Am I wrong for thinking that this APRN was wrong?...

carolinapooh, BSN, RN · Sep 8, 2016

I'm actually headed out the door in the next few minutes to a going-away, but here's a quick and dirty synopsis. I had to type it out in Word.

"One was a new admit and had no meds in the cart, so I asked her to pull them for me from the electronic med dispenser. She says "You don't have any of these in your cart?" I replied with "I don't know I didn't bother looking."

Why didn't you look in the cart to see if the meds were there before asking her to pull them?

"I ALSO mentioned to her that I needed help with scanning in some meds.... Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it."

Why didn't you scan them in when the RN asked you to? I'm sure someone else could've helped you. Or you could've approached her and reminded her you needed help.

"Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it. Well today I noticed that it's been almost 3 days and the box of Fentanyl patches for one of my residents has been untouched. So I asked her about it and she said that it has been a few days and she has been starting to feel a lot of pain. So I go to check the date on it.... but can't find it. We strip her down to her bra and there is no Fentanyl patch to be found. So I go ahead and slap one on her. Partially because it just made the most sense to me and partially because I believed that she hadn't received one yet because I never scanned in the meds. After explaining all this she acted as if I made a huge mistake for placing the Fentanyl patch on without seeing an order in the computer. AGAIN... i thought the order wasn't in the computer because I hadn't scanned in the med... silly, I know... So the charge nurse does some digging.... turns out that resident had a patch placed less than 72 hours ago.... (around 60 lol). I didn't see an order for it because it wasn't going to pop up to be changed until the next day.â€

This is a bit hard to follow, but it sounds as though you didn't check backwards in the MAR to see if one had been placed within the last 72 hours, another one was put on the patient, and then when you were corrected on placing a medication (a NARC, nonetheless) without an order, you thought the charge RN was out of line for telling you the order needs to be rewritten? In my world that's a med error and a PSR gets written â€“ not punative but definitely a learning experience. THIS IS A HUGE MISTAKE. And you've said i thought the order wasn't in the computer because I hadn't scanned in the medâ€ so it sounds as though you have indeed admitted fault here.

one of my coworkers who has been there (and a nurse) a lot longer than the charge nurse, helped me to call the doctor, left him a message and he never called backâ€

Then YOU call back until you get the correct order.

"At the end of the night the next nurse who took over for me just D/Cd and rewrote the order for me... Saying that it really wasn't a big deal or something to bother calling the doctor for. Basically what I've gathered is that she made a big fuss over nothing. I did the right thing by giving the resident her pain medication.â€

If I'm reading this right, someone else told you that asking for an order for a narc from an MD wasn't something you needed to do, and that the charge RN made a huge fuss over nothing. Absolutely. WRONG. Rewriting a narc order isn't something I'd touch with a ten foot pole â€“ no nurse should. And if you gave a med incorrectly, you didn't do the right thing.

"I only had for the first time yesterday. She replies with well "He's layingn in his room passed out." So I go to his room and I see him being stirred awake by the CNA. Obviously she exaggerated a little bit.â€

If he was being stirred awakeâ€, he wasn't exactly awake and alert.

So I go back to my med cart. I read to her what I have for him on my report she and admit that I don't know what "CKD" is.â€

[

You should've asked when you got report or looked it up in a medical dictionary.

"

I pull up his MAR and attempt to pronounce what I now know is the generic name for Seroquel. She asks me what its for and I read it straight from the computer that it's for Dementia. She starts telling me that if she was State that I'd get a tag and that Seroquel is not for dementia.... that I'm supposed to question orders... bla bla bla. She asks me what I'm supposed to look for with antipsychotic meds? What is psychosis? ..... It was crazy.... And she kept trying to say that she's not trying to give me a hard time that she's advocating for me... I call bull.â€

I don't. She's trying to educate you, help you, instruct you. Seroquel (quetiapine) is for depression, schizophrenia, and bipolar disorder. It's also sometimes used off-label as a sleep aid but it's not a recommended use. It's also used for Parkinson's psychosis â€“ which is where I believe the NP was going with that. If you're able to pass meds, and you don't know what you're passing, look it up. I've been at this for ten years and I look up meds all the time. You shouldn't pass a med unless you know what it is and what it does and what it can cause.

There's more, I'm sure...but suffice to say you have a lot to learn - and that's okay, but think about what I've pointed out and how you could've handled each situation differently

NuGuyNurse2b · Sep 8, 2016

I'll tell you this. Telling someone that you don't know and you didn't bother checking tells that person all they need to know about you. And the responses you get are a direct result of that interaction.

allnurses Guide · Sep 8, 2016

(multi-paragraphs omitted)......What do you guys think?
Are these two nurses being kind of ridiculous? Or is it just part of nursing to be made to feel stupid by your superiors? Challenge you into greatness or something? LOL. I mean seriously.. I've been on the floor for not even a month yet. On my own for just a few days.
I need some input please.

Previous posters made the points I agree with but I would also ask what type of input are you seeking?

You never mentioned anything about working things out with your new co-workers, or whether or not you want to continue working there, or any introspective thoughts about your own attitude and behavior.

Suppose we all answered your only actual question and agreed that yes, those two nurses are being kind of ridiculous! It's a lot of paragraphs of details to read through for a question that most likely will have zero value towards a resolution of your complaints.

Have you discussed this with any of your preceptors? I'm just thinking since you've only been on your own a few days that would unearth more relevant advice. Hope it gets better soon though!

roser13, ASN, RN · Sep 8, 2016

OP, how much orientation did you receive? I ask for two reasons. First, because LTC is notorious for skimpy orientation, and also because it is apparent that you need some remedial orientation to the unit, to passing meds, in basic patient care, and in communication with your peers.

I won't belabor your errors as they have been briefly mentioned by PP, but I believe that the RN & APRN are expecting you to carry your weight and you currently are not. Again, this may not be your fault because your orientation may have been inadequate.

Editorial Team / Moderator · Sep 8, 2016

Are these two nurses being kind of ridiculous? Or is it just part of nursing to be made to feel stupid by your superiors? Challenge you into greatness or something? LOL. I mean seriously.. I've been on the floor for not even a month yet. On my own for just a few days.
I need some input please.

You've made a med error with a narcotic. Please be very careful with that â€” really not something to be cavalier about. Be diligent with meds in general, but narcotic errors will get you attention that you really don't want.

As to the rest of it, it sounds like the APRN is trying to educate you, or encourage you to question/learn. Whether or not she did it constructively I can't say, I am only hearing your perceptions. But as carolinapooh said, giving a med with which you are unfamiliar should prompt you to look it up so that you know what you're giving.

elkpark · Sep 8, 2016

So, let's see: You went to your charge nurse, asking for meds, she asked didn't you have those in your cart, and your response was, "I don't know, I didn't bother looking." Your charge nurse gave you some meds and asked (told) you to scan them into the system and you didn't do it. Passed the task on to the next nurse and never followed up to see that it wasn't done. Administered an opioid without an order. Got questioned by the APRN and admitted that you don't know your client's diagnoses or the medications you are administering.

I'm v. surprised you're not getting more than "attitude" -- like, a verbal or written warning about your errors and attitude. To me, the problem is not so much that you don't know this stuff, as it is your apparent lack of awareness that you're making serious errors and feel that you're being unjustly criticized. They're not wrong, and their concerns are definitely not "kind of ridiculous."

I understand that you are a new grad and have a lot to learn. I hope that you will take advantage of this wake-up call, instead of blowing it off as the other nurses being "ridiculous," and start taking your practice seriously and being open to learning what you need to learn, before there is a bad outcome with one of your clients. Best wishes!

Libby1987 · Sep 8, 2016

They're not being ridiculous.

Part of being new is reviewing the common meds you see as well as classes that you anticipate seeing and your facilities P&P pretty much everyday after work and days off until you become functional. There isn't realistically enough time to become competent by learning only on the job. Seroquel is a common med and you should be familiar.

"I don't know" is rarely an acceptable answer. Everyone is looking for signs of being teachable and possessing ability to critically think. Answer with anything other than "I don't know, I didn't look".

roser13, ASN, RN · Sep 8, 2016

And no, we're not NETY. We are giving reasoned, rational responses to the OP.

Just thought I'd get out ahead of the storm.

