Help! The worst training ever! - page 2

I just started my first job as a new grad in LTC. And yes, I'm truely afraid of what's going to happen once I'm on the floor alone. Orientation consisted of 3 days of watching "How to not slip and... Read More

  1. by   PANurseRN1
    I simply cannot believe what I just read. A new grad does not come out of nursing school with the skills needed to function independently. Read it in a book? Look it up on the internet? Good God, is this finally the state of affairs nursing has come to, when even our own are saying this is acceptable?

    Shame, shame, shame on anyone who thinks that new nurses do not deserve a thorough orientation. I don't care if it's LTC or acute care. A new grad is the last person who should be expected to function "autonomously." A new grad shouldn't be in a charge position, for that matter.

    I am just...there are no words. :angryfire

    OP: You need to get out of there. You can bet that if you make a mistake, this place will not support you. Go somewhere where you can get the appropriate orientation for a new grad, and don't let anyone try to feed you that rubbish about only needing a couple of days of orientation.

    Is it any wonder we can't get people to work in LTC, and any wonder why new nurses leave the profession so quickly?
    Last edit by PANurseRN1 on Dec 24, '06
  2. by   Daytonite
    Quote from wefdm21
    I'm just alittle unsure because like I said the class orientation was a little shaky, and the nurses on the floor do what ever they feel like doing, so if the facility wants you to do a certain procedure this way or chart that way then how will I be sure what's correct. I don't want to be written up for something that was never even explained to me. You know what I mean?
    The correct way is always going to be what the facility policy and procedure manual says. That manual is the final word. Whenever anything goes wrong, whether it be something involving a lawsuit, accreditation or a facility licensing violation, the facility's policy and procedure manuals are one of the first places that everybody goes looking. The reason is because these things are in black and white, set in stone. There are certain procedures and policies that you'll want to become familiar with. Get xerox copies of them and put them on a clipboard you keep with you. One might be on the facility fire policy. You might also have a policy on notification of physicians. You are going to find policies on all kinds of things you probably never thought of. So, it's always a good idea to periodically go through these books just to refresh yourself as to what is in them. I've always felt that everyone should go through another refresher orientation after 6 months on the job because there is so much you just don't "pick up" in the first days of working. When I worked in the acute hospital I had xerox copies of the policies on hypoglycemic and heparin protocols, and arrhythmia protocols when I worked on a stepdown unit. When I worked in nursing homes I also kept a list of all the patients who were DNRs on my clipboard.

    If you find that someone is telling you to do something that is different from what the policy and procedure book says then go to the DON and ask him/her to clarify it for you. If the DON is also going against the written policy, then I would ask why the written policy hasn't been changed and won't the facility get in trouble with the state surveyors.

    When it comes to nursing you will never go wrong with the basic things. When you chart, chart facts. I used to ask the MDS nurse to help tell me what was important to be charted, particularly on the Medicare patients. The MDS nurse depends on the nurses charting to complete the MDS reports that have to be sent to Medicare every 90 days. Once I got oriented and comfortable with a place I found out who to call at the pharmacy to find out how to get things changed on the monthly printouts of the MARs and TARs. What you will find is that some people, but not all, will know the answers to some of your questions, and other times you'll have to go searching for your own answers. But, keep in mind that there are right and wrong ways to do things. Someone will know the answers to your questions. Sometimes it will just be a matter of who. And, when the state surveyors come in for their onsite inspection, these nurses who are such bad examples are going to suddenly have a great transformation, I promise! And, they will be revealed for the hypocrites and lazy marys they really are.

    If you are ever in question about the way something is being done, either post a question on a thread here on allnurses, or do a search of the forums for that subject. One thing you will find is that the nurses on allnurses are never without something to say on a subject! Let me also say, that as crappy a beginning as I had when I started in LTC (and my beginning was really crappy) I was determined not to become negative and lazy myself. I've busted my rear end over the years to bring quality to my nursing when ever I've worked in a LTC and I'm proud of that. There are some of us who do want to see things done correctly. I am very much aware of what kind of lowlife nurses still work in nursing homes. You can't let them beat you down. You have know that you are better because you stand for quality. You'll like yourself better at the end of every day. I promise.
  3. by   SuesquatchRN
    I started in LTC and plan to stay there. But this place sounds bad, and I would get out. Yeah, the policies and procedures manual is a wonderful tool but ours hadn't been updated in four years, and laws had changed in the interim, let alone practices.

