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

[bekind_andtrue]

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.

I need some input please.

[traumaRUs, MSN, APRN]

I started as an LPN in an LTC many years ago:

1. Two weeks is no where near enough orientation for a new grad. LTC rules/regs are completely different from hospital and different yet from your clinical experiences.

2. Agree that you could have phrased the "I don't know, I didn't look" a little better but it is done and over with now.

So...to rectify these issues:

1. Go to your supervisor, DON, boss and let them know that you want to do a great job but two weeks is just not enough orientation for a new grad - can you have another two weeks? Or at least one additional week. Can they schedule an extra nurse to help out if they can't offer you two additional weeks of orientation? That way you wouldn't be so rushed

2. CKD - chronic kidney disease. As we get older, our renal function (along with other systems) declines. Always something to be aware of when medicating patients.

You can overcome this - do a little self-reflection and ask for help - best wishes.

[PedNephNurse]

The fentanyl patch is a big deal, unfortunately. It is a controlled substance. Never do anything unless you're sure of your actions. Especially with medications. You would not want to over dose your patient out of an assumption. Scan all your meds. If someone is not helping you follow protocol then don't give the medications until all steps have been properly met. Also, as an LPN your education on pharmacology is less extensive then that of an RN or an APRN. Always follow your orders and if something does not make sense ask for clarification. If the nurse you go to does not help you or answer your questions, move on to the next person. If no one can help you then call the doctor. Looking up a medication that you are not familiar with is best practice. Anyone can make a mistake. Knowing the medications you are giving will help you catch an error on someone else's part. I am a ESRD nurse and knowing your CKD patient is super important. They have strict diets and certain medications given in error can be harmful and cause death. A banana could kill them. The more experience you get the more you will learn. The learning curve in nursing is never ending.

[carolinapooh, BSN, RN]

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.

I am well aware we're dealing with a new grad nurse. Which would be why I recommended another way of doing it. I had to be taught it, too.

What is the difference in YOU recommending a method and me doing the exact same thing?? By my thinking - absolutely nothing.

Give a fellow nurse a break.

[AlwaysLearning247, BSN]

You lost me when you said you didn't bother checking. I do not think the APRN was out of line at all. You should know about the patients you are caring for, its very important. She was asking pertinent questions, especially if the patient is taking psych medications and is passed out. I wouldn't go in and act like you know everything, take her advice and learn from it. CKD is chronic kidney disease, its important to know. You should keep track of ammonia levels in these patients and if you notice them getting very sleepy or passing out as you said, you should let the provider know. To be honest I would be scared if my family members were being cared for by a nurse who had no clue why they were there. You get more comfortable with time but try to look up stuff you don't know or ask a coworker who you feel comfortable with. Its really about providing the best and most SAFE care for your patients.

[bekind_andtrue]

I was speaking about two different nurses in this post. The one that I said "I didn't bother looking" was to my charge nurse because she didn't want to take the few minutes to pull my new admits meds from the electronic dispenser. She wanted me to borrow from other residents medications. I didn't bother looking because it was five different medications and its ILLEGAL... (wasn't quite sure of this but I am now from other nurses)

I often lack tact and eloquence but I am not rude, especially not to my superiors.

[bekind_andtrue]

I just want to say THANKYOU to everyone for all the input. Even those that think I'm dimwitted. I was on this website the entire time I was in nursing school.... even a couple months before I was even in nursing school. This was my first time posting or commenting.

If anyone else has advice on how to be a COMPETENT nurse and survive as a brand new nurse in a LTC rehab facility please let me know!!!

I know someone mentioned reading the Policy and Procedures book. Last week I asked somewhere where I could find that and I'm not sure that she gave me a definite answer. It might be online.... I'm gonna have to ask again and start studying that every night!

I want to uphold the integrity of nursing and I know that means being COMPETENT. I want to be the best nurse I can be. I know that I have a LOT to learn. I'm not quite sure what I expected to get out of posting this but I sure am glad that I did. I think I got exactly what I needed.

I am open to any more criticism and advice!!!

