Putting "your license on the line" at a job... Please explain!

[Nola009]

... I am new to nursing and ALREADY NOTICED/KNOW that things aren't exactly like nursing school. For starters, I did every one of my nursing school clinicals in a hospital setting and our courses were geared more toward managing the acute-care patient too boot.

I work at a SNF/LTC facility where not only to I pass a litany of oral medications per patient, but I do wound care, feeding tube administration, and the occasional IV antibiotic administration. All for 25 pts per shift. I runn my butt off!!

Oh, and only had 3 DAYS of 'training'.

Is this the type of place people warn about when they say "you'll put your license on the line" ??

Or, is there something more specific I should be looking for and worried about??

A want to avoid such a place, especially as a NEW GRAD RN.

Please help

[SoldierNurse22, BSN, RN]

Nursing isn't like nursing school.

There is a certain level of deviation from the textbook standard that is both necessary and acceptable in practice. In other words, there is often more than one way to do a given task safely and correctly.

If you feel overworked, that's a staffing issue, not a "this isn't nursing school" problem. If you're unable to handle it, then yes, you might be setting yourself up to make a mistake, hence putting your license on the line.

Passing meds, wound care, feeding tube administration, and IV antibiotics are all part of the job. You're hardly putting your license on the line unless your BON/state laws/scope of practice/personal nursing practices would say otherwise.

Three days of training doesn't seem all that strange based on what I've seen on AN. You may not feel it is adequate, but there isn't a mandated length of orientation.

[krisiepoo]

I equate nursing school to be like learning a language. You learn the proper forms of everything, how to conjugate the verbs, etc but you don't learn colloquial or speaking level... Nursing school is much like that. You learn the proper ways of doing things, by the book so to speak but it's not the real world.

[amoLucia]

You most likely will also find the same disconnect if working in an acute setting, like a hosp. You can well see this as evidenced by the comments of hosp newbies here on AN. What you're feeling is the unexpected and unanticipated new 'reality shock' sensation.

[MatrixRn]

"I work at a SNF/LTC facility where not only to I pass a litany of oral medications per patient, but I do wound care, feeding tube administration, and the occasional IV antibiotic administration. All for 25 pts per shift. I runn my butt off!!"

I am guessing that you have CNAs because you do not mention any personal care. So you are doing all of the med passes. The work you describe is doable, clearly because you are doing it. If the med passes are too frequent ask for a med tech to support one of the passes.

[MatrixRn]

Three days of training doesn't seem all that strange based on what I've seen on AN. You may not feel it is adequate, but there isn't a mandated length of orientation.

^^Agree, facilities will only orient the minimal time that they think they can get away with...sad but true.

You describe your job as mostly doing med passes. Make sure that you follow your 5 patient rights.

[Yosemite, RN, ASN, EMT-I]

Welcome to nursing. The employer carefully weighs cost vs. liability. There is a "Policy and Procedure" manual someplace. If you deviate from it for ANY reason, including your "lack of organization" or "prioritization," their attorneys will "throw you to the wolves" claiming you "violated policy." You would likely have to employ an exceptional attorney (beyond the $89 per year one your Liability Insurance policy would provide) to defend you. Nursing licenses are now a "dime a dozen." Only YOU can decide if the liability is worth it.

[nurseprnRN, BSN, RN]

Dear heart, you have a job, it's new to you, you will get better at it, and there is no reason to think you are risking your license.

Gawd, I wish they'd stop scaring nursing students about losing licensure all the time. If I've said it once, I've said it a dozen times. There is entirely too much moaning about "loosing (sic)/losing/risking my license" on AN. I don't know if it's related to the general catastrophizing outlook on life that comes from the daily news and how it's reported ("if it bleeds, it leads"), or a general innumeracy related to actual statistics and risk assessment. Probably a bit of both.

You can go online and find out who suffered loss or restriction of RN license in your state. My state nursing association publishes them in the newsletter; it's maybe dozens per year, but certainly not hundreds or thousands. People lose their licenses for things like substance abuse at work, narcotics diversion, fraud, felony theft, patient abuse, and so forth. If you aren't planning on doing any of that, your risk of license restriction or loss is minuscule.

******* off the staffing coordinator, running late on your med pass, forgetting to chart something and not doing an addendum later under established conventions, habitual lateness, getting the stink-eye from your supervisor-- these might cause you to lose a job or a promotion, but they do not rise to the level of losing a license or putting it at risk. Try to remember that.

Oh, and a litany does not mean "a whole lot."

noun, plural lit-a-nies.1. a ceremonial or liturgical form of prayer consisting of a series of invocations or supplications with responses that are the same for a number in succession.

2.the Litany, the supplication in this form in the Book of Common Prayer.

3.a recitation or recital that resembles a litany.

4.a prolonged or tedious account: We heard the whole litany of their complaints.

[Susie2310]

I suggest really knowing and always practicing within your state Nurse Practice Act, organizational policies and procedures, and the national standard of care. Your malpractice insurer will likely have risk control information for nurses on their web site. I have personally found this to be very useful to me in helping me gauge how well I am meeting the standard of care.

I agree with Yosemite, RN that only you can decide if the liability is worth it.

[Nola009]

Lol,

I have been late. Very late. I am late because I do my 3 checks of 5 rights and I want my patients to take their pills with fresh H2O. I encourage fluids all the time unless it's contraindicated. My aides help patients with hygeine, repositioning, and feeding but are too busy / lazy to get my people fresh H2O. Add in 5 accuchecks x2 plus coverage, crushing many pts pills and mixing with applesauce, really crushing other patients' pills and administer via g-tube, and the continual trips to and from the narc room to get scheduled and PRN controlled meds for at least 10 of these people, and I am late. Really late to the point where the aides are saying 'what's WRONG with HER?!'

[Nola009]

Lol,

Oh, and a litany does not mean "a whole lot."

noun, plural lit-a-nies.1. a ceremonial or liturgical form of prayer consisting of a series of invocations or supplications with responses that are the same for a number in succession.

2.the Litany, the supplication in this form in the Book of Common Prayer.

3.a recitation or recital that resembles a litany.

4.a prolonged or tedious account: We heard the whole litany of their complaints.

"Litany" might still work because the med pass is long, tedious, and there may/may not be prayer involved

[Not_A_Hat_Person, RN]

Some facilities will put your license at risk. When I worked at an ALF, the evening supervisor, who worked in another building, wanted to borrow 3 of my resident's fentanyl patches for a resident in her building. I wasn't crazy about borrowing meds, especially narcs. Since she was technically my supervisor, I told her she had to come to my building and sign the patches out of the narc drawer herself.

If you have to work in a SNF, non-profit facilities tend to have better working conditions than for-profit facilities. My only other piece of advice is so stay far, far from any facility run by Kindred. Honestly, I will sell my body on the street before I work at another SNF.