New Nurse, AHHH!!!

Meeshie · Sep 22, 2016

Umm..please don't document that you did an intervention when you didn't do it. That would be illegal and immoral. You could lose your license. Your patient could get septic and die because no one does the required interventions for wound care.

So.. fun story. I live in South Florida which has a very high geriatric population and a lot of LTCs. Quite a few of them have been shut down due to their patient care (or lack thereof, really). One story that did make the paper however is beyond horrific. Patient had blisters on heels due to a wheel chair and doctor ordered wound care. Nurse did not arrange for wound care. Wound care was never called in. Documentation shows that wound care was done. Over time the patient developed more pressure ulcers and the nurse couldn't admit to it without admitting she falsified documentation so she hid it. The patient died of sepsis and the article is quoting as using the phrase "bones liquified" when describing the level of infection. She's on charges of manslaughter now.

Long story short? Don't falsify.

nurseburst, ASN, BSN · Sep 23, 2016

Thanks for your reply Meeshie! And as I stated... NO. I am not and WILL NOT falsify... I know that it's illegal and immoral and puts your patient at RISK. Thank you sharing the true story... that is absolutely horrifying and could have been avoided. I really, really hope and pray that the nurse I've been mentoring with is the only nurse in the facility that does this... I'm not sure why she believes it's okay to check off it was done instead of simply letting the next shift know to do those things?

Ruby Vee, BSN · Sep 23, 2016

I am a brand new nurse who has started working in LTC/Rehab facility. I received 5 days of orientation and will be working night shift. Tomorrow is my first night by myself although my mentor has been trying to let me handle the floor on my own and just come to her as I need to since a few days ago.
I am just really struggling with time managing getting everything done when those 6am meds are due for over 20+ patients some with Gtubes and IVs. I've been recommended to start earlier until I get quicker on the med cart but the last time I worked I was there 2 hours after my shift still because several things came up. I know that this is all part of nursing and that setting priorities, and developing really good clinical judgement comes with experience and time but I know how important it is to provide care on time to these patients and want to do my best!!!
I am also concerned because my mentor has been telling me to sign off that I've completed a task that we don't have time to do such as a dressing change... and I have not been doing that! Because that is falsification of documentation and then the patient is not receiving the appropriate care. But I don't exactly know how to navigate the computer system completely yet and so I am not sure how I document appropriately if I was unable to do a dressing change and want to make sure that the wound care nurse sees it and does it the next day...
I have brought up these concerns (without mentioning my mentor telling me to sign off on items because I am at a rock and a hard place... I need support when I am there at night but it's still completely inappropriate and wrong to document that you've done something you haven't) to the nurse educator and she said she'd try to get me some help with prioritizing and time managing.
I really love Nursing and it's what I am passionate about doing... especially geriatrics.
I have read so many posts on this website that has been helpful but was curious to see if anyone else had some thoughts, or tips they can provide? I greatly appreciate ANY input!!!!!!!!
And also I am not trying to throw my mentor under the bus at all, she has taught me a great deal and I am incredibly thankful - however, it only hurts the patients to sign off care was provided when it wasn't.

It is always a bad idea to throw someone under the bus, especially when you're going to have to work with them in the future. Ask your educator about the proper procedure for signing or flagging that a procedure is NOT done. But you shouldn't make a practice of leaving procedures undone if they fall due on your shift. You're new; time management and prioritization will come. For now, you're going to be floundering with those concepts; that's the part of being a new nurse that sucks. You'll get it eventually.

You are absolutely correct about not documenting as done something that isn't done, and I commend your ethics and your enthusiasm. Clinical judgement, time management, prioritization and mastering the freaking computer are all things that will come.

nurseburst, ASN, BSN · Sep 27, 2016

Thanks Ruby.

I am trying my best to find how to be safe, legal and still do the heavy workload given to me. My confidence has gotten better even over the last few days. I had some issues with CNAs and a fellow LPN and I tried to resolve it as best I could in the moment it happened but whilst the 'drama' continued afterwards I simply don't have the time on my shift for internal conflict when I have over 30 patients to attend to.

I think there is also an issue on our MAR/TAR with some orders not being DC'd properly. For instance, I have a resident who had an order for oxygen tubing to be changed every sunday and yet when I walk into her room (and I have NEVER seen her use oxygen even PRN) she doesn't have an oxygen tank anywhere to be found. Speaking to the oncoming nurse, she agreed that the patient hasn't been on oxygen for months... or I've seen duplicate orders. I've read that the MAR/TARs may need to be cleaned up but I am still learning how to navigate the system on a "learn-as-you-go" basis and I don't think a MD would be happy with me calling between the hours of 11p to 7a to try to dc some old orders!

Lev, MSN, RN, NP · Sep 28, 2016

Thanks Ruby.
I am trying my best to find how to be safe, legal and still do the heavy workload given to me. My confidence has gotten better even over the last few days. I had some issues with CNAs and a fellow LPN and I tried to resolve it as best I could in the moment it happened but whilst the 'drama' continued afterwards I simply don't have the time on my shift for internal conflict when I have over 30 patients to attend to.
I think there is also an issue on our MAR/TAR with some orders not being DC'd properly. For instance, I have a resident who had an order for oxygen tubing to be changed every sunday and yet when I walk into her room (and I have NEVER seen her use oxygen even PRN) she doesn't have an oxygen tank anywhere to be found. Speaking to the oncoming nurse, she agreed that the patient hasn't been on oxygen for months... or I've seen duplicate orders. I've read that the MAR/TARs may need to be cleaned up but I am still learning how to navigate the system on a "learn-as-you-go" basis and I don't think a MD would be happy with me calling between the hours of 11p to 7a to try to dc some old orders!

