I am a newly licensed RN and just got my first ever nursing job! I was super excited to get started, but now I am so worried about harming a patient and/or losing my license! Many of the things I am told to do at work goes against everything I was taught in nursing school! I am trying to decide if it is as bad as I am thinking it is & whether I should quit or not.
First off, it is a LTC facility, on a dementia/alzheimer hall & I only had 3 days of orientation before I was on my own. I have about 20 patients to care for. I oriented on day shift & began my first shift alone on nights (which I have never oriented on). I am the only nurse on my hall, and there are only 2 other nurses in the building after 5pm.
Here is my list of things that worry me:
#1: Not double checking insulin. My preceptor told me not to worry about doubling checking. "We just draw it up & give" since there are lack of nurses around.
#2: Not following the MAR. There are patients who get meds a 1800, 2100, and 2200. The patients usually go to bed after dinner, around 8, and I was told that "you do not want to wake them or your night will be ****." So I was given a list of patients to give all their meds (both 1800 & 2100) at 1700 & the other half of the residents, I am to give all their meds (again, both 1800 & 2100) at 1900.
If this isn't scary enough, I have to pull the 1800 meds early for those patients & sign them off the eMAR so they won't be past due, was told to put them in med cups, label the cups & put them in the drawer until I am ready to draw up the "1900" meds.
The ADON agreed with my preceptor that this is how they want to be done. I did it on my first shift, but it made me so nervous! I think this is very very wrong & puts me at high risk of not only giving wrong medications, but doubling up or missing medications that I am signing off on giving!
Also, by the time I was giving those "1900" meds, I don't even know what I have in the cup any more! Once you sign off on the meds, there is no way (or at least, I wasn't shown how) to go back & look at the medications list.
#3: Charting "the usual". My preceptor fills out the charting with the patient's usual, sich as "active bowel sounds", "no adventitious lung sounds", etc. I was told not to worry about assessing them & was given the "answers" to fill out their charting. I have been there a total of 4 days & never once seen anyone assess the patients heart/lung/bowel sounds! With the crazy number of patients & their medications, I only have an hour that I could spend assessing them anyways!
#4: Not wearing gloves for anything! I've seen me preceptor & other nurses draw accuchecks, give insulin, and eye drops with no gloves on! She told me not to worry about it (I did not listen to her, I refuse to give injections or draw blood of any sort without protection!)
So adding all this to the fact I am brand new, on my own, and no one to ask questions to, I am pretty sure you see how uncomfortable I am. I cried the whole way home from my first shift, terrified I am going to harm a patient or get my license taken because of the things they expect me to do. I tried to talk to the ADON and other upper level managers about my worries & feeling like I am not ready to be alone after only 3 days, but I'm just told "you're fine. It'll be ok."
I really think it is in my best interest to quit, but my husband is worried because I need a job & he doesn't understand how bad these things are. I need advice, please!!
Jul 20, '13
by BrandonLPN, LPN
Quote from Altra
1. Double-checking insulin is a common (though not universal) practice in acute care, where you likely had the bulk of your clinical experiences as a student. It is not universally required.
2. For patients in a long-term care setting, there are few meds that really need precise timing. Administering meds in that setting at 1800, 1900 and 2100 is neither necessary nor efficient practice, and likely is bothersome to the patient. I would suggest that a longer-term goal of nurses in your facility should be to get the patients' physicians to change their orders to reflect something more reasonable.
3. Again, for LTC patients ... daily assessment shouldn't be required. Your documentation should not be designed to set up the expectation of daily system-by-system assessments. In an LTC setting I would expect a note at least daily, if not each shift, that indicated a more general assessment - skin color, respirations unlabored, no cough, ambulating/moving in a manner consistent with that patient's baseline, at baseline mental status, tolerating p.o. intake, no reports of new pain, etc. Listening to bowel sounds on each shift in LTC??
4. If you want to wear gloves - wear gloves. Generally accepted standards on universal/standard precautions and OSHA regulations are on your side.
The first year of nursing practice is often frightening. Learn all you can, and accept that there will be rocky spots. Lots of support here at AN. Good luck to you.
^^this is perfect advice.
I would just add that you're spending too much energy worrying about what other nurses are doing. I don't wear gloves when giving an insulin injection either. Many nurses don't. If want to, do it. Is you're preceptor slapping you're hand and taking the gloves away?
And the assessments you're describing would present an undue invasion of the time and privacy of you're residents. We assess by exception in LTC. I was a little unclear about the part where your preceptor said "just chart their normal", though. I would never chart on lung sounds or bowel sounds unless I actually listened to them.
But the bigger point is you don't need
to auscultate lung/bowel sounds every day. You do if they sound wheezy. Or they vomited. Or they have CHF and have increased edema. See what I mean? Focused assessments based on symptoms presented. Trying to chart an full assessment on every resident every shift will be impossible and, frankly, would just look silly.
In any event, good luck. You're more worried than you need to be. all new nurses feel overwhelmed. It's normal. Don't listen to posters telling you to "run". They're being melodramatic and clearly have zero conception of what LTC is. Nothing you described about your facility sounds particularly worrisome. As far as I can tell it's a perfectly safe and nice place to work. It only seems
horrible because you're applying hospital standards to an environment that is not
a hospital. Common rookie mistake. Give this place a chance. You might be surprised.
Last edit by BrandonLPN on Jul 20, '13