LPN Help

[Ratched, Nurse]

I'm an LPN and have been for quite a few years now. Understaffed, hectic jobs led me to my most recent job of less than 1 year -nurse at a university's health center. I love the schedule and work, but recently have ran into many issues. Over time as I oriented, I realized our 'Director' is an LPN herself and in the place to 'supervise, complete our appraisals, etc' which took me back. I've learned the job was given to her years ago after her just being in an LPN position for a while. MANY things of that position she actually does and listed on her job description go outside the scope of practice and I'm not sure the University is completely aware. Before her taking it, an RN has always been in that job.

I slowly realized this the more I oriented and I realized that there is virtually no policies and procedures to follow or fall back on and Standing Orders haven't been updated in YEARS and are not in the appropriate format. The center does work with providers that are here only a couple of hours a day, so there is a lot of independent work we need these things in place for.

I have brought all of this up to the appropriate departments and even the VP and have gotten absolutely nowhere. I don't feel safe as a nurse and feel I'll be run out of my job if these things aren't remedied. The general vibe is very old school where positions are taken due to seniority and competency and work isn't checked on. I feel this is a huge disadvantage for something that should be run appropriately and nothing less. I've emailed and had meetings and done everything I can for weeks now. I've ceased generally all independent work because there is truly nothing in place covering us. The providers know this is all lacking and being contracted, expect this stuff to be in place.

Has ANYONE ever experienced anything similar? It's driving me insane.

[caliotter3]

Any time I have found out that something was as out of whack as this, I have had to think about my own involvement. When I sabotaged my own job by being too vocal, or too vocal too soon, or vocal to the wrong person, etc., I have ended up leaving the job sooner rather than later. You have made your observations known and requested intervention by those whose responsibility is to keep the place running as it should. No action on their part makes it clear to you that they are happy with the status quo. Not surprising at all. Frankly, at this point, I would brush off the resume and start my job search now. Hopefully you can find something more suitable soon, at least before TPTB become proactive in making your work life a living hell.

[Ratched, Nurse]

Exactly, thank you. Deep down I know I should probably just go and honestly I've wanted to walk right out several days, but because I actually like what the job could be, I was hoping it would be respected and made appropriate. I'm unable to help students as I should be able to and won't do just anything with the mess that we're in. I'm getting more frustrated and it makes me feel stunted as a nurse. I was just curious as to others' experiences. So thank you!

[StillNursin, LPN]

I was deeply affected by this post, having experienced a very similar situation over the past year in the rural hospital where I worked up until this week when I was asked to vacate my position - for making the very mistakes "caliotter3" mentions,

On 1/16/2019 at 9:23 AM, caliotter3 said:

Any time I have found out that something was as out of whack as this, I have had to think about my own involvement. When I sabotaged my own job by being too vocal, or too vocal too soon, or vocal to the wrong person, etc., I have ended up leaving the job sooner rather than later. You have made your observations known and requested intervention by those whose responsibility is to keep the place running as it should. No action on their part makes it clear to you that they are happy with the status quo. "

I started noticing unsafe practices with meds, antiquated/outdated policies, favoritism, nepotism, predatory nurse management practices, the allowance of CNAs to perform duties they were not qualified to do, etc. Unfortunately, being from another state (read: "you're not from around here, are you?" ) made me "an outsider," and no matter how correct I was to bring my objections, no matter how badly change was needed- I was the nurse who wound up being viewed as " difficult. " And, in the end, the nurse who LOST HER JOB FOR IT.

I've been an LPN for 11 years, and had never experienced people in the professional arena so resistant to change as to put employee and patient safety at risk- reactive about everything instead of proactive. A patient falls? Let's see who we can blame. Patients complain that nurses aren't sanitizing their hands before and after care? No way could it be that the staff could use an inservice (what's that?) And sanitizer dispensers on the outside of the rooms in addition to inside.Perhaps it was the fact that I never cut corners with meds, charting, patient care, etc (and witnessed along the way a myriad of nursing no-no's that made my head spin) All the things we learned NEVER to do- HIPAA violations, (he's my mothers, brothers, cousins, neighbor and I heard he was here...) administering meds that dropped on the floor, sharps from am lab draws accidentally left in patients beds which on several occasions resulted in a needlestick, overriding the scan function at med pass, even sending doses of meds home with patients (hoping they'll take them later but documenting them as administered) the list goes on....

Maybe it was my poor assumption that the things above wouldn't happen-let alone be tolerated and perpetuated in a CMS-accredited hospital, or that I be treated fairly and talked to(along with my fellow nurses) instead of dictated to by a DON that excelled in the art of bullying her nurses into compliance with her scheduling and staffing needs...

