Content That Lev <3 Likes

Content That Lev <3 Likes

Lev <3, BSN, RN 41,707 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has 'A few' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,567 (52% Liked) Likes: 4,731

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  • 1:11 am

    I was recently conned into the NEW GRAD ORIENTATION at Hoag. They conned hundreds of aspiring new grad RNs into thinking there were job opportunities. Some drove HOURS to get there--only to learn upon arrival that they DO NOT hire new graduate RNs for anything but PCA positions... the hospital with the highest educated PCAs in the country, I imagine. Why not have an Bachelor or Masters degreed RN be your PCA when you can pay them the same price as a PCA with a 3 month-certificate, right?

    I was LIVID. I will NEVER work for Hoag because I feel that they have no respect for anyone, and only seek to fit their own agenda. It is not surprising that they do NOT have a union and were so scared of one forming that they had to immediately give back the perks they took away once the RNs started meeting to form one.... (spoke to an employee).

    I have no respect for an entity that feels the need to scam people into coming to a job hiring event. And then they have the nerve to tell us that we may as well work as a PCA, because we won't get a job anywhere else but a SNF (basically what they said in the orientation).

    Then they told us if we were to apply for PCA, that they do not want us ask about salary or when we would be moved into an RN role??? As if they were going to pay my loans FOR ME? It is enraging and personally degrading to see desperate or discredited new RNs taken advantage of like that.

    I turned around and got a job in a hospital EMERGENCY DEPARTMENT as a new grad within 24 hours of receiving my RN number.... and friends are all hired or interviewing in Med Surg or similar units... Bottom line... As a new grad, stay away from Hoag if you respect yourself. It's probably fine if you are already experienced and can move straight into an RN role, but for new grads.... NO !!!!!

  • 12:59 am

    Thanks Ruby.

    I am trying my best to find how to be safe, legal and still do the heavy workload given to me. My confidence has gotten better even over the last few days. I had some issues with CNAs and a fellow LPN and I tried to resolve it as best I could in the moment it happened but whilst the 'drama' continued afterwards I simply don't have the time on my shift for internal conflict when I have over 30 patients to attend to.

    I think there is also an issue on our MAR/TAR with some orders not being DC'd properly. For instance, I have a resident who had an order for oxygen tubing to be changed every sunday and yet when I walk into her room (and I have NEVER seen her use oxygen even PRN) she doesn't have an oxygen tank anywhere to be found. Speaking to the oncoming nurse, she agreed that the patient hasn't been on oxygen for months... or I've seen duplicate orders. I've read that the MAR/TARs may need to be cleaned up but I am still learning how to navigate the system on a "learn-as-you-go" basis and I don't think a MD would be happy with me calling between the hours of 11p to 7a to try to dc some old orders!

  • 12:59 am

    Quote from nurseburst
    I am a brand new nurse who has started working in LTC/Rehab facility. I received 5 days of orientation and will be working night shift. Tomorrow is my first night by myself although my mentor has been trying to let me handle the floor on my own and just come to her as I need to since a few days ago.

    I am just really struggling with time managing getting everything done when those 6am meds are due for over 20+ patients some with Gtubes and IVs. I've been recommended to start earlier until I get quicker on the med cart but the last time I worked I was there 2 hours after my shift still because several things came up. I know that this is all part of nursing and that setting priorities, and developing really good clinical judgement comes with experience and time but I know how important it is to provide care on time to these patients and want to do my best!!!

    I am also concerned because my mentor has been telling me to sign off that I've completed a task that we don't have time to do such as a dressing change... and I have not been doing that! Because that is falsification of documentation and then the patient is not receiving the appropriate care. But I don't exactly know how to navigate the computer system completely yet and so I am not sure how I document appropriately if I was unable to do a dressing change and want to make sure that the wound care nurse sees it and does it the next day...

    I have brought up these concerns (without mentioning my mentor telling me to sign off on items because I am at a rock and a hard place... I need support when I am there at night but it's still completely inappropriate and wrong to document that you've done something you haven't) to the nurse educator and she said she'd try to get me some help with prioritizing and time managing.

    I really love Nursing and it's what I am passionate about doing... especially geriatrics.

    I have read so many posts on this website that has been helpful but was curious to see if anyone else had some thoughts, or tips they can provide? I greatly appreciate ANY input!!!!!!!!

    And also I am not trying to throw my mentor under the bus at all, she has taught me a great deal and I am incredibly thankful - however, it only hurts the patients to sign off care was provided when it wasn't.
    It is always a bad idea to throw someone under the bus, especially when you're going to have to work with them in the future. Ask your educator about the proper procedure for signing or flagging that a procedure is NOT done. But you shouldn't make a practice of leaving procedures undone if they fall due on your shift. You're new; time management and prioritization will come. For now, you're going to be floundering with those concepts; that's the part of being a new nurse that sucks. You'll get it eventually.

    You are absolutely correct about not documenting as done something that isn't done, and I commend your ethics and your enthusiasm. Clinical judgement, time management, prioritization and mastering the freaking computer are all things that will come.

  • 12:58 am

    Umm..please don't document that you did an intervention when you didn't do it. That would be illegal and immoral. You could lose your license. Your patient could get septic and die because no one does the required interventions for wound care.

    So.. fun story. I live in South Florida which has a very high geriatric population and a lot of LTCs. Quite a few of them have been shut down due to their patient care (or lack thereof, really). One story that did make the paper however is beyond horrific. Patient had blisters on heels due to a wheel chair and doctor ordered wound care. Nurse did not arrange for wound care. Wound care was never called in. Documentation shows that wound care was done. Over time the patient developed more pressure ulcers and the nurse couldn't admit to it without admitting she falsified documentation so she hid it. The patient died of sepsis and the article is quoting as using the phrase "bones liquified" when describing the level of infection. She's on charges of manslaughter now.

    Long story short? Don't falsify.

  • 12:57 am

    So, my disclaimer is that my first job orientation was not very well laid out, not was it well structured for a new grad. For many reasons, I left that employer relatively early, took another job and then left that job for my current institution.

    Take a deep breath. While your preceptors should *ideally* be able to help you and be well suited (personality) to help you learn, they may not be. They may also have a particularly not fun or bad day. They may be someone it takes time to warm up to. They may be introverted. None of those are necessarily bad. Just remember that all of your coworkers started somewhere, nobody was born being a perfect nurse (and your coworkers haven't figured it out yet either - I can promise that - I had a day this week that proves that myself for me). If that doesn't help - remind yourself we all get dressed in a similar fashion. I am not saying they should be allowed to be outright rude or abusive. That's not it at all. Please don't misunderstand me.

    When I was on the floor I started by doing clinical skills, and having my competency (at being safe for doing them) assessed by my precpetor. She was not checking off that I was great at it, but checking off that I knew how to do it, knew what could go wrong plus how/when to call for help. Gradually my share of tasks and the assignment grew, I think I started with two patients with a fair amount of guidance and built up (typically, we were 1:4 to 1:6 on days depended on census and acuity) while reducing my need for assistance. However, expectations were not clearly set, more was expected of me without necessarily communicating it to me, and that was frustrating. I also got less orientation than I was promised. Someone (not me) decided I was "ready" to be on my own, regardless of how I felt about the situation. I suppose nobody feels ready, but I was not involved in assessing my own abilities and skills.

    I didn't carry much with me. I carried my "brain" sheet (fact sheet about my patients). Everywhere I've worked, in an inpatient setting, the nurses have some kind of tool for themselves generally patient info, code status, allergies, isolation, pertinent labs/diagnoses, admitting/attending physician, pending studies/tests etc, as well as things like activity level, and lines/tubes/drains. I had a few pens, a pen light (I started in neuro), and generally had a saline flush or two plus some alcohol pads.

    Orientation has been different everywhere I've worked. It's really different now that I'm in the OR. I'm now precepting folks in my environment. I only have one patient at a time. But there are a series of steps that have to be done before different parts of a procedure. I generally work with my orientee to determine what my expectations should be. How far into orientation are they, what is their assessment of themselves / their needs, etc. I also look at the cases / procedures we're doing and who we're working with surgeon and anesthesiologist wise. They have their eccentricities too, and I definitely gauge their mood and assess how my plan is going to go based on those things too. Often, I let my orientee do as much as they can with as little assistance as possible. I do not stop someone unless what they are doing is going to cause harm, is truly unsafe or is really not appropriate for the situation (trying to worry about something minor when something major - ex difficult intubation is occurring). I try to talk through situations orientees may not see to help them learn how to process them / critically think through them. Sometimes I take over because of the patient's condition, things in the procedure, etc. I always explain what I did and why plus why I took over.

    When I was on the floor / stepdown my orientation was several weeks (4-6 weeks) and in the OR I was on orientation for about 8 months. Depends on the situation, what you're expected to learn and how orientation goes.

  • 12:56 am

    My orientation for my telemetry position was 12 weeks long. I loved our orientation/hospital and actually enjoyed it. First 6ish weeks was lots of nursing program refresher classes on anything and everything nursing related. It also included paid skills day, paid certification course (EKG, ACLS, critical care classes, etc), and last but not least, how to work the computer. The last 6 weeks was precepting. We all started off at 1 patient and gradually moved up the ladder to 4 patients. They kept us at the same preceptor but you could request a change if needed and if you felt you needed more time precepting you could ask for it. I had a wonderful nurse educator and preceptor, awesome charge nurses and great nursing management. Based on hearing orientation here and my previous nursing classmates, I'm lucky to work for this hospital.

    Tips/advice? Always ask questions no matter how dumb or bad they are. You are better off asking a dumb question and having it repeated multiple times than doing something unsafe for your patient or potentially causing them harm. If you don't know what you are doing or what to do, ask for help. If you FEEL uneasy about doing something or just this yucky gut feeling, speak up. Get a 2nd opinion. Last advice I have for you, get plenty of rest before each shift and find multiple coping mechanisms (praying, working out, etc).

