Told to Cut Corners at Work

[Nurse Beth, MSN]

I am a new grad nurse and I'm having trouble adjusting to my new job. I took a per diem nursing position at a nursing home and I'm having difficulty with med pass to 45 plus residents. Now because I'm new, I know that I do not know everything and I know that it will take time to adjust to; however, each resident is on 10 plus medications and I fear that there is a high risk for medication error.

I am also a float nurse so I do not know who the residents are and how the residents take their medications. I try to go half an hour early before my shift but I do not know what floor I'm on till until 5 minutes after the morning shift begins. The nurse manager once sent me to a floor to do med pass, but half an hour later I was sent to another floor with a heavier med pass. I fell behind on most medications and the supervisor just told me to do the best I can.

Also, I have not been trained on passing med during orientation. I had 4 days of orientation and only 2 were one on one with my preceptor. I asked for an extra day because I felt that not everything was covered but it did not seem to help. While working one or two shifts after orientation some LPN's and RN's advised me to cut corners with medications. They said that even the regulars on the floor do not finish the entire med pass within their shift and they don't know how you are expected to do so.

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I feel that for a new nurse it is important where you begin your career and the right orientation is necessary. I am thinking of resigning but I need experience to find another job. I do not know what to do. I have not gone for like two weeks or so and I'm really scared to go back because I feel like I'm risking my license. Please help me.

Dear Told to Cut Corners,

The conditions you describe are unsafe for patients and put your license at risk. You have been given an impossible job that can't be done unless you cut corners, and you have not been adequately trained.

You need at least a year in a stable, supportive environment.

Taking a per diem position of any kind is not recommended for any new grad. Per diem positions are intended for experienced nurses who can hit the ground running...and in the nursing home you describe, it would be hard for anyone.

This is a tough spot because what you really need is a residency in a reputable facility. I would try really hard to find a residency, even if it means re-locating. Technically, you have worked but it was in sub-acute, and you may be eligible for many programs. Look for areas that have a shortage of nurses and are less competitive (i.e. perhaps rural as opposed to large city). Cast a wide net.

Do you have any classmates who would put in a good word for you where they work? How about your old nursing instructors? Most of them have ties in local facilities. Ask your current colleagues for names of other sub-acute facilities in your area that have a better reputation.

Put all your efforts into landing a job because the next few months are important for you to establish a work history.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[bugya90, ASN, BSN, LVN, RN]

I worked in a nursing home as a new grad LVN. The med pass are terrible and lengthy no matter how you do it. I was technically PRN but I was working almost full time but was constantly rotating shifts and units so like you I never got to know the patients. Once you know pharmacology a little better and learn what each pill looks like (metformin is a huge horse pill, BP meds tend to be tiny and round, etc) it makes pulling them easier. Everyone finds their own way to run their med cart and that's ok. We had all the MARs in a big binder with dividers for each patient. I would pull the divider up one ring in the binder so t was sticking out of the side. As I gave each patient their meds I put the divided back in place so once the binder was back to normal I knew the pass was done. It helped me make sure I didn't miss anyone and allowed me to skip around in the binder so I didn't have to chase down a patient just because thusly were next in the binder.

[RNrhythm, BSN, RN]

You have a very demanding job made exponentially harder because you are a new grad. I was in the same boat a few years ago and let me tell you, I do not miss those days!

What helped me, and this will sound unkind, was privately I would look at my coworkers and think to myself, "Well, if SHE can do this, I certainly can." The only advantage they have is experience and you are getting yours now. Keep your eyes open and see what strategies people are using. ADPIE your job until you figure out what works. The end result will NOT be perfect. For example, unless you can bend time and space, your 45 patient med pass will start early and end late, just like your coworkers.

One thing you will get from experience is the ability to anticipate problems and stop them from snowballing. That will help a lot.

As for cutting corners, don't do anything that would get you in trouble if you had to honestly retell it in court.

Be kind and friendly to everyone. Even if it is not the culture of your workplace, it can be YOUR culture and, in time, that kindness and support will come back to you. Even if you don't have 5 seconds to help another staff, do it anyway.

Don't let this job harm you, physically or emotionally. Use good biomechanics and try not to get bitter and jaded. My old job had a culture of bitterness and constant complaining. That does not help anyone and I stayed out of that.

I left my horrible job after a year and really like my current job. On those occasional crazy days when it feels like I am having a flashback to that first job, I am proud of the skills I acquired during that horrible period.

[Ambersmom, BSN, RN]

Dear OP, I have worked in the situation you describe both as a new nurse and an experienced nurse. A 4 day orientation is ridiculous, even as an experienced nurse I insisted on a 2 week minimum orientation. What you describe is fairly typical in ltc facilities, and the chief reason I will NEVER work in ltc again, it is a huge liability. If you are taking shortcuts with meds and possibly other patient care God forbid if something happens there is NO defense for that, you can't say "but the other nurses told me too..." Even though as a new grad it might be hard to find something else I would literally run from this facility, its not worth hurting someone, its not worth your license. Best of luck to you.

[feelix, RN]

Sorry to say, I endorse every word Nurse Beth wrote. You need to get out and find a precepted experience of at least 6 weeks, even if you have to work at minimum wage. Go to your college's student employment rep, your instructors, and beg for help. If they asked me to med pass for 45 patients, I would not be able to do that in 2 hours. No hospital floated me alone as a new nurse. When I did get floated, it was because my preceptor was floated and I went with her.