Should I walk away from this job?

[hotflashion, BSN, RN]

This is long, but if you read and offer an opinion, I'll be very grateful.

I think the question is, should I walk away from this job?

I interviewed for the job at a rest home on a Thursday, and was hired on the spot. (I wondered that she was not waiting to see the results of the CORI check or my immunization status.) I started the following Monday, observing/shadowing an LPN on the smaller of the two units. The job is primarily medication administration, plus other typical duties as they arose: answering questions from residents, collaborative talk with other health care providers (PT, OT, Drs., NPs), packing medications for residents who are going out for the day, etc., answering the phone. Quite a few finger stick blood sugars and insulins, regular dosing and dosing according to sliding scale. There are a lot of narcotics and psychotropics. On this particular unit, there are 20 residents.

That first day, we delivered meds to an elderly woman in her room. The woman expressed to us that she did not feel good, and she looked distressed: face contorted, pale. She sat up on the side of her bed, making small distress sounds and not using a lot of English words. She patted her stomach and her chest. The LPN asked several times if the woman felt sick, and did she want some Maalox. The woman clearly said no. I wondered if there was more to this than stomach upset but being new and unfamiliar with the person, and ASSUMING the LPN was familiar, I said nothing. We returned to the med room, and shortly thereafter, the DON comes in and tells us that the resident is having some kind of heart trouble. She brings her stethoscope to the room, says the woman's heart is in artrial fibrillation, call 911. I read later in the resident's chart that she is aphasic. There was no real discussion about the incident, only the LPN saying that the resident complained of stomach distress.

The second day, I passed meds with the LPN watching. It was predictably chaotic. All documentation is on paper and there is no efficient way (except by experience) to know who gets what medication when. I stayed late the day before, writing down who got meds earliest, so I at least knew who to start with. I ended up changing a dressing on a small surgical wound but the only materials on hand was sterile gauze and paper tape. I felt uncomfortable not having a similar type dressing to apply as what I'd taken off: a non-stick sponge covered with a Tegaderm film. I covered it with what I had, and next day the DON said that was fine, we work with what we have.

The third day I went to the other unit, which has 36 residents and more narcotics. I observed. The next day I passed meds while being observed. At the end of the shift when the narcotics count was done with the person coming on shift, I forgot to sign the book. My responsibility, I know, but the experienced person coming on shift could have reminded me, or said "Hey wait we have to sign the book." I remembered on the way home that we should have signed the book, and wondered if I should go back. I did not. I told the DON about this the next day, then went and signed the book.

The 5th day, I was supposed to be passing meds on the smaller of the two units, by myself. I fell behind. The DON filled in for me as needed. At some point in the day, I heard an alarm. Not very loud, but noticeable. I went out into the hall to see if I could hear it better or tell where it was coming from, what it was. I saw the maintenance lady and asked her what it was. She told me it was a call bell; I didn't know they had call bells. I looked up and saw which room the bell had been rung from, and went there quickly. The resident was on the bed, seizing. I said aloud, she's having a seizure, turned and asked the maintenance lady to get the DON. I'm standing there, waiting for the DON to show up, watching the woman seize thinking "Ok, what do I do?" and at least I remembered to note the time. The resident did not respond to my voice. She was on her back in her bed, not in any danger of harming herself. The DON showed up with a blood pressure cuff, and as the resident came out of the seizure, took the pressure, pulse, and respirations. The resident knew the seizure was coming on because she pulled the cord, but didn't remember. The DON took the pressure, pulse, and respirations again after 5 minutes and encouraged the resident to breathe deeply and slowly. The seizure was a generalized, tonic-clonic seizure that lasted 8 minutes. That's a long time. There was no discussion by the DON after it was over. Later I wondered, at what point do they call an ambulance?

Since I've been there I've heard snippets about the history of the company that owns the rest home. They've owned it for 2 years. Three-four months ago they had had some very bad trouble with employees such that most were fired, including at least one who was escorted away by the police. Most of the employees, including the DON, were hired after this. I wonder why was it so mismanaged?

They are so short-staffed the employees they do have are, as a matter of course, working double shifts. The DON says I can have the time I need to become comfortable with the job but then tells me she thinks I'll be ok after 2 days. I'm not really getting any orientation. I don't think they have any policies and procedures. Everyone is stretched too thin. I did buy myself some Liability Insurance yesterday.

I suspect this is a job I shouldn't have taken in the first place, but I was desperate and discouraged. Someone I told this to said she wouldn't go back because she would be afraid for her own safety, i.e., her license.

Opinions?

[MJB2010]

Trust your gut! I think you probably are having all of these little red flags waving in your head and you are trying to explain them away. Unless you want to eventually be giving the kind of care you see (and what seems to be acceptable) at this location, I would leave. What can you learn by staying? Is there anyone there that will teach you anything? I think the weight of second guessing and carrying all the second guessing around is going to get to you.

Trust yourself, trust your instincts. You already know what you should do.

[Blackcat99]

No, don't just walk away from this job. With all of the nurses being unable to find a new job be careful. Look for a new job and then after you are actually hired at your new job then give your 2 week notice.

