I am a newly licensed RN and just got my first ever nursing job! I was super excited to get started, but now I am so worried about harming a patient and/or losing my license! Many of the things I am told to do at work goes against everything I was taught in nursing school! I am trying to decide if it is as bad as I am thinking it is & whether I should quit or not.
First off, it is a LTC facility, on a dementia/alzheimer hall & I only had 3 days of orientation before I was on my own. I have about 20 patients to care for. I oriented on day shift & began my first shift alone on nights (which I have never oriented on). I am the only nurse on my hall, and there are only 2 other nurses in the building after 5pm.
Here is my list of things that worry me:
#1: Not double checking insulin. My preceptor told me not to worry about doubling checking. "We just draw it up & give" since there are lack of nurses around.
#2: Not following the MAR. There are patients who get meds a 1800, 2100, and 2200. The patients usually go to bed after dinner, around 8, and I was told that "you do not want to wake them or your night will be ****." So I was given a list of patients to give all their meds (both 1800 & 2100) at 1700 & the other half of the residents, I am to give all their meds (again, both 1800 & 2100) at 1900.
If this isn't scary enough, I have to pull the 1800 meds early for those patients & sign them off the eMAR so they won't be past due, was told to put them in med cups, label the cups & put them in the drawer until I am ready to draw up the "1900" meds.
The ADON agreed with my preceptor that this is how they want to be done. I did it on my first shift, but it made me so nervous! I think this is very very wrong & puts me at high risk of not only giving wrong medications, but doubling up or missing medications that I am signing off on giving!
Also, by the time I was giving those "1900" meds, I don't even know what I have in the cup any more! Once you sign off on the meds, there is no way (or at least, I wasn't shown how) to go back & look at the medications list.
#3: Charting "the usual". My preceptor fills out the charting with the patient's usual, sich as "active bowel sounds", "no adventitious lung sounds", etc. I was told not to worry about assessing them & was given the "answers" to fill out their charting. I have been there a total of 4 days & never once seen anyone assess the patients heart/lung/bowel sounds! With the crazy number of patients & their medications, I only have an hour that I could spend assessing them anyways!
#4: Not wearing gloves for anything! I've seen me preceptor & other nurses draw accuchecks, give insulin, and eye drops with no gloves on! She told me not to worry about it (I did not listen to her, I refuse to give injections or draw blood of any sort without protection!)
So adding all this to the fact I am brand new, on my own, and no one to ask questions to, I am pretty sure you see how uncomfortable I am. I cried the whole way home from my first shift, terrified I am going to harm a patient or get my license taken because of the things they expect me to do. I tried to talk to the ADON and other upper level managers about my worries & feeling like I am not ready to be alone after only 3 days, but I'm just told "you're fine. It'll be ok."
I really think it is in my best interest to quit, but my husband is worried because I need a job & he doesn't understand how bad these things are. I need advice, please!!
I want to add that double checking insulin comes from back in the day when there were multiple variations to keep track of. We had beef, pork and human insulin, then there was U40, U80, U100 strengths, along with the different types-long vrs short acting, or mixing the clear and cloudy, and the syringe used had to coincide with the strength of insulin. Only then did we draw up the correct number of units, and add in the "rainbow" coverage. Rainbow coverage would be similar to sliding scale today, but it was done according to the color of a dip[stick that would tell you how much sugar was in the urine. There were about 5 variables to each dose that had to be checked (plus the 5 rights).
The process is much simpler now. Still, we have nurses double checking insulin, but hanging and titrating inotropes, medicating for sedations, without a second checker. It seems illogical to me. If you feel you need a second check you should getone, no matter what med it is. I'll bet that after a year in practice you'll be pretty confident about your insulin doses though.
canoehead, BSN, RN
6,909 Posts
I want to add that double checking insulin comes from back in the day when there were multiple variations to keep track of. We had beef, pork and human insulin, then there was U40, U80, U100 strengths, along with the different types-long vrs short acting, or mixing the clear and cloudy, and the syringe used had to coincide with the strength of insulin. Only then did we draw up the correct number of units, and add in the "rainbow" coverage. Rainbow coverage would be similar to sliding scale today, but it was done according to the color of a dip[stick that would tell you how much sugar was in the urine. There were about 5 variables to each dose that had to be checked (plus the 5 rights).
The process is much simpler now. Still, we have nurses double checking insulin, but hanging and titrating inotropes, medicating for sedations, without a second checker. It seems illogical to me. If you feel you need a second check you should getone, no matter what med it is. I'll bet that after a year in practice you'll be pretty confident about your insulin doses though.