Is my short career over? - page 10
ladies and gentlemen, i am having great difficulty deciding if my nascent career is, or should be, over. please be kind enough to tell me what you think. i am an rn with an as who recently graduated... Read More
1Feb 9, '12 by Ruby Vee, BSN, RNQuote from aloeveraEveryone seems to have such a different take on the same post! I don't think it's an "insult" to be trained by techs when the OP took a job in a dialysis clinic. Such places usually don't have a plethora of RNs handy, and being trained in tech duties by the techs seems like a good use of resources. Being insulted by learning such skills from a tech reeks of being "above all that", and that's not what nursing is about. It's all our job -- we need to learn how to do all of it.Oh, my.don't know where to begin !!!!You jumped right in to a nightmare !!! what an awful first job experience.......to be trained by your techs is an insult and I would not have allowed that, I would have insisted on another RN to train me...........Don't worry about your med error........you DID NO HARM....I repeat, you DID NO HARM....that is the bottom line....we have all had med errors........and those that don't admit it, are not telling the truth !!!You sound like a very caring and conscientious nurse.........just need to start out in a better environment....make sure wherever you go, they have a long preceptorship......as in a hospital........you need a year of hospital experience and then you can pick and choose to find your niche.Good Luck, don't give up...........you went thru too much hell to get that license !!!!! you WILL find your place !!!
And about the med error -- while it's certainly wonderful that no patient was harmed by the OP's error, I certainly wouldn't just dismiss the whole thing because "no one got hurt." A medication error is a potentially serious mistake, and I wasn't comfortable with the lengths the OP went to to explain it away. There are always going to be noisy workstations, time pressures and someone who wants to talk to us about something else while we're trying to prepare meds; none of those things make good excuses. I'd rather see a nurse who made an error -- and we all do make errors -- immediately own up to the error and set about mitigating the potential harm to the patient rather than spending a lot of energy making excuses for why it happened.Last edit by Ruby Vee on Feb 9, '12 : Reason: Paragraphs -- why does it strip away my paragraphs?
3Feb 9, '12 by CrunchRNGeez, I usually agree with ruby, but....
If the techs were having her spend the majority of her time doing chores and all doing everything differently and giving her a hard time about it then that is not the training she needed and I would have been PO'd too. Unfortunately the manager was not managing them well.
Med error - I never got the feeling she was casual about it. And it was minor. And it was difficult circumstances. I long ago worked peds clinic and you have 18 people around all asking you questions as you are trying to draw up meds. It is insane and super easy to make mistakes. I do feel that kind of pace is probably not the best for the O/P.
0Feb 9, '12 by Oldest&UgliestOne thing I thought about the Dialysis Clinic job while reading your post was that it was a terrible job for a NG. I am in a similar situation as you in that I graduated about 19 months ago and I am an older second career nurse. I also did well in school as far as the school work but struggled a lot in the clinical setting. I had absolutely no confidence my first job; I'm fairly sure I would not have had the courage to take that dialysis job. My first nursing job and where I still am is in corrections at the County jail. (Corrections, one of the fastest growing industries in the U.S. - sad); I love it, I think it is a great job for a nurse with a lot of life experience. It is not as physically challenging as many nursing jobs. You really learn a lot about assessment, patient communication, mental health medications and management of chronic diseases.
0Feb 9, '12 by aloeveraIt certainly was an insult to the OP the way she was treated by those techs !!!!!!!! It was horrible........
I would want another RN to train me if I was brand new in a Dialysis Clinic...techs may know the basic skills, but they certainly do not know how to handle emergencys and what to be looking for..........and what to do about them !!!!!! but that's me....
I certainly would never minimize a med error.........we are all trained to do our utmost NOT to make med errors... BUT they do happen.........more than just once in a while..........but this OP was letting this minor,,,yes minor.....med error devastate her...I was trying to lift her spirits with honesty and compassion..........the main thing she needed to hear, was she DID NO HARM....
