Trying to learn from mistakes

[Learningtobenurse101]

Hi

So I am a new nurse and I was fired from my first job after a month. My preceptor and I didn't get a long and as much as I tried to figure out ways, we clashed a lot. I didn't want to get my manager involved just yet, but by the time I felt it was necessary, it was too late. I know I can come off strong, and when I am confused about something, or felt that it was unsafe, it was easy to question my preceptor because I didn't feel comfortable. My preceptor had a few times went outside the scope of practice and that ruined my faith in them, and often times would force me to change my assessment to something that I felt was an inaccurate picture or left things out that I felt were necessary to give a bigger and more accurate picture of the patient. In addition, I felt I was scolded from checking my patient too often (who were kids btw) when the alarm would sound, and then I erred by not checking them enough and couldn't seem to find balance to them. Also, I felt I was misaccurately represented to my manager, and when I would explain what happened they would say, "that doesn't sound like so and so" and I realize that human nature tends to trust those who know in longer, but it sucked. Another instances, I had checked the a pt who needed more O2, because O2 was low, and I stimulated them by tapping on their chest ( as shown to do) and checked their mask and it didn't increase their stats so I increased the O2, but was then told I didn't assess enough before deciding to increase O2, and should have called my preceptor before doing that, when it felt that my preceptor had put me in charge of this particular patient when a friend went on lunch and did what I was instructed to. I was told I was being confrontational when I said, "I was doing what I was instructed to do to keep their sats up" too loud when my preceptor scolded me from doing that...and now I find myself without a job, and it was already hard to find a job as a new nurse, now even more difficult for being let go from my first job....I am not even sure how to recover from this or anything...

[Learningtobenurse101]

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

So Yes, I am CERTAIN the preceptor went outside her scope.

[Libby1987]

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

That's just flat illegal, not a scope of practice issue. Why did you mislabel it?

[Learningtobenurse101]

I reported it to managers. They were taking care of the issue. It is illegal yes. My apologizes for mislabeling it. That act they did made it extremely difficult to trust them, since it should be common sense to NOT do that.

[Ginger's Mom, MSN, RN]

I reported it to managers. They were taking care of the issue. It is illegal yes. My apologizes for mislabeling it. That act they did made it extremely difficult to trust them, since it should be common sense to NOT do that.

So, you were let go and your preceptor still has a job? Something does not seem right.

[Learningtobenurse101]

In this case, yes, my preceptor would have a corrective action as they saw fit (whatever that may be), but retained her job. I was still within my 90 days, and they had overstaffed making it easier to let me go.

[Anna Flaxis, BSN, RN]

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

So Yes, I am CERTAIN the preceptor went outside her scope.

In some settings and under some circumstances, medication administration can be delegated to a PCA.

"Borrowing" medication from another patient is common practice in some settings.

also it was not prescribed yet either.

Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

[Ruby Vee, BSN]

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

So Yes, I am CERTAIN the preceptor went outside her scope.

It's not really as clear cut as all of that. In some situations, delegation to a PCA is allowed. And there are degrees of delegation. If the PCA is feeding the patient and I have a pill to give, crushed up in pudding it is reasonable to hand the PCA the pill mixed with pudding and have her feed it to the patient. That is not delegation of medication administration. I pulled the med, identified the patient, crushed the pill and ensured that the patient received it, and then I charted it as given. All the PCA did was hold the spoon. *I* gave the medication.

Also, in some situations it is not only appropriate but desirable to take a medication from Mr. Jone's drawer to give to Mrs. Smith. The physician gave me a verbal order to give it because the patient needs it right now. He'll put in the order as soon as he contacts IT so they can remind him of his current password for the order entry system. I cannot get the pill for Mrs. Smith from the pharmacy until two hours after he orders it, and Mr. Jones won't need the pill for another four hours. As soon as I get Mrs. Smith's pill from the pharmacy I'll put it back in Mr. Jone's drawer. That has been common practice for years, although the practice is gradually fading away as medication administration systems change.

[Learningtobenurse101]

There is the 5 rights in medication administration to. You wouldn't be able to go through the 5 rights if the names do not match. Completely unacceptable.

And as mentioned previously, the hospital has rules against it, and in this case, managers agreed it was never allowed.

And some states does allow the PCA to aid a pt in administering meds, however, with babies, I strongly am not okay with them administering meds. Other than "handing the meds" to the pt, while I stay in the room and see that they hand the meds to them. I am not comfortable with that under my license if I would have left the room. In addition, I need to be able to assess the patient before administering and might as well administer myself. I am very uncomfortable with the practice of having UAPs give medications, and will not under my license. As mentioned above, it is a moot point, because as previously stated, hospitals had rules against it, and managers already stated it was out of scope, at least at this hospital.

[Libby1987]

Geeze, I thought you were referring to patient controlled anesthesia and narcotics. And then I was confused by posters calling this common or acceptable practice.

I still wouldn't call that outside of scope but rather outside of usual protocol. Whether it should have been enough to throw you off center I'm not sure. I think it's more of the need to develope discernment and judgment gauged to the situation. Some come by that inherently, for others it's more challenging. Your communication style might be inflexible to the personalities you're working with and will face in future jobs. So perhaps that's the first step, learning how to work with different and challenging personalities.

[Cricket183, BSN, RN]

Nevermind! I can tell this is useless!

[Learningtobenurse101]

The wonders of PIXIS allows those kinds of meds to be given without under someones elses names in emergencies. :) And a verbal order is still an order :)

Also, hadn't had problems with other nurses. I was a PCA myself also, not a problem there either. Always had high ratings in work performance.

And again, Hospital has policies and rules & regulations against it, and managers agreed it was not okay.

[Learningtobenurse101]

Thank you. As mentioned way early in the posts, I originally didn't want to talk about the out of scope part since it was dealt with under where I worked, and managers said it was out of scope (at least at this hospital), and not okay to take from other patients medications. In this case, that is all that matters, moving on.