Ok guys. I'm a new nurse. LPN. Just graduated in May. Got my license June 30th. Started working at a Nursing Home & Rehab center in August. Been on my own now for a total of 5 days. This little story is about my experience today with a charge nurse and an ARNP. I believe they are related. I apologize for all the details.
The supervisor is a new nurse herself (an RN, not even one year) and I noticed that she's starting to give me a little bit of an attitude and treating me like I'm stupid when I ask for help. Today I came up to her for help with two different residents. 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." Because first of all --- isn't it technically illegal to take meds from one resident and give them to another?? This resident had 5 different meds .... I figured it would be faster to pull it from the electronic medication dispenser. (I am too new -- don't have login access yet - so she would have to do it for me.) 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. 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. Charge nurse is all giving me an attitude and telling me that I need to call the doctor to get a new order. Well the other nurses that I mentioned this too told me that the charge nurse was being a little bit ridiculous... 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 back... 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. WELLLL...... just a few minutes after all this went down... I go into the little office where I was keeping my purse and water in the mini fridge and I see the charge nurse in there with a couple other people. One of them is an APRN whom I've never seen before.
Twenty minutes later I'm back on my hall trying to pass out meds and the APRN marches up to me demanding "What can you tell me about Res Room ###??!" I told her honestly. I don't know anything other than what's on my report sheet. 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. Then she asks me what psych meds he's on. 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. She asks me when I graduated from school and then asks me why I'm caring for patients that I know nothing about. 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. I'm sure that she BELIEVES that she is helping me (and in a way she did...a little...) but for the most part I feel like my supervisor came into that roo and started b****ng to her and whoever else about me being a new nurse, and so she decided to test me out and push me around to "teach me a lesson".
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.
In my opinion, 2 weeks' orientation for a new grad nurse to learn to function independently is criminally wrong, and just asking for failure. LTC's are hard, hard work and require many organizational skills that are not learned overnight. I hope you do not give up quite yet, as long as they are willing to work with you and perhaps extend some more orientation time.
Good luck to you, and thanks for taking our advice in the spirit in which it was intended.
Followed by "I'm a new nurse. LPN. Just graduated in May. Got my license June 30th."
I didn't have a lot of confidence that I was going to read that a brand new LPN had schooled an APRN or caught her in some kind of clinical mistake. But I wasn't totally closed off to the possibility, given that no nurse is infallible.
I didn't have to get very far to get the answer to your question, OP. Yes, you are wrong. Incredibly wrong. Others have addressed the specific shortcomings in your practice and attitude. I don't think it's necessary for you to go for the more "comfortable" setting. You should want to challenge yourself and put yourself completely out of your comfort zone. If you don't, you aren't going to advance as you should.
Most nurses relate that it takes a good year or two to finally feel "comfortable" in your practice. This period is essential to personal and professional growth. Don't rob yourself of that by retreating from the challenge.
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!
Elk, the inference on the the meds for the new patient, was to borrow, them. the charge just did not want to bother.
Elk, the inference on the the meds for the new patient, was to borrow, them. the charge just did not want to bother.
That may well be -- my real point was that, when your superior asks you a question, "I don't know, I didn't bother (doing (fill in the blank))" is rarely a good answer.
I think this situation could have been handled better by all parties. OP, I would advise being very direct in your communications with your charge and others, and lose the snark. Instead of "I didn't bother looking," how about what you told us? "she does not have cards, and I believe it is against policy to borrow from other patients." And if your charge knew that you a new grad as well as a new hire, she could have been more supportive.
Agree with previous posters about narcotics: be very deliberate with checking, verifying, administration. This can get you fired and reported, even if you are totally innocent of any wrongdoing.
The ARNP could have picked a better time and method for coaching. In the hall, in a public place, and during a med pass is not conducive to learning! Perhaps she meant well, but I think it only added to your frustration.
My first job was at an ECF, and I studied meds all the time on my days off. My pharm training at that time was limited, but I was exposed to a lot of meds and learned a lot that first year. Looking back, those patients were probably overmedicated, but it was an amazing learning opportunity for me.
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".
Can you explain critical thinking?
Please list what she should have done to show that she was thinking critically.
Elk, the inference on the the meds for the new patient, was to borrow, them. the charge just did not want to bother.
You are so right on, Morge.
And borrowing is illegal, I believe, per CMS and probably other laws, right? So right that Charge didn't want to be bothered.
Once a Supervisor told me that she couldn't get me an Albuterol Inhaler from the Night Locker because it wasn't in there. I knew better. I told her which drawer it was in and reminded her that, as an emergency med, as a rescue inhaler, it was definitely there. I was going to have to send the pt to the ER if she couldn't get one. She didn't even look. So, yes, those in charge can be very wrong, very lazy.
Please list what she should have done to show that she was thinking critically.