In that case I would leave a written note on the front of the paper chart for the doctor to see in the morning.

LanaEl · Oct 1, 2016

That is kind of sad that your mentor would falsify documents like that. I certainly wouldn't want that pt to be me or my family :/

I'm a new grad and will soon be starting orientation in a rehab facility on nights. I will only have 5 days orientation as well. :dead:

Any tips/things not to do that you learned during your orientation?

Ruby Vee, BSN · Oct 1, 2016

That is kind of sad that your mentor would falsify documents like that. I certainly wouldn't want that pt to be me or my family :/
I'm a new grad and will soon be starting orientation in a rehab facility on nights. I will only have 5 days orientation as well.
Any tips/things not to do that you learned during your orientation?

I learned a lot from my first preceptor, but the message that sticks with me the most was unintended, I'm sure. I learned that it's not smart to drink alcohol before work and snort coke on break.

nurseburst, ASN, BSN · Oct 2, 2016

@Ruby and @Lana I think over the past few weeks I have learned a lot of WHAT NOT TO DOs and What to Dos... and there are more to come. You hear all the time to not pick up other Nurse's bad habits... you will probably be shown them, Lana and you just need to decide for yourself what the ethical and right thing is to do for your patients and to protect your license you worked your behind off!!!!

I think I've learned big time and from researching several articles that the workload I am given is nearly impossible. And this isn't an uncommon problem from what I can tell. So, I'll do the best that I can with what time I have and what I'm given.

It is incredibly scary when you talk to numerous nurses at your facility who refuse to work your hall due to the patients being combative and the workload being "impossible" (their words, not mine.) And then I had a day shift nurse tell me, "When I worked this floor at night I had no choice but to pre-pour medication which I know is wrong but if you don't... you will be here 2+ hours past your shift." And guess what? I am there everyday at least an hour after my shift. Sorry, but I'm not going to pre-pour meds because it can easily lead to a med error! Do things the right way no matter what for the protection of your license and more importantly YOUR PATIENTS!!!!!

Just trying to figure out how to get everything done on my shift THE CORRECT and best way I can!

@Lana, don't give up but get ready to develop some thick skin. You can do this. Your first year of nursing is the hardest and that is THE truth but I know it will get better!!!

@Ruby, I have been lucky to not run into that yet although I am SURE I smelled what is the distinct smell of weed on one of my CNAs when she returned from her "Smoke Break."

nurseburst, ASN, BSN · Oct 2, 2016

Oh, and Lana... at my facility they seem to want to try incredibly hard to keep me or any Nurse for that case. So, that means they try to be understanding and help you fix any mistakes you may run into. (Like Night Shift takes in new Meds from Pharmacy and I apparently messed that up... oops, only did it the way I was shown it!!! But I wasn't written up or anything and it didn't pose any harm to a patient.)

Just don't be afraid to ask questions, even if they seem stupid. And if you can - try to be orientated with more than one nurse. I orientated with a different nurse one night and it is incredibly beneficial to see how someone else runs the shift. I have a lot of people's cell phone numbers now and I text them if I have questions (well, if they are awake at 3am!!! haha.)

When you talk to a MD or ARNP working with the doctor, if you let them know you are new they will not give you a hard time if your report is not quite to their liking yet. Many of the Nurses who work there have been dealing with these same doctors for over a year or more... and you 1 day Don't be so hard on yourself but give them pertinent info.

If you can, have cheat sheets... one of the day shift nurses gave me 3 papers with #s for EVERYTHING AND EVERYONE. That includes cell phone numbers for doctors!!! I now carry this with me every shift and it is a life saver.

Figure out what brain sheet works for you. I have too many patients to fit on one sheet which erks me like mad but I'd rather it be legible and readable than cram 28+ patients on one page. I made my own.

If you don't know how to do something, or you aren't confident in that skill yet then don't do it yet without help from another Nurse. Better safe than sorry. Now, that isn't to say I haven't played with like their old IV pump until I figured it out and whatnot but anything that may cause harm to the patient - don't do unless you know it!

And just because one person does something (like signs off on this but doesn't do it...) doesn't mean you have to. So, yes, I do my dressing changes every night and just don't take any breaks (hopefully if I get fast enough I can take one )

But about breaks... we are SUPPOSE to take our lunch and 15 min breaks but I don't because I have so much to do in 8 hours. So, I'll drink and eat a snack when I am charting. So, if this ends up being you... (which I hope it doesn't) then at least try to take 5 minute mental breaks. And DRINK plenty of water. I am REALLY struggling with that because I am hardly at the Nurse's station and usually in a patient's room or at the med cart... and I don't want to be drinking at the med cart at least and definitely not in a patient's room! But get your routine down, taking care of yourself is important so you are ready to take care of your patients...

These are my tips as a brand new RN for 3 weeks! Sorry so long and hope it helps you even if it's a bit.

P.S. I've seen recommendations for buying good documentation books as well. I plan on picking one up next pay day as you don't really get a good course on documentation. In school it was mostly just, "Document or it didn't happen!" Yep, got that... but it is apparently an art. You want to make sure you are documenting properly, giving the right details, and protecting yourself. Some of the Nurses at your facility should be able to help a little with this.