New Nurse Horror Stories

[Baking Nurse]

I am wondering if any new nurses have had horror stories on a new job. I worked one 8 hour shift at a nursing home, It was horrible. I called the DON the next day and said I worked my first shift the night before and it would be my last. I then called the companies compliance hotline and the state.

Here are just a few things my "trainer did or told me"

1) If we don't have a med for the patient we just initial we gave it because we don't want the state to know we don't have it.

2) A patients 5 pm meds and 9 pm meds were given at 11 pm

3)Meds from the day shift were not charted as given and I was told the day nurse would get caught up with her charting the next day:down:

4) If you realize later you forgot to give a med - just chart as refused :argue:

5) A patient fell and they put him back into bed and said he did it all the time so they don't do any reports.

6) Gloves not worn to do accu check or give insulin - and don't wash your hands too much because they will become chapped. Hand sanitizer not available for use:smackingf

7) Several times - if a patients med was not available, the took another patients med to give. She also broke a postassium 20 mEq with her hands that was one patients to give to another patient that was ordered 10 mEq.:grn:

8) One patient was not to receive a dose of meds that day but was to get it the next day. The next days dose was already marked as given. I was told the nurse that gave that dose would see it the next day and skip it.:angryfire

9) Patient ordered Vit D 1000 IU and Vit D2 50000 IU. In the drawer was Vit S 1000 IU and Vit D 1.25 mg. I was told the Vit D 1.25 mg rounded to Vit D2 and since it was in the patients drawer it was his and thats what we give.

I was then told that this was real world nursing and I better get used to it (I was actually told to take off my rose colored sunglasses). I went home and threw up. I pray I hear about a hospital job I interviewed for last week!!! I will never do their type of nursing.

[oncnursemsn]

Lindarn- thank you! Fortunately this was in CA and was over 15 years ago when I didn't know much better. We were told that NO overtime would be paid, and we *must* punch out for meals (that were worked) and punch out on time. I was naive. Didn't last long and am wiser and happier today. Teach full time, work on a great BMT unit in Boston part time. And paid really, really well for every hour I work. Educating my students about "real world" nursing, but we have a way to go.

[lindarn]

Lindarn- thank you! Fortunately this was in CA and was over 15 years ago when I didn't know much better. We were told that NO overtime would be paid, and we *must* punch out for meals (that were worked) and punch out on time. I was naive. Didn't last long and am wiser and happier today. Teach full time, work on a great BMT unit in Boston part time. And paid really, really well for every hour I work. Educating my students about "real world" nursing, but we have a way to go.

PLEASE teach your students the law concerning things like this. The lack of preparation for the real world of nursing employment leads to workplace abuses, such as this. Nurses have no idea what their rights are in the workplace, and they are "run over" by administration. Perhaps partnering with a local community college that runs a paralegal program would be a welcome addition to the nursing program. They teach Employment Law to paralegal students, and also Administrative Law. I have stated many times on this listserve that ALL NURSING STUDENTS WOULD BENEFIT FROM TAKING THESE CLASSES!! Expect flack from hospitals in the area who, without a doubt in my mind, would object to future nurses learning how to stand up for themselves, and not be taken for a ride in the workplace. The last thing hospitals and nursing homes want is for nurses to know their rights in the workplace.

I strongly disagree with individuals on this listserve who state that all they want to learn in nursing school is classes on how to be a nurse. These classes would be, what I call, "quality of life classes". As I have already stated, there is more to being a nurse, or any other profession, than the "how to's". Learning how to practice safely, and protecting yourself from abuse is just as important as learning how to make a bed, calculate drug dosages, and sterile technique. As well as learning how to effect change politically, within a system or organization, or in the state and community we live in. Nurses do not learn how to lobby for political change, and it has been our down fall. Just look at the AMA. They make everything their political agenda. We need to learn how to emulate successful organizations and career fields who have made positive changes in their professional practice. JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[PedsAtHeart, LPN]

I agree. It used to drive me nuts when patients would have meds at 0600, 0630, 0700, 0730, 0830, 0900, 1000, 1200, 1300, 1400, 1500 etc. etc. Pharmacy and the physician need to coordinate to make this possible in as few time slots as possible.

