New Grad Ethical Difficulties

[theycallmeking]

I just graduated and passed my boards, and I got a job working at a nursing home. My problem starts with the facility only offering a couple of eight-hour shifts of orientation. Frankly, I don't believe this is enough to ensure my competency in the field. And while nursing school was great, I believe it's true that the majority of learning happens on the floor after you graduate.

After a couple of days of orientation so far, I've noticed a number of violations of HIPAA as well as safety issues at the facility. One big one is passing meds in the dining room. I know this is pretty common practice, but technically a violation and as a new grad, I'm not sure I want to jeopardize my license by working at a facility where this kind of practice is expected. It's become so ingrained in the resident population that I don't think it would even be possible for me to do it any other way at this point.

So my dillema is this - do I take the job and possibly risk not only my license, but learning how to do things the right way? Or do I pass and play it safe? I'm very torn over this and I would love some opinions. Thanks

[PeekabooBSN]

I feel you girl! I graduated a year ago. I found a job working in a post rehab SNF. I had 27 residents and 3 CNA's helping. I had 4 days of orientation. You hit the ground running. I lost 15 lbs working there. Do what you have to do and just be sure to be a safe nurse. You will master time management working there.

Take the job as jobs are scarce for new grads like us. This job will help you find a new job.

I now work at the VA (I am still in my 6 wk orientation) and have 5 pts. Trust me the same short cutting and HIPPA violations occur here. There is no perfect nursing, and nursing is not like school in any way, shape, or form. You will learn to choose your battles, and med pass in the dinning room is not a major one. If you don't get it done in the dinning room it will take you 3 times as long to pass meds, time that you do not have. Definitely DO NOT pre poor. I straight up had nurses tell me that I needed to. That was a battle I picked. Pre pouring is just down right unsafe. After about 2 months I could do the dinning room med pass for about 22 people in just under an hour, which is freaking unbelievable. It took me the next hour to get the 6 others in their rooms. You'll hit your grove. Make sure you ask for help even if you feel like a pain the ass, it is the only way to learn. I still ask for help all the time. Even worse, the VA is a teaching hospital and most of the interns (I call them baby Dr's) have no clue what they are doing. I literally am learning everything a doctor knows so that I can advocate for my pts and make sure they are receiving the tests, meds, and procedures they need.

Once again, TAKE THE JOB! you will learn fast. you will get by. be safe. follow your gut. This will help you in the long run.

[RN*2010]

I agree with the other posts in that it is impossible to give medications to residents when they are not in the dining room and I do not feel this will ever change. You are in a position to make sure that you let your DON know that you want and need additional orientation. You are also in a position to change the "norm" in long term care by putting your foot down in a nice way and make suggestions that could change the way additional new employees are given orientation by letting the DON and upper management know that additional orientation is needed for new employees. Be strong and you be the one that changes the way things are done in your facility. Good luck

[CoffeeRTC, BSN, RN]

How is handing a resident their pills a HIPAA violation? Now if you are talking loudly "Here is your coumadin, here is your colace"...yeah, I see a HIPAA violation.

I've worked LTC and sometimes manage to get the pills in before dinner / dinning room. Eye drops, injections, inhalers, accu checks should always be done in private. UNLESSS....the resident refuses to leave the dining room or hall for them.

If that is the only ethical delema that you can find in that LTC then you should stick with it...I'm sure many of us have stories to tell.