Hi everyone, I know this is all about Nclex but I just want to share with everybody my experience. This site helped me a lot when I was studying for my nclex and I will answer some questions of nclex as well if anyone has questions. All I want to say is working as a new RN is as hard as passing nclex.
I graduated from a BSN school in May 2012 and passed my nclex at the end of june. I got hired as a RN in a rural hospital at medical unit before I graduated. It takes an hour and twenty minutes to get there so yes, I commute. I started my job on 2nd, July and the orientation was supposed to last a month. Everything worked alright till this wednesday morning. My director told me I was not a good fit for their unit and I didnt know how to waste narcotics and I wasnt pay attention to details enough. Besides that, I also totally made one patient feel uncomfortable. Here is my side of story of that compliant of one patient:
I got complaint from one patient as he stated that he was not comfortable with me being in the room. what happened was he aspirated and almost choked three times when I gave him medications because he didnt turn his head to the right side. He has COPD and right side weakness so he was supposed to turn his head to his right when he was eating or drinking. I was not aware of that situation(his right side weakness) and I was totally panic as there was nobody with me at that time. I didnt get report from last shift nurse as well so I dont know should myself be responsible for that his being choked accident???
As for narcotic waste, I didnt know if you only give half dose, you are suppose to waste half doses, but after the nurse I was orienting with pointed out, I was doing the right way afterwards. so in summary, I didnt actually make any medication errors so I was assuming she meant potential med errors.
The director also said I am too hyper, not calm enough and the fact was I wasnt nervous with every single patient (she said shes not gonna go from there). She also pointed that I didnt have good IV skills I was supposed to have from learning at school. The point is IV skills staff like that is not gonna be perfect just by learning at school, right? Practice makes perfect and now I feel like I am such a loser!!
I am here to hear everybody's thoughts and dont afraid to say harsh things. I like different opinions. Thx
I do appreciate your comment. This is really helpful. For the aspiration thing, the first time happened I thought he was just drinking water too fast because it did happened to another pt so I didnt really pay attention(I learned my lesson). I asked him do you want to take a break and he said "I will be fine" so I let him try second time (he drank slowly) and coughed. Then he told me he should have turned his head to the right side and he was fine. When you drink sth too fast, dont you sometime cough little bit water out?! However, I do realize that being panic was not very professional. The point was I do not believe being aspirated made him mad at me. It was when he asked for inhalation (THE ORDER was BID) so he could not have it till night time and he was so not happy and then he told me he wanted to talk to the nurse I was orienting with. BTW, I DID apopolize to him and he said he should be the one to apologize for not having telling me in advance. I know I should have known better.
FYI, I did not have narcotic waste during oriention. Here is how my orientation worked: starting at the first day I was on the floor and I followed a nurse and I've had about 9 shifts and each shift I was with a different nurse and all I was doing was just doing assessments, giving meds (some of them will follow me and some of them just let me do things by myself and ask them if I have any questions). I never had any formal classes except glucose testing and documentation. I did ask a lot of questions.
FYI, for the IV, I didnt even to get to do a single one:( so I have no idea how did that poor IV skills judgement come from.
I strongly agree with you with your last paragraph. I am trying to learn from this experience thats why I am posting this. I didnt ask you to judge whether they fired me was right or wrong; instead, I asked for your opinions. I do realize I made bad decisions and I have so many things to learn.
I personally feel you started out as a new nurse at the wrong facility. I graduated the same time you did and I started working on July 5. The only differences between you and me is that I am working on a limited permit and not taking NCLEX until end of August. Also, I am technically still on orientation and part of a residency program. I had 2 days of hospital orientation, 6 days of nursing orientation and am currently on a 12-week unit orientation with a preceptor until the end of the 12 weeks. I did clinical and capstone on this unit, so there is also a familiarity factor for me too. Despite that, as a new grad we won't be given our own patients until we are thoroughly evaluated.
Look at going to work for an academic center (i.e, a university hospital or a similar teaching center) ... they have the resources and programs in place to help you transition safely from student to professional nurse. Your former employer seems like they really gypped you in this kind of prep. I am not sure if you are eligible any longer to start a residency program, as I heard through our director that residency programs are for BSN new grads who have no prior clinical experience as a nurse. But perhaps there is an exception for your short stint? Good luck with getting into a much better place for you. I hope there is a blessing in disguise in store for you based on this experience!
I'm really sorry for you. I have to add my old crusty bat 2 cents here. This sounds to me like this is a total system failure.
