New Nurse Rant

[Lorrie34]

I just need to vent and see if I'm the only newly licensed nurse that has been made to feel like a complete Idiot by their superior nurses.

I graduated LPN school in December as valedictorian of my class. I passed my boards with the minimum number of questions. Prior to becoming an LPN, I worked as a Medical Assistant for 14 years.

I just came off of orientation at my new facility. I work midnights and there are a lot of challenging nights for us with the sun-downers etc. It usually seems happen that once one starts climbing out of bed, they ALL do and the 2 LPNs and 1 RN on duty quickly feel overwhelmed with chasing residents back to bed or doing one-to-ones and/or filling out incident reports on top of our "normal" duties for the night.

I can understand that when a resident has already fallen out of bed and possibly injured themselves and needs sent out to the hospital, the last thing the RN wants to hear is the other LPN report to that she has another sour resident. HOWEVER, if this were to happen, for the RN to brush that LPN off and tell her she is mistaken in her assessment findings makes that newly licensed LPN feel so stupid and doubt herself!

I had a non-verbal patient that is completely bed ridden and contracted in all 4 limbs. The previous shift reported that he was running a low-grade temp off and on but seemed okay. So I go in and check his temp which is normal, and decide that something might be brewing with him so I better look into it...I do a quick listen to the lungs and hear wheezes bilaterally. Then I notice a rash on him. It was not an obvious, blazing rash, but the rash was on the majority of his body. Thinking to start with the simple, I remove the extra blankets from his bed in hopes it is heat rash. Then I take my findings to the RN.

When my RN follows up with her assessment on it about an hour later, she comes back and reports no wheezes, no rash. "humpf, well, maybe I'm stupid and don't know my lung sounds, and guess it was just heat rash...but it was on his face and head too...?" so I promptly go back to his room to see for myself, and....I STILL SEE THE RASH ALL OVER, AND I STILL HEAR THE WHEEZES!

So I quietly sit down and decide to chart on it anyway to cover my butt, then I fill out an investigative report and put it in the ADON's mailbox for the morning. When I gave report to the oncomging shift, I informed them of MY findings and of the RN's findings.

When I came back on for my next shift that night, that resident had been sent out on daylight and admitted to the hospital with PNEUMONIA. I asked the RN that sent him out what made her send him and she said "He had a funky red rash all over him and he had wheezes and a low-grade temp so I just figured I better send him". Well, whadya know? Somebody else saw my mysterious rash?

This is not the first time this has happened to me and it isn't just with one RN supervisor! They all know I'm a "New Nurse" and I really feel like my assessment findings are not being counted on as accurate and it's making me MAD!!

When I report something and get fluffed off, I want to tell them "Look, I know I'm a newly licensed nurse, but I AM A LICENSED NURSE. SBON felt I have enough knowledge to provide safe NURSING CARE so please don't dismiss my assessment findings just because I'm new. I may not have seen and done it all yet, and I realize that you have been doing this for however many years, but maybe possibly at some point, we might cross something that you haven't seen in awhile and it isn't fresh in your head, but I just learned about it in my schooling and it's still in my memory bank so maybe I might catch it, and you might not--THAT'S OKAY!! We are supposed to be working together to provide high quality nursing care to every one of our residents. If you ignore my assessments and reports, that can't happen. I need to know you trust me as the nurse that I am!".

Being a Green Nurse stinks! But one thing is for sure, the next time I find something abnormal and my peers try to dismiss it "because I'm a new nurse" I'm not going to back down! I'm going to jump up and down and flap my arms and yell "Let's go assess the resident together because I'm sure I'm finding something that needs a second look!!!".

How could I let somebody make me doubt myself? A rash is a rash. It is either there or it isn't. I've listened to enough lung sounds by now to know wheezes now too. It would be kind of hard for somebody to say they see a rash and have it turn out that there isn't a rash so why did I let her let it go? I just need to stand up for myself and earn their trust.

[goodstudentnowRN]

Calm down...Everywhere you go it is the same. Some of these nurses believe they know it all and most times they are the ones who make the more serious mistakes. Let them have their 15 minutes of fame and continue to do your job.

[GN Dave]

Well, you were right, but even when you are right you are wrong, because it's the RN's job to assess the patient, not yours. You are licensed, but charting assessments is out of your scope of practice. You need to read your Nurses practice act for your state, which will tell you what is, or is not, in your scope of practice. Assessing patients takes an RN, so if you are charting assessments, you are beyond your scope of practice, and are actually practicing as an RN without a license, and can be legally culpable for it. You can gather data and report it to the RN, but anything more could get you in deep trouble if the RN pushes the issue.

[Lorrie34]

Umm, I'm not sure how you say that I'm out of my scope of practice to chart on abnormal findings. Maybe you are in a different state? But I am obligated to document if there is a change of condition in a patient on my assignment AND report it to the RN for further action. I do have to do head-to-toe assessments, we were taught that in school. I have worked at another facility since getting my license and they too had us doing assessments and charting. When I say that I assessed the patient, I mean that I took vitals, listened to lung sounds. That is absolutely within my scope of practice as an LPN in my state. If it were not for the LPNs doing the inital "assessment" of the patient and getting the vitals to report to the RN, quite honestly, the RN would never have a clue if a patient is going downhill because they are glued to the desk with all the paperwork and they only manage to get to check a patient when the LPNs tell them something is up and they need checked.

