Thrown off orientation too early??

[banpoprock]

Hi all, I just got off of my night shift job at a skilled/acute care unit and I had the worst night of my life. I started working on July the 28th and was taken off of orientation last night because someone called in sick. This threw me off guard, but I felt as though I could handle it because the staff I work with are wonderful and I had basically been taking care of seven patients on my own while my preceptor sat at the nurses desk and played on her phone. My preceptor showed me things but only at her convenience. Any ways the night began well and all of the staff assured me that I could come to them for help. So I assessed my patients and proceeded to pass meds. I got into my new admits room and realized that I did not pull his warfarin from the pyxis so I go to pull the warfarin and the pyxis says for it to only be given on Mon, tues, Wed, fri, sat..so I said well today is Thursday so he must not get it. So I go back to my computer and now the pharmacy has messaged me wanting me to clarify if the patient takes warfarin on Thursdays and Sundays so I ask the patient since I am standing in front of him and then I look at the patients h&p the doctor left and it said that he receives 2mg on thurs and Sun and 1mg the rest of the week. I sent this to pharmacy and then they messaged back telling me to put the order in well I finally asked my charge nurse and she got to looking and saw that the doctor had ordered for the patient to receive a one time 3mg dose that night, so I asked her if I needed to get it and she said that she would well she looked in the pyxis and it said that the nurse before me had pulled the 3mg dose, well we go back to the computer and this was not charted so we called the nurse and she said that she had in fact given him the warfarin. So I potentially could have caused a lot of harm to my patient if I had administered this med. This was basically a glitch in the system and a miss communication of orders, we resolved this issue in around two hours. After this the night seemed fine, I did my dressing change that usually takes an hour, then I had a patient going out for testing at 7am so I had to get him ready and off telemetry etc etc do that I could give report. I finally begin giving report and the girl is complaining about everything I say and in front of my patients. First thing was an Iv that was due to be change the night before last, well yes I didn't realize that I needed to change it out, it never crossed my mind. I apologize and she tells me how she can make me stay longer and change it, I tell her well I wouldn't get it anyways. And next patient, this patient has a picc line so I am telling her about it and she ignores everything I am saying and goes straight to the picc and looks at the date, then she looks at the iv tubing which I had changed because I saw the stickers I tell her yes I changed that then she zooms in on the dressing and shows me where the tiniest little nibble of a piece had began to come loose and she says and you should have changed this look at it (it had just been changed two nights ago) I look at it and tell her that I had not seen that. And honestly I hadn't. She says yea now look what I have to do today. I proceed with report and go to my car and cry, I feel so defeated about missing those things ugh, advice, stories, anything please

[banpoprock]

Also I haven't seen my husband or daughter for tow days because of this job, I am.thinking about leaving..Lord help me

[addylpn]

Shortening of orientation happens pretty frequently especially in LTC. If a nurse knows she has an orienteee, the chances of her calling off increase. I know this to be true because I've seen it time and time again. That nurse puts your co-workers in a bad position because they are having to pick up your slack. Honestly, your night doesn't sound half bad. Annoying? Yes. The AM nurse seemed to be picking on you a bit which I would have explained, "I'm really sorry if I've forgotten something but you see I was supposed to be orienting last night". I would definetly talk to your nurse manager and explain your need for more orientation. Everyone is different and needs different things. If you don't speak up, they will assume you are fine on your own.

[canigraduate]

Calm down, take a few deep breaths.

Yes, there are a few little things you missed. No, they are not that big of a deal.

You need to have a talk with that nurse and tell her you don't appreciate being treated like that. Nursing is 24/7. You do not need to stay late to do tasks she can do just as easily on her shift. No one, and I mean no one, needs to talk bad about you in front of patients. You need to get that hussy in the manager's office and have a little three-way convo about appropriate work behavior.

As far as the piddly stuff: if the dressing is falling off, you need to change it. If it isn't falling off, you can reinforce the border until the next scheduled change. Sounds like it wasn't falling off, so you were good. Keep some paper tape in your pocket and you can whip it out and reinforce borders under that jerk's nose. Also, stand up for yourself and tell the nurse that it's time to move on so you can finish report when she does stupid stuff like double check lines in front of you. If it's not part of your hospital's policy to check lines during bedside report, then she can check them on her own time instead of wasting yours.

I'm more impressed with the fact that you caught the med error and didn't give your patient a potentially life-threatening extra dose of coumadin.

It's the judgment that makes nursing important, not the tasks. You can train a four year old to change a dressing.

Your judgment was sound. Tasks are meant to be passed on when time runs out. That nurse needs to deal with it.