Also, I tend to believe that nursing home patients are overmedicated anyway. Polypharmacy is a serious issue that rarely gets addressed and patients suffer because of it. What is the overall effect of combining 20 different medications all at the same time? No one really knows the answer. Therefore the poor patient becomes a human guinea pig. I wish that more physicians would try to see the "bigger picture" when prescribing drugs for their patients. In the end its more about quality of life than quantity of drugs.

But as nurses we are not the ones to make that decision. I'm not saying the Dr's and such couldnt coordinate better, it would make things sooo much easier for the nurses and the patients, but if you do anything that was not ordered by the physician and something were to happen... who's license would be on the line? your's. mine. I have worked to hard to get to where I am to have that taken from me.

[Dolce, RN]

But as nurses we are not the ones to make that decision. I'm not saying the Dr's and such couldnt coordinate better, it would make things sooo much easier for the nurses and the patients, but if you do anything that was not ordered by the physician and something were to happen... who's license would be on the line? your's. mine. I have worked to hard to get to where I am to have that taken from me.

I agree 100%. It is not our position to change the schedule. But, we need to encourage pharmacists and doctors to think about things before they order are time drugs.

[Coastie_wife]

After working in LTC for about 6 years straight, some of the OP's reasons are why I left for almost 2 years and questioned if I really wanted to continue nursing. The borrowing meds, initialing for meds not given, because they will catch hell if the state sees a med circled as unavailable, giving meds all at once regardless of time. I have seen this repeatedly and it makes me sick just writing this.

[Nightcrawler, BSN, RN]

I agree 100%. It is not our position to change the schedule. But, we need to encourage pharmacists and doctors to think about things before they order are time drugs.

I have to disagree with this a little bit. As a night shift nurse who checks the MAR's for the next shift, I will often re-time medications that were timed inappropriately by pharmacy. Our pharmacy will automatically time everything out that was ordered as TID for mealtimes, and this is inappropriate if it is a blood pressure med, or a pain med that should really be given q 8. Our hospital also times all Protonix and Synthroid for 0730, and I will regularly give these meds early when doing other care for the patients- but chart the time that I give it.

Physicians rarely write orders that say "Give colace at 06, give metoprolol at 07, and give Protonix at 08." All of these medications were probably written as daily, and were probably entered on the MAR by different pharmacists.

I don't know specifically how things work in LTC, but medications should be given as ordered, and if ordered daily can be given and timed in a way that keeps the resident from having to be disturbed every hour, yet not have to swallow 20 pills at a time. If you have MAR's that tell you to do either of these scenarios- then the timing should be edited by the RN on the current MAR, and the future MAR's corrected by the pharmacy.

There is such a thing as nursing judgment, and unless the MD ordered the medications to be given at specific hours we can use that judgment to give patients appropriate care.

All of that being said, I am in no way condoning the behavior of the nurses described in this post, merely stating that MAR's aren't always inviolate.

[angelonsunset]

I know exactly what you are talking about. I went to the DON. I can just say. Be careful as to what you say. Because it may harm you instead. Because they are aware of everything. And now that they know that you know what is going on well, just watch your back. I didn't.

[MelodyRNurse]

After working in LTC for about 6 years straight, some of the OP's reasons are why I left for almost 2 years and questioned if I really wanted to continue nursing. The borrowing meds, initialing for meds not given, because they will catch hell if the state sees a med circled as unavailable, giving meds all at once regardless of time. I have seen this repeatedly and it makes me sick just writing this.

I agree with you, they do not tolerate holes in MARs/TARs, they make it like there is something you did wrong, not them. I don't initial if the med is not available, I circle and leave a note on the back, which I have been told not to do, but in my opinion if the med is not available it is the facilities problem and they should catch hell because they need to do something about it. We are expected to get that drug, even if we have to personally call the doctor, get an order, and pick the med up at the pharmacy ourselves. How unfair, because then we get in trouble for working past our shift. The last five shifts that did not order the med, however, do not get written up and neither does the stupid pharmacy who failed to send it if it was ordered. You cannot win.

I am not at all criticizing those of you who do initial because I know how these places are, we all need our jobs. It just makes me soooooo sick that things are run this way.

