Dear Nurse Beth,
I recently started a new job at a small rural hospital that when I was hired was told my title would be Night RN Charge. I quickly found out my actual title was House Supervisor and that I was expected to help out in ER. Well okay I did tell them that I have limited ER experience which was back in the 90's and that I am not competent to know what to do nor how to do it with anything critical. They mix most everything here and I am expected to know how to mix meds such as Drips and take it to the ER and they hang the drip. I feel like I am jeopardizing my license. Should I just look for another job? I feel like I may harm someone with my not knowing what to do in an emergency!
Dear House Sup,
In small hospitals it's not unusual for nurses in leadership roles to wear more than one hat but one of the hats you are wearing is Pharmacist if you are mixing and dispensing meds. Back in the day, nurses used to mix many of their drips, but in subsequent years CMS focused on admixtures with increased regulations. In response many hospitals developed training and competencies for nurses who did this during an emergency. Note that reconstituting (such as adding a diluent to a powder) is not the same as admixture (adding medication to an IV infusion).
Then again, you are a rural hospital, and if you are a designated critical access hospital, rules are different and not as stringent. Critical access or not, mixing meds when you are uncomfortable with the medications and dosages is a personal liability for you.
This is all to say you must find out your policy's policies on admixture. If they don't have one, that tells you they are naive to regulations and that alone is a red flag. Clearly written polices and job descriptions protect you.
In the meantime, be very conscientious about labeling. Review your ACLS if you respond to codes. Familiarize yourself with the code sheet so you can take the role of scribe. As House Sup your primary role during a code should be to find an ICU bed and adjust staffing as needed.
Have a talk with your manager around job expectations, and be specific with your questions. For example, if you are expected to help in the ED, will you be provided orientation and training in the ED? If you cannot reach a satisfactory understanding, you may want to re-consider the position.
Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!