I want her to get back in the saddle !!!!!!!!!!!! sorry if anyone felt I was minimizing the situation.....i
0Feb 10, '12 by cdsga, BSN, RNI work in the OR where everything is fast-paced and distractions are rampant. People interrupt you, invade your tiny little work space (if you are circulating) and you are doing many things at a very rapid succession. I did not start in the OR though, I trained in the ICU first to get my assessment skills down to a fine art-repetitive assessment is the name of the game in ICU, and you can concentrate on 1 or 2 maybe 3 patients in a shift. That prepared me for any place I decided to work. I always chose departments where I did not have a huge patient load-so I could concentrate on doing the best I could for my patients. After ICU, then PACU, then I went to the OR. That is where I stayed. I came to that conclusion based on knowing what I was best at, and what my skills were, and where I wanted to grow. After working in the OR for many years I became a Surgical Services Nurse Educator. That is where I learned so much more. Teaching allows you to learn how to transcend book knowledge to real life situations and how to prepare inexperienced nurses to their new environment. I wanted other nurses to have a better start than I did, and to prepare them for success and warn them of the pitfalls. I have seen people come and go because sometimes what they think they will like is not necessarily a best fit for them. You have to soul search, then try places that will enhance your attributes. It's a journey. And if you decide that you want to have an attitude of life-long learning, then you will have more successes than unhappy situations. I have learned from surg. techs, environmental techs, other nurses, doctors, cooks, nutritionists, infectious disease personnel, lab techs, etc. I was never too big to not learn from anyone. You can learn from everyone. But and this is a big "but", nursing is responsible for so many things. You still have to take what you can use, then tailor it to the nursing practice act of your state. Sometimes you have to gently correct, and prove through text, policy and procedure specific to your institution. You have to do due diligence to your profession. If you want to be the best then that is what you have to do. If you want to just get by, then just go with the flow and let others influence you and mold you into what they want you to be. I personally want to know the right way. I do have to say that I had much experience in a diploma nurse program that gave me much more clinical time than the present day BSN education.
0Feb 10, '12 by Frankie SladeThe hazing was encourage by the nurse supervisor. The techs talk bad about her, because the nurse manager told them too. They wanted to see how you would react. They set you up far failure. I worked at 18 different facilities, and they all play the same game. You were smart no to take the dialysis managers position, those techs would have really sabotage yout license. You would be smart to avoid all hospitals and all dialysis companies. If you volunteer at the free clinic, that might be good way to get full time at a later date. Remember, health care's philoshopy is always profit over people. Trust no one.
0Feb 11, '12 by DeLana_RNDon't give up, I can so totally relate to what happened to you. I have worked in dialysis (not as new grad, though, and I would never recommend it to a new grad), and thankfully was not precepted by PCTs - however, the RN was just as cruel, ridiculing me and calling me "slow" (that's their favorite insult, as no one who starts out learning complicated machinery and procedures can possibly be as fast as they are with their hands-on experience). As for the med error - holy cow, since when is it a horrible mistake because the kid got a lower dose and was only a day older than the arbitrary cut-off date (let's face it, there is nothing magical in the "6 months to a day" age limit)?! Again, you landed in a toxic workplace with depraved coworkers and supervisors. Do nurses (and PCTs) eat their young (and even their supervisors)? They do, and certainly will try.
It's no you, it's them. Solution: Find a better workplace. I like the idea of volunteering in a free clinic. And guess what - I just got the job of my dreams after starting out as a volunteer! So it can work.
Best of luck to you! Please don't give up, there is hope!!!
