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Should I stay or go?

Posted

I'm hoping for some advice from other nurses who may have similar experiences. I started a new job in Mass. at a LTC/rehab facility last week. Yesterday was my first day training on the floor and the preceptor they put me with has only been a nurse for 7 months (I worked in KS for 5). The preceptor is already looking for another job and told me some pretty negative things about the facility.

But, my main concern was the way she was documenting. She was giving meds early (outside the 1 hour before, 1 hour after window) and then documenting it as it came due, so the time stamp wouldn't match when she actually gave it. She acted like that's what everyone does in order to get meds given on time there and wasn't trying to hide it. The administration gave the impression like they were putting me with one of their best nurses to train and seem to have no concerns about her. The residents seem to like her as well. Meanwhile, she had me sign in and was having us both give medications and document on my name. I had to put my foot down about it, but I still wouldn't be able to say what all she documented under me.

I was hired on the spot at my interview and I'm training with 2 other brand new nurses, 1 of which I will be working with when we get out of orientation. I'm pretty concerned that they're putting us alone together after two weeks of training. Should I run for the hills now? Or, wait until I'm out of orientation so I can do things my way and maybe it's not as bad as I think? Thanks in advance!

kiszi, RN

Has 9 years experience.

You really haven't given us much to go on, other than that you were told some bad things and you don't like how your preceptor practices. You will need to investigate whether the things you were told are true and make an informed decision. What is staffing like? If it is anything like most LTC facilities, you will be hard pressed to find a nurse who gives everything within the prescribed "window". A lot of times it is just. not. possible. Where did you work previously? Two weeks orientation is pretty standard for LTC.

I apologize for being vague. I understand that a resident may be leaving to go to an appointment so in that case you would give medications early. Or, you may get an admission and be forced to give medications late. It's not so much the action that concerns me as much as the documentation being inaccurate and dishonest.

Let me give a specific example. Say you have a medication due at 4, 5, and 6 o'clock. This nurse would give the 6 o'clock med at 4:20 with the 4, and 5 o'clock meds and just not document it. That is, until the 6 o'clock med was due. Then she would document that she just gave it and the time it was given would be completely inaccurate. She wasn't going back in later to adjust the time or adding a note about it and she wasn't having any regard to why certain medications may have been scheduled apart. She was also popping medications hours in advance for several residents and then leaving them in med cups in the med cart and going back to get them later. Yes, she was labeling some of them so as to not mix them up, but she even said to me, "You're not supposed to do this, so don't do it. But, you kind of have to so you don't fall behind."

She threw away empty blister packs with labels on them with no regard to HIPAA. And, she consistently documented things she had not asked residents like pain scales and fluid intake. She would just guess and I understand that when you're familiar with your residents you can do this to some degree, but it was still concerning. Lastly, towards the end of the shift she wanted me to fabricate skilled notes on a couple of residents whose rooms I hadn't been in. She gave the meds and took the vitals, but she wanted the documentation to be under me and to have me make assumptions about their breathing and ambulation. I don't know if she checked those things. I know that I'm responsible for what I document and protecting my own license, but I feel like it says something about the facility if I'm being put in these positions on day 1 and this is who they chose to train me.

Unfortunately, this sounds very typical to me. Exactly like every place I've worked for

LakeEmerald

Specializes in Emergency/ICU. Has 4 years experience.

I've never worked in LTC, but why would a resident have meds due at 4 and 5 and 6 o'clock? Seems like a total pain and unless there is a valid reason, why not give some of them together? Not condoning, just asking.

vokaybo

Specializes in NICU, Acute Rehab, Med/Surg, Quality. Has 30 years experience.

False Documentation ??? What would happen if there were a reaction to the medication or the patient choked on it when taking it? There are many what ifs? You will have to decide for yourself if it is ethical?

Make your concerns known to the administration. This is the right time to do it. You need to feel comfortable in order to do your best work. I have worked in a LTC, and even with the pages of medications you have to pass, you still have to remember the 5 rights. You have to stick up for yourself, because as a new nurse, there may not be anyone to have your back. If you make your concerns known, and nothing changes, I would respectfully give your notice. :nurse: