Was this safe?

  1. Hi,

    I'm a brand new RN (I've had my license for less than a month). I'm also a new grad and am in training in a peds unit. This is also the first job I've ever had. I have to give you a little info about the unit for you to understand the situation. It's a peds/mother/baby unit. Most of the nurses are mother/baby nurses and some of them float to peds, but only a few. There was only one ped pt for the day so my preceptor was the only peds nurse there. Then there was me, but I don't count myself as a peds nurse yet since I've only been working there for 3 weeks and I'm supposed to have 12 weeks of orientation before I can work on my own.

    Ok so here is what happened. My preceptor went home sick and the charge couldn't find another peds nurse to replace her. It was a weekend so the manager wasn't there. The best they could do was an LVN who hadn't done peds for years, but was willing to do it. Our ped pt was on IV antibiotics and the LVN could not give them legally, or even cosign with me. So I gave the meds. I gave them correctly and charted correctly etc. But now that I think back I'm wondering if this was safe or legal since I'm supposed to be working under another RN. Also, the next day I worked with a different nurse and she said that all peds meds needed to be cosigned by another RN. My preceptor had never told me that. She would check meds with me the first time I gave them, but I don't think she ever cosigned the meds I gave. So even though no errors were made I'm wondering if I shouldn't have been giving meds at all when I worked with the LVN, or if I should've checked them with one of the mother/baby RNs even though I wasn't really working with them. No one told me that I had to be cosigned or that I shouldn't be giving meds. I'm just really confused. I hope that my manager or preceptor will give me some kind of feedback about what happened over the weekend and if I did something wrong.

    I came home after the first day feeling really good about myself and how independant I had been, but after the second day I felt like a complete failure and now I'm dreading going back to work tomorrow.

    Jessica
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  2. 7 Comments

  3. by   purplemania
    I am sorry you feel that way. Remember, you have a license so you are legally able to do whatever you have been trained to do. Sounds like you did that. Your charge nurse should have explained more to you about delegation & working with LVN or should not have assigned you to work with the LVN. She probably thought the two of you would support one another. Anyway, NOW is a good time to talk to the manager and/or charge and/or preceptor about the event so you can get feedback. This is better than waiting "for the next shoe to drop" or dreading your job. Talk it out. By the way, I think you handled the event successfully.
  4. by   rn/writer
    Quote from jesssko
    I hope that my manager or preceptor will give me some kind of feedback about what happened over the weekend and if I did something wrong.

    I came home after the first day feeling really good about myself and how independant I had been, but after the second day I felt like a complete failure and now I'm dreading going back to work tomorrow.

    Jessica
    Two things. First, it is the job of the preceptor or manager to be aware of your boundaries and make sure you stay within them. Before the preceptor went home sick, she should have made sure the manager or someone else would be looking out for you. Instead, you were left hanging and so was your patient. Since you were not supposed to be counted in the staffing ratios, it's as if they sent the regular RN home and left the unit completely uncovered. The fact that you were a warm body doesn't outweigh the fact that you had no legal standing whatsoever in caring for that patient. I'm sure no one looked at it in these terms, but in a legal sense, both you and your patient were abandoned.

    Second, take a look at your closing sentences. It's good to be open to constructive criticism, but only to a point. You have to decide what YOU think about what happened independent of others' thoughts or you will find yourself being at the mercy of anyone who has an opinion. It isn't easy being the new kid on the block, especially when you are new to your career as well. That's all the more reason to develop a strong sense of yourself both personally and professionally. The trick is to balance trusting your own judgment and still being teachable.

    If you can learn to separate yourself (and your self-worth) as a person from your actions, you can evaluate both good and bad without ending up inflated or crushed. In your example, you can be pleased that you gave good hands-on patient care while still acknowledging that management didn't do its part. And you can express concerns over the situation without believing that you were a failure. Either end of the all-or-nothing spectrum can lead to a false picture.

    Go back tomorrow with humble confidence. Express your concerns as well as your thankfulness that nothing bad came out of this and work with your preceptor and manager to make a pre-emptive plan so that you don't find yourself in this kind of bind again.

    The most important thing I can tell you is that this is a learning experience, not a test of your self worth.

    Good luck in your new job. Mom/baby (that's what I do) is a wonderful, happy place to work.
  5. by   cathyish
    you need to know that you can refuse to take any assignment for which you feel unqualified, untrained or unsafe. you are working under your license now, and it's up to you to know your own level of competency. do not allow a short-staffing situation to become your responsibility - it should have been your nm/charge nurse who took responsibility of those patient(s), not you.

    that being said, i think you did a great job in what must have been a stressful situation for you.
  6. by   llg
    You sound like you are becoming a great nurse -- one that I would be happy to work with. So please, don't be too hard on yourself about this one. Take it as an opportunity to help your hospital fix a problem (that will probably come up again sometime) and helpl everyone learn from the situation.


    My opinion is that yes, you should have checked the med and probably should not have been working unsupervised. You should never be giving meds or any treatments that you are not experienced with without double-checking it. That will be true throughout your whole career, not just at the beginning. Even experienced nurses should be double-checking things that are new, different, and/or potentially dangerous. That's just good, safe professional practice.

    You should also be checking your hospital's policies about such things BEFORE you do them. I know it can be very boring to read through policy manuals as part of orientation, but it is vital to at least skim over them and to read the policies directly related to orientation and the scope of practice in detail. You need to know what you can and can not do on your own -- and you shouldn't be relying on a preceptor for that kind of information. You should be taking the responsibility to check the policies yourself.

    It sounds to me as if your hospital has a problem with staffing and the procedures for filling a hole in the schedule in relation to orientation. By discussing the events with your leadership team, you may be able to help them improve things.

    Good luck,
    llg
  7. by   military spouse
    Just to make you feel better, LPNs give IV ABT at our facility. We just require that 2 nurses (LPN or RN) check all meds and initial the MAR. I'm sure she was capable, but your facility policy doesn't allow it. If you have questions regarding that event, I would clarify with your preceptor or manager.
  8. by   jessnurse05
    Thanks for the feedback. It turns out that the cosigning the meds was an old policy that isn't done anymore. Working with the LVN was still an odd situation but my preceptor thought I did everything right.

    So I went back to work today and was faced with a different situation. My preceptor tells me that people think I have a negitive attitude and that I don't enjoy working there. I was crushed (yes, the whole separating myself from the situation was discussed in an earlier post). I don't know what could've happened that people would think that about me. I try to help out as much as I can, I get call lights and answer the phone when I'm not busy. So I tried to be more helpful and friendly today to other staff and that just got me in trouble too because I ended up behind at the end of the shift and I had to stay late to finish charting. I'm also shy with new people and I don't know how I can change that, it's how I've always been. I'm not one of those people who jumps out and introduces myself to everyone around. I really do like the unit I work on and I like the people. I'm trying to be more guarded in what I say to people now. I've never been told those things before...

    Thanks again for the advice.

    Jessica
  9. by   KatieBell
    Well, you sure seem to like the unit you are on. Are you the only new grad they have had in a while? Maybe they are unaware of how intense the transition from student to RN can be! People can misread all sorts of things. Especially if they don't realize how hard you are concentrating to do your job at this point...They might have mistaken your furrowed brow of thought as one of unhappiness!

    To me, from what you are saying, you are doing just fine, progressing as you should and learning each day. If there is no problem with your practice- then do not worry, the unit will come around eventually- and get to know you. Right now, concentrate on your new role.

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