New grad LPN on tele floor

[nrcnurse]

I've been working on a cardiac floor since November, 7a-7p, at a 500+ bed, L2 trauma center that does everything except transplants. I have two weeks (6 days) left on orientation, and I am wondering if this job is in my/the patients' best interest. There is SO much to know, that I don't know. I learn at least 100 things every day. This is REALLY a RN job. I was an LPN honors grad, and have taken all RN prereqs, so I'm reasonably educated, but it feels like this job requires a boatload more knowledge than I have. I haven't killed/coded anyone, but I have made mistakes that are stupid. I set up a piggyback med with the wrong IV set, I forgot to give a pt a 1800 med, I gave PO meds to a pt with a PEG (though she swallowed them just fine, and thanked me for the glass of water, as she was very thirsty)(I didn't see anything that said she was NPO), and I never seem to have my assessments in the computer early enough to suit my preceptor. I've been working on my speed, developed a "one-page-brain" to help me stay organized, and I really am faster, but I'm not nearly up to hyperspeed. My pt load is usually 4, maybe 5. (Yesterday I started with 5, had two d/c's and one admit, but the d/c's were EXTREMELY needy before I got orders to send them home. Oh, and one pt was isolation, total care and = 2.5 pts.) I am doing all the normal stuff, plus admission assessments (which are very time consuming). I'm just feeling woefully inadequate. My co-workers are terrific and supportive, but I've had some "communication issues" with my preceptor, which have been very distressing to me. We've worked through this, I think (yesterday she seemed to treat me as an equal), but I could be completely wrong about this. Are my mistakes forgiveable? Am I experiencing usual and customary new nurse anxiety?? I am not a crisis-oriented person, so I'm not intending to create drama. I just want to know if I'll be invited to leave after the next 6 days, or if my experiences are normal.

Thanks for the benefit of your experience.

[TheCommuter, BSN, RN]

Personally, I would stick with this job for at least 1 year. It seems that you are gaining plenty of valuable experience.

With all of the new things you're learning in this position, your skills will be in demand by future employers. The mistakes should slowly disappear with time, grace, and experience.

[Vman]

i am in NY and a recent grad......if i remember correctly, Admission Assessments are NOT in the LPN Scope of Practice here, is it different there? (if i am wrong, please correct me, thanks)

[ChronicNurse]

I am an LPN and have worked tele for 5 years. It's great experience and if you stick with it you will be able to work just about any unit if asked. Some of the mistakes you say you have made seem to be new grad forgetfulness. Pay attention to detail always no matter where you work. That's first and foremost. Second, most places I know of (at least in my experience) will allow new grads some leeway when it comes to orientation and grant some extra time. I would go to your nurse manager and in a very diplomatic way ask 1. for more orientation. Say you want to provide the best care possible for the pt's and you feel you still have some learning you need. and 2. Request a new preceptor. Don't bad mouth the current one but explain that their my be some personality conflicts and you would like a fresh view from someone else.

[NikiChiki]

I am a new grad and will be working on a medsurg floor starting this week.

As with Vman, here in Delaware it's not within the scope of practice to have LPN's do new admit assessments. (at least where I work)

ChronicNurse gave very good advice.

Good luck to you.

[BKRN]

i am in NY and a recent grad......if i remember correctly, Admission Assessments are NOT in the LPN Scope of Practice here, is it different there? (if i am wrong, please correct me, thanks)

No, an admission assessment is not in her scope of practice. What she is probably referring to is after the RN completes the initial assessement the LPN will complete the History portion and screening portion (atleast that is how we do it were i work). It is very time consuming. I also think that chronicnurse gave very good advice. Stick with it!

[TheCommuter, BSN, RN]

i am in NY and a recent grad......if i remember correctly, Admission Assessments are NOT in the LPN Scope of Practice here, is it different there? (if i am wrong, please correct me, thanks)

Also keep in mind that the Southern states tend to have much wider LPN/LVN scopes of practice than the rest of the United States.

[nrcnurse]

an admission assessment is not in her scope of practice. What she is probably referring to is after the RN completes the initial assessement the LPN will complete the History portion and screening portion

I don't know what my state Nurse Practice Act says, but I'm doing admission physical assessments and history. It's hospital policy. This was a question I asked when I interviewed for this position, as I was surprised when my manager made a reference to LPNs doing admissions. I've also been trained to start blood transfusions (with a RN and all the proper double checking), and will be able to give IV meds after a class I take next week. I'm surprised, as in school we were told these things were not done by LPNs. My facility is very large, and well regarded, and I'm not exactly in a position to question the tasks they give me. They did, however, train me thoroughly and required multiple check-offs before I could start IVs, hang IV meds, and use/re-dress CVLs and PICCs. Admissions are huge for me, though. I don't want to miss something, and many times pts are not all that forthcoming with information!

[nrcnurse]

Thank you all for your support and encouragement. I really like my job, and don't want to change floors. I guess I just have new nurse anxiety. I'm back on the floor tomorrow, with a refreshed attitude, determined to move and think more quickly. I'm going to make the most of these last 6 days on orientation!