kakamegamama · Sep 8, 2016

I'm actually headed out the door in the next few minutes to a going-away, but here's a quick and dirty synopsis. I had to type it out in Word.
"One was a new admit and had no meds in the cart, so I asked her to pull them for me from the electronic med dispenser. She says "You don't have any of these in your cart?" I replied with "I don't know I didn't bother looking."
Why didn't you look in the cart to see if the meds were there before asking her to pull them?
"I ALSO mentioned to her that I needed help with scanning in some meds.... Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it."
Why didn't you scan them in when the RN asked you to? I'm sure someone else could've helped you. Or you could've approached her and reminded her you needed help.
"Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it. Well today I noticed that it's been almost 3 days and the box of Fentanyl patches for one of my residents has been untouched. So I asked her about it and she said that it has been a few days and she has been starting to feel a lot of pain. So I go to check the date on it.... but can't find it. We strip her down to her bra and there is no Fentanyl patch to be found. So I go ahead and slap one on her. Partially because it just made the most sense to me and partially because I believed that she hadn't received one yet because I never scanned in the meds. After explaining all this she acted as if I made a huge mistake for placing the Fentanyl patch on without seeing an order in the computer. AGAIN... i thought the order wasn't in the computer because I hadn't scanned in the med... silly, I know... So the charge nurse does some digging.... turns out that resident had a patch placed less than 72 hours ago.... (around 60 lol). I didn't see an order for it because it wasn't going to pop up to be changed until the next day.â€
This is a bit hard to follow, but it sounds as though you didn't check backwards in the MAR to see if one had been placed within the last 72 hours, another one was put on the patient, and then when you were corrected on placing a medication (a NARC, nonetheless) without an order, you thought the charge RN was out of line for telling you the order needs to be rewritten? In my world that's a med error and a PSR gets written â€“ not punative but definitely a learning experience. THIS IS A HUGE MISTAKE. And you've said i thought the order wasn't in the computer because I hadn't scanned in the medâ€ so it sounds as though you have indeed admitted fault here.
one of my coworkers who has been there (and a nurse) a lot longer than the charge nurse, helped me to call the doctor, left him a message and he never called backâ€
Then YOU call back until you get the correct order.
"At the end of the night the next nurse who took over for me just D/Cd and rewrote the order for me... Saying that it really wasn't a big deal or something to bother calling the doctor for. Basically what I've gathered is that she made a big fuss over nothing. I did the right thing by giving the resident her pain medication.â€
If I'm reading this right, someone else told you that asking for an order for a narc from an MD wasn't something you needed to do, and that the charge RN made a huge fuss over nothing. Absolutely. WRONG. Rewriting a narc order isn't something I'd touch with a ten foot pole â€“ no nurse should. And if you gave a med incorrectly, you didn't do the right thing.
"I only had for the first time yesterday. She replies with well "He's layingn in his room passed out." So I go to his room and I see him being stirred awake by the CNA. Obviously she exaggerated a little bit.â€
If he was being stirred awakeâ€, he wasn't exactly awake and alert.
So I go back to my med cart. I read to her what I have for him on my report she and admit that I don't know what "CKD" is.â€
[
You should've asked when you got report or looked it up in a medical dictionary.
"
I pull up his MAR and attempt to pronounce what I now know is the generic name for Seroquel. She asks me what its for and I read it straight from the computer that it's for Dementia. She starts telling me that if she was State that I'd get a tag and that Seroquel is not for dementia.... that I'm supposed to question orders... bla bla bla. She asks me what I'm supposed to look for with antipsychotic meds? What is psychosis? ..... It was crazy.... And she kept trying to say that she's not trying to give me a hard time that she's advocating for me... I call bull.â€
I don't. She's trying to educate you, help you, instruct you. Seroquel (quetiapine) is for depression, schizophrenia, and bipolar disorder. It's also sometimes used off-label as a sleep aid but it's not a recommended use. It's also used for Parkinson's psychosis â€“ which is where I believe the NP was going with that. If you're able to pass meds, and you don't know what you're passing, look it up. I've been at this for ten years and I look up meds all the time. You shouldn't pass a med unless you know what it is and what it does and what it can cause.
There's more, I'm sure...but suffice to say you have a lot to learn - and that's okay, but think about what I've pointed out and how you could've handled each situation differently

Yes.

Add to all of this, the OP's seeming disregard for her own culpability. I'm not sure how she passed the LPN program she graduated from.....

bekind_andtrue · Sep 8, 2016

I did not explain mysrlf correctly. The resident did not have her own cards present because she is a new admit. I looked for meds with HER name on it. The charge nurse was telling me to look for the meds from OTHER residents cards. Isn't that wrong?

bekind_andtrue · Sep 8, 2016

Thank you all for the input. I knew I probably deserved the attitudes I was receiving. Both from my superiors and the nurses on here. Honestly I do not believe that I am prepared for this job. The nursing program that I graduated from is a joke. Everything that I learned was 100% self taught and I saud the whole time to my instructors and classmates that I felt like I wasmt learning admitting. Perhaps I will ask for more training. I was given a little over two weeks and everyone stayed asking when I was going on my own so I figured I would try it out. It has been very stressful. I have 20 different residents or 35 when I was on the long term side. I SHOULD be researching and refreshing up on meds and diseases but even with other nurses helping me with my assignments I am still behind on my medpass and TAR so I've been feeling overwhelmed and just trying to make it through the night. The earliest Ive gottem out is two hours and a half hours after my shift ends.

I have a PRN job at an assisted living memory care unit which seems much more relaxed and not rush rush rush. I'm starting to feel like I should try to work there full-time instead =(