I'm a new hire & want to start making protocol changes

MPKH, BSN, RN · Apr 15, 2016

You can do preventative care and advocating for patients when you're on shift and caring for the patients.

Do NOT go and point out how things aren't done right in your new place. Do not compare the care your coworkers provide against the "well rounded and exceptional" care. You're a new comer. You don't get to rock the boat.

Lay low for a bit, and after a few months you can start bringing issues up to your manager. But present it in a way that is constructive--"I notice that there is no formal charting on BMs here. It is hard for me to determine whether or not a patient needs to start a bowel routine or not without it. How should I proceed? What do you suggest I do?"

Do not start turning the place around just right off the bat. You will be seen as a know it all.

A.dela · Apr 15, 2016

Thank you. Ya thats exactly what I want to avoid because I find patient care is much better when every one works together, and coming off as superior would cause a rff (even though I'm not superior by any means, my coworkers are genuinely great people and I look up to them). But I am really concerned for the BM monitoring specifically soccer many of them are on chronic pain management/aging proccess

**I would however like to jump into more for a management role eventually and be involved with protocol changes, I'm not even sure what this job would be called and it most likely doesn't exsist, but how would you bring that up? Again, not trying to be misunderstood and have the DON think I'm implying she sucks at her job or anything like that

OCNRN63, RN · Apr 15, 2016

It's great that you're eager and have goals for the future, but in all sincerity, your first goals should be learning your job and how to be a new RN.

When I first graduated, I was a ball of fire. I had this "great idea" for staff education; I just couldn't understand why I was getting less than enthusiastic responses from the other nurses. Finally, someone took me aside and said "Look, you are brand new to this and you are trying to tell people who have been doing this for years how to do their jobs. How did you think they'd react?"

That was a tough blow for me, but I learned to try to keep my mouth shut and listen to my colleagues more. Those people who I initially dismissed because they'd been in the profession for a while actually had much to teach me. It was hard to temper that new grad zeal, but as they say, there's a time and place for everything.

Farawyn · Apr 15, 2016

OP, are you a new RN, or a new hire?

A.dela · Apr 15, 2016

I'm not a new nurse, I'm just new to this facility, which is why I notice these things are missing. I have several years of experience as a charge nurse

allnurses Guide · Apr 15, 2016

I'm not a new nurse, I'm just new to this facility, which is why I notice these things are missing. I have several years of experience as a charge nurse

I sounds like you are working in LTC and maybe for the first time. I have been doing LTC for a year and can tell you that it's a whole different animal than Acute care. Staffing ratios are very different as you (as an RN) may have the care of as many as 40 patients to oversee. There may be 20 or so patients for your LVNs and CNA to cover. If they are using electronic charting like PCC you can quickly look up things like BMs and Fluid intake and food consumption. Do not go in trying to make big changes. Simply try to be humbly competent and keep your head down. If you stay with the facility you may have opportunities for advancement such as DSD of even DON at some point but be careful what you wish for. It's ok to ask questions when you receive report like "When was the last BM, how much did they eat, are there new skin issues?" I am not saying you are but try not to be snotty about it. LTC can eat nurse alive so take care of you own side of the street before you start sweeping up after others.

Hppy

A.dela · Apr 15, 2016

Was a charge nurse for SNF, I'm doing somewhat the same thing here. I believe in providing high quality care and I'm used to typically 20-30 residents with high acuity. So when I came in to this, it makes me feel so bad for the residents because even something like 2 hour repositioning can greatly affect their outlook. Like I said, all of these nurses truly mean well, I just don't think the previous managers provided them the resources to allow them to put their critical thinking skills at the forefront of the care they provide. I used to work in a rural area so we HAD to get creative with resources. It would be great to get creative with the rest of the team.

seaofclouds21, BSN, RN · Apr 15, 2016

I agree with the others that you should lay low for a bit. Perhaps model the behavior you think should be happening. For example, if you want information about bowel movements in report, start giving it and asking about it. If you want to turn patients, do it during your shifts. Don't tell others to do the say, just do it and see if it starts to rub off on others.