I can tell you from my own experience that it's a very thin line we have to walk as nurses at times- between what we know is right and ethical and the pressure to keep with the "status quo." This is even harder to do in small towns and small hospitals with staff who often equate any change to the "way we've always done it" as inherently bad or wrong.

On 1/16/2019 at 10:51 AM, Ratched, Nurse said:

I don't feel safe as a nurse and feel I'll be run out of my job if these things aren't remedied. The general vibe is very old school where positions are taken due to seniority andcompetency and work isn't checked on. I feel this is a huge disadvantage for something that should be run appropriately and nothing less. I've emailed and had meetings and done everything I can for weeks now. I've ceased generally all independent work because there is truly nothing in place covering us.

I can't express how much I sympathize with what you're experiencing, and think that a well timed resignation might be a good option- especially if you feel unsafe and you question the work of anyone. I made no friends by being outspoken about the issues at work and when I got nowhere with management, ensured that the care I gave was always above and beyond- documenting everything to the hilt, keeping a log of all narcs I pulled from Pyxis, refusing to cosign any med I didn't physically see compounded or the components, adding safety checks for fall risk patients ( because my CNA was "busy") and simply, doing a lot of work myself, to protect my license.

For all the good I did, my refusal to simply "shut up and do my job" put a target on my back. I know however that I didn't compromise my ethics or sacrifice patient care. I may not have been a "team player" according to my supervisor, but when I think about it, that's not the sort of "team" I ever want to be a part of. No career is worth tossing your ethics out the window.

I always thought "if you see something, say something -" but found that many people have the unfortunate mentality of, " if it ain't broke, don't fix it. " When it comes to caring for people, I think we, as nurses have an obligation to do things right- every time. But, if you find yourself in that impossible situation and you've tried all the appropriate remedies with management - and you still come up short, at least don't give them the satisfaction of firing you, too. It's no fun?

Best of luck!

[Ratched, Nurse]

Your comment means so much, unfortunately. Some of the things are so out of this world crazy, I start to think it’s me that’s crazy. Venting to my husband, I’ll realize how insane it is that our standing orders haven’t been reviewed since ‘92 and that our policies and procedures are nothing more than a general summary of the facility and it’s hours. I tactfully brought things up through the correct chain months ago with the best intentions. When I began the job, I was told changes were needed and they were glad to have a fresh set of eyes on everything to step in. They just didn’t mean it in this way, but that’s exactly what I’ve done. Now I feel I’m viewed as a troublemaker for daring to shake things up. I certainly don’t feel comfortable. I love what the job could and is supposed to be so I hate to leave on this kind of note, but this is beyond me. Again, I hate it’s a similar scenario, but I felt so much relief reading your comment. I had no idea things could really be this way for nurses, not like this. I’ve dealt with understaffed jobs where everyone hates everything and jobs where admin and managers run the entire clinical ship which can surely cheapen care at the end of the day, but I never imagined a setup so poor, you had to scour laws and your scope of practice to do a single thing and be okay. It’s really hurt my nursing heart, but I’m preparing myself to move on before they make me.

I mentioned earlier than my ‘Director’ was an LPN and until I came in and made everyone aware of the scope, she was supervising, in charge of policies and essentially everything. I no doubt believe an LPN is capable of those things and that the right one could do it and do it well, but in our state, it’s a no. And obviously it hasn’t been done well with all of the issues. She’s relished in the title and not done a thing, appropriate or not. A few supervisory duties have been taken away after going over everything, but the latest news is she is in the running for a position over our dept (not clinical) and many other depts. in the University. Due to other accolades, she could be eligible for the job, but I can’t imagine someone who lacks documents of a health facility even they should follow, being responsible for that department and then some. Is this real life?

[caliotter3]

Sounds like an example of The Peter Principle at work.

[StillNursin, LPN]

On boy, I get so sad when I find out that what's happened to me - just isn't "unique." I think most LPNs ( including me!) would agree with Ratched Nurse in questioning whether a supervisor should be an LPN. It doesn't mean we're not highly qualified, or valuable to the nursing team- It's just not the way it works in Acute Care. ( SNF, LTC and VA- totally different stories!) It sounds like we've all seen our share of cruddy management , outright unsafe nursing practices and the downright perpetuation of "the good ol' boy system" in our careers. None of it is fun. Speaking up rarely makes you any friends- especially if you're new, and especially if you shed light on an issue that people at work have just ignored and accepted. I think you're awesome for doing what's right. Just don't forget about having that back up plan.

?‍⚕

[Ratched, Nurse]

You’re right. Initially when I brought this up, they quickly redid our appraisals and all things that would affect them. They completely skipped over what we as nurses in a health facility need so now we’re still without policies, legit orders and everything else. I definitely haven’t forgot about the backup. Working on it and just cringing in the meantime. Thanks you two!