wefdm21. . .a short period of orientation is very typical for LTC. LTC nurses are expected to be more autonomous than acute hospital nurses. There is less staff and many times YOU are where the buck stops in LTC. I'm sorry you didn't know this going into this kind of job. Did you expect to get a crash course in nursing at orientation? Sorry, that doesn't happen. You learned everything to get you started as a nurse in nursing school. And, what you don't know, you have textbooks, the Internet and other employees to use as resources to help you find the answers. The training "on the floor" that you receive is merely to familiarize you with the routine of the facility. It doesn't take more than a few days to introduce this to you. And, if something isn't clear, then ask. As a new charge nurse, no one is going to think less of you for asking. As a new graduate you are going to be looking up a lot of drugs that you've never given before and doing treatments for the first time that you've never done before. LTC is highly regulated. Some of the things crappy nurses did were much worse 30 years ago before all the legislation was passed. And, still, there are plenty of crappy nurses in LTC that persist in practicing their bad ways proudly. Do you realize that there is something psychologically wrong with people who can brag about doing things the wrong way? You can't make these people change their behavior. But, please don't copy them. You can only be responsible for your own actions.
Are you saying that throughout your entire nursing school program the subject of nurses who didn't follow good nursing practices and do things the "right way" never came up in discussions with instructors? Just because others are exhibiting bad habits, not wearing gloves when handling body fluids, not answering call lights, or giving medications later than scheduled doesn't mean that you will be expected to do the same! You should practice what you were taught in nursing school and nothing less. You had time during your clinical experiences in nursing school to see examples of how things should be done.
What should you do? You should practice what you were taught in school--not what you see others doing! Students are taught principles of nursing for this very reason. It is so you can think and reason out these kinds of situations.
I started my career working in LTC and I saw much the same as you are seeing and experiencing. What I did was I kept my integrity. I followed the "rules" of nursing as I was taught them in my nursing program. Some of the other charge nurses laughed and talked about me behind my back. It was difficult, mostly because I was inexperienced and did not have the confidence to stand up to them if they made fun of me to my face. So, I quietly went about what I knew was the right way to do things each day. At home I looked up meds and re-read my textbooks. I learned over time that when meds are getting passed late that changing the administration times on the med sheets kept the facility in compliance and I was no longer late with certain meds. Good nursing has to start with you. You have to decide if you are going to do things the way you were taught or take shortcuts and compromise your integrity. The fact is that in a month or so you will get to know your assigned patients much better and you will be working on your own and have the freedom to organize the way you want to do your work as long as you follow the facility rules. Ones first nursing job is always very stressful. However, you have a lot of growth and maturing as a nurse that you still have to go through. Your first year out of nursing school is still a period of learning, but learning that you have to often do on your own initiative. As time goes on you will find nurses who will become role models and mentors that you will cherish. Unfortunately, like true friends, they are too few and far between.