Good afternoon one and all,
I am new to nursing (grad '08, boards '09) and new to hospice though I have had three clinical rotations with the organization with which I am associated. Like all new persons coming into a new role and a new culture, I am clumsily feeling my way, trying to fit in, not come off as an idiot and forge relationships with my team members. Unfortunately, I am a month into the game, and this last week was especially trying, and have had several unpleasant experiences in offending the sensitivities of an LPN, a NP and my boss (a certified hospice nurse) to boot. I am male, early 40's, with hospital experience in cardiac telemetry working with persons living with chronic conditions such as heart disease, lung disease, and so on. I do not, however, have any direct long term care experience, nor have I worked as an LPN or CNA. My position was that of an operations technician, which is a marriage between these two positions, only med admin was outside of my scope. What I am hearing from from the LPN via my boss, is that I am stepping on her toes by not consulting with her in my decisions and choices. I have addressed this and accepted my naivete with her and move beyond that. Second, in my apology and commitment to her to do better, I used the phrase ancillary care provider at some point. I was made aware, again via my boss, that this term was upsetting and left my LPN team member feeling hurt and diminished. Second, my interactions with NPs of late has been equally unpleasant. I am finding some like to be updated, some dont, some like to be faxed, some like to be called, etc.
I am very aware of the hard work, knowledge, experience and intuition that each LPN with whom i work brings to the table. I am grateful to have them as a resource. I admire them, look up to them and can only work to emulate them as I begin my profession. As for the NPs/MDs, school does not provide etiquette and politics lessons on when to call them, or how to speak with them.
I am hopeful some of you can offer some pointers on how to work on improving relationships in my new role. Thanks for your time and your suggestions.
Mar 9, '09
First of all, obviously you are sensitive to your co-workers or you would not be posting your concerns on the forum.
It's like walking a tightrope at times, trying to figure out co-workers. I too have ancillary teammembers (chaplain that is a delight to work with and I can call at anytime, and a social worker that I can call and leave messages for-but will berate me at the IDT for "not letting her know about a care plan meeting in the nursing home)... Everyone is different.
I would sit down with my supervisor and have that person delineate exactly "WHEN" and WHAT SITUATIONS are necessary to contact team members. I work with an LPN that is just a joy to work with. When she sees my team of patients, she will call me at the end of the day and update me. Maybe that is what your LPN needs. Especially if the LPN is seeing your patients after you have seen your patients.
I also work with 4 wonderful nurses aides, who call me with anything the patients need or request or issues. But there is one who is a certified hospice nursing assistant, that won't call me for anything, but then at IDT points out that patient with CHF is no longer on oxygen (nursing home didn't call me and there was no order to stop oxygen--plus I only see this patient once a week......) It's almost an accusing tone--like "you should have known..."
I've been an RN since 96 and some folks you have to just handle them with kit gloves. Some folks are just easy to be hurt.
Again, I would take it up with your supervisor, or maybe a team meeting with these members so you can get a clear picture of EXACTLY what is required--what requires a call, what requires a consultation. Maybe they need you to be more collaborative until you get some time on the job. If that is the case, your supervisor needs to tell you this is required....
Best wishes to you!
Mar 13, '09
As others will tell you, your first year in nursing is wonderful, frustrating, brutal, and just about anything else you can think of. You sound like you have some good experience to build a foundation to last throughout your career. Hospice isn't something that you can always say "If this happens, you always need to do this", it depends on so many different things. The fact that you care about developing yourself and your relationships at work say an awful lot about you: a lot of good things.
The LPN should have spoken to you directly. Could it be your boss was trying to cue you to what was going on and protect you? Your apology to the LPN was well intentioned. You mentioned that you are consulting her and treating her with respect, no one can ask for more than that. Everyone makes mistakes, everyone.
Hang in there, it gets better. Go easy on yourself when you need to and know that you are an asset to the patients and your peers. You have a gift that only you
can give--that's why you have the job you have.
Continue questioning yourself, but don't doubt yourself.
Mar 16, '09
sage words from a kindred soul. Thank you.
Mar 16, '09
sage words from kindred souls. thank you both.
Mar 26, '09
I've worked in hospital and LTC nursing in my career. At the hospital, LPNs were feeling diminished by the hospital itself (ending the hiring of new LPNs, while current LPNs where "strongly encouraged" to go back to school and obtain their RNs). In LTC facilities, the RN butts heads with LPNs a lot. Frankly, because in LTC facilities the roles are very similar. An RN may be a supervisor, hang IVs, but the differences tend to end there--at least in the facilities I've worked in.
I have found that many LPNs that I've worked with feel compelled to tell me that they just never wanted to be RNs because all it meant was a lot more work (IVs, certain assessments, supervising) for just a few dollars more an hour. Some would even bring me work to my station and say "Supervisor (ya they would call me that)...you need to do this or that for me." It was usually with a grin that probably meant "I'm dumping this on you because YOU'RE the RN." But in any other situation, their years of experience was more valid than your license...in their eyes.
Not all LPNs behaved this way to me, but the ones that did stood out from the rest for a long time. Especially when I was a new nurse. Being new, male, young (compared to some of them), made it very difficult to learn my job effectively---when this comment was thrown at me at every chance..."Well your the RN, you don't know that?" or just "Come on, you should know what that means...you're an RN!"
Compounding this, the 3 men at my facility are RNs. Usually I hear about how stupid or lazy the other 2 are when the rest of the nursing staff speak with me...I'm willing to bet they say the same about me when I'm not present. I try to shrug it off like I don't care what people think, but I do. I think the place would run so much smoother when people just did their job and stopped worrying about other people. Nurses have enough stress, and new nurses have even more.
In my humble opinion, the LPN who is running to your boss when you "mess up" has a chip on her shoulder. Whether it be because you are male, new, or have called her ancillary, it seems that your problem will not fix itself with kind words. Just learn as much as you can to be an effective nurse. Treat her with respect, but also realize that you are probably not the first new male nurse she has worked with...and I wonder if the situation was the same the last time.