NUR 451 discussion reply

I am currently working in the emergency room in southwest Florida, and I must admit I am not having a stellar experience. The culture of caring in this hospital, as far as I can see, is completely absent. This has been a horrible experience and it is so bad I had to call my recruiter ant tell him I can not work in this unsafe environment. I will try to explain. The hospital I left in June was a Magnet, not for profit, religious based hospital, and I worked in the ICU. My contract was originally for 13 weeks, but I ended up extending my contract many times, and I ended up staying for 10 months. Nurse theorist Jean Watson describes caring “as a science: Caring is a science that encompasses a humanitarian, human science orientation, human caring process, phenomena, and experiences” (Stroehlein, 2016). In the previous hospital I worked at there was a true culture of caring. We worked together as a team, we empathized and communicated effectively with each other, our patients, and patient’s families. At times it was difficult as we were covered from head to toe with PPE which we had to don and doff carefully every time we entered and exited a room. This was time consuming, but our manager made sure we had “runners” to get us whatever we needed inside our rooms and in the unit. During our morning huddle, we discussed what happened in the unit in the previous 24 hours, and our charge nurse asked what we needed for our shift and how we were holding up. Our manager made sure we had the necessary equipment to do our jobs and take care of our patients, and we had a wonderful unit educator to make sure we were up to date on all the latest information. During our daily walking rounds we worked collaboratively with everyone on the patients care team. On extremely stressful days, the hospital made sure we had food and snacks available to grab on the go, as well as a grief support group to help us deal with the aftermath of Covid-19. The culture of care in this hospital allowed us to work together as a team, lift each other up, and give excellent patient care.
I am not sure I can explain how horrible my current assignment is. This is the exact opposite of a culture of caring. When I arrived, they did not know who I was or that I was starting that day. I was told to work on the computer on Healthstream to finish the mandatory education and become familiar with Meditech, the computer charting system the hospital used. After about three hours, I was pulled to help on the floor, and I was given five new patients at one time. That was the extent of my orientation. This ER is referred to as the “dumping ground” for all the psychiatric patients, alcoholics, and drug addicts in Palm Beach County. According to the Joint Commission and CMS there are rules that must be followed specifically for suicidal patients and patients in restraints. I have yet to see any documentation pertaining to this, and when I asked about it, I was told not to worry about it, they don’t do that here. I asked if I could use a WOW (workstation on wheels) so I could draw labs and give my meds at the bedside. I was informed they put the patient’s sticker on a piece of paper and do all scanning of labs and medications at the desk and not at the bedside. I refused to do this as it was a huge patient safety issue and could easily end in a medication error. The nurses and other staff members are rude to each other and rude to their patients. They treat the psychiatric patients as if they are subhuman, and there is certainly no dignity or respect given to these patients. The ER is filthy, there are no environmental service employees overnight, so the nurses clean their own rooms. If the room isn’t clean, they throw a sheet on a dirty bed and put a patient in there anyway. I had a patient with a traumatic intubation who almost needed a bedside cricothyrotomy. The patient was restless and trying to remove his ETT. I was in his room for a long time because I knew if he lost his airway, he would die. I had requested assistance with my other patients, but when I went to one of my patient’s rooms, she was hysterical because she had been calling on the call light, and then screaming for help. No one helped her. She had a broken hip, she was in horrible pain, and she was incontinent of urine because she didn’t have a bedpan. I was beside myself with anger and shame that my patient had endured this, and I was not there to care for her. I could go on and on, but I am sure you understand what I am saying.
In my first experience I was surrounded by a caring culture, and in my second experience there was a total lack of communication and lack of caring. According to this week’s lesson, Groenwald stated, “Leaders change the culture of an organization when they perceive a gap between the desired and prevailing culture and a compelling reason to remediate the gap” (Chamberlain, 2021). The hospital system I currently work for definitely needs remediation on multiple levels. I am surprised their doors are still open. I reported this information and my experience to my recruiter as well as the Joint Commission.
References
Stroehlein, M. (2016, June 25). Caring Concept. SOJ Nursing