Lost 1st job because "there are things they don't teach in Nursing School"

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I graduated as an LPN about 3 months ago. I started a full time position in a LTC/Skilled facility. I was given different preceptors and four different units with 20+ on each unit. Had to figure out who had CBG's, insulin's, who slept after breakfast, whole, float, etc. Each preceptor wanted me to do things a different way (med pass). Couple this with having to learn 20 new faces/rooms, I likely looked as dumb as I felt. I noticed that there were "holes" in the MAR, sometimes 2 days in a row. Narc counts were off and then the nurse would go through and sign the med out to equal the count. I finally found an excellent preceptor on the skilled/rehab floor. I was getting good a the med pass, but I made a couple of small errors and was spoken to rather harshly. I could take this.

Final day...someone had to go. Went to give insulin and roomate "Alice (not real name) was crying in her room complaining of cramping in the chest and that her shoulder hurt. I told the preceptor and she kind of rolled her eyes and said "she is always like that". I checked the MAR for pain PRN meds and she only had Tylenol. Very busy so I got back to work with med pass.

Later that day ARNP saw Alice on the toilet and crying. They got her into bed. When I went down to do vitals, ARNP asked if I noticed anything different about her today. Said she was complaining about chest cramps and I spoke with "Rhonda" (not her real name), my preceptor. Rhonda came down and when the ARNP said "she was having pain or cramping in the chest area?" Rhonda looked at her then me and said "I didn't know that".

I let it go not realizing the two errors I made. Admitting That pt had chest pain or not standing up for myself. Next day Unit Manager said he was going to give me my 30 day review where I got all needs improvement. Mainly: Not communicating with my preceptor, not doing the med pass without errors, and he had input from all my preceptors. It was at this point I stood up for myself and explained what happened. He said "you should have assessed her". Which is technically right. I went to the nursing station to tell preceptor which is where the Vital machine is anyway so I spoke to her and she brushed it off. Said I do not lie.

So someone had to go? Yup, I gave notice after receiving a brutal review. My preceptor said to me "there are some things you don't learn from Nursing School"

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Actually that unit manager was wrong.. As an LPN you cannot assess a patient, you can only collect data. And any change of condition has to be reported to the RN who than should have gone to assess the patient. That nurse was very clearly in the wrong.

Apparently that facility needs to improve it's orientation procedure, especially with brand new nurses. Be glad you're out of that place!

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You're lucky to be out of that place. People are ignoring the patients and covering up narcotics errors, and preceptors are hanging their orientees out to dry! The lesson to be learned from all that is you should trust your instincts. If there is a change in condition of a patient and you are not sure what to do, and a senior nurse brushes it off, still follow up with the supervisor or doctor and document your interventions carefully. Also, don't ever let anyone rush you through a med pass. Take your time and make sure you check everything carefully before administering. You will be very slow in the beginning, but you'll get the hang of it and catch up. You might be bullied by other nurses but stay focused and keep doing things the way you were taught in school. You worked way too hard to get your license, don't let anyone pressure you into putting that license at risk.

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One door closes.. and another opens.

Be thankful you are out of there.

I think the main thing you should take away from this is.. never trust another nurses eyeroll for an assessment.

Do your own.

Good luck.. keep us posted.

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Thank you for the new perspective. I have some interviews in the next town, but this place has about 15 locations within 20 miles of my house so it stinks. I don't know enough to stand up to people. The support feels very welcome.

It really made me incompetent and being new is enough for that. You are right that it IS my license and yes, I worked darn hard for it.

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Specializes in Pediatric/Adolescent, Med-Surg.
Actually that unit manager was wrong.. As an LPN you cannot assess a patient, you can only collect data. And any change of condition has to be reported to the RN who than should have gone to assess the patient. That nurse was very clearly in the wrong.

Apparently that facility needs to improve it's orientation procedure, especially with brand new nurses. Be glad you're out of that place!

You do realize that a lot of rehab/LTC facilities may not have an RN in house 24/7? Especially if you are an LPN working nights, you may be the only nurse in the facility. So, regardless of what term you want to call it, the LPN will be "assessing" their pts

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I don't know what state you're in or what your state regs are but in WI even if there is no RN in house there has to be one readily available to come in and assess a patient for a change in condition. I'm not naive and I know LPNs do plenty of assessing on their own, but if there's a change in condition and there's no documented assessment from an RN that facility puts themselves at risk for citations from state.

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Sorry that this happend to you. With all the "covering up" and throwing under the bus and outright untruths, you did the right thing. The only thing that needs to be said is that you were not a good fit for the facility.

When going to a new facility, I would ask about changes in condition, and what the policy is on same. Because you may find a patient who has a change and be the only nurse in the facility. Or, a CNA may come to you with a report that someone is not acting the same, has a complaint, that type of thing. I know it is overwhelming with that many patients and that many meds, however, if you are clear on what you are supposed to do, be sure that you document as well--and document what you did do--ie: Patient c/o pain, 6/10. Charge RN aware, PRN medication offered, no relief. MD made aware, no new orders" or "sent for evaluation"

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

There are separate scopes of practice for each state for LPN/LVNs and RNs. Therefore, it is good to rely on those of the state you are working in and inquire with your state BON if you have questions. There are many differences as well as what you find "de facto" in various facilities and levels of acuity.

Studentjoy, "there are things they don't teach in nursing school" is true of all new nurses. It takes time to develop skills and judgement about when to speak up - this learning experience you'll carry with you into your next job. Best wishes!

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Just wanted to say you are lucky to be out of a place like that, and though it is distressing to go through now, you will likely find it to be a blessing. I worked in a similar place and after I was let go, my dream job was just around the corner. I'll wish the same for you!

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Specializes in Hospice.

ALWAYS trust your instincts.

If you have a little voice inside your head saying, " This isn't right." or " Something is wrong here." listen to it, don't ignore it, because it will come back to bite you in the butt.

I hope you find a good job with better preceptors.

She was right there are some things that are not taught in nursing school and it was her job to teach you!

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Specializes in Peds Homecare.

If this ever happens again, and the rn ignores you, just go to the residents chart. Write reported change in residents condition to blank rn. Describe what the person is c/o . Guess what, it is something I bet you learned in school, CYA. The preceptor/rn can't deny you told her, it's charted. She can try to lie, but she is caught. Don't let that happen to you again. Hugs, better opportunities are on the horizon! We were taught this in school!

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