Quit Nursing?

[tayabee]

Okay, so I graduated with my RN in 2013, I didn't work or take BSN classes for a full year after that. Now I'm working my first job as a hospice nurse, I have been for 5 months and I'm in my last semester of school for my BSN. With hospice I work as an on call nurse and I typically drive around to pts homes/facilities to make visits. In this past month I've made two big errors. The first was I had been accessing a pt's port to run in IVF, my first few attempts were unsuccessful and after two sticks with different gripper needles I placed them in the trash to take to the office and drop off in the sharp's container later. But I forgot to do this and the pt's husband got a needle stick. Luckily since it was the pt's husband who has already been exposed to her body fluids and he didn't complain or was angry it was okay. Now my next mistake happened this past weekend. I was having a particularly crazy on call day, I got a call about a pt that was having s/s of URI. I went out and assessed and decided to order abx, I didn't know which abx to order so I called my DON and he wan't available, so then I called the doc (who happens to be an ass) and said to go with zithromax, it was right then that my DON got in touch and said to order rocephin or augmentin. I reviewed drug interactions and everything and looked it all up in my drug guide and I decided to go with augmentin, I called the pharmacy picked it up and dropped it off with the pt. a few hours later I get a call from the facility that said the pt is allergic to PCN. I checked her chart and sure enough she is. At this point I had a panic attack, a real full on panic attack. I got the whole situation taken care of, new abx, assessed pt, benadryl. The pt was totally fine, no reaction whatsoever, the problem was that i just simply forgot to check her allergies, something so basic. I went in on Monday and spoke with my DON and administrator and I got a warning. I also had another panic attack the day after the incident. I have never felt so incompetent in my life. In nursing school I had way more bad days than good days, I never felt like I was doing enough or was good enough, and when I did it didn't last for long. I started this first job really optimistic and I felt like I wanted to be great nurse, and now I just feel stupid, worthless, and stressed out of my mind. I don't even think I want to be a nurse anymore. I am petrified of making another stupid mistake. I love taking care of people and blessing lives, but I don't think I have what it takes, I feel too stupid and incapable of being a great nurse and now I'm terrified of being on call again this next week. And on top of all of this I have been thinking for a while about getting a new job at a hospital, I told my employers that I've been looking. Right after I told them they called me and said they wanted to warn me that if I made any mistakes in the hospital that they would not be as nice to me about it. This just further reinforced my feelings of low self-esteem, its like they are expecting me to keep making terrible stupid mistakes. Any advice or thoughts out there??

[llg, PhD, RN]

First ... you need to realize that you are not qualified to be making the final decision as to which abx to give. And your employer is abusing you if they are expecting you to make that decision.

Second ... a hospital job will provide an orientation for you that will help prepare you for your job. Hospital orientations usually provide you with a preceptor for a while as a resource -- and even after orientation, there will be other nurses around that can be a resource for you. That should help you develop your skills, your judgment, and your confidence.

It seems to me that your biggest problem is that you are currently in a job that is not appropriate for a new grad -- out there on your own without much orientation or back-up -- trying to make decisions that are "above your pay grade." It's no wonder that you do not feel good about yourself. Don't let your bully of a boss intimidate you into staying where you are. Keep seeking a job that will give you adequate orientation and readily available resources to help you develop as a nurse.

[MostlysunnyRN]

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.

[caliotter3]

I think you might benefit from some time working at a facility with coworkers and supervisors available to help provide you with support until you gain more experience. Consider a job in LTC/LTAC, where there are people that you can ask for input when you have questions. If you can get a med/surg position in an acute care facility, all the better.

[dishes, BSN, RN]

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.

[Here.I.Stand, BSN, RN]

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.

[Asystole RN]

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.

[ICURN3020]

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?

[Libby1987]

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.

[chicookie, BSN, RN]

I agree with everyone else!

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

[MostlysunnyRN]

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.

[tayabee]

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.