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.
Your charge nurse was wrong to expect you to take another patients meds so you were correct about that. At least that's the correct way of doing things. In real life, many times there are shortcuts that get taken especially in an environment like LTC where there is an overwhelming amount of patients per nurse.
But your charge nurse was correct to point out you needed a new order. Sounds like she was actually nice enough to refrain from writing you up for a med error with a narcotic. The APRN was not wrong although I think the APRN could have been a little nicer about it. They are both trying to teach you even if it comes across as mean. I think it sounds like you work with a good team.
I would suggest a couple tips for you.
1. Pretend you're in nursing school again. Show up for your shift a half hour early and look up your patients, their meds, and any conditions you don't understand like CKD. This will help you better understand why you're giving them the meds that they're getting.
2. Be a sponge, try to swallow your pride and learn from any other nurses and doctors when you have the opportunity. If you had asked the APRN ahead of time about what CKD is, I'm sure she would have been happy to help you understand it better and since you asked her, you would have come away from it seeing it as a positive interaction rather than negative.
3. Help out your coworkers when you can It goes a long way toward good relations with them and they will be more willing to help you in the future.
I will repsond to the APRN scenario with what I hope is constructive.
I think in most of our careers we have all been caught in a situation were we didn't know the information we should have known. It's professionally and personally embarrassing. I would be happy to share mine with you but it involves a very pissed off attending surgeon after hours that took me down a few pegs for my ignorance as a new APRN, and rightly so. Afterward I felt angry. At first I was mad at the surgeon but the more I thought about it he really was impressing on me (maybe not in a nice way) that I didn't know what I was talking about and in some ways actually was leading me towards the right answer. The truth was I was mad at myself because I didn't know what I should have known. I still think about it at times and, honestly, it makes me a better nurse. Under no circumstance should you accept care of a patient that you don't understand from their history to their meds and indications to their plan. If you don't understand, stop right there and gather the information you need to understand. You are their last defense. It sounds liek the APRN in this case was trying to lead you to the information you needed. Have you learned from it? Do you now understand why the pt was on seroquel now? What to assess?
At first I was mad at the surgeon but the more I thought about it he really was impressing on me (maybe not in a nice way) that I didn't know what I was talking about and in some ways actually was leading me towards the right answer. The truth was I was mad at myself because I didn't know what I should have known. I still think about it at times and, honestly, it makes me a better nurse. Under no circumstance should you accept care of a patient that you don't understand from their history to their meds and indications to their plan./QUOTE]
Quoted for truthiness (not that I am excusing the surgeon's rudeness, that is never acceptable.)
One of the markers of a seasoned health care provider is how comfortable they are with their own ignorance. The more expertise you gain in a field, the more apparent it is that there is SO MUCH MORE to know. When I first started in health care way back in 2002, I knew everything. 14 years later, and I am now acutely aware of the limitations of my expertise- because it is that very expertise that shines a light on the huuuuge sphere of ignorance surrounding my tiny island of knowledge.
And I am totally fine with that. In fact, it's pretty much my favorite part of being a CNM- I will never, ever run out of things to learn. I can't wait to see how much I don't know when I am 50!
Teal deer. Long story short- your knowledge base is small; so small that you don't yet know the full extent of your ignorance. That is normal and certainly not a criticism. But you need to OWN your tiny knowledge base and dedicate your efforts to expanding it; drug by drug, patient by patient. Learn how to get the information you need independently. Learn how to professionally seek guidance from those around you, and gracefully accept feedback and correction.
One of the markers of a seasoned health care provider is how comfortable they are with their own ignorance.
Yeah, the irony of that story was if I had just said "I'm not sure" from the start it wouldn't have ended the way it did. It still embarrasses me that I made it seem like I knew more than I did and I got called on it.
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.
You have completely misinterpreted her use of the word "attitudes". She didn't mean we were being defiant or arrogant. An attitude is also, by definition, "a feeling or emotion with regard to a fact or state".
I was confused by the abbreviations when I was a new grad--my program didn't teach us any because "you're not supposed to abbreviate!" Then I got in the real world of SNF where everything is abbreviated. One way I got myself up to speed was reading all my patients' charts whenever I had spare moments--I picked one chart a day, looked up their meds, read their whole history, all the progress notes from their hospitalizations, looked up everything I didn't understand, asked other people if Google wasn't helping. As far as accepting report without the diagnosis--in LTC I've never ever been given a report with a whole patient history included. At most you might get "they're a diabetic" but during shift to shift report nobody lists off the 10+ dx most residents will have. So, start googling! I went from being "the dumb new grad" many years ago to being promoted to unit manager after 3 years--because I asked questions and didn't get defeated. The learning curve is very steep, but it's not impossible. Don't give up!