    The day will come that something that you have never experienced and don't know how to handle will occur and it will result in a medical catastrophe. And, if this place is anything like my last one, you will become the fall guy to protect their mismanaging rears.
  4. by   Simplepleasures
    Quote from Suesquatch
    I started in LTC and plan to stay there. But this place sounds bad, and I would get out. Yeah, the policies and procedures manual is a wonderful tool but ours hadn't been updated in four years, and laws had changed in the interim, let alone practices.

    The day will come that something that you have never experienced and don't know how to handle will occur and it will result in a medical catastrophe. And, if this place is anything like my last one, you will become the fall guy to protect their mismanaging rears.
    Hallelujah sister! All the good advice about policy and procedure manuals flies out the window when the book is locked in the Nursing Office where no one who needs it can have access .OR as above poster states , so outdated , not to be a viable tool anymore.Over the years the Policy and Procedure book has been a joke amongst seasoned nurses.The facilities Ive worked in didnt follow their OWN policies and procedures.
  5. by   withasmilelpn
    The other nurses I work with laugh sometimes about how I am the only one who reads the policy and proceedure manual. But it has saved me before when I have furnished a copy of said 'policy' when something has been questioned. I also reguarly check my state board licensing regulations. I knew about LPN's being able to take VTO's in my state (pa) before my facility did.
    That being said, I am beginning to think that LTC nurses are totally set up to fail. The shear number of patients, meds and tasks are simply too much to be able to do 'by the book' ( doesn't stop me from trying). A prime example is not being allowed to do accuchecks or give meds in the dining room. Combined with the rule I have to be in the dining room the entire time people are eating, then add in the mix the requirement I am 'supposed to' give my meds within the 1 hour before or 1 hour later. Meal time is 5p, my meds are scheduled @ 5p- how is this possible?! Management is oblivious to this, of course.
    When I was a new nurse I thought I just needed more experience - time management skills! Later on I thought I'll just do the best I can and that was enough. Now @ 10 years I'm tired of 'doing the best I can'. (I don't mean not taking good care of my patients, being out of compliance.) I've seen management protect their interests but not ours. We will always be the sacrificial lambs when there is a problem.
  6. by   Daytonite
    well, locked up and outdated policy and procedure manuals shouldn't be happening here in the u.s. or the nursing staff should be notifying the accrediting and licensing bodies that it is occurring at their facilities. if they don't have the guts to report it, then they should get out of this specialty. as i got experience i worked my fingers to the bone to bring better quality to the ltcs i worked in. it has to start somewhere, with someone. once the process of doing things the right way gets started in one place, other nurses in the facility get onboard and pretty soon the bad apples get fed up with the people who are good because they are negative thinkers anyway and leave or else ride the fumes of content that will begin the waft through the air. i feel so bad for those of you that haven't had the experience of working in a place where people do get along and do things the right way! it is extremely rewarding.

    withasmilelpn. . .there are many ways to skin a cat. they way we charge nurses learned to get in compliance with the 1 hour grace period allowed before and after medication administration times was to sit down and rearrange medication administration times. we changed the meds of the tube feeders that required crushing to times in between other major med passes. we also put some of the tube feeders daily meds that we could on the night shift. we changed the morning medications of the real early risers to the night shift. some of the daily vitamins were moved to the evening med pass. by spreading out the medications that way the med passes were lightened up for the day and evening shift and we were in compliance. this was a cooperative effort between the charge nurses and our don not something administration had control over.
  7. by   SuesquatchRN
    Quote from daytonite
    well, locked up and outdated policy and procedure manuals shouldn't be happening here in the u.s. or the nursing staff should be notifying the accrediting and licensing bodies that it is occurring at their facilities. if they don't have the guts to report it, then they should get out of this specialty. as i got experience i worked my fingers to the bone to bring better quality to the ltcs i worked in. it has to start somewhere, with someone.
    key phrase, daytonite, italicized by me: "as i got experience i worked my fingers to the bone to bring better quality to the ltcs i worked in."

