New grad RN, See problems how to make changes. HELP

[Valcorie34, BSN, MSN, RN]

I am so happy you clicked here to read this. I could REALLY use some advice.

I am a new grad RN. I have worked LTC for 3 years as a CNA then as a Nurse Tech for a year doing wounds/ostomy care and then the last 6 months on a med cart as a floor nurse. I just couldn't pass narcotics. I worked in a good facility with high standards. I graduated and accepted a sign on bonus and more $ at another facility. I was all excited new job Woohoo.

I am still orienting. But I am seeing a lot if issues. Many of which may be due to the infection control/education nurse who is orienting me. I am working on a cart with her. But I am appalled at the lack of professionalism and infection control. No gloves for injections, no gloved during wound care on a bleeding skin tear. She *licked* something off the floor from under a pt. bed to see if it was a pill or candy. She didn't want to use ice in a bucket on her cart to put med plus or pudding in. (12-hour shift hot weather, needs refrigerated or thrown out). She didn't talk respectfully about her pt to other staff, used the F bomb all shift, and wasn't professional to a few residence (not abusive or reportable but not good). Some of the other nurses I met seemed much better. This CANT be reflective of everyone. But she is training people and her attitude has rubbed off.

I am also a bit annoyed there is a checklist for skills for new grad RN. I have to watch her do a skill, then she will teach me the skill, then I do it for her to be able to do it. I have really strong clinical skills. I have had excellent mentors. I have higher standards then she does with more EBP. I know it sounds bad to be a 'new grad' and say I am so good don't train me. But the things she showed me already with ostomy changes and wound care were SO WRONG! the ostomey appliance was too close to the stoma, there was a reddened area of skin she should have documented and notified the provider. A few patients had c/o pain she gave them meds and when that didn't resolve it she said I can't do anything I am NOT going in there and ignored them. I went and assessed and handled it, as well as an IV that infiltrated. She got annoyed and assigned me 8 hours of training videos for the rest of the shift.

I was pleasant and nice. I was not confrontational. But I am with her twice more this week. I just don't know how to handle this. My gut says just to establish myself as the nurse who just does it right. Who says something when there is an issue or something I see wrong. The problem is I don't know everything. I may not know the right way to do it. plus it is my first 90 days and she is evaluating me. HOW the heck do I handle myself in a way that keeps my job, requires good care of pts and does the right thing ethically? I am not just going to quit I made a commitment. I just need to navigate the waters and improve the quality of care.

I could use some tips LOTS of tips.

[CapeCodMermaid, RN]

I don't have lots of tips. Only this one: Do what you know is the correct way to do things. I am from the old days where we didn't wear gloves for many things but I've changed my practice to fit the latest standards. Licked a pill? I almost tossed my cookies when I heard that. Do the right thing. Is there some way you can let the DON know that this person is practicing unsafe nursing?

[ChryssyD]

Gotta agree with Mermaid--licking something off the floor under a bed? GROSS!!! Some of the other stuff, not as gross, but still...

The thing is, though, you aren't ultimately responsible for anyone other than yourself. So she doesn't put pudding in an ice bucket--unless you're passing meds outside for several hours in 90-degree weather, I have trouble seeing how that's a big deal. And I've been known to take off a BandAid without gloving up first. There is bad practice, which endangers patients, and then there is nit-picking, which does nothing but mark you as a tattle-tale. If you feel compelled to report this nurse, be sure that you are reporting things that could actually harm patients.

I say this not as a paragon of nursing virtue (which I am definitely not) but as a realist. Don't rock the boat, especially as a new nurse, unless there is a compelling reason to do so. I understand your concerns, but I also want you to have a realistic view of how the world actually works. Putting a wafer too close to the stoma? A matter of opinion. Dropping the F bomb all day? Unprofessional, yes. Reportable? I don't know...how badly do you want to alienate your new co-workers, who will then believe that they will get reported to management for uttering a curse word? Because that's how they will hear it. Being burnt out and blasé about patients' pain complaints? Maybe she knows them better than you and they're always complaining. I don't know, but there may be another side to a lot of the things you're worried about.

Except licking stuff off the floor. That's just nasty. :)

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

I'd just like to add that, until you have some years of experience under belt and even after, you can expect to see that (or a similar) checklist each time you change jobs. You may be confident in your clinical skills, but as a new grad, they are far from being strong. Strong for a new grad, maybe; but trust me, there is so much more to learn and so many ways to skin a cat. Besides, you may know what you're competent in doing, but employers do not.

As soon as you make a mistake that harms a resident, the State is going to be crawling through your personnel file searching for documentation that your skills were validated/verified by your employer.

So don't take this checklist personally at all. The fact that you resent this shows that you indeed have a lot to learn. But that's ok, too. I didn't know myself why all the need for this silly stuff until I went to the regulatory side of things two years ago and saw that the most insulting things required of nurses by facilities are actuality regulated by the State.

Good luck in the new job and remember, there is a method to the madness. :-)

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Oh, and licking something off the floor??? Our moms taught us better than that before we could even 'say' nurse. I don't even think forensic scientists do taste tests. ;-)

If it's on the floor and it's pertinent to your assessment, simply describe it in your notes, get another nurse to witness it if you need to, and discard it (because if you have alert and oriented NURSES licking **** off the floor, you probably have residents with dementia who'd swallow things).