new rn supervisor

[ellexias]

I have started a job as a rn supervisor. I am a new grad and totally lost. My orientation was 2 days with lpn's that had attitudes toward rn's. The facility is going through management changes and a new ownership. The procedures that I have to do are foreign to me, like a pt. is on tpn and we mix medications. I have never done this before and the dayshift rn said mix according to 1 liter but there is 1.6 liters. The lpn's borrow medications from a pt. for another pt. Is this not illegal? They do this with narcotics also. There was a pt with chest pain, full code, dr says send but pt doesn't want to. Pt gets on the ems stretcher and later the hopital er nurse called and said we kidnapped him. What is she talking about? I feel like I am being set up to fail. I have a little hospital expierance but ltc is so confusing. Any advice?

[jeffgordanfan]

That home is a mess....get out NOW!!!!! There are far better out there, I know as I have been there. This sounds like a home that will take anything and everything because they have to in order to keep up census. You need more training/orientation and if they aren't willing to provide it LEAVE..that is your license you worked long and hard for....never forget that.

[traumaRUs, MSN, APRN]

You're a new grad and I'm sorry to tell you, but they are taking advantage of you. I too second the "get outta there" sentiment.

[CapeCodMermaid, RN]

You're a new grad and they hired you as a supervisor??? No offense but shouldn't that have tipped you off to something? Why did you apply for the job in the first place?

You have 2 choices-run like crazy now to get out of the place or sit down with the DNS and let her know you need some real orientation to the facility and your job description. If I were you, I'd choose to leave. You are not prepared to be a supervisor since you have little to no experience in skilled nursing.

Try to find a facility which offers a good orientation and, yes, we are out there. My facility gives a 4 week orientation to new grads which includes a lot of 1:1 training with a seasoned (she'd shoot me if I called her old!) nurse manager and then pairing up with one of the staff nurses to learn the routine. It works out well for us...it's expensive but in the long run our retention rate is very high and the nurses are trained the right way. Good luck and let us know how you made out.

PS. Most skilled facilities, at least around here, no longer hang TPN.

[LesMonsterRN, ADN, RN]

I agree with the other folks - get out quickly. And yes, I'd have to agree with CapeCodMermaid - you need more of an experience base in LTC to be an effective supervisor. The fact that they hired you as a new grad makes me think that they're desperate; you don't need to work in a facility that thinks they have to grab a nurse just for her title and not her experience base. You worked too hard and too long for that precious license to have it devalued in that way by an employer. Good luck!

[txspadequeenRN, BSN, RN]

lol!!! i am not laughing at you, but welcome to ltc. not all ltc's are this way but a lot of them have serious issues. i agree the place is desperate to have a rn in the building. you really need ltc floor experience before you can adequately supervise over one.

[TheCommuter, BSN, RN]

The lpn's borrow medications from a pt. for another pt. Is this not illegal?

It's perfectly legal to borrow meds from 1 patient and give them to another in LTCFs. If Mr. X runs out of his Norvasc and the pharmacy isn't going to deliver it until tomorrow, I must borrow the Norvasc from another patient's supply to ensure that Mr. X receives the med that was prescribed to him. If I simply do not give the Norvasc, it's a medication error. In addition, if Mr. X's blood pressure spikes because I failed to give his Norvasc, I'm liable.

There was a pt with chest pain, full code, dr says send but pt doesn't want to. Pt gets on the ems stretcher and later the hopital er nurse called and said we kidnapped him. What is she talking about?

Even if the physician gives the order to send a patient out, a fully alert and lucid patient has the right to refuse to go to the hospital. Patients have the right to refuse medications, treatment, appointments, trips to the hospital, and emergency care. All you can do is completely and meticulously document the patient's refusal to be sent out to the hospital.

I agree with TxSpadeQueen that you need some LTC floor experience before you can ever adequately supervise the people who work there.

[txspadequeenRN, BSN, RN]

it may not be exactly illegal, but it is a wishy washy practice and against most facility policies. if the staff did their job of reordering meds on time then you would never run into this situation.

it's perfectly legal to borrow meds from 1 patient and give them to another in ltcfs. if mr. x runs out of his norvasc and the pharmacy isn't going to deliver it until tomorrow, i must borrow the norvasc from another patient's supply to ensure that mr. x receives the med that was prescribed to him. if i simply do not give the norvasc, it's a medication error. in addition, if mr. x's blood pressure spikes because i failed to give his norvasc, i'm liable. .

[TheCommuter, BSN, RN]

it may not be exactly illegal, but it is a wishy washy practice and against most facility policies. if the staff did their job of reordering meds on time then you would never run into this situation.

however, i only work doubles on the weekend, so i've gotta do what i've gotta do to ensure that the meds are given. i hate arriving on saturday morning to find only 1 pill of a certain medication remaining in the blister pack, and the reorder sticker was never removed and faxed. 1 pill of a certain med is not going to get me through 32 hours on the weekend, especially if it is something like reglan, which is to be given 3 to 4 times per day.

[SuesquatchRN, BSN, RN]

Oh, you poor thing, your post has me laughing out loud over here!

Welcome to LTC.

[noc4senuf]

Not sure if it just different states or not but, it is illegal to borrow from another resident's medication supply. If we are in need of a medication that is out of stock, we have to call the pharmacy and have it sent "stat" and not wait for one of the two daily deliveries.

Orientation of any nurse in my facility involves two days in the classroom and then orientation on the floor with a seasoned nurse. The floor orientation can take from two weeks up to a month depending on how quick the nurse catches on.

To become an IHC (in-house charge), the nurse has to have been in our building for 6 months first. That ensures they know the workings of the building itself before taking on the responsibilities of other staff and the residents.

I also agree with some of the others that you need to leave that facility and find one that will be more responsive to their staff.

[txspadequeenRN, BSN, RN]

yes , i understand ...i too work double weekends. i don't know who thought up the regulation that if the med is not there then lets write up the nurse. especially, when i can walk into my job saturday morning and have numerous meds missing ( not really a problem at this job, but previous jobs yes) ,so i have automatically created med errors. a lot of times it's the pharms fault too. i spent half of last sunday fighting over lactulose , which i had ordered already 3 times.

aps only delivers to us once a day

however, i only work doubles on the weekend, so i've gotta do what i've gotta do to ensure that the meds are given. i hate arriving on saturday morning to find only 1 pill of a certain medication remaining in the blister pack, and the reorder sticker was never removed and faxed. 1 pill of a certain med is not going to get me through 32 hours on the weekend, especially if it is something like reglan, which is to be given 3 to 4 times per day.