Growing concerns about new RN position

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Just landed my 1st position as an RN and there are a few things that are weighing heavily on my mind in regards to patient safety. All of the following have happened during my orientation and I am seriously questioning whether I should stay at this facility. How would you have handled the folowing?

  • Night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. Accucheck was done at 0600...neither pt was covered w/insulin
  • Night shift reported of on a pt who looked terrible. Orders were to have pt on 02 to sat at 94%. I assessed pt immediately...no 02 on pt, HR >200, SOB, sats @ 88..did what I could do and called rapid response
  • Received an admit without report or notice
  • Charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
  • Asked preceptor multiple times for help and preceptor helped by siging off on my orders when I begged for help with pt care.
  • Received report that a pt was heplocked, only to discover that pt should have been rec. NS @80 ...and yes the order was signed off on by the reporting RN.
  • Given a pt with altered mental status, was known to be violent and had to call security. I felt like this was an inappropriate assignment for a new RN.
  • Received report in the am on a pt who during the night had a troponin II of 2.8 (MD was called), checked labs 1st thing, troponin III was 4.05..pt was having an acute MI and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....I noticed!

There's more but I think you get the idea. I have read that your orientation can make you or break you. Worried that I might not find another new nurse position, but more worried that I am not building a good foundation for my nursing career as well as being extremely concerened about my patients well being and safety.

Peace,

Daisy

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

I would be more worried about my license if I continued to work there with those HCPs.

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Specializes in Cardiac Telemetry, ED.

What kind of a unit is this? These pts sound very typical of what I would receive on a PCU/cardiac tele unit. I started as a new grad, and I have to say that it's a tough place for a new grad to start. You get thrown into crazy situations the second your feet hit the floor. What bothers me is your preceptor not jumping in and helping. You need more support than that.

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Specializes in ICU, ER.

This sounds like a bad place to work, esp. for a new nurse.

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Specializes in oncology, med/surg (all kinds).

Night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. Accucheck was done at 0600...neither pt was covered w/insulin

this is not unusual. usually insulin is given right before breakfast. it might not be best practice, but that is what was done wherever i have worked. this is something you will run into often.

Night shift reported of on a pt who looked terrible. Orders were to have pt on 02 to sat at 94%. I assessed pt immediately...no 02 on pt, HR >200, SOB, sats @ 88..did what I could do and called rapid response

pt's can deteriorate quickly. could have been orders neglected or that he went that bad that quick. this is also something you will likely run into--hopefully not due to prior nurse not paying attention

Received an admit without report or notice

as much as i hate that--put that on your "get used to it" list. i only had that experience with ED and it was standard from them.

Charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"

Asked preceptor multiple times for help and preceptor helped by siging off on my orders when I begged for help with pt care.

that is lame and you should not get used to it or tolerate it now--because if you do, they will keep doing it to you.

Received report that a pt was heplocked, only to discover that pt should have been rec. NS @80 ...and yes the order was signed off on by the reporting RN.

that could have been an honest mistake. another thing you should not "get used to." i would keep an eye on orders to make sure that nurse doesn't make a lot of those honest mistakes.

Given a pt with altered mental status, was known to be violent and had to call security. I felt like this was an inappropriate assignment for a new RN.

when i was a new grad, i felt there were certain patients who should not go to new grads. seems, it is only the new grads who think so! i see both sides to the argument. try to get used to this one.

