Just wanted some thoughts on my situation, here it is...
I graduated in May-gotta job on a med/surg floor- 4-weeks of orientation-and I'm now caring for 6-7 pts all by myself.
But get this. I have no resource person, no one offers help, and I'm still working under a TEMPORARY LICENSE! What's the legalities on this?
Also, yesterday a doctor asked me why I turned off a morphine drip when respirations were 6, and this pt is braindead after a massive MI. The order said "titrate to comfort". A dnr ofcourse but, I almost laughed and said kiss my a**.
Not really-I just told him i learned it in school and the ativan was working just fine until respirations came back up. LORD HELP ME!
In a pt who is receiving both benzos and opioids, if resps. decrease, it is better to decrease the benzo, which is more often the culprit for oversedation and decreased respirations. It sounds like this is a comfort care case, so you would want to keep the med that is going to keep the pt. pain free.
Also, abruptly stopping an opioid can precipitate acute withdrawal symptoms, something you do not want to subject your pt. to.
You should not be out there on your own yet. You need to have someone to act as a resource person for you. There is so much to learn beyond graduation.
I'm a little concerned with your attitude you displayed when the doc questioned you. That really wasn't appropriate, even if you didn't say it. It suggests that you aren't open to being questioned/criticism. Did you even have an order to D/C the drip/hold the drip for resps
Even the most knowledgeable/experienced nurses get questioned. A "kiss my *ss" attitude is definitely not going to win you friends, imfluence enemies, and help you in the learning process.
Temporary license as in interim permittee? You should not be working on your own, because an IP is NOT NOT NOT licensed. An IP is someone who has taken the NCLEX but has not gotten licensed yet.
In our state, you are given an IP after graduating from nursing school until you pass the NCLEX. It's called an Interim Permit and allows you to work until you take the NCLEX. I can't remember how long it's valid for but I do know you cannot work on your own (or you are not supposed to) with the IP. I ended up working 1 shift in the ICU after orientation because of how I scheduled my NCLEX. My orientation was 6 weeks long and I didn't take my NCLEX until a few days after my orientation was over. So I ended up doing 1 shift with an IP....bad, I know.
I can't believe they are allowing you to work on your own with an IP. In my state, you can only use that IP from the time you graduate until you take your NCLEX. You are supposed to be supervised by an RN the entire time you are on the floor if you only have an IP. Sounds like you have an awful lot of responsibility in a short amount of time. Then again, I was on my own after 6 1/2 weeks off orientation in the ICU. That was overwhelming. I felt sick (and still do on occasion) before coming to work...LOL!!
When I first graduated from LPN school 15 years ago, We had our temp. lic. until we got our results from the board, which took about 3 months. I went to work for a LTC facility, was given 2 weeks orient. and then had the whole LTC facility with 5 aids to myself from 11p-7a. One night I reported and they said, so&so in room 1234 is FTD, and so is Mrs. such and such in 2345, have a good night. If they would have passed I wouldn't have known weither to give them cpr, call the ambulance, or the coroner. Needless to say I got out of there and have not been back to LTC. Oh by the way the facility held 98 patients.
yikes. you are in a bit of a situation. you are going to have to deal with dr.'s, pt.s, and others questioning you your whole career. don't let that bother you. you still should be under a licensed rn until you are more comfortable. you need to talk your supervisor and let them know you need more training time. if they are not willing to accomidate there is something wrong here. you would think they would rather have a more confident nurse on the floor less likely to crash and burn then to put themselves at risk for losing a competent new hire. hugs:icon_hug: and best of luck to you. i hope you have better days ahead.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Communications with your charge nurse or above! If you don't feel confident...this should be addressed and fast! I mean look...do you feel your pts are safe at this point if something were to happen? Remember, pt safety is A number one!
Orientation...heck, I never got any!!!!!! Not fun!!! But wow..now that I am agency it helps :) LOL! :). I just learned to be 'on the fly' and really leaned who my resource people were fast (typically my Charge Nurse because if it comes down to it...they will get it too if I was to mess up!).