    the op is on her first job post-licensure and graduation. this is simply not the place for her to begin, neither her career nor what some might consider to be tilting at windmills.
  8. by   Simplepleasures
    Quote from daytonite
    well, locked up and outdated policy and procedure manuals shouldn't be happening here in the u.s. or the nursing staff should be notifying the accrediting and licensing bodies that it is occurring at their facilities. if they don't have the guts to report it, then they should get out of this specialty. as i got experience i worked my fingers to the bone to bring better quality to the ltcs i worked in. it has to start somewhere, with someone. once the process of doing things the right way gets started in one place, other nurses in the facility get onboard and pretty soon the bad apples get fed up with the people who are good because they are negative thinkers anyway and leave or else ride the fumes of content that will begin the waft through the air. i feel so bad for those of you that haven't had the experience of working in a place where people do get along and do things the right way! it is extremely rewarding.
    pretty words, but the ugly truth still remains.as for having the guts to report this to the state, i guess you dont know my background yet. i did report this and other far worse violations to the state and immediatly fired in retaliation. luckily i have a state law that protects me from this retaliation and am now in the middle of a law suit . as for the state regulating bodies, read "patients pain and politics", by mary richards rollins rn bsn former wisconsin state examiner. she spells out pretty clearly the abismal lack of enforcement and worse goings on of some enforcing agencies.i really think it is about time that management in ltc wake up and smell the coffee, because as things progessivly worsen in ltc and healthcare in general, there may yet come a day that the poop may hit the fan and there will be some big explaining to do.anybody really interested in the truth about ltc, contact your state nursing home reform groups, it is worse than you even suspected.these are harsh statements, but it really needs to be said, its long overdue.its not only the negative thinkers management needs to get rid of , its people like me who do have the guts to make a difference, even if it is a drop in the bucket. maybe my case can set a legal precedent, that would be more than worth getting fired for.
    Last edit by Simplepleasures on Dec 26, '06
  9. by   Simplepleasures
    Quote from withasmilelpn
    That being said, I am beginning to think that LTC nurses are totally set up to fail. The shear number of patients, meds and tasks are simply too much to be able to do 'by the book' ( doesn't stop me from trying). A prime example is not being allowed to do accuchecks or give meds in the dining room. Combined with the rule I have to be in the dining room the entire time people are eating, then add in the mix the requirement I am 'supposed to' give my meds within the 1 hour before or 1 hour later. Meal time is 5p, my meds are scheduled @ 5p- how is this possible?! Management is oblivious to this, of course.
    When I was a new nurse I thought I just needed more experience - time management skills! Later on I thought I'll just do the best I can and that was enough. Now @ 10 years I'm tired of 'doing the best I can'. (I don't mean not taking good care of my patients, being out of compliance.) I've seen management protect their interests but not ours. We will always be the sacrificial lambs when there is a problem.
    Yes that is so true, its really sickening that mangement "pretends" they dont know this.
  10. by   TheCommuter
    You are fortunate to have received a few days of training. I was a new grad 10 months ago and received only 8 hours of orientation before being cut loose to work on my own at a shabby nursing home.

    I have worked at several nursing homes and, honestly, very few nurses do things by the book due to limited time. Who has the time to pass medications to 40 patients within the legally allotted time, perform all the treatments by the book, and answer call lights within a timely manner? If I pass morning meds by the book, I will start my 0800 med pass at 0700 and not be done until 1000. Sorry, but a 3-hour window to pass meds is illegal in my state.
  11. by   Midwest4me
    Quote from withasmilelpn
    That being said, I am beginning to think that LTC nurses are totally set up to fail. The shear number of patients, meds and tasks are simply too much to be able to do 'by the book' ( doesn't stop me from trying). A prime example is not being allowed to do accuchecks or give meds in the dining room. Combined with the rule I have to be in the dining room the entire time people are eating, then add in the mix the requirement I am 'supposed to' give my meds within the 1 hour before or 1 hour later. Meal time is 5p, my meds are scheduled @ 5p- how is this possible?! Management is oblivious to this, of course...
    GREAT RESPONSE--I couldn't agree more! I SO agree that we are set up to fail!!!! Here's another distraction--another duty we need to do too---how about when the MD comes in and wants to do rounds with you on pts at 8am or 8:30am OR a pt or two falls during med pass? There are just too many tasks expected in a short period of time.
  12. by   banditrn
    Quote from Daytonite
    The correct way is always going to be what the facility policy and procedure manual says. That manual is the final word. Whenever anything goes wrong, whether it be something involving a lawsuit, accreditation or a facility licensing violation, the facility's policy and procedure manuals are one of the first places that everybody goes looking. The reason is because these things are in black and white, set in stone. There are certain procedures and policies that you'll want to become familiar with. Get xerox copies of them and put them on a clipboard you keep with you. One might be on the facility fire policy. You might also have a policy on notification of physicians. You are going to find policies on all kinds of things you probably never thought of. So, it's always a good idea to periodically go through these books just to refresh yourself as to what is in them. I've always felt that everyone should go through another refresher orientation after 6 months on the job because there is so much you just don't "pick up" in the first days of working. When I worked in the acute hospital I had xerox copies of the policies on hypoglycemic and heparin protocols, and arrhythmia protocols when I worked on a stepdown unit. When I worked in nursing homes I also kept a list of all the patients who were DNRs on my clipboard.