Received report in the am on a pt who during the night had a troponin II of 2.8 (MD was called), checked labs 1st thing, troponin III was 4.05..pt was having an acute MI and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....I noticed!

i am not a cardiac nurse, so i can only say that doesn't sound kosher for that to be missed, but i don't really know.

i hope i don't sound harsh are cavelier about your situations. i don't want to condone practices that are less than best-practice care. but real world nursing has a lot of these types of things. i believe you will find most of these things everywhere. sometimes it is a case of everyone is doing the best they can, but we just can't get to everything just right. sometimes, you are dealing with nurses who, for whatever reason, are simply not careful or attentive enough. the trick is to know the difference. that you will only learn with a little experience under your belt. and of course, do the best you can yourself.

be careful of sounding accusatory with your co-workers, because if you are being nit-picky with them, they will be nit-picky with you. and as a new nurse, you deserve some serious slack while you are getting the hang of things. the things you mentioned are not nit-picky and in this forum, they are most appropriate questions. while i am not saying that what you encountered is okay, i am saying that it is not unusual, so i don't think changing facilities will help.

except for the preceptor thing and the "not my patient" thing. that is just completely unacceptable. hang in there--you will learn not to be shocked by this soon. glad you are so conscientious and do your best to never lose that. you sound like a good nurse!

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"it is a case of everyone is doing the best they can, but we just can't get to everything just right. sometimes, you are dealing with nurses who, for whatever reason, are simply not careful or attentive enough. the trick is to know the difference. that you will only learn with a little experience under your belt. and of course, do the best you can yourself.

be careful of sounding accusatory with your co-workers, because if you are being nit-picky with them, they will be nit-picky with you. and as a new nurse, you deserve some serious slack while you are getting the hang of things. the things you mentioned are not nit-picky and in this forum, they are most appropriate questions. while i am not saying that what you encountered is okay, i am saying that it is not unusual, so i don't think changing facilities will help. "

Very good points..didn't think about it from that perspective. The last thing I want to do is be accusatory or be preceived to be, and your right that does come from experience. Getting to know your co-workers and such. And the point you make about everyone doing the best they can..I can relate even with my limited experience. Still making that transition with doing everything by the book with a stickler for a clinical instructor standing over my shoulder. Sometimes we can only do what we can with the resources available. I appreciate your frankness with the things that I will just have to get used to, just wondered if some of these things were the "norm". From where I sit right now, everything is a priority; but being able to differentiate will come with experience. Can't wait to look back on all of this a year or two from now. Thanks again mykidzmom.

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This sounds like a bad place to work, esp. for a new nurse.

Thanks for your input..means a lot coming from your ICU & ER standpoint.

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What kind of a unit is this? These pts sound very typical of what I would receive on a PCU/cardiac tele unit. I started as a new grad, and I have to say that it's a tough place for a new grad to start. You get thrown into crazy situations the second your feet hit the floor. What bothers me is your preceptor not jumping in and helping. You need more support than that.

Its a crazy busy floor, we don't have psych unti per se so we get all of those admits. Its a med/surg/tele oncology floor. I have a year to get chemo certified, concerned about that too. Some nurses are transfering out d/t the chemo. And while I stay out the rumor mill and gossip, the nurses that are leaving have said that they are doing so because the nurse to pt ratio isn't going to change when you have a pt that your are administering chemo to.

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I would be more worried about my license if I continued to work there with those HCPs.

Sorry JoPACURN please excuse my newness/ingorance..but what is HCPs?

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Mykidzmom offers some great perspective.

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I hate to say this but it sounds pretty much like standard med/surg/telemetry unit. Every where I worked I had patients and problems like this. The only thing that varied was the good jobs had co-workers that were supportive and the bad job had unsupportive even critical hostile co-workers. The patients assignments were pretty much as reported above. By the way, the nurse that report incorrectly on the patient, well that happens to everyone and that is why we all check the cardex.

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Specializes in ICU, Home Health Care, End of Life, LTC.

If you decide to continue at this institution I would strongly suggest you document as much as possible. This might include keeping your own notes but will certainly include official documentation of the patient care. Many of your issues seem to concern what has been done for the pt before you take over, make sure you do what you feel is needed and document doing it. As others have said it is fairly common (in my limited experience) for there to be things that need to be "caught up" from the last shift. In the most serious of cases it would probably be appropriate to fill out incident reports. In the case of the nurse who said "not my pt" the issue should be taken to the charge nurse and a system for transfer of pt responsibility should be made clear to both.

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