Every single time a nurse administers a drug, he/she should think about following questions, in addition to "right 5 or 6":
- what I give it for?
- what I have to watch for now?
- when I have to watch for it? (sometimes it matters)
- are any other drugs there that might interfere with purposed action? If so, what do I expect to see?
- as above, about any condition that might interfere with the drug action?
Yes, it takes time at first, but doing it any other way leads to all sorts of "events", from silly/stupid to plain dangerous. It is OK not to know all answers right away - that's what pharm books are kept on desks for.
Followed by "I'm a new nurse. LPN. Just graduated in May. Got my license June 30th."
I didn't have a lot of confidence that I was going to read that a brand new LPN had schooled an APRN or caught her in some kind of clinical mistake. But I wasn't totally closed off to the possibility, given that no nurse is infallible.
I didn't have to get very far to get the answer to your question, OP. Yes, you are wrong. Incredibly wrong. Others have addressed the specific shortcomings in your practice and attitude. I don't think it's necessary for you to go for the more "comfortable" setting. You should want to challenge yourself and put yourself completely out of your comfort zone. If you don't, you aren't going to advance as you should.
Most nurses relate that it takes a good year or two to finally feel "comfortable" in your practice. This period is essential to personal and professional growth. Don't rob yourself of that by retreating from the challenge.
I would respectfully disagree - I think that if the OP isn't comfortable, this might be a good time to go to some place she is. She does sound harried and concerned, and it may be best for her to go back to a slower pace job until her confidence and abilities improve.
Nothing wrong with taking a step back sometimes. Or in reality - ever.
Instead of "I didn't bother looking," how about what you told us? "she does not have cards, and I believe it is against policy to borrow from other patients."
I'd even recommend another way. "She doesn't have cards yet. Isn't it against policy" or "can we borrow meds from other patients?" or "I don't think I'm supposed to borrow meds from other patients." We use that near deflection technique in the military as a gentler way of telling those who outrank us - hey dude, you're dead wrong, but I'm giving you a chance to save face and look good. Then if they persist - then zing with "I believe that's against facility policy". (Where our answer would be, 'according to the Air Force Instruction blah blah blah'.)
I'd even recommend another way. "She doesn't have cards yet. Isn't it against policy" or "can we borrow meds from other patients?" or "I don't think I'm supposed to borrow meds from other patients." We use that near deflection technique in the military as a gentler way of telling those who outrank us - hey dude, you're dead wrong, but I'm giving you a chance to save face and look good. Then if they persist - then zing with "I believe that's against facility policy". (Where our answer would be, 'according to the Air Force Instruction blah blah blah'.)
Please remember that we are dealing with a new grad LPN. Her "deflection" skills and "zingers"may not be quite up to speed. Give a new nurse a break.
Always always always look stuff up when you don't know. I personaly hate seroquel use for most of my residents at my LTC job. Most of them end up with sever EPS symptoms and the psych NP will early adjust correctly. But that's neither here nor there.
From your follow up response it is easy to see you were just not trained adequately and are overwhelmed. In LTC you don't have time to do much else other than pass meds and do your treatments. However, it is ALWAYS a priority to know what meds you are giving and what for. It is also NEVER a good idea to say you don't know without even looking. To see what CKD is, all you have to do is google search. When any key asks you about a drug, don't say "I don't know" I go off the diagnosis used on the MAR. It is ok to say "I am unfamiliar with that but let me look it up" then look it up in front of them. You will then learn about whatever you are bein asked about as well as build others confidence in your ability to be taught and practice safely.
I am a new grad RN, (licensed since Jan/2016). At my LTC job I'm pretty comfortable because it's very low acuity and I work nights. But in my hospital job (just started 2 weeks ago and am still in orientation) I am completely out of my element and learn things everyday by being challenged. When I don't know something I look. If I still don't understand I ask and preface with what I do understand. If my preceptor, charge, whoever asks me about something I don't know I am honest in that I don't know and then proceed to look it up or ask for help. The coworkers want to see that you are teachable and not afraid to ask for help. That is how you practice safely until you are more confident. But you need to be challenged in order to really learn.
If you feel completely overwhelmed and that your license is at risk by staying, then go full time at your easier job. But if you're willing to push yourself and advance your knowledge, then stay at the LTC and learn from this. You are new and it is ok to not know everything. I would be concerned if you thought you did. You just have to be able to admit your faults and learn from them.
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roser13, ASN, RN
6,504 Posts
In my opinion, 2 weeks' orientation for a new grad nurse to learn to function independently is criminally wrong, and just asking for failure. LTC's are hard, hard work and require many organizational skills that are not learned overnight. I hope you do not give up quite yet, as long as they are willing to work with you and perhaps extend some more orientation time.
Good luck to you, and thanks for taking our advice in the spirit in which it was intended.