[ddaviddudley]

Even me who does not work on the floor, I still deal with nurses like that who pick at the tiniest insignificant details when I send them patients from the ER.

It's hard but as you gain experience over time you will develop the marketability power of being able to work wherever you want to work at. If your in one environment where there's snobby nurses who have nothing better to do than to be negative then you have countless of other facilities that you can go to where you can find a more positive atmosphere.

[Jules A, MSN]

It doesn't sound like a horrible first night alone! I'd have been proud if I managed to get it done like it sounds you did. Although you could have done without the nasty nurse you handed off to but I'd let it roll off my shoulders, it happens. I'd probably just ignore that part and try to remember to be extra vigilant in the future when I knew I'd have to hand off to her which will increase your quality of work.

What it does sound like is there is as much discontent of missing your family as stress at the job. ??

[Pneumothorax, BSN, RN]

#1 you caught a potential huge med error. SO good job with that. Thank you for paying attention and taking that seriously.

#2. if everyone stayed late to do things that the on coming nurse is more than capable of doing, there would be no point in handing off. BFD.. you were busy with more pressing things. The IV will get changed, and the picc line dressing..ugh whos to say the patient wasnt messing with it or it peeled in their sleep. you cant control everything!

#3. the girl you handed off to sounds like she hates her job, based on how u described her behavior. her inattentiveness and rudeness wasnt necessary.

dont sweat this stuff... use it as experience and move on. its ok to cry. if you feel like u need a bit more orientation. ask. it will keep u sane and your patients safe :)

[VANurse2010]

I'm curious how experienced the oncoming nurse was, because the stuff she's complaining about makes her sound like an ignorant new grad. A little piece of the PICC dressing coming up at the corner does not necessitate changing if the transparent part is still intact. If you changed them every time they looked like that you'd be removing them everyday - exposing the site to the outside germs - and changing them qday.

As far as the iV tubing - that's just complete BS. The appropriate response should have been - "no problem, I'll change them. Just look more carefully next time."

[emmy27]

A nurse to whom you're giving report fussing over small things/trying to guilt you in to staying late to do tasks is something you will encounter over and over in your nursing career. In some cases it's sheer laziness, in some it's resentment over a perceived imbalance in workload on shifts, sometimes it's just frustration over a lack of control in every other aspect of the job oozing out in to their interactions with others (she can't make management give her a better patient load, families listen to her teaching, patients stop trying to fall out, or doctors be respectful in their interactions, but by god she can pressure the new nurse in to changing that IV before she leaves).

It's important to try to get everything done on your shift, but if you don't? It's a 24 hour business, and that's what shift report is for. If I stayed late every time I d/c'd a patient at 5 minutes to shift chance in the ER and got a new one in the bed just as I was starting report, I'd never get home. As long as you're making a good-faith effort to complete tasks in a timely manner, the fact that some of them fall on the next shift is just really not your problem. I'm sure you come in to tasks that were due earlier at times as well.

Get good at practicing a serene smile and saying "let's step out of the room for a moment" when people start getting ugly in front of the patient, though. That's not just unpleasant to you, it's very upsetting to the patient- would you want to be taken care of by someone whose judgement had just been called in to question in front of you? It really wasn't a serious issue, but the patient doesn't know that. She's being incredibly unprofessional in doing that, and it needs to be addressed with management, for the patients' sakes as much as yours.

[iluvivt, BSN, RN]

Tell this nurse in private that it unprofessional to put down another colleague in front of a patient because it can undermine the patient's trust in their caregivers. This is a big NO NO and she needs to told this as it is obvious she does no know it. She will keep doing it because she got away with it and it meets a need she has so you are going to need to address it.

As far as what you did not do...BIG WHOOP..she had to dig deep to find some things. I would have said that I will take care of it and just changed the tubing and reinforced the PICC dressing border. What a drama queen,poor me I am going to be worked to death because you did not do two tasks that take all of 15 to 20 minutes at the most! It will get better and don't let anyone railroad you

[AlwaysLearning247, BSN]

You're going to come to find out that you meet many bad apples in nursing. When I was new I dealt with very similar situations. At my workplace now there is an older nurse who is known to bully all new nurses. I shut it down quick by talking with that nurse when I was on orientation. Don't take it personally, as these lovely nurses are usually just bitter and burnt out. When you're a newer nurse you try to do everything perfectly and in a timely manner and it feels bad to have someone basically telling you that you didn't do your job. You did a great job! And next time the peach you gave report to says another word, kindly remind her that nursing is a 24/7 job. Good luck, things will get better!