2nd day on my own as a new grad, with a student, cried three times

[whitebunny]

im a new RN, had my licence for over a month, offered a FT position in a long term care facility.

This LTC has many units, Peritonial dialysis unit, dementia unit, respite, ect....

I was sent to PD unit for orientation, with a 28 pt load. There are 2 RNs on the floor, one is nurse in charge, the 2nd one is me. Everyday one RN does meds pass, one RN does PD( now we have 4 PD pts, the busiest time we had 9 PD pts, with off and on PD emergencies such as peritonitis, which pt could die over one night). Many times we have work injury pts who are D/C from hospital but not ready to go home yet, so they would stay on my unit for between 3-8 weeks.

I was there enjoying my time there, Im using my med/surg knowledge for work injury ppl, im learning PD as an extra specialty, and learning geriatric knowledge. So much learning, i felt great!!!!Absolutely love it!!!!! After 3 weeks, i am fully confident with the medications, i know the pill(colour, size, 7 rights) without looking at the plastic bags, i felt i reached a milestone =D,and if i continue learning like this, i will be able to be on my own =D

i set up priority for my self, 1) memorize emergency P&P

2) memorize end of life care P&P

3) create my own route

on my 30th day working, manager came to me. Telling me there is an LPN on a 24 resident facility who constantly making mistakes, sometimes not giving insulins. Recently the care coordinator investigate into an MRSA precaution incident on her floor, and the LPN yelled at the care coordinator, threatening her "you can lay me off right now!" So the LPN was laid off right on the spot. The manager wanted me to take over the unit. At the same time, the LPN was the preceptor of an unlicensed-LPN new grad. The RN supervisor was going to be off for 2 days so nobody can work with me, the manager decided I could take over the student for 2 days until he finishes his preceptorship.

I never had positive impression of this male,young,good looking LPN student because I heard him gossiping in the lunch room with her LPN preceptor all the time. The LPN never really care who is present and things come out of her mouth whatever she thinks: doctors, nurses, care aids....And during the conference, she constantly interrupted manager's speech. I can see what kind of student is from a preceptor like this: gossiper

Overall, I didnt want to precept that student. Not only because i dont think he is competent, but most importantly is i am new grad myself, not fully competent yet! I felt the student is nearly unsafe because he is over confident. The most scary thing to me is that he thinks he knows everything and this is a easy job, and i feel i nearly know nothing and i am younger than him.

The 1st day

1) he came to me with the insulin syringe for double check. I said you shouldnt give me a syringe with insulin in already, you should give me the vial that you drew from because this pt is on two kinds of sulin: lantus and novolin. Me double checking a syringe without a vial is useless. He is not happy, because his previous preceptor didnt care

2) I found the medication care is a mess. Crushed pill chucks everywhere, no stocking after use, diry pill crusher, medication garbage has all kinds of things in it: even personally candies! I observed this student eats a candy every 5 minutes and i told him that the medication cart needs to cleaned after use, nothing in the garbage can except old medication patch or medication plastic bags. EMAR needs to be plugs in after use otherwise laptop has no power. Of course, he is not happy, because his previous preceptor didnt care

3) interruption. I am that kind of person is weak on multi-tasking. At this level, I can do one thing at a time. With constant interruption, I get lost and confused and i panic. But the student constantly interrupts me and started made me nervous

4) Assessment. Skin intergrity. Because i am new on this unit, any skin changes i tell all the care aids to let me take a look. So I took a look at pretty much all 24 residents skin. I found out the previous LPN does not do that or does that sometimes.

5) Guess what i found out?finally, the care aid told me that 2 residence have yellow-green colour, foul smell lady partsl discharge off and on for over a month! To me my 1st reaction is Bacteria lady partsltitis, not fungal! (i was really trying my best to use all my knowledges from school). But i was told by the students that one residence's discharge issue has been dealt with before but the other one never.

The family member came and fed the resident, i asked the daughter if he knew about it and she said no. So i told her i would contact the physician see if we can do something. The daughter said ok. To me she really didnt care. The 2nd day i found out she is a hospital head nurse! Anyway, i contacted the doctor, doctor didnt care at all, order the PV swab, and probably will prescribe antibiotics.

However, to me, its doctor's decision to Tx or not, but i have already done my best.

