"newnurse" syndrome?

  1. Question... being a brand new graduate nurse, I watch...a LOT... because I want to learn and emulate those around me. I see some things which I know are right and good, and some things which I question. Now I must wonder... when is it appropriate to bring something to the attention of your DON ? I saw something take place last week which really bothered me, but I keep thinking maybe it's just that "newnurse" thing.. perhaps I'm being overly picky, etc. And I simply HATE being a "tattletale", so now I'm torn.

    Perhaps you can give me some sound advice here...
    One of our patients had a subclavian cath replaced a week ago and when he was returned to our clinic for dialysis, he had orders to receive Tobra for x amount of days...which he did. Last Sat., our charge nurse slapped her forehead at the end of this pt.'s treatment as she was taking him off, exclaiming "DARN !!! I forgot to give him his Tobra!" She had not yet returned all his blood and would have had plenty of time to give it over the 20 minutes required by running him a bit longer on the machine (even without pulling any more fluid off..) But it was Sat., and she had plans for the day which she told us about earlier. I watched as she hemmed and hawed, deciding what to do about this. She really wanted to go home, and he was our last patient. After going back and forth for a few minutes, she went ahead and took him off the machine, and he did not receive his Tobra even though it was ordered for that day. We would not see the patient again until the following Tues.
    What bothered me was that she made a deliberate decision not to give it, although she could have. And the patient needed it. To me, it was as if her plans were more important than the patient.

    I did not question her about it because she KNEW she SHOULD have, or she would not have deliberated so long over it. What could she have said? She knew what she was doing, and choosing to do. She didn't try to hide it. Nor do I have my State Boards behind me yet, so I'm not "really" a nurse yet and didn't feel right about questioning her judgement.

    So what do you guys think? Personally, I think she was wrong and negligent. What annoyed me most (besides the patient not getting the antibiotic) was that she's the charge nurse and should be setting a good example. I was very disappointed and now don't know that I want to learn from her. Am I wrong to feel this way? Am I being to "new-nursey"? Too "by the booK"? Do I mention this to our DON (who was not there that day) and risk being a "rat" or do I just overlook this incident and keep in under my hat. I hate being in a position like this...need some advice here.
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    About jnette, ASN, EMT-I

    Joined: Aug '02; Posts: 21,359; Likes: 7,204
    Home Health Patient Education Resource Nurse; from US
    Specialty: 10 year(s) of experience in Hemodialysis, Home Health


  3. by   joannep
    Hi, I would be inclined to think this patient was an inpatient? yes? If so could she have handed over to the ward that he didn't get his dose and they could have given it, and you are not aware of this?
  4. by   jnette

    No, this is a freestanding clinic. Our patients come 3 x a week. We would not see this patient again until Tues. He was to be given the med that Sat. during his treatment toward the end of the treatment.
  5. by   gambroRN
    First of all, let me say that I'm sorry that you are feeling stressed out over this particular nurses negligence. I too am a dialysis nurse, and worked in many areas of nursing prior to entering dialysis. I feel that the field is rampant with these type of nurses who concentrate more on moving them in and out - then concentrating on the patients needs. Just the fact that she is the "charge nurse" says it all. She indeed is not setting a good example for a new grad. or for the profession as a whole.
    Personally, I would not comment on it to my DON at this time (I take it you are a GN). Take it from where it comes, and practice nursing as you would want a family member cared for and you'll do fine. Good Luck!!!!!!!!!! I just left my dialysis position to return to acute care.
  6. by   jnette
    Thanx Gambro !
    I've been there 5 yrs. now as a tech, now a GN as you said. I LOVE it, have always loved it, and dearly love my patients. We're a small clinic..(approx 28 pts.) The other nurses there are VERY caring and competent.. this one is rather new (at OUR clinic..she's been in dialysis for more than 10 yrs, tho'...) and from what I've observed, pretty slack about a LOT of stuff. But I believe I'll take your advice.. just do what I know is right. Still bugs me tho'....
  7. by   renerian
    Yes I agree with Gambro. He should have gotten the medication. I wonder if she filled out an incident report for the missed medication. We had to do that if we could not give a med when there was an order..........

    sounds fishy,

    your in a tough spot

  8. by   joannep
    Hi jnette, I should have mentioned that I am a dialysis nurse when I first answered your post. I agree with Gambro and am really puzzled how she justified this situation with her conscience. At our unit we wouldn't have hesitated doing the extra time.
  9. by   jnette
    Thanx everyone... just needed some input there. I did end up discussing it with our DON, because she could tell something was bothering me and asked me what it was. I told her what I had observed and didn't know how I was to feel about it or what to do or say...
    She was very understanding and ageed that per protocol, it should have been given. She added that we are all human, and we sometimes make wrong choices. She said she would have been more concerned if he had been febrile, chilling, etc.,.. and that he was on his last dose and had been doing quite well. But yes, it should have been given, and that it was a variance that it was not. She did ask the nurse to put in a variance.

    She (DON) said as manager, she likes to look at the whole picture and that if this were something that became routine with this nurse, then she would take a closer look at her work habits.. all in all she appreciated my honesty and concerns and told me that I should always ask myself (if I were in such a situation) if my choice would harm or endanger the patient.. she felt that at this particular time it would not have... although agreed that it was an order and therefore should have been given.