Being interested in advancing is not a bad thing, but perhaps wait until a time when you and your DON are talking, such as if she checks to see how you are doing or at an evaluation to bring it up. As time passes and you have a strong grasp of how things are being done at this facility, you can make suggestions to the DON. If I were you, I'd be prepared with some data though and not just, "well we did it this way at the place I use to work at". If you want to start a change, you have to identify what needs to be changed and find the evidence to support the change. For example, if you notice patients are not being turned every 2 hours and feel they should be, get information on acquired bed sores for your facility and then show the research that supports that intervention. If your facility has someone in charge of quality (aside from the DON), you might want to approach them with some of the information.

Either way, take some time to really get to know your new facility and the reasons behind why they do the things they do and don't do. Good luck!

roser13, ASN, RN · Apr 16, 2016

So I am a new hire at a new job. They recently started going through a change in management and many of the nurses stayed with the company. Some have been there for 3+ years and love it there. Im enjoying my job and coworkers, however, I'm finding that because many of these nurses have been working there as their first and only nursing job, they don't have the experience to make 'good' nursing care into a 'well rounded and exceptional' nursing care provided. They're missing minor details that could turn into big LTC issues like contracture care schedules, turn schedules, oral care schedules, NO BM lists ....things I am used to receiving in report and rather I'm getting a only outline of what I should need to know before starting my shift.
So my question is: How can a new hire like me jump in, start taking charge, and start turning this place around? I don't want to seem like a know-it-all and deter EVERYONE from wanting to work with me, but I'm also very adamant about prevention and patient advocacy.

I'm sorry, but is this for real? You are an admitted new hire, yet you feel qualified and (most telling) entitled to "start taking charge" and "start turning this place around"?! Unless you were hired in as Executive In Charge of Everything, LPN, I am calling BS on you.

While you claim that you don't want to appear as a know-it-all, that is exactly how you are presenting yourself. I am truthfully curious as to how you came to take a position in such a woefully deficient facility? Did you have no other choice? And I seriously wonder if your coworkers are enjoying you as much as you profess to be enjoying them.

Should you continue to pursue your stated goals, you will indeed have your work cut out for you. Please let us know how that is working for you.

Kooky Korky, BSN, RN · Apr 16, 2016

I'm sorry, but is this for real? You are an admitted new hire, yet you feel qualified and (most telling) entitled to "start taking charge" and "start turning this place around"?! Unless you were hired in as Executive In Charge of Everything, LPN, I am calling BS on you.
While you claim that you don't want to appear as a know-it-all, that is exactly how you are presenting yourself. I am truthfully curious as to how you came to take a position in such a woefully deficient facility? Did you have no other choice? And I seriously wonder if your coworkers are enjoying you as much as you profess to be enjoying them.
Should you continue to pursue your stated goals, you will indeed have your work cut out for you. Please let us know how that is working for you.

Your response is confirmation that some people will react negatively to any changes she suggests.

OP, lay low, keep your mouth shut, do what YOU personally can do and be quiet about it.

What is "soccer"? Sacral? Sacre bleu!? Or what?

Please stop saying "so" so much. I know it's the trend these days, like "amazing" and "suck". I must be growing crabby in my senior years. They irritate me to death.

:roflmao:

klone, MSN, RN · Apr 16, 2016

My goodness, people are salty today. She said "so" twice?

OP, I get where you're coming from. I'm 6 weeks into a new position, and I knew going into the position that there are a lot of changes that need to be made. But you cannot make changes until you gain their trust, and that will take a few months. Even if you were hired as a manager to a new facility, one cannot expect to swoop in and make changes off the bat without some fear and distrust from the staff.

Give it some time, and as others said, for now just model the changes you want to see.