I need your opinion

RockinNurse2018 · Mar 15, 2018

If it is common practice, it should not be. At my facility, we have people who are designated to put in orders, at least during the daytime hours. When they are gone during the evening/night, then it is up to us nurses to put them in. However, there are not nearly so many orders during that time, so it's not generally a big deal. During our orientation, they extensively go over how to put in orders, and if they notice a discrepancy with how you are doing something, they are willing to spend extra time with you to review it. This isn't to say that situations don't come up where we don't know what the next steps are, but there generally is another person around who does know the answer. Also, there are handbooks that will explain some of the bigger situations that come up and how to handle them if you are by yourself. It doesn't sound like they're willing to help you be successful, so if you can find another position at all, that may be a good idea. Make sure you ask about their training and education process before accepting another position though.

JKL33 · Mar 15, 2018

The most concerning thing in all of your post is that when you expressed the desire to learn and understand a part of your job in order to perform it appropriately in your patients' and company's best interest, that was felt to be unnecessary.

I realize people can't just "quit" in every undesirable circumstance, but this attitude ^ is not healthy and for that reason alone (not to mention it seems like they have some underlying problems) I would start looking sooner rather than later.

Good luck ~

Parrott lpn · Mar 15, 2018

My orientation was following three different nurses for about a week on a different shift then I was hired on and work on. During that week I did two med passes with one nurse and helped out with cna things (like feeding in dining room) because they were short handed. They never showed me any paperwork or steps on things like sending someone to the hospital or even how to write orders. They said I really didn't need to know that because the RN supervisor would be there to handle it.

As for the orders I work second shift and I was told have to only put in the orders that I get while on my shift if something comes up.

There are two office women that are the ones that speak with the doctor when he comes in to look over the charts. They write the orders, fax to the pharmacy, make copies, and put them in the chart. Then they leave the chart sitting on the nurses desk and that's supposed to let the nurse know they have to put it in the computer/on the MAR. No one ever told me that. I was told if you start the order you do all the steps to finish the order.

I have no idea if the charts were there, if someone else picked them up, if I picked them up. However, I was written as a med error because I didn't put it in the computer. I was unaware the order had changed. No one told me and it was not written on the 24 hour report that it had been changed.

RockinNurse2018 · Mar 15, 2018

My orientation was following three different nurses for about a week on a different shift then I was hired on and work on. During that week I did two med passes with one nurse and helped out with cna things (like feeding in dining room) because they were short handed. They never showed me any paperwork or steps on things like sending someone to the hospital or even how to write orders. They said I really didn't need to know that because the RN supervisor would be there to handle it.
As for the orders I work second shift and I was told have to only put in the orders that I get while on my shift if something comes up.
There are two office women that are the ones that speak with the doctor when he comes in to look over the charts. They write the orders, fax to the pharmacy, make copies, and put them in the chart. Then they leave the chart sitting on the nurses desk and that's supposed to let the nurse know they have to put it in the computer/on the MAR. No one ever told me that. I was told if you start the order you do all the steps to finish the order.
I have no idea if the charts were there, if someone else picked them up, if I picked them up. However, I was written as a med error because I didn't put it in the computer. I was unaware the order had changed. No one told me and it was not written on the 24 hour report that it had been changed.

Hmm, that seems a little harsh to write you up for a medication error if this was the first time and you were not previously educated on the policy or how medication orders were placed in the computer. I realize that it likely meant that a patient got the wrong dose, or missed a medication altogether, which would constitute a medication error. But, at the same time, a warning/education session should have been attempted before being written up. Now, if you continuously failed to follow protocol for entering orders, that would be another thing and corrective action would be justified. However, it seems like their education/training is severely lacking, and for that, the facility needs to take some responsibility.

JKL33 · Mar 15, 2018

There are two office women that are the ones that speak with the doctor when he comes in to look over the charts. They write the orders, fax to the pharmacy, make copies, and put them in the chart. Then they leave the chart sitting on the nurses desk and that's supposed to let the nurse know they have to put it in the computer/on the MAR. No one ever told me that. I was told if you start the order you do all the steps to finish the order.

Okay in that case get the heck out of there. I would never tolerate being written up under these types of circumstances. The more you take, the more they know you'll take it, whatever it is.

People worry their license is at risk, and others come along to say that's not likely (which is probably true). I go a totally different direction with stuff like this - I just wouldn't tolerate being toyed with (to put it in nicer words).

sallyrnrrt, ADN, RN · Mar 15, 2018

I have been working my first nursing job in LTC for about seven months now. When I first started we had an RN supervisor on duty that handled almost all the paperwork (admits, sending out, etc). She has been fired.
Now no one was trained on the paperwork and no one knows what they are doing. It is causing such anger and confusion that everyone is unhappy and trying to find another job. Last week I went to the D.O.N who has only been there maybe a month and explained that I wanted to spend some time brushing up on the paperwork because I felt I needed extra time. I offered to come in off the clock. She said she would see what she could do. The next day the ADON told me just watch other people. Hard to do when no one else knows what they are doing. It causes me such anxiety that something is going to happen and I won't know what to do or have anyone there to help me. To the degree that I am really stressed about work all the time.
Is this worth trying to stay when I feel like that not only do I not know what I am doing but I am not ever going to learn? Or should I just try to find another job and make sure I go in learning all of this?
Also, I am confused about how people seem to do orders where I work. I was taught that if you take the order you fax it in, make the copies, and put it into the computer on the MAR. The nurses who work in the office (skilled, etc) either don't do all the steps or they walk past me, say the doctor gave you an order that the doctor gave to them for my patient on the shift before mine. Tell me part of it and I have to contact the doctor to get things like times and dosages.
Is this a common practice?

They need to request the regional nurse consultant, to come in and conduct inservice......STAT!

sallyrnrrt, ADN, RN · Mar 15, 2018

The DON, should teach her / his staff...

Or seek help from regional nurse consultant

Parrott lpn · Mar 16, 2018

I agree the DON should do something. She has only been there a month and is more worried about state coming in because it's that time of year and she keeps hearing "they are coming on such and such date". She was in the office with me and the ADON when the ADON told me just to ask other people on the floor. So I don't see her doing anything different.

The whole place is a mess and I found out yesterday that apparently there were more charts left on my desk with the orders in them. I stated that I was not taking blame for this because no one told me that was how it was done and i dont understand why people can do three out of the four steps and i am the one in trouble. So instead of telling the office women to finish the order, they made a designated spot for these charts and told me if any of mine were in that spot that meant I had an order I needed to complete.

I am grateful for you ladies because I was repeatedly told this is just how nursing is. It's nice to know that it isn't because I was ready to give up completely.

Orion81RN · Mar 17, 2018

"The nurses who work in the office (skilled, etc) either don't do all the steps or they walk past me, say the doctor gave you an order that the doctor gave to them for my patient on the shift before mine. Tell me part of it and I have to contact the doctor to get things like times and dosages. "

NOOO. The Dr. gave THAT nurse an order, and he/she needs to enter it. Picture being a Dr. or NP giving a nurse an order to carry out only to then be called back by another nurse to get the same order. If I were the prescriber, I'd be like, are you kidding me? I already gave this order to a nurse. And rightfully irritated he/she would be.

Parrott lpn · Mar 17, 2018

I agree and he does get irritated and then talks to me like i don't know what is going on.

They told me I didn't need to contact him once I just needed to write what they said. I told them that since I didn't get the order from him, I wanted to make sure I wrote it like it was meant to be. Errors do happen especially when it goes through two or more people.