DeLanaLast edit by DeLana_RN on Feb 11, '12
0Feb 11, '12 by MJB2010It is pretty normal with the dialysis company I worked for to be trained by the techs first to learn the tech role. Once you get the idea of how their role works and all that goes along with it (and there is a LOT) you can move on to the nursing part. The way the training works in dialysis can not really be compared to how you learn in other areas of nursing because it is like comparing apples to oranges. People who do not work in diaysis will not understand how much the techs actually do in an outpatient clinic. You have to learn the tech role to understand it first, before you can get to the nursing part otherwsie you will never succeed in the RN role. I had some "difficult" techs as well. One in particular was into the whole hazing thing. But there were others on the floor and I gravitated to them when I needed help. You will find those kind of people everywhere, even in the hospital there will be techs that have been there for eons resenting you for hving the degree and giving you a hard time. You have to make an effort to seek out the good ones and work as a team Sounds like the dialysis place you worked was poorly run and poorly supervised which is not uncommon. But dialysis is a team, you simply cannot succeed without being able to get along with and work with the techs.
2Feb 11, '12 by SensibilityI know you've gotten more feedback than you could ever want but... I wanted to share some insights. I am 55. I was away from nursing for over 15 years to raise my children after working ten years before 1990 as a nurse and now I'm back... and I'm treated as a newbie. I can relate to so many of the things you've been through.
The meanness of people: I agree that we should call it bullying because that is something that this generation can relate to. All the hype from the public schools and the resulting suicides has brought out how horrible people can be to others. This is totally tolerated in the workplace even though my particular hospital says they don't tolerate it. Bullies find a way to bully. They gossip about everyone about the stupidest things and will often write other people up over ridiculous absurd things that the leadership does not take seriously and throws in the trash. But it is still meant to sting the other person. I had that happen and it hurt me deeply because I know it was a loud and clear message that the hospital leadership was forced to take somewhat seriously. It is bullying that bullies totally get away with.
I don't listen to gossip. I don't want to talk about other people and don't. In fact, I don't want to know how you live your life outside of work. I might have when I was 20, but I know now that those things have a tendency to come back to bite you when you least expect it. What goes around comes around. I know if I'm joining in, one day it will be me that is the source of gossip. Plus, those that gossip will tell the source of gossip what you said about them so that creates more animosity. I don't care anymore. You can talk about me all the day long. Just don't be mean to me in the workplace. Unfortunately, that isn't how it works.
I am often given assignments and those who are supposed to be the support techs (or whatever your institution calls them) do not support me. If I complain, they are meaner. So I have to take that abuse day after day where they leave me to do their work for them whilst they sleep at the desk. They do the minimal requirement and that is all they do without constantly being asked to do the rest. I have decided that it isn't worth it to be mad. These are typically people who are jealous of my education and pay, which leads me to the next topic.
I don't think a tech should have been orienting you. I can't think of anything more dangerous. There is an attitude amongst some people who are paid less than nurses that they shouldn't have to do as much and that they are better qualified than the nurse just as some of the nurses here have expressed. :icon_roll For this particular type of person (and I'm certainly not saying that all techs are like this), you have to bend over backwards to kiss their butts to get them to be respectful, which in my mind is unconscionable. I treat everyone the same irregardless of their education and that works. But I have worked with techs that think that they are superior and have been meaner than snakes to prove their superiority. I honestly do not know what the solution to this is especially when you're new because those people can legally make your life a misery. It is downright abusive the way they treat people but in essence, the team cannot do without them because they are so experienced and they know it.
I think you should learn your institution's protocols and do things that way. If they want 250 ml of saline charted, it should be done that way and there should be a protocol for that and there should be chart reviews done to ensure that. When you run across a discrepancy in protocols, that's when you have to go to those in charge to ask what the actual protocol is and then do it that way. Then when Tech A says to do it their way, you can say, "I looked up the protocol and it says to do it this way." Tech A: "Well that's a stupid way to do it blah, blah, blah." You: "If there is ever a legal issue, I want to be covered by the institution's protocol."
Med errors: I agree with the advice that you have to take responsibility for errors and learn from them. If you feel that you were not able to do what was needed to be done in that situation to avoid the error, think through how to do it better the next time. There are no excuses for errors. What is desperately needed in nursing is more self correction and a whole lot less judging. I think more errors go unreported than anyone will ever know because people cover them up. These were the warning signals that something potentially dangerous could happen but nobody wants to say that there's a problem lest they are judged. It is horrible!! If we could see these blindspots before they happen, it would make a difference. But we aren't like that in this profession....unfortunately.
