How to get experience? Please Advise!

Harleygirl · Dec 7, 2005

Karen-

I am sorry you have had to go through this. It sounds to me that you would benefit from an extended orientation, being able to experience everything that you would generally experience during the course of your day.

I salute you for catching yourself in your med errors and taking responsibility for them. I have known some nurses in my time that would just make the error and wait until the DON caught it and even then wouldn't own up to it.

Also, I would allow yourself some time before your shift to review your MAR, mark any out of the ordinary (such as PICC line flushes, pain patches) down on a sheet for yourself that you will refer to all day. Use that sheet to mark down PRN's, any out of the ordinary behaviors, new orders, labs rec'd, etc. and mark the things you need to do and cross them off as you get them done. This will not only help your organizational skills, it will help you feel like you have accomplished something and it gives you less of a chance to meet something.

The only way to get experience is to "just do it", and when you fall, pick yourself back up, dust yourself off, and keep going. That is why they call it "experience". It is sometimes good, and sometimes not so good. But it is all experience and you are a better person and nurse for it. We all make mistakes and the key is to learn from those mistakes.

I would ask for at least another month of orientation if possible, and hang in there. It will all click together in time.

Harleygirl

kwagner_51 · Dec 7, 2005

I can't ask for another month of orientation, I was fired today! I just don't understand how I can have a 'heart for nursing' but seem to screw up so badly that even a Nursing Home won't keep me. i thoght admitting to mistakes was a part of growing. Maybe I should have kept my mouth shut! [Nah, I couldn't do that, I'm way to honest to let something like that slide.]

Where do I apply now? Nursing homes are out and so is the local hospital. What do I say when asked about previous exp.? Any ideas?

Thanks!!

______________________________

In His grace,

Karen

Harleygirl · Dec 7, 2005

Oh Karen, I'm sorry. I didn't realize you got fired.

You will find your place in nursing. My heart goes out to you. I pray that God leads you to the place that you will flourish and you will enjoy your work.

Harleygirl

ClaireMacl · Dec 7, 2005

How about appealing on the decision given that you had half the orientation that they said you had and their was no continuity? There is plenty in your initial post to work from, I'm sure you have more. Don't just back down, fight it, otherwise it looks like you are guilty of something, imo.

CoffeeRTC, BSN, RN · Dec 7, 2005

Hospital or nursing homes is where you will get experience. Why won't another LTC hire you? Look for places that take GN or GPNs and explain to them that you are really looking for a place where you can learn and grow into ltc nursing.

As far as some of the errors, get back to basics. Read the MAR and go from it. If you have to get back to a certain person, flag that MAR. If you don't know what a certain med is (esp a prn) look it up. Heck yah this will take for ever, but I still look up meds that I'm not familiar with. Keep the nursing Pdr on your cart. You can try reviewing you meds before you started like a previous poster said and make a list of reminders like who gets IVs, breathing treatmenet and patches (pain and nitros) At the end of the shift or med pass, go back thru the book and double check that you gave and signed everything. I still do this and I've been doing it for 10+ yrs.

This is what I tell all my new nurses. Med passes will take forever. Your load sounds like mine but add neb tx for 6 residents q 4 hrs!! We forgot about the treatments too!

After each med pass if I have time I will sneak in some charting, then at the end of the shift I will finish up with the bulk of my charting.

Keep looking and be honest with new employers, tell them you are very willing to learn and work hard if you are given the opportunity and orientation.

nurseklw72 · Dec 7, 2005

If it makes you feel any better, I always hold insulin when a blood sugar is 65. I even give the patient juice and recheck their blood sugar 15 minutes later. I think you would do better to start off in a med/surg unit in a hospital where you can sharpen your assessment skills and learn to effectively manage your time. As for time management, I use a method that I call my "brain". I have a graph worksheet that has the patient's names on the side and each hour of my shift across the top. I write out what I need to do that day at the beginning of my shift. (meds, dressing change, change IV tubing, bath, exercise, etc...). That way, my entire day is mapped out by the hour and it helps keep things organized. Another thing, this is a golden rule...IF YOU DON'T KNOW WHAT IT IS, DON'T GIVE IT! Keep a drug book with you and look up everything you are unfamiliar with. No question is a dumb question. The most dangerous nurses are the ones who think they know everything and never ask questions. Ask your preceptor, your charge nurse, your DON, your nurse educator, and other nurses on the floor if you are unsure or don't know something. More than likely, you'll find they're willing to help you out. Good Luck to you.

RN4840 · Dec 7, 2005

Karen,

I don't understand why nurses continue to insist on eating their young! As a new grad nurse working at a hospital you should have had atleast 3 months of orientation. It also would be beneficial to train with the same person. You also need to be trained by the policy and procedure, not by different nurses opinions. Each facility should have a policy on what to do if a Patient's blood sugar is below a certain level and when you should contact the Doctor etc. It sounds to me like your employer failed you. I would write a letter of complaint to the administrator of the facility from which you were recently fired. If you get no response go to the board. They need to know what is going on! Next time you apply for a job simply be honest with your prospective employer and let them know what happened. A new grad should not be set up to fail, which it sounds like you were! Keep your head up, stick up for yourself and things will work out! :saint:

RN4840

Hoozdo, ADN · Dec 7, 2005

Karen,
I don't understand why nurses continue to insist on eating their young! As a new grad nurse working at a hospital you should have had atleast 3 months of orientation. It also would be beneficial to train with the same person.
RN4840

It's a tough world out there for new grads. I am a new grad and I have to say there is NO med/surg unit or tele unit that will orientate a new grad for 3 months in my neck of the woods! You are given 6 weeks and considered "slow" if you take more than 4 weeks. I am not complaining - I think that is kind of reasonable.

