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
Thank you thank you thank so much everyone for your comment and criticisms. I already moved on and applied for a couple of positions here in town. I like criticisms as long as they are right and I like people being honest with me and point out my weakness so I can learn. I wish people in reality can be this honest!!!!! I wish.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
thank you thank you thank so much everyone for your comment and criticisms. i already moved on and applied for a couple of positions here in town. i like criticisms as long as they are right and i like people being honest with me and point out my weakness so i can learn. i wish people in reality can be this honest!!!!! i wish.
people in reality can be this honest, but most who have been this honest have been burned. in reality, most people would rather that you be nice than be honest. to quote a line from "a few good men" -- "you want the truth? you can't handle the truth." most people can't. in reality, most people hear what they want to hear, and brand anything they don't like to hear as "mean", "nasty" or "bullying."
you have taken criticism extremely well, and i commend you for that. it's a rare quality.
as preceptors, we have a very fine line to walk. we have to give you constructive criticism, correct your mistakes and not allow you to harm a patient, but we have to do it in such a way as to be understood while not appearing to be "mean" or "harsh" or "eating our young." with some orientees, it's impossible to win. about 20 years ago, a manager of mine told me that when you give negative feedback, you have to start off with five pieces of positive feedback before each piece of negative feedback. i've tried to follow that formula since, but there are orientees who hear only the positive feedback and totally miss the negative. then when they're fired after their fifth med error or fourth narcotic discrepency, they're shocked -- they thought they were doing so well. no one ever told them they weren't doing well. all of their reviews were so positive! other orientees hear only the negative feedback and are convinced that you're being mean to them no matter how carefully you try to word things.
an orientee of another nurse's was once getting ready to defibrillate artifact. it's a common mistake with the inexperienced -- i've seen nurses, residents and even a cardiology fellow make the same mistake. but it's a mistake that can harm a patient, so the preceptor couldn't let that happen. she tried to tactfully get her orientee's attention to prevent the error, but couldn't and in the end had to physically knock the orientee's hand away from the "shock" button. she prevented harm to the patient, but the orientee screamed "bully" and the preceptor wound up in the manager's office explaining why she was "so mean" to her orientee. that orientee ended up resigning and all of the preceptors gave an enormous sigh of relief. had the orientee been open to criticism, it could have been so different. they could have just talked about the mistake, reviewed criteria for defibrillation and the orientee could have continued her employment and perhaps learned to become a valued team member. last i heard, she was still looking for that perfect job where no one spoke harshly to her. ever.
Ruby! I love reading your post and I learned so much from reading them. During the 3 and 1/2 weeks orientations, the only negative feedback I got were" calm down little bit" and "be sure to chart carefully". As for the narcotic wasting, I wish someone could said sth to me such as "you didn't learn that from school or you should have known that better" then she/he could start a lesson. Instead, she did not say anything and I got this "do not know how to waste narcotics" from the director.
There were so nurses during orientations helped me so much and they were wonderful while some were just wanted to finish their jobs and did not help me go through everything. Amway, my biggest lesson is to ask ask ask and restart to learn everything!!
I have a question for everyone
When I was applying for jobs at one big hospital in town, they have a question asking "have you ever been discharged or forced to resign from any positions"? I clicked no (I was foolish)and I wanted to fix it but there was nothing I could do. What if they find out I was discharged? I am screwed. Do you guys think I should call human resource and get the problem fixed? Thx
quick question...what is "sth" you use it a lot and I"m curious.
As for your question? Perhaps you should. You dont want to be branded a "liar" and just explain why you were fired. You already called and corrected a mistake, so they should see you as honest.
NewRN- in one word- "NO"!!!! Don't tell any one at any interview, any time , you worked at that other place. No one will find out unless you tell them. It was only 3 weeks for heaven's sake. That doesn't even count. Don't give anyone's name there as a reference- pretend it never happened. Give your instructors as your references.While your looking for another job, go do some volunteer work- Just take your learned lessons, re-read the advisements in this post- make a list of the questions you should ask at an interview. For example:
1. How long an orientation will I get? As them for a specific example of their orientation process: 1,2 days of general hospital orientation- learning the clocking in and out process, when you are considered late or overtime, when you get your paycheck, the benefits speech, the HR speech, the mission speech, where to park your car, meal and break times, the hospital tour, what department takes care of what, ID badges, filling out new employee paperwork, the HIPPA speech, the safety/fire drill speech.
Then ask about the general nursing orientation - the orientation given by the nursing education department( that's if the hospital administration hasn't got rid of all them and it's been delegated to the housekeeping staff, sorry to be a smart a**, but hospital adminstrations are not my favorite people- they do really dumb things that get people hurt. Your situation is a perfect example of one of their mess making endeavors) With that said: In a general nursing orientation by a proper "Nursing Education" department ( these are the RN's with the MSN's and Clinical Nurse Specialists/Clinical Spec's- CNS's after their name)they teach Nursing policy and proceedure- infection control, narcotic waste proceedure, blood and blood product adminstration, IV skills with a practice session on a dummy arm and showing you their IV equipment, the IV policy of the hospital when the tubing needs changing, labeling of IV tubing, they give the medication tests/drug calculations, they orient you to the crash cart and the RRT team, they tell you how to tag damaged equipment for the biomed guys to pick up and fix. They teach the computer system class for your nursing documentation of assessments,patient care and medications, give you your passwords and log in information.( in some hospitals they have a Nursing informatic Rn teaching this class ) they may also give you a tour of the hospital's units. These RN's are your clinical resources- get to know them and rely on them. If something is confusing you and the preceptor can not answer you to satisfaction, call these Nursing Education department Nurses.