6)So at the end of the day, me and the student were both not too happy.

on the 2nd day, the student was very rude to me. he started pushing me, and telling me that "this two medication is your priority." one is a god damn enlarged-prostate pill, which is given once a week,one is a god damn osteoprosis medication for a very very very PICKY/COMPLAINING resident, and the other one is insulin. But on the same day, one 102 year old resident with a hematuria foley catheter (UTI off and on) had a fever over the night. He has anemia, CVA, arotic-valve disease, he could go with a sudden stroke in any second. His output was decreased from 500-300 last night, which i noticed and i told everyone, but nobody really care(student didnt care, less output means nothing to him). His bp last night was from 88/41, then 98/48, and my 1st priority i ran into his room and took his vitals, 101/44, afebril, confused. Many things going on in my mind: 1)checking DOI level, level 1? ok. 2) contact family member. when i come out of the room,

the student pull out my meds and telling me"I think your priority is to give these these two medication." he use his fingers and knock on the pills over and over again, and i started panic. Under the student pressure, so i grabbed the medication and went into the very very very PICKY resident's room, apologize to her for giving her medication late, and she said "did my pill change colour?" I took a look－－－its the prostate gland pill for the resident who is up early at the breakfast table!!!!!!!!!!!!!!!!!!!!!!!

A near-miss medication error!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I took a deep breath, left the room, and went to check the insulin residence's sugar, her sugar is fine. So i said i will come back to you, and i went back to the PICKY residence and gave her the correct pill. The reason i did that is that i need to distract myself a little bit. I talked to the student, student said "nobody enjoy working with you! You have no team work, you have no communication! you live in your own world! " I said "i know. Thats why i dont gossip. at this moment, my personality makes me can only focus on my own nursing job. Teamwork will come later, but i need time. And i really dont care if care aid likes me or not!" I went to my dialysis unit, found the charge nurse, broke down, cried.

i said to the RN,

"to the student, his priority is the insulin. His priority is who gets up for breakfast, who gets the pill first. His priority is the very PICKY residence's osteoporosis pill. But he doesnt know enough about the insulin. he cant look at the blood sugar picture. I still gave the insulin within window period based on a good blood sugar. I gave the lantus first, because it is a 24 hour insulin. I gave the novolin at the breakfast, because her sugar is ok.

to me, my priority is my unstable residence last night. To you, as an experienced RN, the priority is DOI, and family member. I cant work with a student. Look at the near miss medication error! He has no licence, i just had my licence for over a month. When i was trained by you, you never interrupt me when i do med pass. You just let me do it, but now, he constantly interrupts me i cant function. please help me. I am not competent!"

She smiled at me, and said "tell him not to interrupt you and you are competent. I will come and check on you." and she gave me a hug.

[CaregiverGrace]

I think you are far too inexperienced right now to be a preceptor. In fact as a graduate within the last 4 weeks, many places would still have you on orientation and partnered with a more experienced nurse. You either need to get this kid in line, or find a way back to your previous position. It takes time, years, to get a good routine down and be confident enough to do your job as well as mentor another. They are asking too much of you, and the near-miss is a warning that you should heed.

[Kooky Korky, BSN, RN]

For the student's evaluation give a big fat ZERO. FAIL. Student is arrogant and dangerous. Let your boss and/or his Instructor know the stuff you wrote here about him and give him a failing grade. If he's already an employee and no longer a student doing a rotation at your facility, let your boss know. Be very nice and totally professional. Leave out personal issues, such as he gets you flustered and he caused you to nearly give a wrong pill and he bosses you around and he attacked you personally.

For the LPN who was "laid off" - be super glad she is gone. She sounds lazy and disorganized, like she gave up caring a long time ago.

For you - you have to learn not to let losers throw you off course. Remind yourself of who is in charge (you are). Do not let gossipers make you gossip or shoot your mouth off. Do not believe "no one likes you" trash talk. Who cares if they like you or not anyway? You're not there for a popularity contest. Besides, they probably like you just fine. It is this student who doesn't like that you were holding him to a higher, safer standard than did the LPN.

While it is the doctor's decision to treat or not treat, it is the nurse's job to be persistent in reminding doc that a discharge exists, smells bad, pt is scratching or crying, etc. Who cares whether patient's child cares? you're the nurse. It is enough that you care. See the matter through.

