, phones steady ringing, everybody wanted pain meds every hour. Then I lost my badge & locator badge for the rest of the shift, from running in and out of rooms helping turn patients & putting the confused ones back in bed.
One patient pulled out his IV, making it look like a murder scene in his room. The next patient who was “allegedly” paralyzed on her right side managed to get her clothes off and get out the bed. Then another patient down the hall Colostomy bag was constantly leaking all over the place and her PICC line did not work (absolutely no blood return). Another one is throwing up every time you walk out the room. While all of this is going on another confused patient who cannot ambulate is climbing over the rails trying to get out of the bed & two other confused patients are screaming from the top of their lungs.
Meanwhile a patient who is nearly seven feet tall that can barely ambulate refuses to use his cane. Then a patient who was just in a MVA asks for a T-Bone Steak as soon as he gets admitted to the floor. To top it all off I had to make the assignment for day shift & after all that happened that actually was the most stressful part!!
This night may have been absolutely ridiculously insane, but with the help and laughs of my other staff members it actually made it a better night. One Nurse who had to stay over to day shift because she could not finish all of her charting decided not to come back tonight. The other one stuck it out and will be working & lucky me I’m off for the next three days ;-)!!
Ever had a shift that was crazy from the time you clocked in until the time you clocked out? If so, how did you handle it? Were you stressed the entire shift or were you able to keep your cool? Did you call off the next day/night or did you come back to work hoping it would be better this shift? Most important were your other staff members helpful?
I have been present too many times with my patients during the unnerving drama of a hospital CPR or a code blue scene, I question how good it would be for a family member to watch. It’s probably the most dramatically graphic and emotionally charged event I’ve witnessed as a nurse.
The all-consuming helplessness that one can feel while it’s happening is probably the main reason I’d tell families not to stick around. Especially knowing that in all likelihood the outcome will be poor. How will or do families of a dying patient accept or cope with the result?
Time stands still from the moment the first responding medical team member pushes the big red emergency button next to the dying patient and yells “Code!” Staff members are drilled on how to act when it happens and everyone has an assigned role. Within seconds the “code team” arrives and the room is filled to capacity with a frantic sea of nurses, doctors, respiratory therapists, lab technicians and voyeuristic students who stand against the wall straining to see what’s happening. It would look like chaos to a lay person.
I will venture to guess that family members who would opt to watch imagine that it will be just like on TV quick and clean with a happy ending. They need to be told it’s not like their favorite TV drama. It’s a long, drawn-out battle: blood, cracking bones, shouting, loud beeping, lots of needles and extreme roller-coaster-style energy, anger, joy, tears, smiles, terror, relief, frustration and exhaustion.
The team does their absolute best to have a positive outcome and this might be the sole reason for a family member to watch. They’ll see the dedication and effort that went into the attempt to save a life.
During my hospital bedside nursing career I did a stint on a surgical step-down unit and it seemed that almost every shift I worked someone’s patient “crashed” and a code was called. If it was my patient I would stay throughout the process. Even though I didn’t have a required role to play I’d often step in and do a round of chest compressions. I felt that I owed it to my patient a show of solidarity or support at the end. From a psychological standpoint, assisting with chest compressions helped me to feel less helpless. A family member in the room wouldn’t be able to do anything but stand against the wall and watch. And they would feel extraordinarily helpless.
If one of your patient’s family members asked you if they should watch this detrimental situation, how would you respond?