In the last month I landed my first nursing job ever since I became an RN this past winter. It's at a home health agency where I will be a supervisor that opens new cases and conducts follow-up visits every two months to see if the care plan is meeting the patients' needs. Pay and benefits are excellent, and they didn't have a problem with me being a brand new nurse when I was hired.
Problem is, the agency is starting to seem increasingly more disorganized and unprofessional to me and I'm afraid that my license is on the line if I continue to work with such little guidance and so few opportunities to ask questions.
There has been no training or orientation. I'm working for a relatively new department that hasn't ironed out the kinks yet, and even my manager can't give me complete answers to my questions because he doesn't know how the system works yet. I was sent to do patient visits immediately with just a stack of blank assessment forms and care plans. The only information they provided me with was a patient's name, phone number, and home address (no history, reason for seeking care, principal diagnosis, etc). The patient's info was sent directly to my personal email address because I was not yet issued a company email and they were still working on the logistics. In order to schedule visits, I was expected to use my personal cell phone to call the patient at home. I was also given paper copies of the patient's info to take home, in hopes that I could map out visits to patients' houses while I'm at home (on my own computer)?
On one hand I am scared because my nursing assessments directly influence the type of care that my patients will receive, and I don't want to miss anything. I'm new, and newbies tend to miss things that experienced nurses will pick up on. Had I been trained a little and allowed to shadow an experienced nurse, I'm sure I would feel more confident. But I'm being sent to visit patients who live alone and are often not the most reliable sources when I'm asking about health history (one couldn't even provide her birthdate). The home care aides often know as little as I do about the patients' needs, other than "she needs assistance with toileting and bathing." Shouldn't I at least be supplied with some more information before I go in? My assessment isn't going to be complete if my patient is nonverbal or confused and can't provide me with any of his/her medical paperwork or show me all the medications he/she is taking. Am I supposed to dig through their house and find the contact info of their doctors and family members myself so I can call them and get the full story? Am I supposed to search their house for their meds if they're unable to answer my questions? I want my assessments to be as complete and correct as possible, but if I don't have a clue what's wrong with my patients other than what I can visibly observe then I will be missing key information that can lead to my patients not receiving the care they need.
On the other hand, I'm very uncomfortable having unencrypted patient info sent to and from my personal email address, having to call and receive calls from patients from my own personal phone, and having a stack of forms with more patient info in my house. I don't want to violate HIPAA and put patients in harm's way because my department isn't organized enough to figure out a safer way to do all of this.
The more I think about it, the more I realize that the company might have made their decision to hire me even before the interview. The screening process was unusually minimal for such an important job (I've been asked for a whole lot more even just for volunteer positions!), and I feel that they would've hired absolutely anyone that applied. I should've realized something was off when there was no skills assessment and only a few, basic questions related to clinical decision-making, assessment, and planning (all of my responsibilities!!). They seemed almost too eager to get me on board right away and throw me right into the action. In hindsight, I should've asked what the training process was like, but I was too blinded by the excitement of being offered the job to even realize that I wasn't even provided with an opportunity to ask questions. When I told friends and family (including several experienced nurses), they were happy for me and the general consensus was "of course they'll train you, they wouldn't just throw you to the wolves right away!" I checked out this forum to see if home health nursing was appropriate for new grads, and saw both positive and negative experiences. (Everyone knows that internet forums and comments are full of negative nancies, sour grapes, etc so I tried to take the naysayers' words with a grain of salt and just give it a chance for myself). The naysayers were totally right.
My nursing license means a lot to me. To me, it's a symbol of how I overcame so many obstacles because I wanted to make a difference in peoples' lives. I don't feel that I can deliver what I owe to my patients because I work for a company that doesn't see the need to train a brand-new nurse that they already decided to hire. I may be an absolute newbie nurse and I may be an idiot for not running away from a job that might have been too good to be true, but I'm not a dishonest jerk who fudges assessments or turns in incomplete information and then signs her name at the bottom.
Should I call my manager tonight to share my concerns and request more training before I'm out doing patient visits, and quit if my concerns aren't addressed satisfactorily? Any thoughts would be appreciated, but please don't beat me up for this because I already feel like the dumbest person ever. /:
If your employer isn't giving you the tools to do your job, i.e. procedures in place to prevent HIPAA violations/inappropriate PHI disclosures or sufficient training to perform safely, then that's a failure on their part and unless they fix themselves quickly, in a hurry, and right-bleeping-now, I'd recommend you leave with your license intact...
Last edit by Cohiba on Jul 5, '14