Let the boss know about the skin issues. This is major neglect, even abuse. Residents could be in pain, facility could be punished. Probably should be punished for under-staffing or failing to supervise this lazy LPN. But that is not your concern. Just get the skin issues dealt with.

What is DOI? What does it stand for?

Hang in there. Take a deep breath. Rome wasn't built in a day. You're in this for the long haul. One thing at a time. Speak frankly to this student. Tell him you will have to sideline him, no longer precept him if he doesn't work the way you say he is to work. YOU are the boss. Got it?

You owe him nothing. Where is his Instructor?

[whitebunny]

i did so and lunch time, the son of the unstable pt came. He is a doctor himself. So i asked him about widened pulse pressure, he said he wouldnt concern about the pulse and low BP because his dad is always althetic, I asked him his opinion about comfort care, he said no comfort care, letting him alive is discomfort, letting him die is comfort care. I asked him about hypothemia of geriatric population, he said no tylenol unless the fever is 39,40. I asked about alternation of mental status, he smiled and said his confusion is not all by his fever, mostly by dementia. he said only O2, monitor his Sp02. i felt great!

Another resident's daughter is a dietitian, i asked her how to feed the residence with thicken fluids with medication.

my 2nd cry is a very depressed residence in his bed, asked me"do u know what you are doing?" i said "for a bp, i think i know." he said" you looked like a rat bumpping into everything." I had my tears in my eyes, said" i am new. I already tried my best. I will improve overtime. I apologize for your inconvenience." he turned his head away, I left his room. He yelled at me,"hey!!!!!!!!!!!!!!!!!!!!!!!!". I went in, and he said" put my head down!" i did so and left, had a cry.

my 3rd cry, is one of the residence who is on PD unit, condition deteroiated. She told me, "i want to eat. " i said "what?" she said "scamble egg." i talked to the kitchen and asked him if he has any. He said, and meanly said to me" If you need that you should let me know ahead of time 4 hours!" i meanly said back "how can i let you know 4 hours ahead if the residence doesnt eat for the whole day and all of a sudden she wanted to eat when she is dying!?"

the nurse(my very good friend) told me not to talk to cook like this, because he just cant make scramble egg. I said that when i tell her i cant give her scramble egg, she disappointly said "oh no?" that just absolutely broke my heart. I had my tears down, and the residence look at me, said "dont cry." a family member kicked me out and said" dont cry in front of her because you are upsetting her and dont push cook." i said i know i cant help with it. I said i know cook wont make scramble eggs for me but i still want to give a try for comfort care. i said i could ask family member to bring some and she said dont do that cuz u r putting burdens on family while my nurse family said dont push cook tell family to do it.

I asked what abut hospice? no hospice. Phone hospital and they sent volunteers here just sit and listen to the residence. Thats not hospice. hospice is a place that if i want to eat banana cake during mid of the night and kitchen will make it for me, thats hospice.

anyway, thats my 3rd cry, i know im too sensitive, too serious, that this job is not for me. Hospital and research suits me more and eventually i will move to there. im weak with organization skills and multi-tasking, i can panic, i can be agitated, i am sensitive, these are all personality issue, they can be worked on if i truely want to work on. I dont think i can personality, but i can modify it, right? I have done my best, i have no regret.

To me, my yearly goal is

1) learn physio knowledge (thats a 4 year degree)

2) learn dietitian knowledge(thats a 4 year degree)

3) learn gentle hygiene knowledge (thats a 4 year degree)

but i was trained as an RN

Plus, i felt relatively less respected in LTC because its their home and im pretty much a high paid maid.

[whitebunny]

For the student's evaluation give a big fat ZERO. FAIL.

You owe him nothing. Where is his Instructor?

thank you so much! i already brought the issue to the manager, she said thank you so much for letting me know. everytime i asked about the LPN regarding this student, she only says GOOD. i know nothing about him. RN supervisor is coming next week to help me with paper work, such as admission and discharge. Student has finished his preceptorship and wanted to get a job on this floor. But now manager wont let him be on the floor.

I felt great support from your reply. I know im doing the right thing. i know who are good care aids who are not. i know who are taking advantages of me but i will fix this issues as time goes by.

Everytime i do something, i know the reason behind it why i am doing it. God bless me i can go through this overwhelming stage!

[whitebunny]

hi, DOI is degree of interventions, 4 levels of intervensions.