Also never fearing asking a question! I find that is a very good skill to have!
If they are pushing you too hard for safety, and not listening to you..time to move on! You can't take a new grad and plop them into the fast current...that just shows a lack of employee/pt respect and common sense at that facility and something that will continue to effect you as you work there! I don't work for facilities that do not have common sence or safe practices when it comes to employees or sometimes pt loads (some facilities take on pts they are not equipt to handle).
I am so sorry your facility has treated you this way. The licensed RNs you work with are being VERY stupid. Whose license are you working under?? An IP means you are working under the supervision of a licensed RN at all times. Which one of the RNs on the floor is going to take the fall if you make a major mistake on the floor?? I hope you don't, but it happens. Your facility is setting itself up for lawsuits and putting the licenses of their staff at risk. I would not stay in a facility that did not respect my license. If you do stay someone needs to write a letter to risk management regarding the limitations of an IP license. Please learn how to protect your license as well as your patients!! I don't let my students/IPs do anything unless I have double checked their work and our orientation is 3 months for new grads. IPs are never on their own here. You deserve better. Best of luck.
Talk to your supervisor, that's not right to expect you to take care of that many patients on your own without help. I assume you are working as a graduate nurse, and haven't received your nursing license; they can't let you be on your own yet.
Just wanted some thoughts on my situation, here it is...
I graduated in May-gotta job on a med/surg floor- 4-weeks of orientation-and I'm now caring for 6-7 pts all by myself.
But get this. I have no resource person, no one offers help, and I'm still working under a TEMPORARY LICENSE! What's the legalities on this?
Also, yesterday a doctor asked me why I turned off a morphine drip when respirations were 6, and this pt is braindead after a massive MI. The order said "titrate to comfort". A dnr ofcourse but, I almost laughed and said kiss my a**.
Not really-I just told him i learned it in school and the ativan was working just fine until respirations came back up. LORD HELP ME!
Sounds like me a few days ago. Only place that would hire an LPNA was the Metro jail run by a contractor. What an experience! I went to the board of nursing and they told me if I was uncomfortable with situation don't do it, so I quit. I have savings enough having been a truck driver I could quit after getting 120 hours of "direct patient care." and can take NCLEX now. I still have a class A CDL, and talked to a school friend who like me is rethinking this whole nursing business. It ain't what I expected, just short staff, cut costs everywhere, and cover ass with a paper trail. I refer to documentation as toilet paper now, just ass covering. I know a few nurses, and only one is still with it. One is a security guard, one a truck driver, one sells high school text books, one sells cars, and the smart one married a founder of Lexmart.
According to Ky. Board an LPNA (applicant) can work as an LPN if there is a nurse within "telephone distance" to call if one gets in trouble, really thats what I was told. Great comfort if the phone is busy.
Big problem is the management mindset today. One nursing home in the Ky. news hired a taco bell manager to manage string of nursing homes. You know what that meant, cut staff and run everyone else ragged, relplace them, and falsify documentation. They lost a several million dollar lawsuit for wrongful death.
Enough, I'm sure experienced nurses are familiar with what I am refering to.
PANurseRN1
1,288 Posts
In a pt who is receiving both benzos and opioids, if resps. decrease, it is better to decrease the benzo, which is more often the culprit for oversedation and decreased respirations. It sounds like this is a comfort care case, so you would want to keep the med that is going to keep the pt. pain free.
Also, abruptly stopping an opioid can precipitate acute withdrawal symptoms, something you do not want to subject your pt. to.
You should not be out there on your own yet. You need to have someone to act as a resource person for you. There is so much to learn beyond graduation.
I'm a little concerned with your attitude you displayed when the doc questioned you. That really wasn't appropriate, even if you didn't say it. It suggests that you aren't open to being questioned/criticism. Did you even have an order to D/C the drip/hold the drip for resps
Even the most knowledgeable/experienced nurses get questioned. A "kiss my *ss" attitude is definitely not going to win you friends, imfluence enemies, and help you in the learning process.