New Grad Trying to Find Her Way

[n2biology, ADN, BSN, RN]

I graduated in May 2013 and got my first job as a hospice admissions nurse, per diem. I received very basic training of watching 4 days of outdated vcr videos by myself and answering some test questions. The nurse educator spent one hour going over a huge binder of paperwork and policies, some of which were incorrect or outdated. My field training consisted of following a tense, overwhelmed admissions nurse around. I was not allowed to talk or ask questions. I was told that I could only watch. Another nurse showed me how to fill out paperwork, all handwritten for each of the types of admissions. I work two days out of the week and am on call every other weekend. On weekends, there is very limited support and everything is left on me to do on my own. Now I am finding the company pressuring me to visit complicated patients for other RN case managers. I have received no actual training for this. I am told that it's a simple visit with some wound care. However, when I get there, it is often a situation where the family needs teaching, patient has symptoms that are need immediate addressing. I have had no training on any of this and often have to "wing" it. Over the weekend, one of the head RN's was pressuring me to assess and review care for a complicated patient in continuous care. I know that has different assessment requirements. I made it clear to my charge RN that I was uncomfortable with this assignment since I have had no training on it. She didn't want to hear it. All she said that they need a higher level of a nurse to assess and do the paperwork on this patient, and I was the only one scheduled for the weekend. I have frantically called another case manager to get educated on what to do. She seemed surprised I was being sent but gave me the basics that I needed to do. I am seriously worried about compromising my license and feel pressured to do assignments that I haven't have any experience or training in. By the way, I have routinely asked for more training and placed a list of what I need training on with the administrator RN. It has been ignored for months. I need some input from other hospice nurses to see if this is the norm or I am walking into a minefield. Sorry for the long rant, I am just worried and don't know how to address these concerns further with RN administrators who are unwilling to listen. I feel in some situations, patient safety is being compromised and I have mentioned this several times to the higher-ups, but it falls on deaf ears.

[SoldierNurse22, BSN, RN]

Time to find another job. If you're being pressured into doing things that you 1) haven't been trained to do, 2) aren't your responsibility and 3) are being made to feel like it's your fault the company's staffing sucks, you need to get out before something happens and someone ends up hurt or out a license.

[n2biology, ADN, BSN, RN]

Thank-you for your input. I have been looking for another position for months now. Unfortunately, it's a tough job market and novice nurses are not in demand in the area I am in. I was lucky to even get hired in this job. As far as looking out of the area, it makes it difficult. I have school-aged children, ailing parents and in-laws, established home, and a husband with a business here.

[SoldierNurse22, BSN, RN]

That is tough, but if you're really worried about your license and you're being told to do things with which you have no experience as a novice, you are putting the patients and yourself at risk. While I understand the need for making money, making money will be significantly harder if something goes wrong and you lose your license or find yourself with restrictions.

[n2biology, ADN, BSN, RN]

Thank-you again. I implement safe practices when seeing patients. I do assessments, wound care, order the necessary meds and equipment. If there is an issue, I contact the doctor and or nurse administrator. My concern is more with being put in a situation where there is an unexpected event, and I don't have the full training to address it. For example, some patients that I visit for case managers are on oxygen. My concern is that I haven't learned how to troubleshoot the oxygen concentrator nor learned how to switch to portables if the electricity goes out. I asked over and over to have someone show me how to work the machines. The response is that it's easy and just to call them if something like that happens. Unfortunately, there's an assumption that a simple phone can address every problem. In an emergency, phone systems aren't always up and working. Also, I am not in it to make money. I am in it to be a good nurse. This is a well-thought out and planned career choice. I have had two other careers prior to this. Plus, I dedicated several years to volunteer work.