[ckh23, BSN, RN]

At least you know you shouldn't have a student. I would bring it up to your Nurse Manager. As for the student, that's exactly what he is a student. Don't let him get you flustered because he is the one that needs to make the grade not you. If I were in your situation I would send him home. If he is a student he is there to learn, and if he is unwilling and impeding on your ability to do your job than there is no point for him to be there.

I would also keep track of all these instances so that you have evidence to give to your manager about the student. Your facility and the school of some kind of contract in place for this student to learn at your facility in exchange for compensation. However if you can keep track and document the incidences with this student than he has dug his own grave.

[RNbrent]

If it were me, I would have put this kid's nose in the corner a long time ago. Still, you're still WAY too new to be precepting (even though I know you got stuck with it). Your preceptor should have NEVER let you do that. Shame on her! You can only do your best and that's what you did. Don't worry about it too much, just be more assertive in future situations.

[evolvingrn, BSN, RN]

im confused by your post your asking family members to educate you on how to do your job as a nurse? and a dr who says no to comfort care letting him die is comfort , letting him stay alive is discomfort.....is NOT a qualified person to be teaching you about EOL / comfort care. by definition Comfort care is focusing on managing pts discomfort, pain, symptoms ect....without the goal of prolonging their life. Letting someone die without managing them is certainly not comfort.

Im glad your aware that you are no ready for the responsibility you have been handed, i also don't think your qualified to even be evaluating a nursing student at this stage in the game. Good luck on your new career! it all will come together quickly and the first lesson of being a good nurse is knowing when your in over your head.

[whitebunny]

hi:

i know comfort care, and i know comfort care policy and procedure in our facility. I know to give medication for pain and fever, i know to give oxygen, i know to let residence die in clean and on the bed.

However, knowing the routine of the residence and knowing the routine from the family member is also critically important to me. Especially while pretty much all family members of our residence are in health profession. I know how to do comfort care and i know how to feed, i just dont think i know enough.

[shiccy]

I will have to second what others have said. A month out of school you should not be taking students, no questions asked.

There is NO point in getting upset or even flustered by a student. If he is not being helpful and not learning what you're telling him (I don't know if you're telling him what needed to be done priority wise on a Qweek med vs. unstable vitals, but if you do then ...) tell him that he can go home or call the nurse manager and tell her you're not comfortable teaching at this point. I would NOT be comfortable just out of school teaching - heck I didn't teach until I was a YEAR out and was still like, "Hmm ... how do I do this?"

Something I would have said, honestly, if he said something along the lines of, "Nobody likes to work with you" would be the lines of, "That's awesome, thanks (sarcastically). You can go home now and think about how toxic gossip can be to you and your job. You better hope I don't have to sign your final papers, because your predominant theme will be about your unprofessional attitude and gossiping about other employees. We're here to help the patients, we're not here to have girl time and be catty about each other. I'm the new person here, so I'm obviously not going to be the most popular girl on the block. ... just wait until you start where ever you do because it'll probably be the same for you as well. If you want to come back (next scheduled time) without the attitude and come in with the sole purpose of learning how to do your job correctly, then that's great. If not you might want to look at how the rest of this semester will be spent."

Just remember to smile internally when you put him in his place and don't laugh when you see his 'shocked' face.

I hope you can grow in your new position, because with some of the things you said I wouldn't have even thought about, so you've got some great nursing skills for a new grad AND an experienced nurse... Your comfort level just isn't there quite yet, and it'll feel less overwhelming when you get it back :)

[agldragonRN]

don't cry in front of patients and in front of coworkers. go to the bathroom and cry there and wash your face after.

i have a nurse coworker who cry all the time in front of everybody. she is very sensitive like you. most bully nurses pick on her because she is weak. i try to defend her most times but she is just too sensitive so people still pushes her around. i feel sorry for her.

please don't let that happen to you. do not be perceived as a weakling because the bullies will target you. there are many bullies in the nursing field. i know i am getting a little off topic but i just wanted to give you a heads up because i was seeing my coworker in you when i was reading your post.

good luck with the new job. ltc nursing is a tough job. don't ask the family who are dietitians and nurses what to do. you don't want to be seen as incompetent by the family members. ask your facility's own dietitian for advice and seek one of the senior nurses for advice.