I started a new job about 2 weeks ago at a residential program for the mentally ill. The place has two units. One for long term mentally ill patients, and a unit for those in transition from an inpatient hospital stay back to the community.
So far, orientation has been . . . . interesting.
There's been a couple things that are happening, and I'm just so unsure if I should bail because these are signs of things to come or voice my concerns to the DON and possibly be known as, "that nurse."
1) I haven't seen a single nurse do blood sugar checks and insulin injections the same way. In fact, on several occasions I have witnessed nurses giving insulin without ever wiping the vial with an alcohol pad nor the injection site. I asked if there was a protocol for doing insulin administration, and was just told, "Everyone does it different."
I was taught to always use alcohol to wipe the vial and the injection site. Is there something I don't know?
2) I've witnessed OMT's and nurses dropping resident's medications on the floor, and still giving that medication to the patient to take. This totally grosses me out, and is against everything I've learned in school. What gives?
There have been other issues, more personal in nature, such as established nurses bad mouthing me to the DON when I've done nothing wrong. In fact, I was called into the DON's office last week to discuss these non issues. It was embarrassing and upsetting.
So nurses with more experience than I, what's your take on this??
Going with what Selene006 said, definitely do what you know is right.
First of all, aside from all the bullsh*t and drama involved in work, the RN's job first and foremost is to advocate for the patient. This means doing your due diligence when it comes to safe medication administration, infection control, etc. What did we all learn when studying for our NCLEXs?!
PATIENT SAFETY above all.
So, I would continue to do what you're doing right, as in wiping down the vial and the patient w/ alcohol before withdrawing the insulin and injecting it into the patient. Remember, you are advocating for your patient. As nurses, our job is to do the least amount of harm. We CARE for our patients. I just finished nursing school and this is what I've been taught to do. I mean, it makes perfect sense. Anything exposed to air is no longer sterile. The needle will pick up microbes if the vial is not wiped down after it has been uncapped and used the first time. Microbes live on our skin, especially if you're a hospital employee; you're most certainly already colonized with MRSA in your nares or skin. So, if you break the skin with a needle without cleaning it first, you would introduce whatever was on the skin into the skin, such as MRSA. Not good in an immunocompromised patient. Patient advocacy and safety first.
Same goes with medication administration, if a pill lands on the floor, don't give it. Hospital floors are SO dirty, even with housekeeping. I mean, theoretically, if the patient is healthy (and there aren't many healthy people in hospitals!), the stomach acid would kill whatever is on the pill, but I personally would discard the medication and administer another one, because you never know AND you're supposed to advocate for your patient.
Now, while you're busy advocating for your patient, who's advocating for you? Probably no one. Which really does suck, and is the reality of nursing. It's easier said than done, but hang in there unless you have a backup nursing job you can fall on. And in today's economy, it's pretty hard finding a new job, especially for nurses. So unless you have another job lined up, I would recommend sticking by your guns, but not rocking the boat, just until times get better at least. Because it won't do you any good if you're out of a job too.
But most importantly of all, patient safety and advocacy. Because at the end of the day, you can go home knowing you did what you know is right for your patient. And sometimes, that's all that matters in the end.
Hang in there. If things don't improve and the DON and staff continue to belittle you and dehumanize you, then it may be time to move on, but hang in there and continue to assess and evaluate the situation before doing anything rash.
MLT,RN
27 Posts
Going with what Selene006 said, definitely do what you know is right.
First of all, aside from all the bullsh*t and drama involved in work, the RN's job first and foremost is to advocate for the patient. This means doing your due diligence when it comes to safe medication administration, infection control, etc. What did we all learn when studying for our NCLEXs?!
PATIENT SAFETY above all.
So, I would continue to do what you're doing right, as in wiping down the vial and the patient w/ alcohol before withdrawing the insulin and injecting it into the patient. Remember, you are advocating for your patient. As nurses, our job is to do the least amount of harm. We CARE for our patients. I just finished nursing school and this is what I've been taught to do. I mean, it makes perfect sense. Anything exposed to air is no longer sterile. The needle will pick up microbes if the vial is not wiped down after it has been uncapped and used the first time. Microbes live on our skin, especially if you're a hospital employee; you're most certainly already colonized with MRSA in your nares or skin. So, if you break the skin with a needle without cleaning it first, you would introduce whatever was on the skin into the skin, such as MRSA. Not good in an immunocompromised patient. Patient advocacy and safety first.
Same goes with medication administration, if a pill lands on the floor, don't give it. Hospital floors are SO dirty, even with housekeeping. I mean, theoretically, if the patient is healthy (and there aren't many healthy people in hospitals!), the stomach acid would kill whatever is on the pill, but I personally would discard the medication and administer another one, because you never know AND you're supposed to advocate for your patient.
Now, while you're busy advocating for your patient, who's advocating for you? Probably no one. Which really does suck, and is the reality of nursing. It's easier said than done, but hang in there unless you have a backup nursing job you can fall on. And in today's economy, it's pretty hard finding a new job, especially for nurses. So unless you have another job lined up, I would recommend sticking by your guns, but not rocking the boat, just until times get better at least. Because it won't do you any good if you're out of a job too.
But most importantly of all, patient safety and advocacy. Because at the end of the day, you can go home knowing you did what you know is right for your patient. And sometimes, that's all that matters in the end.
Hang in there. If things don't improve and the DON and staff continue to belittle you and dehumanize you, then it may be time to move on, but hang in there and continue to assess and evaluate the situation before doing anything rash.