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??
Thanks everyone for commenting, these posts have actually helped me a lot. I went in today and spoke with my nursing administrator and mentioned that if they hire new grads for on call they really should have a better orientation. All I did was shadow one of the CM's for a few weeks and then was thrown into on call. I often had to do procedures on my own that I never actually did in school, I would go online and watch videos as to how to do them or read in my old nursing textbooks. Needless to say I am realizing that this is not a new grad friendly position. I also went into counseling today and was diagnosed with generalized anxiety disorder. Yay nursing! You are officially pushing me to the brink of insanity.
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?
The wings are the guard - you squeeze the wings towards the needle as you're pulling it out and the wings separate and cover the needle.
OP - Your work environment really sucks. I know it's hard to find something new with so little experience, but you really should try looking. You are setting yourself up to fail, and possibly ruin your future in nursing, if you stay.
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.
Good for you! Only problem I see is that most nurse residency programs, at least the one I graduated from, only accept nurses who have never worked as an RN. I think this is a requirement of the UHC, the entity that governs residency programs. Double check this with hospitals. However, this does not mean you would be precluded from getting a med surg position and getting a proper orientation. Just means you won't be taking residency classes. Not a major negative in my book.
The wings are the guard - you squeeze the wings towards the needle as you're pulling it out and the wings separate and cover the needle.
OP - Your work environment really sucks. I know it's hard to find something new with so little experience, but you really should try looking. You are setting yourself up to fail, and possibly ruin your future in nursing, if you stay.
So the DON, who is an RN, gave you a verbal order for an abx?
Illegal.
You acted on that order.
Illegal.
You might be best served by quitting and filing a report with the BON.
I posted on this a little earlier...not necessarily outside the DON's scope of practice at all. Depends on the Hospice standing orders. ABX orders are within the scope of practice for Hospice certified nurses where I live.
I posted on this a little earlier...not necessarily outside the DON's scope of practice at all. Depends on the Hospice standing orders. ABX orders are within the scope of practice for Hospice certified nurses where I live.
You have standing orders for RNs to choose an antibiotic for a URI?
Specializes in ICU, ER, OB, Hospice, House Sup, Float.
First off, I feel your frustration. Being a new grad is hard enough by itself, let alone being in this situation.
I worked hospice after I had multiple years of experience with ICU, ER, OB, and acute care. I had years of skills to support me. It felt like a natural transition because I could go off of previous experiences and had the comfort level to go with it.
Hospice is an area that requires both autonomy and critical thinking on the run. You have to be the best nurse you can be, in whatever situation you may encounter.
My best opinion would be for you to switch over to the hospital for at least a year. You will get a huge amount of experience under your belt and get really good at your basic skills (IV, catheters, dressings, etc). Plus you will be in an environment where you will have that extra body to throw ideas around with.
Hospital nursing is team nursing, as is hospice nursing. The goals of both are similar...take care of our patients to the best of our ability. We collaborate with other departments and specialties in order to ensure the best outcomes...life and death...
Get some experience under your belt and then you could try hospice nursing again if you wanted. However, I would look for a hospice that is more willing to ensure your success, not throw you off the cliff and expect you to be perfect without any reliable guidance.
Good luck to you going forward. I hope you are able to love nursing again. You had a bad experience that gave you a bitter taste of the profession. That isn't how it should be. You can do this...take a step back and approach it different. We all have had days that make us question why we are in the field, but then we remember all the good, satisfying days when we really have made a difference. That makes it worth it every time!!
Thanks everyone for commenting, these posts have actually helped me a lot. I went in today and spoke with my nursing administrator and mentioned that if they hire new grads for on call they really should have a better orientation. All I did was shadow one of the CM's for a few weeks and then was thrown into on call. I often had to do procedures on my own that I never actually did in school, I would go online and watch videos as to how to do them or read in my old nursing textbooks. Needless to say I am realizing that this is not a new grad friendly position. I also went into counseling today and was diagnosed with generalized anxiety disorder. Yay nursing! You are officially pushing me to the brink of insanity.
Good news on going to counseling.
Also, you are not insane; if anything the way that your job operates IS insane.
Some if not all of have mental traits that end up exacerbating depending on how we cope. there are plenty of us that have anxiety and depression that thrive in stressful environments; you will find me (and others) over at the nurses with disabilities or health management forum for support.
I am going to echo others that state to look ini a facility job whether it be a hospital, LTC, or even home health where it is new nurse friendly, which won't have that "sink or swim" mentality; as a new grad LPN I started out in private duty home health and because they started me out slow and sent me to classes and made sure an experienced nurse observed me before I went on more complex cases-a good agency will ensure that you get comprehensive orientation or not hire you at all.
Keep pounding the pavement for another position; if the most positive thing that occurs in nursing is when you have a job, it gets easier to find a job; also, if and when you have interviews, state that you are looking for a change to help solidifying your nursing base because you are a new nurse. In the meantime, keep self studying; regardless of the position you have, self studying is imperative in building your nursing practice, especially when you are new or in a new specialty.
Moving forward, with the mistakes that you have encountered; utilize an empty laundry detergent plastic container for sharps, if they don't have a sharps container and find out how disposal occurs in your areas, as well as make sure you have an updated drug guide or find one for free if you have a smart phone-Epocrates is a good resource with free updates.
You have standing orders for RNs to choose an antibiotic for a URI?
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Yes, ABX for treatable conditions to maintain comfort are covered under our Hospice providers standing orders. In the case of a UTI nothing will be prescribed until the C & S comes back, but for a URI there are protocols for appropriate abx orders in place. Orders are always written in the chart under the hospice nurse's name and the overseeing MD. I would assume that even though any new meds or med changes are covered under standing orders the MD still needs to be notified. I know with our facility standing orders [which are not nearly as broad as the hospice ones] we need to update our rounding when we initiate them.
Yes, ABX for treatable conditions to maintain comfort are covered under our Hospice providers standing orders. In the case of a UTI nothing will be prescribed until the C & S comes back, but for a URI there are protocols for appropriate abx orders in place. Orders are always written in the chart under the hospice nurse's name and the overseeing MD. I would assume that even though any new meds or med changes are covered under standing orders the MD still needs to be notified. I know with our facility standing orders [which are not nearly as broad as the hospice ones] we need to update our rounding when we initiate them.
The vast majority of URIs are viral in etiology so I am unsure how the RN is able to appropriately diagnose them as bacterial and order an appropriate abx.
tayabee
3 Posts
Thanks everyone for commenting, these posts have actually helped me a lot. I went in today and spoke with my nursing administrator and mentioned that if they hire new grads for on call they really should have a better orientation. All I did was shadow one of the CM's for a few weeks and then was thrown into on call. I often had to do procedures on my own that I never actually did in school, I would go online and watch videos as to how to do them or read in my old nursing textbooks. Needless to say I am realizing that this is not a new grad friendly position. I also went into counseling today and was diagnosed with generalized anxiety disorder. Yay nursing! You are officially pushing me to the brink of insanity.