I thought this forum was for new nurses to support each other, but from your reply, all I get is yet another person trying to make me feel STUPID, and like I don't know my SCOPE OF PRACTICE and I'm jeapordizing my license...not what I really needed and you are wrong. I'm within my scope and I'm done with this forum thanks to conceited know-it-all jerks on powertrips like YOU.

[GN Dave]

I say that you are out of your scope of practice simply because you are. Then you chart the fact to prove it. Not trying to push your buttons, you asked for opinions, and I gave one. Attitudes like yours are what eventually costs licenses... do as you want, in the end it's your license to lose. The other thing you should think about is "everyone is treating me like I'm stupid"... so, everyone else is wrong, and only you are right? You must have a lot of issues...

[HyperSaurus, RN, BSN]

Lorrie34, calm down. Not all of us think you're stupid or necessarily acting beyond the bounds of your license. You two are from different states, so I would disregard Zak's post.

Regarding your original post, I'm sorry you're going through that. I'm, obviously, not graduated, but I think you make a good point that you may be newly licensed, but you are licensed nonetheless. It must be frustrated to be blown off like that. I'm not sure how this would work, but you could ask them to come watch you do the assessment and follow up next time you do see something funky and they are inclined to ignore. Or, you could just, politely, say, "I am new, but I am licensed, and would appreciate if you could respect that and follow up on what I am reporting to you."

Good luck

[HyperSaurus, RN, BSN]

Zak, there's another thread discussing the scope of LPN practices between states. You should take a look--In some states, they are permitted to perform assessments and report somthing that is wrong to the RN, which Lorrie did. Calling names or insinuating that she 'has issues' is hardly the most constructive way to provide feedback.

[GN Dave]

Zak, there's another thread discussing the scope of LPN practices between states. You should take a look--In some states, they are permitted to perform assessments and report somthing that is wrong to the RN, which Lorrie did. Calling names or insinuating that she 'has issues' is hardly the most constructive way to provide feedback.

Hey, she's the one in attack mode, so yes I think she has issues. I doesn't matter what state you are in, LPNs do not assess, that is the pervue of the RN... LPNs do collect data and report to the RN, and yes they can chart the data, but what she was saying is that she charted an "assessment" which is not allowed. She should do an entry, such as "Rash noted on upper extremities, RN notified." But to chart as assessment, and then go over the RNs head to the ADON, well... her job and her license won't be long to this world. NOT trying to pick on anyone, just giving an opinion from an EXPERIENCED nurse...

[Fiona59]

Hey, she's the one in attack mode, so yes I think she has issues. I doesn't matter what state you are in, LPNs do not assess, that is the pervue of the RN... LPNs do collect data and report to the RN, and yes they can chart the data, but what she was saying is that she charted an "assessment" which is not allowed. She should do an entry, such as "Rash noted on upper extremities, RN notified." But to chart as assessment, and then go over the RNs head to the ADON, well... her job and her license won't be long to this world. NOT trying to pick on anyone, just giving an opinion from an EXPERIENCED nurse...

It is within my professional scope to assess and chart. I can even call the doctor.

But wait I work in Canada. Thank god.

[abbnurse]

I think it sounds like you're doing a great job. You made a very astute assessment (yes, LPN's DO assess patients in Ohio!) and your actions thereafter were totally appropriate. I do agree that sometimes "older" nurses (like myself,haha) can become blase' and can actually dismiss things that they wouldn't have dismissed when they were first out of nursing school. I love working with new nurses for the very reason you wrote about. I would be happy to have you taking care of me or a family member! Don't let the negativity get to you....you worked hard to get your nursing license and you sound like a good nurse. You will likely be a great mentor to new nurses when you're old like me! Take care.

[Lorrie34]

Thanks to everyone that replies with SUPPORT. Zak, to you, where do you get that I went "over the RN's head" and reported it? If the LPN finds an abnormality on their assessment, we are required, by my facility to fill out an investigative report for the ADON and to chart our findings stating "RN made aware" which is EXACTLY what I did. The RN saw me fill the paperwork out, she knew I had to! My license is NOT nor will it EVER be on the line for me reporting what I see on patients on my assignments. The only issue I have is with people that are on support forums and are so quick to point out "mistakes" and form judgements without understanding the whole story. Did you really read my thread? Just because I referred to it in my thread as charting my "assessment" does not mean that I charted it as "my assessment". Who is the one with the attitude and issues here, Zak? I did not waiver from my scope. I followed protocol. My RN is aware and has no problems with my charting or completing the required form. Wow. You are on some powertrip here with this.

[Lorrie34]

Furthermore, the RN did have me call the next of kin to inform them of the rash etc. I was upset that she didn't have the same findings on her "official omnipotent RN ASSESSMENT". That was my only gripe when I posted this thread. Sorry I ever did now....