Yes. You should have known better but I don't think you had very good example of a preceptor/preceptors. You did say you had a different one precepting you every time. It has been my experience the orientee follows the schedule of the preceptor- days off, lunches etc. I'm really curious as to how many years of experience these preceptors had as floor nurses themselves and how many people they have precepted. or was it a case of ego trip- Look at me, i'm a preceptor, i know every thing, I'm all that and a basket of chips- not aware of the responsibility that preceptorship is- no just an extra buck or 2 / hour in the paycheck
1. The entire orientation process at that hospital sucks from start to finish.I know you said rural but I dont think that means dark ages. There should have been 1 designated preceptor- experienced RN, precepting you. That preceptor should have gone to a preceptor class- this class they do have, there is such an animal. The preceptors job is to mold your book learning into a practice whole in a real life patient situation(s)from the start of the nursing process to the end and every where in between. That preceptor should have showed you the path to developing critical thinking from day one.
Your first day on that unit should have been alot of "housekeeping things" I'm not talking about mopping floors. I am talking about' this is where the linen is', this is where the crash cart is, this is the clean utility room- give you a scavenger hunt sheet to find a long list of supplies on your own', showing you where the hospitals policy and proceedure books , the Policy and Proceedure for on narcotic waste- that should have been day '1' because of the federal and state regulations involved.
Day 2 should have been attached at the hip with that preceptor at 7AM, this is the assignement board, who makes the assignments, why the assignements are made the way they are, then getting report from the night shift nurse - the first day or 2 should be just listening and writting/taking report, your preceptor and you discussing the patient's breifly and completely in route to the patients room.( time managment skills) then after afew days asking questions of the night shift nurse about the patients during that report but still that precptor is with you- you should not have been flying off on your own for about 12 weeks.
Your place was to watch your preceptor assess the patients, ask why he/she went into which patient first, second, third( priority setting). Watch the preceptor give meds. There is constant dialog going on all day, every day; day in and day out, between you and that preceptor. That hospital should have NEVER have let a brand new grad/nurse give meds with out an experienced RN precptor side by side, hip to hip with them, in the room at the patient's bedside observing, coaching and instructing until they were checked off as competent in the skill of medication administration( implies there is an orientation check off list), which is usually at the end of a 12 week orientation program. Every opportunity to learn on that unit, you and the preceptor should have been at- IV insertions, admission process for new patients, receiving new post ops, discharging patients, foley insertions, etc, etc etc. This is the newgrad/nurse's path to "learning curve". An there are many more in the 'evolution' to becoming a competent nurse- it happens with every new place you work at and every new speciality you go into. It is a dynamic constant learning process.
That patient could have ended up up with which different senerio's? you answer: What are all the different senarios that patient could have ended up with with a diagnosis of CVA, hemipariesis, dysphagia. What is your nursing care plan for this patient- what are the patient goals, what are your nursing actions and how are you going to impliment them?) This is how you have to begin the your thinking process for each and every patient.
I'm sorry to be such a crusty mean old bat with what was i told i had on another thread- a "Queen Elizabeth complex".
The next job you get- i would ask about the orientation process, it's length and what kind of preparation the preceptor who would be precepting you has.
I wouldn't even put this current place on my resume, for what: 3 weeks? i would also take lessons learned about as the Nurse- you are responsible for you actions.That's what the license means.
Not to be argumentative, but in my program we were not taught about wasting narcotics, for that matter, we were taught nothing about a medication administration record. I saw a MAR and worked with it at the clinical site; it was explained by my preceptor, not my clinical instructor. Not excusing, or even addressing, most of the OP, just saying that not all programs do a good or even adequate job of introducing the student to the reality of the job. My program spent most of our time being concerned with writing papers and APA format. Academic papers and APA format did absolutely nothing to prepare me to work as a nurse. I learned most of my duties on the job, my first job. I wasn't run off for being poorly prepared by my school.
Sounds like a place you wouldn't want to work anyway. Maybe they didn't see you fitting in the unit personally (hyper comment etc). Don't put in in your resume.
The facility had unreasonable expectations as far as your IV skills. If you were in a larger hospital those skills would have been included in your orientation.
If the patient was able to complain about you not telling him to turn his head to the right... why didn't he turn to the right himself?(Now you know to never pass meds without getting report). The real reason he was mad at you was because you didn't handle the request for an inhalation treatment correctly.