    Equipment? All you need is your stethoscope. But I guess it doesn't hurt to wear a watch, carry a pen or 2, carry some flushes and some alcohol swabs too. That's how I roll around.

  • 12:55 am

    I just came off orientation and my experience is different. I'm on an emergency psych floor, so the only things I can carry with me are my pens, my keys and my gloves. No stethoscope for me when I'm out in the milieu, and no glove boxes out in the milieu as they pose a safety risk. That's why I have to carry my gloves in my pocket and when I'm done with them, carry them back into the nurse's station.

    The biggest thing I learned is to ask questions. My preceptor would rather I asked him a million questions than just assuming I knew what I was doing. I was paired for 8 weeks and the first shift, I just watched how things go, then I was slowly given more responsibility as the shifts progressed. By the last two weeks, I was doing the job with him just supporting me when I needed help. Now I'm on my own, and the whole unit has been amazingly helpful when I have questions.

    When in doubt, ask! Congrats and good luck!

  • 12:55 am

    I'm on week 3 of 4 at a Transitional Rehab (short-term patients). I started shadowing the nurse for one shift and then every day or 2 I picked up another patient (started with one...now I'm up to 4). Granted the biggest problem I have is timing 8 am med pass and trying to keep Patient A in her room long enough to get both of her IV antibiotics into her since she wants to go to the Dining Room for every activity they have. That and there are only 9 patients in the facility I work at so having nearly half of them is pretty good I think

  • 12:54 am

    I have 3 weeks of orientation left. I made a post recently about it. It's scary. Taking a patient load is scary. But I'll tell you about how it works for me at least.

    I am paired with another nurse, nurse of the year actually.. yikes. I started with 1 patient and I'm now at 5, my max. I carry a bunch of pens, stethoscope, alcohol prep pads, highlighter, and tape. I advise all of the above. Take a clipboard and make yourself a flow sheet for each patient. On the clipboard have a loose leaf paper on there for you to write notes on that you'll ask some one or go home and look up. Not sure of what an EGD is? Write it down and look it up later. I wish you good luck for this adventure you're starting. Take the advice that I haven't accepted: don't get discouraged. Don't panic. Take your time. You won't know a lot of things for a long time. It's all okay. You got this!

  • 12:02 am

    Quote from NurseCait220
    My patients sleep most of the time Im with them during my shift and I only really interact with them hands on during their care times which is every 4ish hours.
    Yes, I know what you mean. I do my cares and head the break room for the next 3 1/2 hrs because I don't interact with my patients in between care times (sarcasm). Yesterday, between assisting the Neonatologist draw Coags and blood cultures, hanging PRBCs and Platelets, assisting RT retaping the ETT tube, several lab draws, assisting with abdominal xray and abdominal ultrasound, plus my Q4 assessments while wearing Droplet PPE I don't think I sat down for 15 minutes and that doesn't include my other patient and their family. Every day I am interacting with my patients and family frequently throughout the day. Some days I wish it was so boring that I could only interact with them every 4 hrs.

    I have never had an issue with my coworkers as a new grad. Maybe because we are a large unit and have a continuous turn over of people graduating with their Masters and moving on to NP jobs so we always have new people (almost entirely new grads) orienting.

    Maybe you need to move on to Peds or adults if you need the true 2 way interactions with your patients. But those types of patients have their own set of issues that you will need to deal with.

  • 12:00 am

    Quote from NightNerd
    I think that depends. Are they not paying you? Is it unsafe for patients and/or staff? If not, then I would try to stick it out and make the most of it for a year or so. It will actually fly by, and with that year under your belt you'll be surprised at the opportunities that open up.
    I think this is good advice. If the place is exploiting you horribly or not set up to provide even marginal quality of care, then get out and don't look back.

    If it's just not your dream job, then stick with it and get some good experience. You're not going to get really competent while you still have one foot out the door. So give yourself a break from the job listings and focus on being the best nurse you can be in your current situation.

    In a year or two, when your dream job becomes available, you can move on with a clear conscience and a solid reference. And people who will be genuinely sad to see you go, not feeling ripped off.

  • Sep 27

    I agree with previous posters...get out of there! That charge nurse is going to end up
    costing you your job or your license!

  • Sep 27

    I have to agree about getting out of there. This place sounds dangerous.

  • Sep 27

    Quote from Been there,done that
    There is no "growing" here and why would you want to? No doctor on site =not a real hospital.
    Psycho charge nurse (with WAAY to much power) that can't handle a NG tube issue, is out to get you. Manager is leaving you to hang out to dry.
    I would give my 2 weeks notice now, do agency while I found another job.
    THIS.

    Get outta there ASAP before something happens.

  • Sep 27

    There is no "growing" here and why would you want to? No doctor on site =not a real hospital.
    Psycho charge nurse (with WAAY to much power) that can't handle a NG tube issue, is out to get you. Manager is leaving you to hang out to dry.
    I would give my 2 weeks notice now, do agency while I found another job.


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