Quit Nursing?

First off, working 5 months you're still very new at nursing. Then you're in a position where it's much harder bc you don't have another nurse to turn to in the moment to ask for help right away. You really should, at least, have a small sharps container available to use for home visits. You could've very easily been on the receiving end of that needle stick. As for the antibiotic, I'm a little unclear: It reads like you called the doc and got an order, but implemented what the DON suggested instead? If so, that's a big no-no, and frankly you, and most importantly, the patient are very fortunate it didn't turn out much worse!

When you're calling the doc, especially as a newbie, get in the habit of mentioning patient allergies so that info is out there. Did you tell your DON that you'd already heard back from, and received a doctor's order? Take these mistakes as lessons learned. Attitude is huge OP, if you keep telling yourself all these negative things (I'll never...? I'm not good enough to..., etc) your own self-defeating attitude will be your biggest hurdle. It sounds like you love patient care, and hospice is an amazing place to practice nursing--I know from experience--if so hang in there, keep learning and growing, and think positive. Hope it all works out for you.

I don't think you have have the knowledge, skills, and ability to practice safely and competently in your current job, if you stay in it, you are high risk for a complaint to the BON.

I agree that this sounds like a difficult environment for a new grad. For what it's worth, I'm a working ICU nurse with 12 yrs' experience, if if *I* didn't have a sharps container, I'd probably forget about the needle too. Heck I'm always writing myself reminders on my brain sheet for tasky things, otherwise I'd forget something. A new grad needs resources and experienced peers she/he can ask questions of. You very likely WOULDN'T make these kinds of mistakes in an acute care setting.

Plus, as an RN you shouldn't be expected to order meds. This is outside the scope of an RN. You can choose meds from standing orders, which have been verified by a pharmacist, but you shouldn't be expected to choose an antibiotic like you were.

A quick word about LTAC (long term acute care)...you'd learn a ton, but typical acute care positions tend to have better orientations. At least in my experience, they do. I worked in an LTAC hospital for a year and a half; the patients were higher acuity than med-surg patients, but we only got 5 days' orientation. Well we had online classes on stuff like EKG interpretation, sepsis, brain injuries, nutrition and mobility etc. which were helpful, but not the same as extra help in the trenches that are the floor. It sounds like it WOULD be an improvement over this job, though.

Move on, find another job.

Stick up for yourself and be confident, if not for you then your patients. Study and learn from your mistakes.

I'm not very familiar with hospice nursing. My question is why would a nurse call their DON for orders on a patient with new sx that require medication? A DON cannot order meds/treatments, correct (without standing orders)?

To me, this seems like something that would surely need to be brought to the physician who then has the authority to place orders.

Is there something I'm missing?

New nurses should not be the call nurse who has to be able to work independently, usually a year on the job during the day where you 1) have orientation 2) have seniors nurses for supervison and consult.

I'm not sure about hospice but California has specific guidelines for hiring of new grads.

I'm angry for you, you shouldn't have been put in this situation. There is something unique about home visits where you have limited supplies and resources and need to have strong nursing judgment and critical thinking to avoid making what seemed like a good decision at the time. That only comes with experience. The most experienced hospital nurses are a duck out of water in the home setting but they have their nursing knowledge and experience to keep them from causing harm.

I agree with everyone else!

I feel like this is more of a job problem than you.

I'm not very familiar with hospice nursing. My question is why would a nurse call their DON for orders on a patient with new sx that require medication? A DON cannot order meds/treatments, correct (without standing orders)?

To me, this seems like something that would surely need to be brought to the physician who then has the authority to place orders.

Is there something I'm missing?

When I worked hospice, albeit inpatient, we always called the doctor when we suspected UTIs, C-Diff, etc and got orders. There were no standing orders. No nurse could give orders either. We had lots of standing orders for breakthrough pain, fever, etc. In the OPs case, while the DON might be consulted, the DON should not have given orders to initiate a specific antibiotic.

my only resource is our DON, he is a nurse as well and is my direct supervisor. I go to him for clinical questions and he is not usually easy to get ahold of and he doesn't like it when I go to the doc unless I clear it with him and he was unavailable when I made the decision. Hence the reason I went with his suggestions instead of the doc.

Wow, I'm almost 3 years an RN and I wouldn't touch a job like yours. You definitely need to get out of there ASAP. The fact that you put used needles in the trash, even if to remember to take them later, shows that you lack the proper clinical training for safety on the job. I'm not saying you're a bad nurse AT ALL, just that you need to be in a job that takes you under their wing a lot more and one that surrounds you with immediate resources. The first year of nursing is the hardest and the scariest, you're just being thrown to the wolves.

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