I have already written too much. I hope this helps though.
1Feb 12, '12 by RockingItInTheER[QUOTE=llg;6122317]Your first job was a totally inappropriate job for a new grad. No new grad would have succeeded. If you want to be a nurse, you need to look for a job that matches your current skill -- and that's going to be an entry-level job, not one that involvessupervising and/or leading othersI totally agree. a new grad should not be put in this positionbeing called to be the clinical manager is even crazieryou aren't qualifiedyou graduated school but really you learn far more while you are workingyou need an entry level job like on a med surg floor at a hospitaltell the truth in interviews but keep it simple the first year of nursing can be daunting and at times discouraging you need a job you can stick with and get on your feet, developing your routine and refining your nursing skills and talentsdon't give upyou just had an extra bumpy start
0Feb 13, '12 by kath13Quote from golden_dawni would quit nursing all together. it is a thankless profession and i call it "the profession of oppression" for the very reasons your negative experiences you encountered here are demonstrated. if i had to to do it all over again, i'd do anything except nursing. coworkers are cruel and liars, sarcastic, biased. quit now!ladies and gentlemen, i am having great difficulty deciding if my nascent career is, or should be, over. please be kind enough to tell me what you think. i am an rn with an as who recently graduated nursing school with distinction and a gpa of 3.9. i passed my nclex on the first try, in 1.5 hours, with 75 questions. i am acls certified. but, in school, they told me "nurses eat their young", and i have come to believe it's true. i'm not young; i was 58 years old at graduation, but young in the profession.
within a month of passing my boards, i found employment with a dialysis clinic, as a dialysis nurse and team leader. after a training period, they promised i would soon be charge for my shift, assess patients, pass meds, and supervise four techs.
unfortunately, they had my subordinates train me. i was thrown into the lion's den. my subordinates were techs with only 6 weeks of informal training from the company, but had many years of valuable experience. they seemed anxious to let me know that while i would be their team leader, they had no respect for me because of my lack of experience, and that they really ran the show. it was more like hazing than training. i would see them give a patient 250 ml of ns, go for a lunch break, and fail to chart it. when i suggested they needed to chart it before they left, they'd say, "you aren't the nurse yet, and you probably won't last long enough to ever be the nurse." i refrained from reminding them that while i might not have been "the" nurse, i was indeed a nurse, and tried to get along with them, thinking i could address this when i became charge.
they kept me busy with scut work, emptying the infectious waste trash and cleaning up blood off the floor, while they treated the patients. after a month of this, i complained to the clinic manager that i wasn't going to become proficient in treating dialysis patients by emptying everybody's trash cans. i needed to actually perform dialysis on patients. then the clinic manager put a stop to the cinderella treatment, and insisted they give me some hands on experience.
each day i had a different tech preceptor. everyone had their own way of doing things. each day my preceptor would complain that the way yesterday's preceptor told me to do things was wrong, and insist i must do it their way instead. i learned the principals of dialysis, the appropriate responses to dialysis related emergencies, how to access a "button hole", how to access a fistula, and became proficient at catheter care.
it was a crazy way to set it up, but they also had these tech preceptors evaluating my performance. even though i tried to be pleasant, they really didn't like me and i think they just resented having a newbie come in as their supervisor. their evaluations were less than flattering, insofar as they complained i was "slow in the performance of tasks". as my 3 month anniversary came near, the clinic manager told me that i was "too slow."
i explained that i had still not had much experience and that i would get faster with time. i also asked, "do you want me to be fast, or do you want me to be careful?" she said what she wanted both, immediately, and otherwise maybe i should resign. so, i resigned, but very gracefully, saying i was sorry it didn't seem to be working out, and that i had great admiration for the job she did, and the way she did it. i live in a small town, so burning bridges isn't a good idea. besides i did admire her, she was capable and had been kind to me. i did frankly tell her she should not be dismayed if my coworkers spoke badly of me, because they also spoke badly of her. the rest of the staff smiled in her face while making cruel remarks about her behind her back. she said she knew this. i also mentioned that it was probably an ill-conceived company policy to be trained by subordinates. she agreed, wished me well, and we parted on good terms.
