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.
OldNurseEducator
290 Posts
My how nursing students have changed!