New Grad Nurse Needing Opinions

[aspiringrn1987]

I am a new grad RN, graduated in May and I'm at my first job in a LTC facility where I got about 4 days of orientation and then I've been on my own on night shift with 55-60 residents since then. There is one other nurse in the facility but they are at the other end of the building.

I remember over and over AND OVER again in school being told to do things per facility policy. This facility does not have any policies in writing anywhere. I've asked numerous nurses and been given the blank stare. They just have every "policy" memorized. I don't really trust that when I have to complete a task and chart it under my name though and there is no written policy to back up my action.

To give you a couple of examples, a resident has a fever. I am told by the other nurse that a Tylenol can be given if the fever is over 100F, as long as they haven't taken the daily max dose of Tylenol. But again, this is administering a med and there's no protocol, standing order, etc. Another example would be a trach patient. I open her drawer to see an OPEN sterile suction catheter kit with a date written on it. I throw it away and get a new one, because I'm not reusing a suction catheter in someone's trach for goodness sake. I am actually corrected by another nurse that it's different because it's LTC, and we reuse the same one for 24 hours and it doesn't have to be sterile. Again, no written policy or protocol anywhere. I could give numerous other examples but those two are the ones most on my mind.

Is this normal? I have nothing to compare it to.

[Ruby Vee, BSN]

I am a new grad RN, graduated in May and I'm at my first job in a LTC facility where I got about 4 days of orientation and then I've been on my own on night shift with 55-60 residents since then. There is one other nurse in the facility but they are at the other end of the building.

I remember over and over AND OVER again in school being told to do things per facility policy. This facility does not have any policies in writing anywhere. I've asked numerous nurses and been given the blank stare. They just have every "policy" memorized. I don't really trust that when I have to complete a task and chart it under my name though and there is no written policy to back up my action.

To give you a couple of examples, a resident has a fever. I am told by the other nurse that a Tylenol can be given if the fever is over 100F, as long as they haven't taken the daily max dose of Tylenol. But again, this is administering a med and there's no protocol, standing order, etc. Another example would be a trach patient. I open her drawer to see an OPEN sterile suction catheter kit with a date written on it. I throw it away and get a new one, because I'm not reusing a suction catheter in someone's trach for goodness sake. I am actually corrected by another nurse that it's different because it's LTC, and we reuse the same one for 24 hours and it doesn't have to be sterile. Again, no written policy or protocol anywhere. I could give numerous other examples but those two are the ones most on my mind.

Is this normal? I have nothing to compare it to.

Nope, this isn't normal. Having policies is the norm, although I guess I wouldn't be shocked if none of the other nurses know how to locate them. Ask your boss or the educator (if there is one). There's probably a moldy old policy binder somewhere. If there truly ARE no policies, this would be one of the very few times I'd advise a new grad in their first job to find herself another job pronto.

[Lovetobenurse]

You have to talk to your Director of Nursing ! Remember your nursing Practice Act. A long term care facility cannot operate without Policies and Procedures! Do the right thing for your residents. Good luck!

[aspiringrn1987]

They seem to have policies, which seasoned nurses at the facility are aware of, but no pace where these policies are in writing for me to view. I've asked pretty much every employee. I will ask the ADON next I guess.

[kummerspeck]

At my facility, our policies are kept right on shelves in one of our nursing stations, as well as in our DON's office and the main office for the building. Someone, somewhere should know where to guide you. If they don't, ask the DON. There will be written policies. Good luck!