COPD patients are always anxious and focused on their next breath. If the patient asks for a treatment, it means they are feeling short of breath. It is not acceptable to tell them to wait. You need to do a respiratory assessment and get a prn order for the prescribed treatment.
As far as wasting narcs... all facilities are on that like flies on you-know-what. Your preceptor failed you on this one. It sounds like you had a collection of minor incidents during a training period that should not have led to termination.
Pick yourself up and dust yourself off. You learned a lot from this. I wouldn't put it on a resume.
P.S. The one and only time I ever got fired was for not smiling enough. I was depressed from a string of family deaths. Your demeanor is VERY important. Practice in the mirror as to how to look calm when you feel panicky inside.
Good luck, you are NOT a failure you just started out in the wrong place.
Specializes in Critical Care; Cardiac; Professional Development.
You made some mistakes and you are going to learn from them. Not every facility would necessarily fire you for these mistakes but, as you learned, some will. Different facilities have different tolerance for being new.
Your writing style suggests that perhaps English is not your first language. There may be cultural things playing into your ability to communicate effectively and perhaps even to learn effectively. Honestly not knowing to waste a narc baffles me, but in trying to think of how I knew that, I do not remember a specific instruction, just a lot of information here, at school and at work about the risk of narcotic administration to one's nursing license and the necessity of documenting documenting documenting what happened to that med, how much went into the patient, how much did not and what happened to the medication that wasn't used. I have no idea how much of that is your own fault and how much of it would need to be specifically taught. I am amazed anyone gets out of school without knowing how to safety and legally handle narcotic medications or to read a MAR. Scary to be honest.
All you can do now is carefully assess how much of this you can control and be able to explain when applying for your next job what you learned from the situation. I do believe you will learn from this and go on to be successful. I wish you the best of luck as you rebuild. It is unfortunate you were fired rather than nurtured along.
You are a brand new nurse, and you did not recceive an appropriate orientation. Yes, you completed school, and passed boards but actually working as an RN is a whole new ball game. I don't think your preceptor or manager were very good examples of nurse leaders. You might consider appealling to human resources, and see if you could have an opportunity in another unit that is more willing to give you an appropriate orientation. Either way, understand that while you may have made a mistake, you are so new at this, and it was their resonsibility to be guiding you and teaching you. They failed you.
All that being said, I'm sure you learned in school that you don't just give a med because the doctor ordered it. You need to know about the med, why your giving it, correct dose, interactions with your patients other meds etc etc. You are responsible for the meds you give and the interactions you have with your patients, not your preceptor. So, it is up to you. You have to say to your preceptor, "I can't give medications without reviewing the patients chart, and having an opportunity to lookup the meds". For the rest of your career, you are responsible for being safe for your patients, and protecting your license for yourself. It may seem difficult when people in authority are telling you to do otherwise, but it's alot easier to learn to do that, than live with hurting a patient, and losing your license. Remember, as a licensed professional, "my boss told me to" or "my preceptor told me to" is not a defense.
I'm really sorry for you. I have to add my old crusty bat 2 cents here. This sounds to me like this is a total system failure.
Yes. You should have known better but I don't think you had very good example of a preceptor/preceptors. You did say you had a different one precepting you every time. It has been my experience the orientee follows the schedule of the preceptor- days off, lunches etc. I'm really curious as to how many years of experience these preceptors had as floor nurses themselves and how many people they have precepted. or was it a case of ego trip- Look at me, i'm a preceptor, i know every thing, I'm all that and a basket of chips- not aware of the responsibility that preceptorship is- no just an extra buck or 2 / hour in the paycheck
1. The entire orientation process at that hospital sucks from start to finish.I know you said rural but I dont think that means dark ages. There should have been 1 designated preceptor- experienced RN, precepting you. That preceptor should have gone to a preceptor class- this class they do have, there is such an animal. The preceptors job is to mold your book learning into a practice whole in a real life patient situation(s)from the start of the nursing process to the end and every where in between. That preceptor should have showed you the path to developing critical thinking from day one.
Your first day on that unit should have been alot of "housekeeping things" I'm not talking about mopping floors. I am talking about' this is where the linen is', this is where the crash cart is, this is the clean utility room- give you a scavenger hunt sheet to find a long list of supplies on your own', showing you where the hospitals policy and proceedure books , the Policy and Proceedure for on narcotic waste- that should have been day '1' because of the federal and state regulations involved.