within a week i was working again, this time at a community clinic with a low level of acuity. i was treating a broad spectrum of patients, pediatrics, geriatrics, diabetes clinic, surgical clinic, as well as women's health and pre-natal patients. in my first month there i learned how to perform many poc lab tests such as rapid strep, flu tests, rsv tests, urinalysis, pregnancy tests, a1c and accu checks. i learned how to assist in minor surgeries and pelvic exams and do prenatal non stress tests, ecgs and learned the pediatric immunization schedule.
everything seemed to be going along fine until, in my second month, i made my first ever med error. i had a baby who had turned 6 months old the day before he came to the clinic. his mother brought him in because she wanted him to have an influenza immunization. our "standing order" protocol dictated that if he were less than 6 months old he should get a divided dose, 2.5 ml now, and another 2.5 ml in a month. if he were more than 6 months old, he should, instead, have gotten one single 5 ml dose. as it happened i was distracted by people bustling around me, my preceptor talking to me, reaching around me to get into the med press, the unit clerk coming and taking over my computer while i was trying to look at the computer's calculation of his age, etc. i was also dehydrated, tired and rushed. i miscalculated the baby's age, thinking him one day younger than 6 months instead of one day older than 6 months. i gave him the 2.5 ml dose that would have been appropriate if he had come in two days earlier. the child was under dosed. i had only been there two months, and i still had a preceptor watching me, but she didn't notice anything out of the way, either, until it was too late.
well, anyone who has ever made a med error knows the whirlwind of reports that follow. i made out all the reports. i called the baby's mother at home and explained to her that i had made a mistake, but that it should not harm the child, except insofar as he would need to come back for the second dose. she was very kind. my preceptor dressed me down and wasn't satisfied until she reduced me to tears.
the don was livid and demanded to know why this happened. i explained that i had not been given a break, was fatigued, dehydrated, and the clinic was busy with people bustling about, and that a computer was not available to me to look up the child's exact age. she asked what could be done to prevent recurrences of this in the future. i suggested that the nurses should be given a 10 minute break in the morning and another in the afternoon so that we could refresh our minds, use the bathroom, and have something to drink, since drinks were not allowed on the floor. i also suggested that nurses drawing meds should be given a "quiet zone" around their computer for the few minutes they were drawing them. she said, "well, you're not going to get that! so forget it!" "and", the don added, "you are still on probation, you don't get to make mistakes! i'd better not hear of anything else going wrong, or you're out!"
the don also dressed down my preceptor, saying that she should have caught this error before it occurred. my preceptor thereafter became very hypercritical and no longer seemed willing to train me, actually ridiculing me whenever i asked for information. i apologized to all profusely and hoped i would be forgiven, but i felt i was never forgiven. very shortly after, i was so miserable, i resigned again.
i then decided that i needed a hysterectomy, before i got another job, because i had a prolapse and had been waiting for a hysterectomy since before nursing school, never having enough time off to do it. so i took that opportunity. my recovery was complicated by cellulitis of the cuff, and my doctor didn't clear me to go back to work for 4 months. but i didn't look for another job just yet, because my daughter's wedding, scheduled to take place on the other side of the continent, would be happening soon. i thought a new employer would never give me time off to go to her wedding, so i waited 3 more months. very soon after that, my brother in law, (of 43 years), was diagnosed with stage 4 pancreatic cancer with mets, and i flew across the country to help my sister care for him until died, which occurred just last week.
