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 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?
