So what is my problem?

[SuesquatchRN]

My union rep and coworker both say it's because I'm new - I live in a very small area, and half of the nurses have relatives in the facility - like their mothers.

This is (edited for privacy) what I wrote my rep, who said I should just put it down for her.

Tell me if it's me. Please.

I don't know where to start.

I have been picking up a lot of extra days because I know the facility is having a hard time hiring enough nurses. Well, every time I end up on another unit a med error happens.

I still haven't had a 90 day review and I swear it's because MyChargeNurse is trying to figure out how to give me a lousy one with no reason to. As an example, some weeks ago she told me she was uncomfortable with my performance and couldn't pinpoint why. I asked her for an example and she couldn't think of one. "Safety" was her vague answer. Well, a couple of weeks ago a resident was puking and an aide told me about it. I charted on it and nothing more because, the last time this same resident was puking and I told MCN her answer was, "She does that." No intervention, nothing. She told me later that she was waiting to see if I went to her. I guess it's safety when she overhears me being told but not when I tell her.

I had a rash of med errors and figured out what I was doing wrong. Those are still haunting me - and happened after I should have had my review.

Ystdy I was on X and NotMyUsualChargeNurse was really on my back. I made an error - there was a new resident whom I didn't even know existed. The nurses hadn't updated their "cheat sheets" and her room was still showing as empty. I go through my MAR after each pass but had no time to ystdy and every time I breathed NMUCN had something for me to do. Order meds, talk to a resident - keep her occupied - swear to God. No time. Later that day I told NMUCN I hadn't had time to do something and she told me I did. She was rude to me all day. At one point I went to say something and she cut me off saying, "I am a supervising nurse and this needs to be done." Huh? I wasn't arguing.

Well, I told Scheduler, and I mean it, that I will no longer accept assignment to X. This morning I went to fill out the med error and WeekendChargeNurse was there. I told her that I wouldn't work for NMUCN and she told me I couldn't pick and choose. I told her that I didn't need to be made to feel incompetent every time I covered. She was silent, so I urged her to tell me what she thought. She told me that I should be further along than I am. For example, AnotherNewLPN has been here less time but she feels like she's been here forever. I pointed out that ANLPN was working per diem for a long time before I started, and found out later ANLPN also worked here as an aide for years. So she HAS been here longer. And as soon as I got there WCN says to UnitXLPN, the usual unit X LPN, "Do you have her other med errors?" UXLPN said, "She didn't have any others." "Oh, no? I saw another." I said, "Yes, AUsualCoWorker wrote me up for an error that didn't happen. I just proved it in the MAR and wrote a note to MUCN." What the heck?!

Anyway. I saw written on my review "meds - resident y incident." I have no idea what that is unless it's that some aides told NMUCN that I tried to get her up before being assessed by an RN. That's not true. I asked her to grasp my hands so I could check for grip, and I also ASKED the aides, "Do we wait for an RN to get her up?" How that got translated into my trying to get her up I don't know.

I'm disgusted. And I am no longer working per diem. I need the time to study so I can become an RN more quickly because I can't stand this. And I will not work for NMUCN.

[SuesquatchRN, BSN, RN]

Thanks, my friend! I'm feeling less at loose ends.

:)

[UM Review RN, ASN, RN]

Thanks, my friend! I'm feeling less at loose ends.

:)

I'm so glad that it was a favorable review, Sue.

I think you have been very upfront and honest about doing your job better and I have a lot of respect for you because of that. You obviously care about what happens to your patients, no matter which unit you've been tossed to the wolves on.

Wishing you continued success,

Angie

[SuesquatchRN, BSN, RN]

I think you have been very upfront and honest about doing your job better and I have a lot of respect for you because of that. You obviously care about what happens to your patients, no matter which unit you've been tossed to the wolves on.

:)

I took my DON aside today and thanked her for forgiving my melt-down (temper tantrum in her office). She answered, "It's okay, we've had a few of those lately." I just said, "Well, thanks, because my behavior was poor." And it was over.