At first I was mad at the surgeon but the more I thought about it he really was impressing on me (maybe not in a nice way) that I didn't know what I was talking about and in some ways actually was leading me towards the right answer. The truth was I was mad at myself because I didn't know what I should have known. I still think about it at times and, honestly, it makes me a better nurse. Under no circumstance should you accept care of a patient that you don't understand from their history to their meds and indications to their plan./QUOTE]
Quoted for truthiness (not that I am excusing the surgeon's rudeness, that is never acceptable.)
One of the markers of a seasoned health care provider is how comfortable they are with their own ignorance. The more expertise you gain in a field, the more apparent it is that there is SO MUCH MORE to know. When I first started in health care way back in 2002, I knew everything. 14 years later, and I am now acutely aware of the limitations of my expertise- because it is that very expertise that shines a light on the huuuuge sphere of ignorance surrounding my tiny island of knowledge.
And I am totally fine with that. In fact, it's pretty much my favorite part of being a CNM- I will never, ever run out of things to learn. I can't wait to see how much I don't know when I am 50!
Teal deer. Long story short- your knowledge base is small; so small that you don't yet know the full extent of your ignorance. That is normal and certainly not a criticism. But you need to OWN your tiny knowledge base and dedicate your efforts to expanding it; drug by drug, patient by patient. Learn how to get the information you need independently. Learn how to professionally seek guidance from those around you, and gracefully accept feedback and correction.
YES!! I've said before that the saying "The more you know, the less you know" is so true for nursing.
on another Fentanyl patch bc you didnt see the previous one!!! You need to check the order when the next one is due. If absolutely you cant find one one the patient with thoroughly checking their body you need to let the doctor know and they will decide what to do. Big NO NO!!! I think some new nurses do not realize how important these things that may seem minor is to patient safety.
Welcome to nursing. You didn't know how to scan. Yes it is annoying to me as an RN that you don't know that but it isn't your fault, but I am irritable because of some other nonsense and I take it out on you, like kicking the dog. The manager hears something else and goes with it and now your it. I left floor nursing because I was more than happy to pick up poop from my patients, but not everyone else. I had been in other workplaces and in management, to this day I cannot believe we nurses work under the conditions we do.
Most of us have the training to the actual nursing, but there are too many grey areas. I always wondered why management could not figure out how to maximize everyone's time and skills to avoid all the bullying problems we have. the answers seem pretty obvious to me.
In response to the question about it being illegal to give meds from another pts supply...
Yes, at least in my state, you're not supposed to do it, but that's not to say it doesn't get done. I personally wouldn't have given meds to this pt from another pt supply either, however I would have answered the charge nurse differently. As for the rest, I agree with previous posters. I do have this to say though, please please realize that you are literally holding the lives of many people in your hands. These people, their families, your supervisors, all trust you to do your best and make the best decisions for your patient, and your license depends on you doing it the right way. Don't leave stuff for the next nurse to do and take for granted that it got done, don't assume when it comes to narcs, and please please don't write an order without someone actually giving you the order.
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.
in this case it was a reasonable and logical answer.
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happy_life
36 Posts
Your charge nurse was wrong to expect you to take another patients meds so you were correct about that. At least that's the correct way of doing things. In real life, many times there are shortcuts that get taken especially in an environment like LTC where there is an overwhelming amount of patients per nurse.
But your charge nurse was correct to point out you needed a new order. Sounds like she was actually nice enough to refrain from writing you up for a med error with a narcotic. The APRN was not wrong although I think the APRN could have been a little nicer about it. They are both trying to teach you even if it comes across as mean. I think it sounds like you work with a good team.
I would suggest a couple tips for you.
1. Pretend you're in nursing school again. Show up for your shift a half hour early and look up your patients, their meds, and any conditions you don't understand like CKD. This will help you better understand why you're giving them the meds that they're getting.
2. Be a sponge, try to swallow your pride and learn from any other nurses and doctors when you have the opportunity. If you had asked the APRN ahead of time about what CKD is, I'm sure she would have been happy to help you understand it better and since you asked her, you would have come away from it seeing it as a positive interaction rather than negative.
3. Help out your coworkers when you can
It goes a long way toward good relations with them and they will be more willing to help you in the future.
Hope this helps!! Good luck! :)