i'm a new grad, started 1 wk orientation at ltc last week. this is how it went and why i was asked to consider somewhere else:
1. the 1st preceptor i had came down on me alittle hard when i was giving out meds for the 1st time. she also got annoyed with me asking questions.
2. changed preceptors and asked for more time.
3 got more time and my 2nd preceptor wondered why i asked for more orientation time because i was giving out meds so well
4. had to do a med pass today, where someone other than the preceptor watches u give out meds - failed it, here's why:
-i put my meds on a tray and set it down on a chair next to the resident, to give it- according to the person giving the med pass this is not allowed
- she says i didnt wash my hands long enough- even though i was counting as i washed my hands, and 1 or 2 little not drastic mistakes were made- i was nervous, she said these were the problems not giving out meds themselves.
this is annoying and discouraging seeing that it took me 5 mo to find this job, cause here in nyc everyone wants pn with experience. what do you guys think, and what should i do!:trout:
i posted earlier on how i was ''let go'' on my new job. anyway, do you all think 1 week of orientation is enough for a new grad (pn) working in a nrsg home with 40 residents.
A PEG is surgically inserted, so it being in the wrong place is unlikely; it goes directly into the stomach. A nasogastric tube goes through the nostril past the throat, into the esophagus and into the stomach. You use air to check placement because the tube may migrate back up to the lungs and you don't want to use water to check placement or put something down the tube and have it enter the lungs.
A J tube enters directly into the jejenum so no risk of fluid entering lungs. A PEG tube enters the stomach; neither of these pass the lungs. I guess you could check a PEG tube placement if you wanted, but I was told that it was not likely to be out of place.
Oh, ok. I see now. My logical thinking must have flew out the window today. Thanks for clearing that up.
Three days orientation? I put my paperwork in during the morning and was asked if I could do an afternoon shift that day. I got from 1400- 1800, 4 hours then but preceptor was lovely though and very helpful. I was doing the 2000 meds at 2120 hrs for approx 28 patients. The preceptor rang from home to see how I was going. "Oh I am scared I'll never get finished" I was only halfway through. She seemed pleased and said she was pleased the next day. It turns out some of the new RNs were in tears after starting the med round after five or ten minutes later and had walked out, never to return. What annoyed me was only getting two shifts every two months. I resigned as I didn't have any continuity but I actually loved being there.
I'm pretty positive you are confusing a nurse flushing with H2O as checking placement. Flushing just clears the tube feed from the tube before you administer the meds. The rationale is that some meds will interact with the feed to clog the tube. (Which you definitely don't want!)
Although it isn't likely to be out of place, trust me, the surveyers are by the book academia and will look for checking for placement by giving a bolus of air - ng or peg tube.They will also want you to check for residual by aspiration, and know if there is too much residual to notify the Doctor and stop the feed according to your facilities policies. They will want to see you flush the tube before and after each med and make sure that you don't mix the meds together in one huge cocktail. Then they will observe you give the total H2O flush required. They will check that your feeding, tubes and syringes are signed, dated with rate and Patient name. They will check that the patient head of bed is elevated correctly. In short, they will drive you crazy. It is probably fortunate you weren't there for the survey. They can be intimidating to experienced nurses. Best of luck to you, I know you will find a job soon. Keep us posted.
I shouldn't have said my preceptor was lovely, she was but she was my buddy so to speak (Just in case I confused anyone). Mind you once she left and went to work somewhere else, I wasn't asked to do as many shifts.It was as though, whilst she was there she was on my side. Very approachable and understanding. One good thing thing that happened was that everybody knew I'd been thrown in with little direction and had told me that they heard I'd managed well. I went home on cloud nine but I also have to admit I had terrific AINS on with me. it was a real team effort. I miss it too because my patients were lovely,
a new nurse will only be as good as the nurse who orientates her.
Gotta disagree with you there. My preceptor lived in her own little world, and while she was one of the sweetest person I've known, she was not the most amazing nurse. I made sure to schedule myself on her days off when I was off orientation so I could learn from others who knew better than she did what they were doing. During orientation, I did my best to learn from the CNAs and other nurses whenever possible. I survived by asking lots and lots of questions.
I have to agree with the others who say you should be happy that you are away from that place. You probably wouldn't have been happy there anyway given the fact they probably would have been heck to work with.
Pick yourself up and find a job that is worthy of you!
wildcats
39 Posts
Oh, ok. I see now. My logical thinking must have flew out the window today.
Thanks for clearing that up.