Thanks for letting me vent.

[canoehead, BSN, RN]

But as nurses we are not the ones to make that decision. I'm not saying the Dr's and such couldnt coordinate better, it would make things sooo much easier for the nurses and the patients, but if you do anything that was not ordered by the physician and something were to happen... who's license would be on the line? your's. mine. I have worked to hard to get to where I am to have that taken from me.

I disagree, if the meds would be better for the patient on a different schedule then we can go to the doc and get them ordered that way. Or ask for BID, TID, QID etc instead of Q8H, Q6H, when appropriate so we're not going in every two hours. In some cases asking about DCing meds would be appropriate too- like Aricept for the bedbound Alzheimer's patient, or lipitor for anyone over 80- what do they think it will do at that point? Sometimes the struggle of getting the med in is not worth the good the med might do, depending on the patient.

[queen777]

No offense to you, but how can the DON not know what's going on?

The LTC I work in occassionally, is notorious for MARs not being intitaled, missing meds and borrowing, and nurses combining med passes without prior approval from the MDs. And the dayshift expecting the nightshift nurse to give some of their AM meds with the 6 am med pass.

And that DON knows this is going on and approves of it.

They have to know what's going on....if she doesn't know then she's not doing her job. She should be out there checking and observing some med passes.

Of course, some of them can know and still not be doing anything about it.

Excuse me, but a DON can know what is going and do nothing. Let me explain.

I was working 3-11, just starting working at this particular nursing home on their subacute floor. One day I was going about my business giving a pt her boluse tube feeding of Jevity Plus. In walkes her daughter and askes, "how are Mom's AccuChecks?" I kept my cool and ask, "Your mom is diabetic?" So needless to say I stopped the feeding.I went to the MAR and checked it, nope, no one had even put the diagnosis in the MAR! So I went to the head nurse and reported this. She said to take her AccuCheck. It was 432....so we looked in her chart...yes we found a sliding scale, but it only reached a blood sugar level of 300. So I called her doctor, but didn't get her doctor...got the physician's asst. instead. To make a long story short, I got a new order, but didnt' have the insulin he ordered.

I was on the phone calling him back to tell him so and another LPN walkes up to me, took the phone out of my hand, said, "cancel call" and hung up the phone!!!!!!!!!!with the DON standing right there!!!!!!!!I was fit to be tied. This other LPN was going home, so she was out of there while I was left to figure this mess out.

I guess the pt's daughter had gone to the DON behind my back because she was standing there with her and said "I want my mom to get her insulin". WOW.....I was not prepared for this.

Later I took her sugar again and it was going up. I was so shocked by all of this that I had another nurse call the doctor back. I gave her insulin but it wasn't what he ordered. That is a complete NO NO.

I called the DON the next day and told I quit because she didn't trust me to take care of the situation and that I could not work under those circumstances. She said she understood. So I went back anyway.

Another horror story....A lady was going into resp. failure and I called the ambulance..etc,....(this was the same nursing home)......it was 5AM. No one had briefed me on sending out a pt, so the nurse from long term floor helped.....but the RN head nurse had come to work...I paged her......found out later she was outside smoking! Sure could have used her help. Anyway I got that taken care of and this RN said,"you could have given her Lasix IV push!" Its only against the law to do that for LPNs.

I did quit.

[queen777]

I disagree, if the meds would be better for the patient on a different schedule then we can go to the doc and get them ordered that way. Or ask for BID, TID, QID etc instead of Q8H, Q6H, when appropriate so we're not going in every two hours. In some cases asking about DCing meds would be appropriate too- like Aricept for the bedbound Alzheimer's patient, or lipitor for anyone over 80- what do they think it will do at that point? Sometimes the struggle of getting the med in is not worth the good the med might do, depending on the patient.

I ran into that a lot of times in nursing homes with applying creams. Most were never even opened, but had been signed off as given. One nursing home's CNA's asked "you are going to do the treatments?" Yes I said. I asked then "Don't other agency nurses do them?" "NO" "they sit at the nurses station".

[queen777]

I have so many horror stories, that was the many reasons I quit nursing. No one took responsibility!