Hello all. I recently obtained my ADN and just landed my first job. It seems that in my area of the U.S., newly graduated RNs must work in nursing homes/LTC in order to sharpen their 'prioritization and delegation' skills for around a year or so before being taken into consideration for the care of more acutely ill patients. Same for the home health care setting. Everywhere I have checked asks that RNs have one yr. of previous work experience before consideration. So, here I am, working at a nursing home in my area. I was planning on just taking this in stride, but for some reason, I seem to get a lot of gruff from LPNs where I work! Several of them don't want to take the time to count their narcotics drawers at shift change, they sign their name without paying attention to what they are doing, and just rush through their med passes. I try and explain that I am new to nursing and want to take the time with what I am doing, but many of them just roll their eyes and get in a huff. I don't have as much of a problem with other RNs, they seem to understand where I'm coming from with regards to these matters. Is there any advice someone can offer me to help me to deal more effectively with these LPNs? Not sure if they are saddened by their career choice or what the problem is, but I just need some advice on how to deal with working alongside them. Thanks so much...
I always count and we look at the pills and the book together....not too long ago, I came in late (covering a call out as a favor) the keys were handed from the previous shift to someone else and they just tried to hand them to me....No way! the previous nurse was not here as she had left around 7 am....The only way I would accept the keys was if someone else counted with me. The person who accepted the keys was on another unit and left the keys with the other nurse I was working with.
So the other nurse I was working with counted with me. Sure enough, there was a discrepancy in the count...the night nurse forgot to sign out a med and it was missed at the count. The night nurse needed to come back and sign the book and she lived an hour away. I felt bad but thats the way it is.
Had I not insisted on the count, it would have been my issue!
Specializes in critical care, ER,ICU, CVSURG, CCU.
We can start...here.
OP, as a former LPN and 1 year RN, one of the things that I enjoy is learning from ALL nurses, regardless of licensure and scope.
Another thing is to respect the experience that you are receiving; one of the MANY adages is "forget what you learned in nursing school"; meaning, maintain your legal practice, but learn the ropes for the area you are working in, which includes the "culture" of the unit or facility.
One of the many things your co workers don't enjoy is someone in the trenches that don't want to be there. The best way for you to improve that is to improve your attitude to working in LTC; and embrace the many aspects of nursing you will use; learning about focused assessments, therapeutic communication, teaching, family focused care; wound care, care planning, multidisciplinary team work, supervision and leadership.
atttagirl ladyfree, i have been a RN for over 41yrs, you absolutly hit it out of the park......the absolutly last place i would of ever considered working is LTC! why i was a supper critical care nurse, all i can say is I was wrong and the past 7 or so years I have been in LTC! HAVE BEEN WONDERFUL !
OP, kindly remove the titles from the persons you are working with and yourself and look at the situation objectively: You are a new nurse, they are seasoned nurses. As a former new nurse, I can clearly remember thinking to myself that "they're doing this wrong, that wrong, that's not what we were taught in school, you can't do that!!!" etc. I honestly thought they were just, well, sloppy nurses until I had a few months under my belt and began to see why they cut corners the way that they did. I also found that they were an invaluable source of information and guidance on how to perform the duties expected of me in a timely manner while also making sure ALL of my residents were cared for during the shift. Some of them were short with me, if not downright nasty at times not because of me as a nurse, but because they had a million and one things to do and had me tagging along disrupting the flow of their Chi, lol, Titles really mean nothing to me in LTC. We are all in this together for the (hopefully) common goal of resident care and safety.
Specializes in critical care, ER,ICU, CVSURG, CCU.
excellent ! bluegeegoo2, right on, OP you have been given some good insite and advice from some very good LTC nurses....... it is not totally "them" &it is not totally "you"........it is a bit of combination of all. you are a new nurse in an work environment you did not intirely want to be in, saying it modestly , sometimes seasoned staff do cut some corners that should not be cut, initially out of necessity related to lotta workload and not enough time. In my LTC where i am DON, some of those shortcomes or "efficancy practices" may of led to an error or so....now having to work with my staff for a happy safe medium....... who knows, you might end up liking LTC, or it may be truly as you perceive a necessary transition....in either case.....try to smell a few roses while there......those precious residents need us, and have some wonderful stories to tell. granted some of the staff and residents, well lets just say, " need more effort to love! "
OP, kindly remove the titles from the persons you are working with and yourself and look at the situation objectively: You are a new nurse, they are seasoned nurses. As a former new nurse, I can clearly remember thinking to myself that "they're doing this wrong, that wrong, that's not what we were taught in school, you can't do that!!!" etc. I honestly thought they were just, well, sloppy nurses until I had a few months under my belt and began to see why they cut corners the way that they did. I also found that they were an invaluable source of information and guidance on how to perform the duties expected of me in a timely manner while also making sure ALL of my residents were cared for during the shift. Some of them were short with me, if not downright nasty at times not because of me as a nurse, but because they had a million and one things to do and had me tagging along disrupting the flow of their Chi, lol, Titles really mean nothing to me in LTC. We are all in this together for the (hopefully) common goal of resident care and safety.