Then there is floor/unit specific orientation- this is where you meet your preceptor who shows you the specific unit you will be working on, you will get the tour of the unit where things are located( where the clean utility room is, where the dirty utility room is, where the used and broke equipment goes, where the med room is, how to work a Pyxis and/or an Omnicell. Then the majority of the time( weks up on weeks (12 weeks) is spent attached at the hip to this preceptor who, like I posted before, should have taken inservice classes for being a nursing preceptor. Ask if you will be following the preceptors schedule or will there be multiple or alternate preceptors.
2. How experienced are my preceptors- have they precepted new grad/new nurses before?
I have been through soooooo many orientations- I was an agency nurse and every new contract assignement and every new perdeim assignment- there is an orientation. I have been a temp- they all have the same format as I have discribed above and in one of my other post on this thread. I have been through community hospital orientations and university hospital orientation, some good, some not so good- but thank god, i was an experience Rn by that time so I knew which was good and which was shotty and I knew where to go for the answers.
Im also a "diploma" nurse. I got a diploma for my lpn and an associates for my rn. We had 8wks in the lab lpn year then the rest was on the floor. By graduation I was taking on full cares of 4 patients with about 15 iv starts and iv med administration on nearly every patient. I also had my fair fair share of blood product patients which I couldnt admin but I had to monitor. Your assessment sounded like a focused assessment rather than a full head to toe. Head to toes take a tad longer and most nurses ive seen do not use this to assess after school but my rule of thumb is a full head to toe in the morning and then focused after unless I notice a change. A full head to toe would have shown you the right sided weakness.
I think that your preceptorship was not very good. I worked as an lpn for a year before I got my rn and you do learn med wastes and importance of documentation. I wass peeing in a cup about monthly because our narc counts at our facility would be off (i usually was the one to catch it).
With your pill situation I would say that was a new lesson learned. I feel that the choking could have been anything but if a pt chokes you should try with applesauce or pudding. I seemed to get my fair share of admits at the nursing home on my shift (2nd) and would have to give the first meds. It was a crap shoot a lot of tge time. They could be alert and oriented with a regular diet and still have problems with pills and some I had were on a puree diet but took their meds whole. A good trick I learned (because its not always documented like it should be) is if the are alert, oriented, and verbal and its your first time working with them then I ask them if they take their pills any special way. If not alert and oriented I usually crush them unless otherwise noted.
Copd patients may need prn neb treatments. I had one copd pt who kept having SOB whic was unusual for him but the albuterol helped. (Now this case gets more interesting and illustrates when I should have assessed better.) He had dimished lung sounds but nothing that was way out of case for him. He was sent to the er later the next day and had been found to have had an ami! Now I always check lung sounds and pulse with neb tx but I didnt assess him further. I did report he got more nebs than normal to the charge nurse.
You are not alone in making mistakes. Learn from it and move on. Dont be afraid to speak up with preceptors either. Its your learning so dont skimp yourself. Emergencies will be scary th rd first couple times but try to take a deep breath and start assessing with gou abc's. You know more than you think you do!
I would definately go talk to the Dean of your Nursing progam and if the Dean thinks it's advisable to write a letter of complaint to the Board of Nursing then I would go ahead and do it. There is other way for this stuff to stop if we all turn a blind eye to it. That's what got nursing in the mess it's in others outside of the profession qwith no nursing education and background running the nursing profession: staffing and one of the first Nursing staff to go is the Nursing education department. Funny, the hospital ( financial dept, CEO) adminstration doesn't see this as a necssary part of the hospital landscape. Maybe with enough letter to the Boards of Nursing in this country, The boards of nursing can ope their eyes and make them see. it's not going to happen on it's own like magic.
Thank you. I wrote an email to the dean of my program and she is currently out of town and she will let me know when she is in town. Hopefully she will give me some advise and discuss whether it's a good idea to write a letter to BON
I hope not to come across as rude, but I am really astonished by the OP's grammar skills. All of your posts appear to be written by someone who does not have a firm grasp on the English language. You say that you earned a BSN so I assume that you had to take English comp classes and write papers in school. I would recommend that you really work on your writing skills. I hate to sound like a total snot, but it really amazes me that colleges graduate people with writing skills like this. There is really something wrong with the American education if you can graduate high school with no idea how to fashion a literate sentence, let alone college!! It seems many RNs graduate with really poor writing skills, and I think that if nurses want to be viewed with respect, instructors should make sure their students can write and read competently before graduating them. Dont mean to be harsh, but it's the truth!
I feel badly that you were fired. I remember being new and being scared out of my mind! I still am on a lot of days. Shake it off, relfect on the lessons you have learned, and go find a new job. Maybe working in LTC initially would give you time to build some confidence. LTC is challenging in it's own way, but acute care is not for everyone.
I wasnt going to reply to that post. But I think I should. I already explained in my previous post that english is not my first language so knock it off!If you are so concerned about RN's writing skills nowdays, why dont you bring the issue to your director or BON or other athorities?!
I posted this post was meant to seek everybody's opinions about those situations occurred to me at work. That's it. I am clearly aware of my not compotent writing skills. That's all I want to say.
Specializes in Complex pedi to LTC/SA & now a manager.
After admin review, closing thread for a cooling off period. Thread may or may not be reopened.
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A lot of good suggestions and advice has been already posted in this thread.
newRN2012
14 Posts
Thank you thank you thank so much everyone for your comment and criticisms. I already moved on and applied for a couple of positions here in town. I like criticisms as long as they are right and I like people being honest with me and point out my weakness so I can learn. I wish people in reality can be this honest!!!!! I wish.