Noting physician orders

[chiuli]

Charting is a world that Im lost in. Nurses notes are easy but checking the new monthly orders is hard.

In my facility, you compare the new orders against last months. About 99% of the medication orders are unchanged except 1 or 2. How do I know if the doctor didn't add the new medication by mistake? Is there a way for me to know? Also, the lpn who writes the orders confuses me because she'll write a new medication order without writing that the other medication is discontinued. The patient was on 0.25 mg Ativan and the new order was .5 mg Ativan. She did not write that the 0.25 mg was d/c so I assumed the patient is not getting 0.75 mg. Thankfully someone caught it. The nurses who work with me day shift and evening are old and nasty. They refuse to teach me things when I ask for help. They just send me to do treatments which is checking blood pressures and weights, feeding the residents ensure, and doing wound care. We dont have foleys or suctioning or oxygen. They then criticize me and say things like, "you could have done that faster." or when I did wound care they'll ask the obvious like if I put on the 4x4 gauze. I left the Ensure in the residents room after she requested it stand for half an hour because its too cold for her to drink. When one of the nurses found it, she said, "where is that girl? I am going to twist her neck." I want to cry

[blamejoe]

Your coworkers need to be reported. They're not playing for the same team as you, and in fact it sounds like they are against you. Regardless of their intention, stating that they will wring your neck is an overt sign of lateral aggression, and I doubt your human resource policy would support that. Nurses eat their young, it's true, and it probably will never end due to the nature of the occupation (sadly). However, there are two solutions to keep you out of the food chain - either all new nurses will work elsewhere and the oldies will starve to death, or round them up and hunt them down using the ammunition that HR provides. You shouldn't be made to cry at work by your colleagues. Ever.

[indigonurse]

If you have a question about an order then you need to call the MD and clarify it. As far as the ensure thing goes if it is ordered to be given at a certain time then the person needs to drink it at that time. If the res. is refusing to drink it, or does not want it cold then you should find a can that has not been refrigerated. If you cannot do that then you can take the can with you and bring it back in 30 minutes. Nourishment left at bedside looks like it was not offered. Then you can't chart it given until they finish it. If someone has an issue with your time management you might want to ask them to go with you and let you know what you need to do to get it down quicker. The situation sounds like a ball of frustration.

[DC Collins, ASN]

Ugh, get out if/when you can. A hostile environment is no place to work.

Sending good thoughts your way.

DC, ED RN

[CoffeeRTC, BSN, RN]

Are you on orientation? Have you spoken to your DON about this or even went to the nurses that should be training you? What happenes when you come off of training...you will be lost.

Every facility has their own policies about how to do change over but the basics are that you look at all of the orders for the month and make sure they are on the new month's MARS, TARs and monthly order sheets. You will need to look at the last months order sheets and the newer orders. If you see any in question, that is when you should call the doc for a clarification order. You might also need to see if monthly labs were scheduled or other labs are carried over to the next month.

A lot of times some nurses will just check the current MARs and TARs with the new ones.....this is where orders can get missed...bad practice.

[General E. Speaking, RN, RN]

:hug: Just wanted to say it's those nasty older nurses that give the rest of us *seasoned* nurses a bad name. We're not all like that.

It is a toxic enviroment and they seem intent on spewing their Nurse Ratchett vileness on others. I would imagine mgmt is aware of this but turns a blind eye and doesn't want to or isn't willing to get involved. I would get out as soon as I found another job. It's not worth your sanity.