[Selene006, BSN, LPN]

I know you're seeing all of the red flags flashing at you and you're probably torn at what to do next.

I agree with the above poster. Find another job first before you leave this one. Write down all of the concerns that you have and let the DON know that there are some things that you would like to discuss with her. Since everyone is stretched so thin there, what's the worst that can happen? Will she tell you that she's not available to respond to your concerns in a professional sit-down meeting?

I was dumbstruck when I started a job and started seeing some crazy things. Once I was oriented and figured out what Charge nurses did, I acted. I looked through the policies and procedures manual and I followed up questions with the nursing educator. Hang in there!

[Peetz, BSN]

Maybe you were put there to make changes in the care? With all the new staff you have the opportunity to change the level of care if at least it is just with you. If you leave because you don't like the level of care, will you not be leaving an opportunity to improve the level of care also? Just a though. If you really feel there is nothing you can do to change things and could care less if they get changed or not, then find a new job. If you want to impove things start today, make positive changes, then if you still feel like leaving at least you can say you made a difference for the better instead of just bailing on a bad situation.

I don't mean to make you feel bad about wanting to leave, just wanted to give you the other side to think about so you don't regret leaving for any reason.

[NewNursiegrad]

I am a new grad too, and of course, I want to work in a facility that is supportive of it's nurses and who's staff is very willing to discuss any concerns or questions I have. I've read Patrica Brenner's book "Expertise and Nursing practice" and feel it has a lot of useful insight for me to consider before beginning my journey as a new grad. I'd recommend reading it.

Not being in your situation, it's difficult to give advice. Only you know all the details, and can futher expand of reasons for why you should and shouldn't stay. However, from Brenner's book it discribes that how discriptive a nurse is with their narratives can depend on experience. For example, maybe you are dealing with expert stage nurses who feel that certain knowledge is expected and you don't have questions. Being a new nurse you have to speak up.

In nursing school, we also learned that LPN's are less refined in nursing assessments...however, I am sure some LPNs are very good and can know more than RN. But you're responsible for the patient too, orientation or not. So the patient was exhibiting signs that something with going on......from our nursing education, we should know at least we have to follow up with any patient concerns. You could have jumped in and assessed. A quick assessment of the patients pulse could have revealed that her pulse was irregular.

I'd not leave, I'd try to speak up more. Ask more questions to who you are orientating with, make them consider if what they are doing is the right course of action. If you question whether or not an ambulance should come, ask why. If the facility isn't supportive, isn't willing to answer your questions, or doesn't have good rationales to what they are doing... then I'd say definately leave because you can't expect to develop good safe nursing care in such an environment.

[netglow, ASN, RN]

You can do a little research, best to choose the optio[/url]n to search with zip code as sometimes the facility is not "named" the same as you know it:

http://www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp

Here is another one I check from time to time:

National Nursing Home Watch List from MemberoftheFamily.net

[caliotter3]

I would find another job, then leave. Meanwhile be very careful and try to educate yourself as much as possible as you go, because that is what you will need to do no matter where you work. Sounds as if your coworkers are not very forthcoming. I would certainly note that tidbit.

[hotflashion, BSN, RN]

I appreciate all the responses I've gotten, but have very little time at the moment to respond. I haven't yet decided what to do, and haven't had the opportunity or the time yet to talk to the DON or supervisor. Being at work is like being in the middle of a firefight, I never have time to take a break or eat lunch, I have to keep beating down those fires. I eat my lunch in my car as an early dinner before I leave for home.

NewNursiegrad, I appreciate the care and thought you put into your response. I felt terrible that I did not follow my hunch and take the patient's pulse. I didn't have my stethoscope with me. I lacked confidence. It won't happen again.

2ndwind, the website you mention, Medicare Compare is great, but where I work is not a nursing home and so not listed.

I wrote a pros and cons list last night and the only reason to stay is because it's a job. It's a job I can put on my resume after 6 months, when I'm looking for a better job. I don't really know if I can stand it for 6 months. I'm having a rude awakening right now but I don't think anyone should have to work like this. Yes, some people seem to be able to get the job done, but I don't know how patients can get good care when their nurses heads are spinning. And what satisfaction do they get from the job? Maybe I'll ask. As for a patient's thank you making it all worthwhile? There are easier ways to make a difference in people's lives, volunteering for example.

Those of you who advise keeping this job until I find another, I can tell you right now I have no time to look for another job. I don't have to keep the job for the money. I was only desperate because I was desperate to use my education and make the 4 hard years of school worthwhile. If I quit now I don't have to put this on a resume. I've already learned how important it is to ask about orientation. I've had a taste of what I don't want, and I expect this will stay in my throat for a long, long time.

[Leelee2]

Someone I told this to said she wouldn't go back because she would be afraid for her own safety, i.e., her license.

Opinions?

Agree with above, you will need to work very hard to protect your license there.

[Orange Tree]

The whole time I was reading this I kept thinking, "Wow....the director keeps showing up and helping." I don't know any new graduates who aren't terrified and don't have spinning heads. If there are positions like that out there, I'd like to find one.

[Carrie_MTC]

I would look for another job, and express your concerns with the DON. I'm in a similar situation, just be careful and don't put your license or your patients in jeopardy.