Refusing assignment and management

[HeyitsSarah]

Good morning!

I am a new grad who has been working at a LTC facility part time. I work 8 hours per week, or 1d/wk. I was told when I was hired that I would be provided with adequate training, educational modules that I would be completing and plenty of time orienting. I have been working at this facility for 3+ months. Initially I was floated to other units until management decided to assign me to a typical LTC floor. I was not oriented, I was put directly on the floor with little training, and no education modules.

There are 47 patients on this floor, and I am familiar and comfortable with one of the halls with 24 patients. I have been floated recently to other floors, usually as a treatment nurse, which I did not mind as I enjoy providing treatments. There are many things I could say about this certain nationwide facility, but I wont go there. The internet reviews say it all, and some days I wish I could just take all of the patients home with me instead of staying there. I will just say that it is the epitome of unsafe patient care; and nobody seems to care except those who have been working there for long periods of time.

Today I was given the assignment of medicine aide for all 47 patients. I advised my supervisor that I did not feel comfortable with that assignment and was concerned about patient safety. The last time we went without a medicine aide, it took me an hour to provide medications to three patients. As a new grad with so many patients, I would not have been able to provide them their medications within a timely, appropriate manner. We have also recently incorporated a new computer system which I have had no training with and am unfamiliar with.

My supervisor's response was "you need to do this now so you can eventually build up to providing the meds in a timely manner" but that's not my point of view. I wanted to build up on my load slowly, until I was confidently able to provide care for 47 patients. Am I wrong? I just feel like I was being thrown into a fire and possibly taking on something that I know I can't do safely.

I refused the assignment and left for the day. I asked the supervisor to have the nurse educator/supervisor (who hired me) to contact me about the assignment refusal and asked her to call me about it and further education and training.

I left the facility and called a nursing relative who advised me that they can try to turn it around and say I abandoned my patients and assignment. I was not given report, no keys, no count. I was given the role as medicine aide which I refused, immediately.

I'm still concerned even after calling my state BON, who advised me that they can report me but chances are good that nothing will happen to me because I didn't accept the assignment.

I'm looking for words of encouragement and any advice from fellow nurses. I still haven't received a call from the nurse educator/supervisor, and I've sent an e-mail asking her to contact me again to talk about this. It's been two and a half hours now, and nothing. Every time I call, she does not answer.

[Golden_RN, MSN]

Since you did not accept the assignment I think that your license should be ok, although the company can definitely punish you.

I will say that it is typical for LTC facilities, in my experience, to float nurses to different units without orientation. You have been oriented to the facility and after 3 months should know the policies/procedures and work flows for the company. Since you were assigned to work as a "med aide", that leads me to believe that you wouldn't be responsible for other nursing duties - assessments, documentation, treatments, orders etc. Only giving meds to 47 residents is not an unusual assignment in LTC.

It should NOT be taking you an hour to pass meds to 3 residents. I don't know the regs in your state, but in my state all meds have to be passed in 2 hours. You definitely need help with time management and it will be difficult to get proficient only working once/week.

Best of luck to you. LTC facilities can be great places to work!

[kp2016]

I think it is very likely they will fire you and honestly you should consider it a blessing. This is not a safe place to work and if you stay they will continue giving you unsafe assignments potentially jeopardizing your license.

They can’t report you to the BON, well they can but you don’t have a case to answer as you followed the correct action. You given an assignment that you weren’t skilled or trained to complete. You personally notified the manager of this fact and asked for a different assignment which she decided not to give you. That was her choice. You did not abandon your patients as you never took handover and received them for the shift. Start looking for a new job and put this mess behind you.

[Nurse SMS, MSN, RN]

You will probably lose your job and your reference from them. Beyond that, you are fine.

[beekee]

They will likely consider you walking off as your resignation. If they don’t, they will likely fire you. They may report you to the BON, so be prepared for that possibility. However, it doesn’t sound like the complaint will go far.

What more orientation or training could you possibly need at the three month mark? You knew the policies and procedures at that point. As a graduate of nursing school, I am sure you know how to pass meds. You just didn’t like your assignment and left.

Time to dust off the resume and find a new job.