Unethical behavior on my first day of floor orientation

[TJMICHAEL]

Seeking constructive feedback on this situation.

I have 5 years experience as a trach/vent nurse in home health, right out of nursing school. This will be my first experience working in a facility. I just completed my first day orienting on the floor at an addiction recovery residential/detox unit. Several things stood out to me over my first 12 hours of orientation:

1) This nurse works FAST - mostly because she is pre-pulling meds & copy/pasting her charting. (how will I ever keep up? Does everyone do this???)

2) This nurse has horrific bedside manner - Telling her patients and ME that she is the one with the medication & if she doesn't like a patient - she's going to let them suffer through withdrawal longer, & if she likes a patient, she will try to get them onto the meds sooner. Also, openly ridiculing patients about the validity of their pain & questioning a patient's claim that she had been sexually assaulted in the days prior to entering the facility for treatment.

3) This nurse is prefacing almost everything she does with "this is how I do things, but you didn't see this because JCAHO..." How am I supposed to learn how to correctly do things (I have no floor experience) if the nurse orienting me only shows me how not to do things & doesn't have time to show me according to the policy/procedures. (BTW...the week prior to my orientation, JCAHO was on site.)

First, I'd like to ask if this type of situation is common, as I have never worked on a unit in a facility.

Second, I want to be careful as to what action I take & who I approach if/when it is warranted. While there is certainly unethical behavior occurring, I am not certain what the appropriate action is/would be on my part. It's been suggested I contact the DON. I "feel" like I need to take action, but I want to make sure if/when I raise concerns, I bring only specific examples & have done my diligence.

Thank you for your input. This "new" nurse is trying to adjust to a whole new ball game.

[klone, MSN, RN]

No, this is not common. Or at least, not in my experience. She sounds awful. I'm sorry.

[ponymom]

Don't tell us all this....tell her.

[BlinkyPinky]

Congrats on missing JCHAO

[caliotter3]

If you want to keep your job, tread lightly. That does not mean that you can't keep a personal "journal", just in case, but don't be so quick to go to management to report her. You have no idea where she stands in the organization. As they say, you do you. Should the time come, then act. Until then, mind your job. It looks as if you used your real name as your screen name here. Not a wise move.

[djh123]

Items 2 & 3 are a lot more of a concern than item 1. You might talk to mgt., but then again, it might be too soon since you're still in orientation.

[Serhilda, ADN, RN]

1 and 3 are somewhat common sadly, especially 1. As much as you, and most people, would like to change her bedside manner, that almost certainly won't happen. I wouldn't make a big fuss over any of this because chances are, it's a cultural issue of that particular unit and management. I'd be polite when she states to do something a certain way that goes against Joint Commission standards and make a note to look up the hospital's policy on it later. After orientation, you can practice as you wish.

[Meriwhen, ASN, BSN, MSN, RN]

Copy and paste charting is not necessarily bad, provided that the overall charting is individualized to each patient each shift. You can't just cut and paste in its entirety yesterday's note and call it a day. But if you have frequently used phrases that appear in almost every note, then there's no harm in cutting/pasting those phrases in and then charting around them.

For example, when I am writing discharge notes, the bulk of the discharge instructions are going to be the same for each patient. So it's convenient for me to have these instructions pasted in. Then I tailor the instructions as needed to each specific patient.

The EPIC charting system uses Smart Phrases, where you can assign frequently used text/phrases to shortcuts. That allows them to be inserted into a note with a couple of keystrokes, and then the phrases can be customized as needed.

[maji2002]

Read the policies and procedures and stick to them. That is your legal and ethical standard. Do what you know is right, you may have to take some initiative to do the learning on your own. Good Luck.

[Nunya, BSN]

Kind of surprised no one has suggested she start job hunting again....

[eyesis84]

I'm not sure if this is the right forum for this but I am a nurse who was recently a patient in the ER and treated horribly. I am interested in telling my story in the right forum and am new to Allnurses. I attempted to write an article but it cut me off at so many characters. Does anyone know of a forum on allnurses that would be a good fit for this? Thanks !

[JKL33]

eyesis84, sorry to hear of your experience. Probably the most productive thing you can do would be to discuss your concerns with the patient liaisons at the involved facility. Hopefully you've already done that, though, and come to some sort of resolution.

This is a public forum so you can share as you wish, but doing so won't have any particular guaranteed effect. Personally, although I am very concerned about providing excellent care to my patients, I find it difficult to feel too much when reading a single-perspective account of someone else's situation, you know? Rarely I do, but most of the time there are too many unanswered questions. I wasn't there, I can't do anything about it, and the fact that someone may have done something or behaved a certain way doesn't mean that's how I or most other nurses would've handled the situation.

Anyway, I hope you are well now. If you wish to share maybe reach out to AN admin to get the specifics on writing an article?