[BoopetteRN]

Suesquatch, I am also glad that you got a good review. Long term care nursing is difficult, you have med passes that are overwhelming at times, residents who are needy and at times demanding, and family members that have problems coping with their situation, add staff that are overworked, underpaid, and feel that they are not appreciated. Put it all together and it can be a very hostile work environment. Cheat sheets do help to keep you on keel; however, paper brains (what I call my cheat sheets) are only as good as the information passed on from the previous shift and the accuracy of the sheet themselves. Last night I worked pms and had one of those wonderful nights that I will unfortunately remember for a long time. How we deal with difficult situations is 90% of the battle, as you get older, and more seasoned you will learn to pick your battles. I am speaking from experience, not trying to lecture. Keep your head up, pass meds using the 5 rights, and you will be fine. Some med errors are due to transcription, and there is no way you can pull a chart to check orders for all the meds you pass, but if you have any question at all always double check the chart. Med errors are serious business and all nurses need to be aware of them, at our facility if a med error is noted we are to write it up, we are not necessarily writing each other up, but, when all nurses work together med errors actually decrease, transcription is better and communication lines are open. Meds errors that continue can lead to disaster, so, by working together, we can make it easier for everyone. We even write up potential errors which help prevent them. The difference is the mind set, not attacking the person making the mistake, but rather looking at how and why the mistake happens so it does not happen again.:pumpiron:

[SuesquatchRN, BSN, RN]

Put it all together and it can be a very hostile work environment. Cheat sheets do help to keep you on keel; however, paper brains (what I call my cheat sheets) are only as good as the information passed on from the previous shift and the accuracy of the sheet themselves.

...........

How we deal with difficult situations is 90% of the battle, as you get older, and more seasoned you will learn to pick your battles.

Precisely! I won't trust another person's cheat sheet again, even after the charge hurse has looked it over for me and okayed it. Which happened the day before my meltdown.

I'm 53, boopette.

I'm usually pretty good with stress, but in the past two months I lost one cat to old age, a dog to cancer, and one is on the mend from being hit by a car. Plus I was working WAY too many PRN days - we're short per diem nurses so I was getting plugged in allll over the place.

Thanks.

:)

[BoopetteRN]

I'm 53 too, I did not mean it in years, but the longer we do this, the more seasoned we become, nice to chat with someone my own age. Last night I had a bad night also, I stayed over on a pm shift because they needed a nurse, came to the aid of a cna in need and got wooped by a resident, my 1900 med pass was running late and the daughters of the resident who wooped me where upset with the times of his meds. To make a long story short, they accused me of being rude, and stated they were going to report me in the AM, I made out an incident report, copied my nurses notes, wrote a letter to both the DON and the unit coordinator regarding the events of last night, and talked to social service this am. Every night this family causes choas and have refused to give permission for prn meds to help his behaviors.

[SuesquatchRN, BSN, RN]

Gotcha.

God, those combative, demented folks whose families wonder why we aren't using them as behavioral role models!

We have one family whose mom, while not combative, is quite demented and WILL spit in your face. COPD, desats in a heartbeat because she's a mouth-breather - Daughter One wants to know when we are going to begin PT because "I'm not ready to see Mom in a wheelchair yet." No? Well, sugar, get ready for a big box because it won't be more than a year.

Another changed her mom to a different unit. Now she's fighting with dietary because even though her mom has a history of diverticulosis she wants her to have more of some stuff, but not of other. And why don't we have this 94-year-old O2 @ 2l/min dependent woman on a walker.

Well, at least sometimes it's funny and fun. I have a demented woman I adore, combative behaviors and all - she gets frightened, and has never hit me (yet). She was sniggling her way off of her bed the other day and one could not help but notice the huge turd underneath and on her. "Oh, honey! We have to get you cleaned up and out of that bed! Someone pooped on you!" She laughed - and believed it - and we got her into the shower without a battle. I had a good aide helping me and we simply spent 10 minutes getting her out of bed without scaring her.

It's a good thing I love my folks because without that it would be impossible to do this job.

I'm interested in knowing how your situation plays out.

[CapeCodMermaid, RN]

My advice,get your RN and start passing on your good,caring attitude to students who will hopefully benefit from it and take it with them in their nursing careers.

I don't know where all y'all live, but around here you need at least a MASTER'S degree to teach in an RN program.

And those med times at 7,8.9.10....give the 7s 8s and 9s all at 8am. Get you pharmacy consultant in the building to help streamline that pass.

[SuesquatchRN, BSN, RN]

And those med times at 7,8.9.10....give the 7s 8s and 9s all at 8am.

Believe me, 7 - 9 all get started as soon as my cart is rolling. The phoslos and renagels - dialysis patients - are impossible to streamline, though.

I'm okay, though. I was serious when I said, "No more per diem." You're gonna give me outdated notes and not even tell me we have a new resident, then your staffing problem is no longer mine. I'm studying for my RN on those off days and plan to be ready for the CPNE come December.