Day 2 should have been attached at the hip with that preceptor at 7AM, this is the assignement board, who makes the assignments, why the assignements are made the way they are, then getting report from the night shift nurse - the first day or 2 should be just listening and writting/taking report, your preceptor and you discussing the patient's breifly and completely in route to the patients room.( time managment skills) then after afew days asking questions of the night shift nurse about the patients during that report but still that precptor is with you- you should not have been flying off on your own for about 12 weeks.
Your place was to watch your preceptor assess the patients, ask why he/she went into which patient first, second, third( priority setting). Watch the preceptor give meds. There is constant dialog going on all day, every day; day in and day out, between you and that preceptor. That hospital should have NEVER have let a brand new grad/nurse give meds with out an experienced RN precptor side by side, hip to hip with them, in the room at the patient's bedside observing, coaching and instructing until they were checked off as competent in the skill of medication administration( implies there is an orientation check off list), which is usually at the end of a 12 week orientation program. Every opportunity to learn on that unit, you and the preceptor should have been at- IV insertions, admission process for new patients, receiving new post ops, discharging patients, foley insertions, etc, etc etc. This is the newgrad/nurse's path to "learning curve". An there are many more in the 'evolution' to becoming a competent nurse- it happens with every new place you work at and every new speciality you go into. It is a dynamic constant learning process.
That patient could have ended up up with which different senerio's? you answer: What are all the different senarios that patient could have ended up with with a diagnosis of CVA, hemipariesis, dysphagia. What is your nursing care plan for this patient- what are the patient goals, what are your nursing actions and how are you going to impliment them?) This is how you have to begin the your thinking process for each and every patient.
I'm sorry to be such a crusty mean old bat with what was i told i had on another thread- a "Queen Elizabeth complex".
The next job you get- i would ask about the orientation process, it's length and what kind of preparation the preceptor who would be precepting you has.
I wouldn't even put this current place on my resume, for what: 3 weeks? i would also take lessons learned about as the Nurse- you are responsible for you actions.That's what the license means.
Thanks so much for your comment. I would not put this on my resume and I will definitely ask about how the orientation work.
The facility had unreasonable expectations as far as your IV skills. If you were in a larger hospital those skills would have been included in your orientation.
If the patient was able to complain about you not telling him to turn his head to the right... why didn't he turn to the right himself?(Now you know to never pass meds without getting report). The real reason he was mad at you was because you didn't handle the request for an inhalation treatment correctly.
COPD patients are always anxious and focused on their next breath. If the patient asks for a treatment, it means they are feeling short of breath. It is not acceptable to tell them to wait. You need to do a respiratory assessment and get a prn order for the prescribed treatment.
As far as wasting narcs... all facilities are on that like flies on you-know-what. Your preceptor failed you on this one. It sounds like you had a collection of minor incidents during a training period that should not have led to termination.
Pick yourself up and dust yourself off. You learned a lot from this. I wouldn't put it on a resume.
P.S. The one and only time I ever got fired was for not smiling enough. I was depressed from a string of family deaths. Your demeanor is VERY important. Practice in the mirror as to how to look calm when you feel panicky inside.
Good luck, you are NOT a failure you just started out in the wrong place.
Thanks so much for your comment as well. For the COPD pt, I did ask the preceptor about any prn and she told me he would have to wait because all the nose sprayers were BID. I learned my lesson and from now on I will put patient's safety first even if my preceptor told me not to worry about!
You made some mistakes and you are going to learn from them. Not every facility would necessarily fire you for these mistakes but, as you learned, some will. Different facilities have different tolerance for being new.
Your writing style suggests that perhaps English is not your first language. There may be cultural things playing into your ability to communicate effectively and perhaps even to learn effectively. Honestly not knowing to waste a narc baffles me, but in trying to think of how I knew that, I do not remember a specific instruction, just a lot of information here, at school and at work about the risk of narcotic administration to one's nursing license and the necessity of documenting documenting documenting what happened to that med, how much went into the patient, how much did not and what happened to the medication that wasn't used. I have no idea how much of that is your own fault and how much of it would need to be specifically taught. I am amazed anyone gets out of school without knowing how to safety and legally handle narcotic medications or to read a MAR. Scary to be honest.
All you can do now is carefully assess how much of this you can control and be able to explain when applying for your next job what you learned from the situation. I do believe you will learn from this and go on to be successful. I wish you the best of luck as you rebuild. It is unfortunate you were fired rather than nurtured along.