    If you find that someone is telling you to do something that is different from what the policy and procedure book says then go to the DON and ask him/her to clarify it for you. If the DON is also going against the written policy, then I would ask why the written policy hasn't been changed and won't the facility get in trouble with the state surveyors.

    When it comes to nursing you will never go wrong with the basic things. When you chart, chart facts. I used to ask the MDS nurse to help tell me what was important to be charted, particularly on the Medicare patients. The MDS nurse depends on the nurses charting to complete the MDS reports that have to be sent to Medicare every 90 days. Once I got oriented and comfortable with a place I found out who to call at the pharmacy to find out how to get things changed on the monthly printouts of the MARs and TARs. What you will find is that some people, but not all, will know the answers to some of your questions, and other times you'll have to go searching for your own answers. But, keep in mind that there are right and wrong ways to do things. Someone will know the answers to your questions. Sometimes it will just be a matter of who. And, when the state surveyors come in for their onsite inspection, these nurses who are such bad examples are going to suddenly have a great transformation, I promise! And, they will be revealed for the hypocrites and lazy marys they really are.

    If you are ever in question about the way something is being done, either post a question on a thread here on allnurses, or do a search of the forums for that subject. One thing you will find is that the nurses on allnurses are never without something to say on a subject! Let me also say, that as crappy a beginning as I had when I started in LTC (and my beginning was really crappy) I was determined not to become negative and lazy myself. I've busted my rear end over the years to bring quality to my nursing when ever I've worked in a LTC and I'm proud of that. There are some of us who do want to see things done correctly. I am very much aware of what kind of lowlife nurses still work in nursing homes. You can't let them beat you down. You have know that you are better because you stand for quality. You'll like yourself better at the end of every day. I promise.
    Daytonite - I understand what you're saying, but what should be isn't always what IS! At the last facility when they started accepting trached patients, I wanted a policy and procedure - went thru their books and there was none. One finally showed up after the third patient.

    Now at this facility, they've accepted two, and NO ONE knew how to take care of them - I was absolutely appalled when I came in the first nite to take care of this new fella to learn that none of the girls there had ever taken care of a patient like that!! I had to do a quick inservice for the girls - but I wanted to know why the facility hadn't done that?! No one could tell me where the policy and procedure manual was!!

    When I finally got ahold of the DON, who is fairly new, she had no idea that the nurses there hadn't ever suctioned or taken care of that type of patient. I asked her about the P&P manual and she told me that she'd been trying to work on it - so I volunteered to type anything she needed on my own time.

    Another thing I found out before I talked to her, was that some of them wouldn't admit that they didn't know what they were doing, so they thought they'd just come to me on the QT - well, that doesn't impress me - if I don't know something, I admit it. The DON NEEDED to know what kind of situation had been created by accepting residents without knowing if the nurses had the skills to care for them.

    But who would I have reported these situations too?
  13. by   Simplepleasures
    Quote from banditrn
    When I finally got ahold of the DON, who is fairly new, she had no idea that the nurses there hadn't ever suctioned or taken care of that type of patient. I asked her about the P&P manual and she told me that she'd been trying to work on it - so I volunteered to type anything she needed on my own time.

    Another thing I found out before I talked to her, was that some of them wouldn't admit that they didn't know what they were doing, so they thought they'd just come to me on the QT - well, that doesn't impress me - if I don't know something, I admit it. The DON NEEDED to know what kind of situation had been created by accepting residents without knowing if the nurses had the skills to care for them.

    But who would I have reported these situations too?
    Banditrn, chances are that if you had reported this to the state you would be fired in retaliation, the same way I was. This type of retaliatory discipline and firing is MODUS OPERENDI in LTC.

close