now i find that i have been out of nursing school for 21 months, and have only worked a total of 6 months, at two different jobs! i spent 3 months waiting for nclex, 3 months working dialysis, 3 months working the clinic, and 11 months being unemployed, reticent, and trying to fathom my future. i'm very discouraged and actually afraid to go back to nursing. i also don't know how i can be smooth in an interview when i have failed so miserably at both jobs. i was slow at one and incompetent at the other.
einstein said, "anybody who has never made a mistake has never tried to do anything new." that's true, but maybe i'm not fit for nursing, even though i enjoyed scholastic achievement. nursing school teaches you how to be a good student, but only experience teaches you how to be a good nurse.
just last week a headhunter called and asked me if i would consider going back to the same dialysis clinic, this time as the clinic manager, since my former clinic manager had resigned. i thought about it for only 30 seconds and said, "no." i remember how the nurses and techs who worked for that clinic manager spoke evil of her behind her back. when she was not in earshot they called her a fat, ugly, old *****. i ventured to ask them how that was relevant to her job. they said, "well, she doesn't do her job very well either." actually i thought she did pretty well, i did admire her. i can imagine how those techs and nurses would treat me, who they viewed as slow, inexperienced and incompetent. they would tear me apart. and they'd be impossible to manage. it would be mutiny.
if i did go back to nursing, i wouldn't know how to smooth all this into a productive interview. and i don't know what to say in interview about the long hiatus. maybe my patients are better off having a different nurse. i have no self-confidence about it. is there anything else i can do with my degree and license? would an insurance company take me as a case manager? or do they want a lot of experience?
on the other hand, i have enough money and there is a free clinic that operates solely with volunteer staff in my town. maybe they would more patiently precept me, since my labor would be free, and maybe i could get a year's experience there, and become a more astute nurse.
any suggestions on how i might salvage my career? i do have very nice letters of reference from my clinical instructers in nursing school, as well as some of the mds and rns that i worked with at the community clinic. i'm sorry this was so long. thank you very much for your time reading this, and for your consideration of this problem.
0Feb 13, '12 by kath13What you experienced was a case of "Lateral Violence". Your coworkers undermined you and set you up to fail. I've experienced this myself with older, more senior coworkers and the feeling is horrible. The diploma old grads attempted to seal my personal information, my work schedule from another employer in an attempt to accuse me of being on call for the other company while i was working for them, but they got the wrong information. When i told the nurse manager that she was wrong, she replied to me "Tough, You're still fired!" the CPA of the company posed as a RN and did a mini interview over the phone in order to obtain my job position's working times, but my schedule was changed and the CPA got the wrong information! Nurses are thieves! They tried to steal my personl information , my work schedule from another job, but i got fired anyway. it was horrible. i called the police and they said it was "Harassment", and i tried to sue the company, but no lawyer would take it. I had to informm the local board of education and the police department , and inform them that this doctor and a gang of RNs were spying on me, becaue i don't trust anyone. I was afraid they also wanted to know when i would not be home ,and likewise when my teenage daughter would be home alone after school. I was terrorized by my coworkers at "Advocare", Or "Continium Health Associates" in souith Jersy. The worst part is that the nursing manager was part of the scam. I tell everyone , "Never trust a nurse"! Because she 'll only be out to sabatoge you for her own self gain.
2Feb 13, '12 by unsaint77I used to work at a dialysis clinic that was almost like your first job. At least the dialysis clinic I worked for was heavily profit-driven. So, they hire people and provide no management skills, hence the absence of structural organization as displayed by the unprofessionalism of the techs. So, I do not agree with Mazy at all. The word "subordiante" must be well established into the management practice. A work culture that encourages a leader to regard the techs as equal is bound for frequent turnovers. I know people will get on my case for saying this but I agree that the culture of nurse eating their young is prevalent, although it's not just in nursing. Many professions have this, even doctors. Some people get insecure about their skills. I mean, come on, we all have some sense of insecurity about our skills and knowledge. In some people, that insecurity comes out by pushing down on colleagues with vulnerability, such as new grads. So, unlike Mazy's comment, I do not see any flaws in your attitude. You just had a run of bad luck.