This makes sense to me. I HAVE been thinking that 'they are doing things wrong & sloppy' maybe it's true sometimes, and maybe it's just the way that going from school to work is shocking my system. Our nsg instructors were so tough and nit-picky that I am feeling like they set us up for problems at work in a way. They STRESSED the titles in nsg school along with delegating according to scopes of practice, RNs being above LPNs in almost all regards. I have the final word bc if you mess up, technically it's my license in the line too. They need to offer a more down to earth, transitional class in nsg school or afterwards just to prepare us for the huge differences in text and life surrounding these things! Thank you all posters... nice & those who "need more effort to love" (lol, you made me smile sallyrnrrt)! :) Hanging in there, but I still feel like I've had a rude awakening. Had I known these things earlier on, it would have made life that much easier!!!
A far a licensure; LPNs have their own license and scope; they have an equal accountability. In terms of delegating, that is where the scopes come into play.
A far a licensure; LPNs have their own license and scope; they have an equal accountability. In terms of delegating, that is where the scopes come into play.
If I 'delegate' to a LPN (which I don't where I work, but just for a hypothetical situation) and something goes wrong, yeah it's her license on the line, but mine also if I didn't delegate properly, right? They didn't devote a whole class to that portion of nsg, just a chapter or two at the end, but 'prioritization and delegation' was all over my NCLEX. Like, say I switch to 2nd shift and am the only RN around for miles and miles at my facility. If I make up assignments and a LPN gets a more acutely ill pt. and something goes wrong, am I not in trouble also? As I type this out I know I sound like a ball of anxiety... I am. I was a STNA before, then worked in Medical Records (no prioritization and delegation there!), and now a new RN. Don't mind being responsible for my own pts, but others too?? This LTC I accepted a job at wants us to take on 20 pts. Some have IV meds/fluids, Trachs, PICC lines, wound vacs, and that type of thing. Thank-you for any help/insight :)
If I 'delegate' to a LPN (which I don't where I work but just for a hypothetical situation) and something goes wrong, yeah it's her license on the line, but mine also if I didn't delegate properly, right? They didn't devote a whole class to that portion of nsg, just a chapter or two at the end, but 'prioritization and delegation' was all over my NCLEX. Like, say I switch to 2nd shift and am the only RN around for miles and miles at my facility. If I make up assignments and a LPN gets a more acutely ill pt. and something goes wrong, am I not in trouble also? As I type this out I know I sound like a ball of anxiety... I am. I was a STNA before, then worked in Medical Records (no prioritization and delegation there!), and now a new RN. Don't mind being responsible for my own pts, but others too?? This LTC I accepted a job at wants us to take on 20 pts. Some have IV meds/fluids, Trachs, PICC lines, wound vacs, and that type of thing. Thank-you for any help/insight :)[/quote']
There is a process of delegation that comes into play; you don't delegate if that particular person has not received proper training (if needed) or has the education; a review has to be in order before delegation occurs; just like how the nursing process works, you must assess if the person who you are delegating to needs the education, or not.
As a LPN, I managed PICC lines (went to a LPN IV therapy course) , wound vacs, trachs, etc.; we learn how to manage those tasks in PN school; as well as learn the nursing process; pretty much what is learned in an RN program; EXCEPT the more in depth areas of leadership, critical care, and public health as well as EBP.
There are LPNs who are IV competent; unless they require the RNs to manage the PICC lines; LPNs can still manage the PT; if the pt is "acutely ill" then they don't need to be there; LPNs take on "medically complex" pts all the time; it's a matter of knowing what policies are in place; and if education was provided; if they are "seasoned" and are precepting you and are managing the pt; then the facility has those policies in place to manage those complexities; you focus should be putting the little and big things together, and prioritizing the management of your patients- there is a process in prioritizing who is seen first (always airway), and who may be the most acute and potential risks-by learning from your preceptors and putting your own practice together.
Specializes in LTC,Hospice/palliative care,acute care.
QUOTE>>>I've seen it
on coming shift, "is the count ok?"
off going shift, "yeah, everything is there, i already signed"
on coming. "ok, see you later"
Yeah,well-let those fools take that chance-not me.I've had nurses try to rush me,throw the keys at meand say "my ride is waiting" One asked me "do you want report or want to count?" Really? I told her we would do both.I don't take the keys until the count is completed and I look at both the actual supply of meds and the sign off sheet.Addicts can be very crafty when diverting drugs.
The best way for you to improve that is to improve your attitude to working in LTC; and embrace the many aspects of nursing you will use; learning about focused assessments, therapeutic communication, teaching, family focused care; wound care, care planning, multidisciplinary team work, supervision and leadership. 
, sometimes seasoned staff do cut some corners that should not be cut, initially out of necessity related to lotta workload and not enough time. In my LTC where i am DON, some of those shortcomes or "efficancy practices" may of led to an error or so....now having to work with my staff for a happy safe medium....... who knows, you might end up liking LTC, or it may be truly as you perceive a necessary transition....in either case.....try to smell a few roses while there......those precious residents need us, and have some wonderful stories to tell. granted some of the staff and residents, well lets just say, " need more effort to love! "
NutmeggeRN, BSN
2 Articles; 4,743 Posts
I always count and we look at the pills and the book together....not too long ago, I came in late (covering a call out as a favor) the keys were handed from the previous shift to someone else and they just tried to hand them to me....No way! the previous nurse was not here as she had left around 7 am....The only way I would accept the keys was if someone else counted with me. The person who accepted the keys was on another unit and left the keys with the other nurse I was working with.
So the other nurse I was working with counted with me. Sure enough, there was a discrepancy in the count...the night nurse forgot to sign out a med and it was missed at the count. The night nurse needed to come back and sign the book and she lived an hour away. I felt bad but thats the way it is.
Had I not insisted on the count, it would have been my issue!
Not happemning on my watch!