Karen, I do feel badly about you being fired - BUT - shouldn't you know to hold insulin with a blood glucose of 65? Why don't you know what Ambien is. These are some pretty basic things (I am donning my abestos (sp?) fire suit now). You are an RN - you have to know these things. Never administer a drug without knowing what it is - weren't you taught these things? I am truly flabbergasted. I am trying not to be rude, but maybe I am and I apoligize for that now - but someone had to say it.

Best of luck in the future,

Lu Ann

MarySunshine · Dec 7, 2005

She said she DID hold the insulin. Why was that a stupid mistake?

Best of luck to you, you obviously haven't found your exact niche yet, but I think you'll find it and do great with it! Of course, your niche COULD be med-surg, you just need a good orientation. Best wishes.

kwagner_51 · Dec 7, 2005

It's a tough world out there for new grads. I am a new grad and I have to say there is NO med/surg unit or tele unit that will orientate a new grad for 3 months in my neck of the woods! You are given 6 weeks and considered "slow" if you take more than 4 weeks. I am not complaining - I think that is kind of reasonable.
Karen, I do feel badly about you being fired - BUT - shouldn't you know to hold insulin with a blood glucose of 65? Why don't you know what Ambien is. These are some pretty basic things (I am donning my abestos (sp?) fire suit now). You are an RN - you have to know these things. Never administer a drug without knowing what it is - weren't you taught these things? I am truly flabbergasted. I am trying not to be rude, but maybe I am and I apoligize for that now - but someone had to say it.
Best of luck in the future,
Lu Ann

Don't worry about the suit. :wink2: I DO know what Ambein is. it was ordered PRN [AS NEEDED] NOT scheduled. Since it was ordered PRN, I thought he could have it any time. However, after I gave it, I saw that it was for bedtime only. I told the on coming nurse that I did this. She acted like it wasn't a big deal. It was 5:30PM. was I wrong? Yes. I can only state that I saw it was PRN but didn't notice that it was HS only.

As for the insulin I did hold it and the DON brought it up. She said I had no right to hold it because the Dr ordered it to be given before meals. Therefore I was practicing medicine. :chair:

I keep getting conflicting information. I think I was right to hold the insulin. You can bet the next job I get I WILL ASK what the protocal is.

On a more encouraging note, I found out yesterday through my assessment [of this same patient] that she probably has aspiration pnuemonia. Her lungs had rhonci and rales through out all fields. She had a temp of 101.5 Unfortunately, i don't know if I was right because I was fired before I found out for sure.

_______________________

In His Grace,

Karen

reigh · Mar 21, 2008

i hate this i absolutely hate this!

med errors aside please nurses carefully follow your mars's. i also write down meds during my first med pass as i look through the mar for my 56 patients. ugg but your right certain weekly meds are on different days for each patient. :whispers: its a way to try and spread the impossible load they put on you.

money money money money

that's the problem. ok so nursing homes are stretched for cash and rn's its wasn't cheap to go to school so that great salary is being used primarily for dept and lets not forget that the top usually a corporate type sees only the bottom line these in themselves are not even that bad until you add years and compound it with change.

ltc's are so bound for cash these days that they are not really orienting you at all. orienting is not reviewing stuff you already learned. it should be teaching and that also means policies. oh my goodness they don't even realize that somewhere between a&p and nursing school practicum's that you were not studying a specific facilities charting, communication structure, standing orders, doctor preference. hello were are these facilities policies the concrete to fall back on when peggy sue the nurse that before you had no policy either is using shortcuts that don't really work teaches you the opposite of policy.

for real though the truth is there is a problem here there is a nursing shortage so there is also a shortage of experienced nurses to orient new grads. often since you can't get a job at a decent facility due to this shortage and in spite of the fact that decent facilities need lots of nurse you have to go to a crap facility or quit nursing. there isn't a lot of support from the state regulatory committees either while there are lots of regulations on things like the exact temperature of the water in the dishwasher there are at least in my state no rules on number of patients per care provider.

you seem to get stuck at the crap type facilities once you work at one too. since your experience is in a ltc hospitals always say you don't have hospital experience. this is an efficient way of witling down the number of new grads to those that know someone working in the facility or were dishwashers there first but is it fair?

trust me speaking out at a facility in an at will state can get you fired and will not usually change anything anyway either because they can't or won't. i hate it i hate it i hate it. i have been looking at this problem ever since i was a cna at a good ltc that was bought out and then the care was cut to point were i had to quit or face not being able to properly help my patients. i since then worked in several other types of facilities and have my rn. hospice is only place i ever actually felt over prepared and oriented to work at. in fact the mandatory orientation time i had way really long. i wish i had been able to stay there but due the fact that they were full staff with rn's (i wonder why) i had to leave when my lpn turned rn. were am i now the place i promised i would not be at a crap not even a good ltc. i said i'd work nights because i flexible but the truth is i took nights thinking i would have time to make sure i could do it right. i did not realize it meant i would be taking two sections for a total of 56 patients and despite the lack of orientation, everyday time, and several plagues of patient infections i have managed to organize and do better then i believe ever for my patient. still if i could i'd walk away and give my two weeks tomorrow. i don't get satisfaction in helping my patients i feel barley able to even hold the floor together. the only glimmer of hope i have is my insurance is good and my pay adequate to ensure i survive the current recession for now and my past injury will be healed due to it not counting at preexisting. that is not why i went for nursing i came to benefit people with my job.

signed-

honest remarks from a fellow new grad