New LPN and dismissive nurse manager-Help!

lpnpasta · Jul 6, 2016

Document, Document, Document. You can't help if the person your reporting to is pushing everything off. Just document you told her. It's not your responsibility to make sure she does the reports and takes proper action.

KareBearKarez · Jul 6, 2016

Thanks, Pasta. I certainly do document. It frustrates me how reliant I am on someone else to achieve the best results for my patients.

RNBearColumbus, BSN · Jul 6, 2016

Let me apologize in advance if what I'm about to write comes off as judgmental or mean. I certainly don't mean it that way, and I truly want to help.

Almost a year ago, I was hired as charge nurse for the 3-11 shift at one of the nicer LTC facilities near me. At my interview I was very honest about my lack of experience and concern for being a charge nurse. My director of nursing assured me that there would Always be someone to answer my questions and teach meâ€
It's been almost a year since you were hired. You are no longer a new nurse. Even only working weekends, you should be have a general idea of what the facility protocol is for various situations.
Turns out, the only person is the Nurse Manager who is alone and covering multiple floors. In the past I have called her to point out high temps, skin tears, low SPO2 sat, whatever and her go to answer is Don't you think we can leave a note for the next shift?â€ To protect myself, I always document thoroughly and indicate she was made aware.
Even though you have a nurse manager in the building during your shift, you are still a nurse, with her own nursing judgement. Using the nursing process, what do you think you should do in the examples you listed? High temp: assess the patient, call the doctor. Low SPO2? Do a respiratory assessment, apply O2, call the doctor. Skin tear? Treat the injury, determine what caused the injury, come up with an intervention to keep it from happening again, etc. The point is, you need to learn to be more independent in your practice. Now, I realize that you only work weekends, but it's been a year. These are things someone should have taught you. Does the facility have a policy and procedure manual you can consult? At the very least, I would have a chat with the DNS/DON and tell him or her your concerns. It might also be a good idea to sit down with a more experienced nurse and go over paperwork requirements.
Last week, I showed her a large, grey macerated area, from pressure on a patients heel and she dismissed it as as little pinkâ€. It is now wide open and infected and she claims I didn't point to exactly where it was so she never saw a blister.
Again, in this situation, you as the patients nurse, should have taken the lead in documenting the pressure area (Which it sounds like you did.) Determining the cause, and developing interventions. Does your facility have a written protocol the spells out what nurses are to do when a new skin issue is discovered? I'm willing to bet that they do. You need to find it, or ask the DNS/DON where you can find that information.
Additionally, I do not know what paperwork to complete for these items because she dismisses everything so all I do is document and pass it on in report.
See my reply above. You've been there almost a year, and these are things you should know, or at least have an idea of where to find the information. If you don't, this is a situation where it would appropriate to ask for additional training. YOU are the primary nurse in charge of your patients care, not the nurse manager. She's probably busy putting out fires all over the building, and needs to be able to count on the nurses on the individual units to handle these things as they arise.
This is a new world for me and I don't know how to address these things and I don't know how independent I can be of her. I only know I have a responsibility to my patients. I make myself sick when I work because I have so little experience and I fear I will not know what to do when the inevitable crisis occurs.
To me, it sounds like more of a confidence issue on your part. You need to sit down with your DNS / DON and have a conversation about what the expectations are of a charge nurse on the unit you work on. You need to be comfortable asking for additional training or resources so that when a crisis does come, you will feel more confident in dealing with it.
By the way, I love nursing. I'm not posting to complain, I just don't know how to grow stronger here for the sake of my patients and my license. This cant be unique, how does everyone else do it?
You're on the right track. You just need to develop some confidence in yourself as a nurse and ask for the training you need to do an effective job taking care of your patients. The fact that the situation bothers you is a good thing. Lesser nurses would just go with the flow.
I appreciate any thoughts. Thanks!

KareBearKarez · Jul 7, 2016

Thanks RNBear-

That was exactly the direction I needed! No need to apologize for tone, your post was very professional and a huge help. It has helped me recognize my own disconnect so I can address it.

Thanks again for taking the time.

Dafabb, LPN · Jul 9, 2016

I agree with everything you said and I would also like to know where are all the other nurses in the building. If you are uncertain ask them. Have them explain things to you. Most co workers will answer any questions you have. You do not or should not have to rely solely on the DON. One thing at a time as LTC can overwhelm quickly..

TheCommuter, BSN, RN · Jul 10, 2016

Most co workers will answer any questions you have.

Not necessarily, especially if the workplace environment is toxic or full of passive aggressiveness. I've worked at places where many of the coworkers were actually unhelpful saboteurs.