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??
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.
When you implement the order of a nurse over the order of a physician, you clearly show a lack of basic understanding of safe and legal nursing practice. Whether you stay in this job or not, you need to insure that you have malpractice insurance in place.
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.
A supervisor is never a nurse's only resource, in this case, following your supervisor's advice was dangerous to the patient and to your license. I suggest you review your BONs educational resources, the Nursing Practice Act, fraud and practicing medicine without a license.
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.
I have never heard of calling one's Director of Nursing to get an order for antibiotics. Is this DON an ARNP with prescriptive authority? If so, you'd think that a practitioner with prescriptive authority would have checked this patient's chart for her allergies! Good gravy, girl, YOU are not the problem here. Your job is the problem.
The mistakes you made are SO typical of plain old 'new nurse' mistakes. Heck, old nurses working in a NEW environment make those kinds of mistakes. You are being way too hard on yourself -- in that you think you 'don't have what it takes' to be a good nurse. I think you do.
Try to listen to us battle axes here . . . the PROBLEM is not you, or your abilities as a nurse per se. You are trying to do a job that would tax any of us unless we were experienced in doing it. OK? It's really not YOU.
I agree with the others who suggest you start applying to facilities or hospitals. This is where new nurses belong IMHO, not home care or even private duty unless they've had a lot of CNA experience before hand and the patients are low key. You are basically 'set up' for making these mistakes that you can't help but make because you are inexperienced and received inadequate orientation time.
Be kind to yourself :) and go knock on some LTC or hospital doors. Find an RN Residency program in med surg or the like, they are programs for new nurses with more extensive preceptorships and additional support from the nurse educator staff. You haven't seen enough or done enough to KNOW you 'don't have what it takes' to be a nurse. None of us did when we were where you are :)
Specializes in ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC.
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.
You appear to have been placed in an unfortunate and rather unsafe position. You are a new grad and thus require ongoing training and mentoring, preferably at a teaching hospital where new grads will be trained. It is also vital that you re-read your posting as you have already identified red flags that will affect your career unfavorably. This is due to the fact that you are hired to fill a position without the knowledge and skills that are mandatory. You state that you have a DON who does not like it if you call a doctor. That is ridiculous!! It appears this job has elements of abuse, bullying and a real lack of support. Please stop beating yourself up and rather focus on how you can be better organized when seeing patients. ie. carry a pack with some basic needs such as small sharps container etc. tools you will need for basic patient assessment and do not be afraid to call a doctor re. any prescription. If your DON is bullying you then this also needs to be confronted. You have identified areas where he is not often available, when he should actually be available to you especially as a new graduate thus he is not doing his job competently. This is another unsafe practice, especially if he is aware that you are a new graduate..... So focus upon what you need to do to protect yourself and your patients and document everything that occurs systematically, ie. date, time, incident and result. You need this as part of your own accountability and will help you in the long run
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?
I can't speak to the legality of this everywhere as states vary so much in scope of practice for just about all levels of practice, but...our home care hospice nurses are specially trained and certified to start some [not all] meds. These meds are covered in a very large list of hospice standing orders that can be implemented or changed at the hospice nurses discretion. ABX for treatable conditions to maintain pt comfort is covered under these standing orders. So, the DON, at least where I live, would have been within her scope of practice ordering this abx.
In addition to previous posts about the inappropriateness of expecting you to order antibiotics, your agency should be using needles with safety guards, to protect you and your clients.
Thank you everyone who has posted on this thread. I am a newly graduated nurse who eventually wants to do home/hospice care but reading all these posts has reinforced my decision to start on a med/surg floor in a hospital that has a new grad nurse residency program. I can see how being in a home care position which requires a lot of independent problem solving is NOT the best place for me to start my nursing career.
In addition to previous posts about the inappropriateness of expecting you to order antibiotics, your agency should be using needles with safety guards, to protect you and your clients.
Huber needles don't come with safety guards but in the home if you're caught with a needle and no sharps container on hand, you need to sit tight and ask the caregiver to bring you something appropriate to drop the sharps into.
The home should have already had a sharps container (case manager's job) but there are appropriate substitutes that can be used (disposal is City/County dependent).
I think it would be a good idea to find a hospital position with a one year residency program. Maybe you could find a Med-surg position if you like hospice/homecare. Working in a hospital at first builds up your skills. This would allow you to train under supervision too (what new grads need). I just have always heard how hard it is for a new grad to go into hospice/homecare right out of school. I could only imagine the stress. You are burning yourself out. It's not healthy. You need an environment that will boost your confidence and prepare you better. Good luck hun :)
There are indeed Huber needles with needle guards; my hospital has used them for some time. I would links some sites, but my phone won't cooperate. Try googling.
There are indeed Huber needles with needle guards; my hospital has used them for some time. I would links some sites, but my phone won't cooperate. Try googling.
I don't know about hospice, maybe they handle their own IV supplies but we're dependent on the numerous infusion companies. I might be able to have them send something different but not from a prn situation.
In my practice I've never seen a huber needle with a guard, how does it work on an existing inserted needle that you're removing?
Again though, it's the daytime case mgr's responsibility to have the home properly stocked.
PacoUSA, BSN, RN
3,450 Posts
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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