Today I started my day off with an unexpected and nice little chat with my supervisor. We were just settling in, putting our bags down in the break room and she asked me how I was. I told her that I was trying to keep my head up. She was very reassuring and told me that I'm actually doing really well and that all nurses go through this. I mentioned my run in with the ARNP and she told me that she gave her a similar drill when she was new. I know that the ARNP meant well.... and even though at the time she only added to my stress and frustration and I definitely do appreciate her giving me that little wake up call. BTW... resident's Seroquel dose was decreased =)

[OCNRN63, RN]

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 =(

No no one is giving you an "attitude." If you interpret constructive criticism as "attitude," you're going to have a tough row to hoe in your nursing career.

I learned over the years to listen to what was telling me when they were trying to give me feedback. I may not have always agreed with her/him right away, but sometimes upon reflecting on what was said, that person had good ideas.

[OCNRN63, RN]

I just want to say THANKYOU to everyone for all the input. Even those that think I'm dimwitted. I was on this website the entire time I was in nursing school.... even a couple months before I was even in nursing school. This was my first time posting or commenting.

If anyone else has advice on how to be a COMPETENT nurse and survive as a brand new nurse in a LTC rehab facility please let me know!!!

I know someone mentioned reading the Policy and Procedures book. Last week I asked somewhere where I could find that and I'm not sure that she gave me a definite answer. It might be online.... I'm gonna have to ask again and start studying that every night!

I want to uphold the integrity of nursing and I know that means being COMPETENT. I want to be the best nurse I can be. I know that I have a LOT to learn. I'm not quite sure what I expected to get out of posting this but I sure am glad that I did. I think I got exactly what I needed.

I am open to any more criticism and advice!!!

Today I started my day off with an unexpected and nice little chat with my supervisor. We were just settling in, putting our bags down in the break room and she asked me how I was. I told her that I was trying to keep my head up. She was very reassuring and told me that I'm actually doing really well and that all nurses go through this. I mentioned my run in with the ARNP and she told me that she gave her a similar drill when she was new. I know that the ARNP meant well.... and even though at the time she only added to my stress and frustration and I definitely do appreciate her giving me that little wake up call. BTW... resident's Seroquel dose was decreased =)

There's poster here, "Esme", who has brain sheets to use to keep yourself organized. IDK if if they are/can be adapted to the LTC setting, but it would be worth a try. Perhaps someone here remembers how to access them for you.

[OCNRN63, RN]

https://allnurses.com/general-nursing-discussion/med-surg-worksheets-363761.html

Follow this link down to the post from Daytonite; there are several links to brain sheets there that might help keep you organized.

Daytonite was a treasured member of AN who passed away several years ago. She was known for helping students/new nurses. Her legacy of teaching goes on in her old posts.

[Mhsrnbsn]

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 =(

But you were smart enough to pass the NCLEX-PN. You're not dumb, but definitely feel you are dangerous in practice due to a severe lack of initiative. ITS OK TO ASK QUESTIONS. I DONT KNOW IS UNACCEPTABLE. I started as a CNA, I was an LPN, and I'm and RN now and working toward nurse practitioner. I am always looking up new meds and new diseases AND EVEN LOOKING UP OLD ONES to refresh my memory. Never go too comfortable the field of medicine and nursing is forever changing. You need to take responsibility for your own practice because should you ever be called to court you have no one but yourself and your charting to lean on. And I PROMISE if you get called into court for something that charge nurse won't be there holding your hand and saying "it's my fault" learn your job, your responsibilities and meet your expectations. If you aren't ready to be alone on the floor just ask for more orientation. Don't fake it til you make it. nursing doesn't go that way.

[CoffeeRTC, BSN, RN]

Ahh...I re-read this and when you say " i didn't bother looking" did you mean looking for meds to borrow or for the actual resident in question?

You are correct in not wasting time looking for the meds from the other residents. Supervisor should have when to your emergency box to get the meds. We are not permitted to borrow meds. Yeah, in the bunch card system we might still do this, but it is wrong.

Treat any order for controlled substances extra carefully. Always double check if you have a question or the order doesn't seem right. You can never go wrong when you do this.

[Skippingtowork]

Do not sell yourself short, just learn from mistakes. Settings like the one you describe have very little orientation and usually do not always do things by the books, so you are left trying be a good nurse, while management is breathing down your back. If you are uncomfortable with your orientation, ask for more. And no, you cannot use one patient's meds for another.

On a side note, no APRN worth her degree would tell you that a patient is passed out, while she is talking to a nurse in another room. That part did not make sense.

Seriously listen to all the other comments made on this thread and consider another setting. Good luck to you.