Need advice, I am not sure what is my current status.

[SoNan, BSN]

Good afternoon,

I am a new Graduate RN from May. Currently, in an LTC facility, I am on my 8th day of 10-day orientation. I did not get an orientation checklist until the 8th day, and I find out I still have a lot of things I haven't been oriented yet, such as admission from the hospital, transfer to acute care, discharge, Expiration... etc, I am not sure if the DON will help me to fulfill that information in the next 2 days or not, if not, I do not know if I can start to work on my own.

Also, overall I feel I did OK with the orientation: pass med, documentation, assessment....

However, during my 7th day, the DON told me to fill a paper regarding what I saw and did about a pt in the LTC unit that I had orientation on my 2nd and 3nd day (tudesday and Wednesday), because that pt was found out have a fracture on Saturday, and it is not reported or documented. so I just wrote what I did and saw about that pt when I was orienting in that unit.

Then on my 8th days, the DON told me regarding I held a pt's BP med (I have no idea who the pt is, because I am super bad at name, I have to see pt's name or go to pt's room to figure out who is who). the DON told me that I documented I held the med because the pt has low heart rate, I did not document what is the heart rate, I did not call the doctor, or do anything about it. And the DON told me next time call the doctor and document the specific heart rate. I said OK. I did not say anything because I did the documentation then if there is a problem it is my false. I also do not want to make the DON feel like I am pushing the blame to other people, even though I believe if the pt's anything is abnormal, I always tell the nurse who oriented me, and nobody told me which medication I should notify the doctor if I hold it and which medication does not.

Today is my 9th day, I feel overwhelmed to start work on my self next week, and I also nervous to show up today and the DON grab me again to tell me there is a other problem.

I feel OK to do the assessment, med pass alone, but if there is a situation comes up I do not know if I can handle it or not. 

I don't I should get more orientation or not. Because all I did in the past 8 days of orientation is assessment, med pass, documentation, which I believe I can do it alone. the most things I am worried about is when the pt has abnormal findings, admission, discharge, and transfer out. During orientation, I have back up and reference. I am afraid when I start to work alone, I have no backup and reference.

[Chickenlady]

It is normal to have some uncommon items left after orientation.  Then, when the situation does happen, it is up to you to step up and ask for orientation on it.  For example, we don't have many deaths in our ER and I wasn't oriented on it.  But the next time there was a death on my shift, I went with another nurse who taught me the procedure. 

That said, admissions, send out to hospitals, abnormal vitals are all things that are regular things in a LTC.  So, I would ask for additional orientation time with a focus on those items. 

[amoLucia]

3 minutes ago, Chickenlady said:

..... That said, admissions, send out to hospitals, abnormal vitals are all things that are regular things in a LTC.  So, I would ask for additional orientation time with a focus on those items. 

It is prob highly unlikely that OP can request AND RECEIVE any more extended orientation time. There should be P&P around somewhere for her to pull and check out what to do. It would have been ideal if during her orientation time, that she could have participated in those processes for any admissions, transfers, change-of-status, expirations, etc as they occurred  ON HER SHIFT. 

OP - re the fracture pt > any fracture, and esp one of UNKNOW ORIGIN, is considered a 'sentinel event' and is mandated to be reported to the State DOH. Likely, the DON is obtaining statements from ALL staff (incl therapy, activities, anyone) who had any contact during the pre-discovery time. Of interest is any suspicion of the pt having experienced a fall or altercation/accident with another resident. Also any complaints of bruises, pain and most esp, ANY change in ROM/ADLs. The DON must conduct an in-house investigation!

OP - rule of thumb for practicing as a new nurse in any setting - when in doubt, err on the safe side and notify a supervisor to ask for further directions. If something was abnormal enough for you to undertake an action, then the physician should likely be notified. ALSO THE FAMILY! I tended to keep my information low-key to avoid panic & concern, but there is nothing worse than for some family to learn of something second-handed. You then will always be regarded with suspicion - always keep them in the loop esp with major changes in meds or therapies.

It is good to note that you're feeling OK re med pass, documentation, assessments. That's very positive!! Just know, that will improve with time. There should always be some higher-upper nurse avail, even on-call to contact, if you're in a quandary. Check with your Staff Devel person for resources. Check with your shift supervisor and/or the NEXT shift super. That's part of their jobs.

It takes some fine tuning to learn ALL the ins & outs of staff nsg in LTC. For as long as I worked, I was always catching things. And it takes TIME.

I think you're holding on pretty much decently for a newbie!  Good luck to you.