Thanks so much. I will definitely list this narcotic situation as example in the interview if I get any in future. Yes, english is not my first language and I really did not have any problems communicating with most pts as far I can remember. The thing is we did give the pt the right doses and I just need to pay more attention. I learned so much from this experience. I am always responsible for my own actions because I am a licensed professional not a student anymore. Thank you for your comment!
NewRN,
You are a brand new nurse, and you did not recceive an appropriate orientation. Yes, you completed school, and passed boards but actually working as an RN is a whole new ball game. I don't think your preceptor or manager were very good examples of nurse leaders. You might consider appealling to human resources, and see if you could have an opportunity in another unit that is more willing to give you an appropriate orientation. Either way, understand that while you may have made a mistake, you are so new at this, and it was their resonsibility to be guiding you and teaching you. They failed you.
All that being said, I'm sure you learned in school that you don't just give a med because the doctor ordered it. You need to know about the med, why your giving it, correct dose, interactions with your patients other meds etc etc. You are responsible for the meds you give and the interactions you have with your patients, not your preceptor. So, it is up to you. You have to say to your preceptor, "I can't give medications without reviewing the patients chart, and having an opportunity to lookup the meds". For the rest of your career, you are responsible for being safe for your patients, and protecting your license for yourself. It may seem difficult when people in authority are telling you to do otherwise, but it's alot easier to learn to do that, than live with hurting a patient, and losing your license. Remember, as a licensed professional, "my boss told me to" or "my preceptor told me to" is not a defense.
Good Luck NewRN
Thx for your commment. I am not going to appeal to HR because that job was not my ideal at first place(it takes me 1hr and 20 minutes to get there); besides that, the medical unit on that floor is the busiest and I dont think they have any busier unit at that hospital. I am going to appply a larger hospital. for the preceptors, the nurse I was orienting with when that COPD pt complained only worked on the floor for three years and the nurse I was orienting with when the narcotic situation happened worked as LPN for 6 years and got her license this May.
Once again-nursing programs cannot give you enough experience unless you combine the strong clinical program with the bsn program which would make the nursing degree about a 5 year commitment to complete instead of 4. I can tell you that when I completed the Rn diploma program (and so many were dropped during the 1st year) that we were "work ready" upon graduation and had jobs in hand upon graduation. (To this day you can spot a diploma nurse a mile away) We were hired as graduate nurses then took our license exam.
Nurses are not prepared for the "real world" I'm sorry-degree and all does not mean that you will find a great job experience.
It's sad there is no real apprenticeships for the most part. Some nurses are wise and get jobs as na's, and that's great, but the specialty experiences such as IV skills etc, should at least be covered in nursing school during rotations-so you have a direct observation, and eval at the time. If weak in certain areas, we were re-mediated with more opportunities until we mastered the skill-be it enemas, dressing changes, Insertion of IV's, drug calcs, drug prep, any patient related treatment.
It's a shame that we promote such high degrees without much clinical substance. What's that going to get us? Is someone looking at this?
newRN2012
14 Posts
I do appreciate your comment. This is really helpful. For the aspiration thing, the first time happened I thought he was just drinking water too fast because it did happened to another pt so I didnt really pay attention(I learned my lesson). I asked him do you want to take a break and he said "I will be fine" so I let him try second time (he drank slowly) and coughed. Then he told me he should have turned his head to the right side and he was fine. When you drink sth too fast, dont you sometime cough little bit water out?! However, I do realize that being panic was not very professional. The point was I do not believe being aspirated made him mad at me. It was when he asked for inhalation (THE ORDER was BID) so he could not have it till night time and he was so not happy and then he told me he wanted to talk to the nurse I was orienting with. BTW, I DID apopolize to him and he said he should be the one to apologize for not having telling me in advance. I know I should have known better.
FYI, I did not have narcotic waste during oriention. Here is how my orientation worked: starting at the first day I was on the floor and I followed a nurse and I've had about 9 shifts and each shift I was with a different nurse and all I was doing was just doing assessments, giving meds (some of them will follow me and some of them just let me do things by myself and ask them if I have any questions). I never had any formal classes except glucose testing and documentation. I did ask a lot of questions.
FYI, for the IV, I didnt even to get to do a single one:( so I have no idea how did that poor IV skills judgement come from.
I strongly agree with you with your last paragraph. I am trying to learn from this experience thats why I am posting this. I didnt ask you to judge whether they fired me was right or wrong; instead, I asked for your opinions. I do realize I made bad decisions and I have so many things to learn.