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.

[Meriwhen, ASN, BSN, MSN, RN]

In my state you (the LPN/LVN) can't do initial assessments or create an initial plan of care, but you can do continuing assessments on a patient and report what is abnormal/different to the RN, and you can help update that plan of care as needed.

Based on what you tell us, it sounds like you did your job correctly. Sorry you didn't have as much support as you would have liked at work...wish I could give you a solution for that but you got some great tips from others in the thread. Hang in there--every day you get a little less green!

And don't let any negativity here get to you--internet forums tend to be like that at times...it's that pseudo-anonymity that can bring out the dark side in people :)

[HyperSaurus, RN, BSN]

Don't be sorry about starting this thread. As an RN student, I find it very educational to read this--it makes me wonder what I will face once I become a newly licensed nurse like you.

[rn/writer, RN]

As an AN Staff member, I'm going to ask thread participants to refrain from making this personal. It's generally not a good idea to take a few thoughts from a post and announce that someone has issues. By the same token, there is no need to take offense, even if someone is less than supportive. It's better to ignore or politely disagree than to turn this interesting discussion into a tug of war.

When you start a thread on AN you are putting your thoughts out there for others to see and perhaps comment on. Politely stated dissent is not the same as an attack. Even if the dissenter is wrong in their assertions, their posts are still within the bounds of the Terms of Service for allnurses.com as long as they don't resort to flaming (blatant disrespect). The best response to such messages is to either simply disregard the information or to post a calm and rational rebuttal.

Please, debate the issues at hand and not the individuals involved.

Thanks.

[Lorrie34]

I'd like to apologize. I did go on the defense when it was posted that I jeopordized my license. Not every fact was posted in the original thread. Nothing scares a new nurse worse than thinking they could be in trouble.

The fact is that I did act directly under the superivision of that RN supervisor at the time. Every action I took regarding my findings as well as hers was under her supervision. She was the one that called it to my attention to fill out the investigative report for the ADON and she even signed off on it.

In the end, she didn't totally fluff off my report on the resident, it was that she didn't see what I saw that upset me and prompted me to post this thread.

Despite her not seeing the rash, she did stand behind my report to a degree, being that she told me to fill out the report and notify the family.

I'm sorry for getting defensive.

[toninurse]

Here in Wisconsin an LPN can assist in the nursing assessment by collecting, reporting, and recording objective AND subjective data about the patient's condition at the direction of the RN. You are doing what you should be doing if your state laws are similar. I would document, document, document your findings so you are prepared, in the future, if you should have to go back to the issue with this patient or any other patient.

[toninurse]

Zak, I think you are wrong. You're from WI and practice the same scope of practice as I do (or did as an LPN). It may be your hospital POLICY that states an LPN cannot assess a patient but that's not the scope of practice for an LPN. For example, in nursing homes the LPN does not do the initial assessment on a resident but is required to assess and document on a daily basis.

[Kim, HHRN]

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.

I'd like to make a point here, as the devil's advocate. Just wondering, how could an LPN NOT chart her assessment? Are you saying that she can only report it to the RN who would then have to chart the assessment? That would be rather time consuming and expensive. Part of the collecting and reporting of the data is documenting the findings, regardless if you are an RN or LPN. Not only that, but what RN would document what someone else finds? They told us in nursing school not to do that unless you want to lose your license.

In my state

The Licensed Practice Nurse contributes to assessment of the patient by conducting

focused assessment of the client through collecting data, comparing the data collected to

the client's previous condition, and determining when, to whom and where to report the

data collected.

She did nothing wrong. She acted in a prudent manner. Now, if she did NOT report the findings, she could be found legally responsible because that is an error of omission but not for something that any prudent nurse would do in the first place.

Well, that's my .