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Unsafe Environment for Graduate Nurse?

KMcRN19 KMcRN19 (New) New Nurse

Looking for some advice. I have worked in this ER since last August as a PCT. we are the smallest ER/Hospital in our whole hospital-wide system. (14 ER beds) we recently lost 5 nurses at once while already being shorthanded. However, we did just gain one brand new grad nurse who started 2 weeks ago. And me, another grad nurse starting next month. I don’t think that offers a lot of help, considering we don’t have the experience... So we had a pretty busy day yesterday & had 2 RN’s & the graduate who was on orientation training. Her preceptor made her take her own 7 patient assignment alone, even though she explained to her that she does not feel comfortable doing so since she was on orientation for 2 WEEKS! That is so unsafe and scary! I don’t want to be put into a situation like that where I’ll put my license in jeopardy because they are short. I don’t know if I should try to switch jobs at this point (start date being June 10) or try to stick this out. This just seems like a good way to lose my license before I even get it!

kbrn2002 specializes in Geriatrics, Dialysis.

Yeah, that's so not OK. Expecting a nurse still in the beginnings of orientation to accept a full patient load is just asking for trouble.

OldDude specializes in Pediatrics.

We have this option in Texas...don't know about your state.

"Safe Harbor (SHPR), which may be initiated by a LVN, RN or APRN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with Rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer."

ruby_jane specializes in ICU/community health/school nursing.

While waiting for some ER nurses to weigh in- We never drill for this. So now's your chance to practice what you would do in your own head. Decline the assignment initially, seek advice from the manager (and given the situation you've described, there may not be much help forthcoming.)

You're in a different situation. You have some familiarity with how processes and equipment work. That may give you a boost even though you're not currently an RN.

It may also have been thusly: These seven may have been walking well and the preceptor may have felt that the nurse had skill enough to monitor seven uncomplicated and brains enough to realize if someone began to CTD. Or that nurse may have decided already that the grad nurse isn't fit for the ER and tried to make (a very unsafe) point.

Try to secure a position elsewhere.

I wrote more and erased it because this scenario as described is a total non-starter. Don't try to lay down the foundation of your career this way.

Absolutely agree. I am in the state of PA so I’m not sure if we have an act like that, I definitely need to get in touch with that. The other thing that complicates everything is my boss’s last day was yesterday, so NOTHING was done about it at all. Currently waiting for them to hire a UD & new clinician too! So the entire structure of our ER is not there at all. It’s so sad to say that because I love the people I work(ed) with & it’s all. Changing. Nurses who have been there for 10+ years are leaving. But, my heart I don’t think this will set me up for success. I really appreciate all of your responses

Seven patients means the most prudent ED nurse will not be delivering prudent nursing care even if in the end they all turned out to have sprained pinky toes and sore throats. But this place gave the 7 patients at a time to a nurse who not only has negligible familiarity with the ED but is also newly licensed. And is supposed to be learning, not serving as a warm body working a conveyor line.

Don't do it. Even if you're smart, quick, and fairly resilient, you will be rightfully scared [blank]less even in your dreams. 🤨

Update: I called talent acquisitions and informed them I want to apply for new positions yet stay in house with the company. She sets me up with a few med-surg interviews in the area, which im ok with to get my feet wet; within an HOUR the DON calls my cell phone. Trying to explain that staffing is bad everywhere (duh), it’s not as bad as I think (that’s why we have to shut half the ER down due to lack of staffing), they’re hiring 2 SWAT nurses, bringing back one RN (yeah the one they caught sleeping on the job in front of family members!) things will get better & more established after we get a new unit director / clinician, that we have plenty of experienced RN’s that aren’t planning on leaving (yeah, 5 of them. 4 full time... and that’s not what they tell me!) and that maybe I don’t realize that med/surg is stressful too & maybe I need to shadow before I interview there... I worked as an intern in their med surg, CCU, and 1 year of ER. I know how things differ between units. Sounds to me she is fully aware of the staffing situation and she is trying to not be one less RN. Thoughts?

Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

I am not sure what you are asking here. Is a 14 bed ER staffed by a competent ER nurse and a new grad safe? No. Simple answer.

Should you take a job there and see how it plays out? Hard to tell. It depends on what your goals are. If you want to be a well trained nurse working in a safe environment, you will have to find a place with a well established training program, that has earned a good reputation for safety.

On the other hand, your priorities may be more focused on pay, commute time, and other factors.

What are your priorities?

3 hours ago, hherrn said:

Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

Excellent advice, except for the part about licensing being anything other than “fragile”, which is highly state-specific.

In my state, a simple accusation made to the state makes your license info turn red & puts an “under investigation for XYZ” within a day or two of the accusation being received by the state. Six months or a year later, sometimes two or three years later, you’ll have an opportunity to prove yourself innocent. My state’s board meets three times a year, for two or three days at a time & you can count on one hand the number of nurses who walk away without at least a “letter of concern”, which they don’t consider to be discipline - tell that to a jury when you really do make a mistake!

please don’t be flippant about the BON unless you have first hand knowledge of how the process works. I do - I was falsely accused and one of the handful who walked away “unscathed” - if you don’t count the scarlet letter on the licensing site for seven months, the lost wages for seven months or the $2000 in attorney’s fees to clear my name.

Anyone can make a complaint to the board & if that complaint isn’t glow-in-the-dark “innocent”, you’ll have at least six months of anal-puckering to deal with. (In my state).

Edited by rzyzzy
Added

sarolarn specializes in Telemetry.

I would be interviewing with other units if I were you. If a 14 bed ER only has 2 nurses on it, what happens on the days when it's that nurse with a 2 week orientation and you alone after your orientation is cut short? This is setting you up for failure, moral distress, injury, poor patient outcomes... get yourself out of there and trust your gut on this one.

4 hours ago, hherrn said:

Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

I am not sure what you are asking here. Is a 14 bed ER staffed by a competent ER nurse and a new grad safe? No. Simple answer.

Should you take a job there and see how it plays out? Hard to tell. It depends on what your goals are. If you want to be a well trained nurse working in a safe environment, you will have to find a place with a well established training program, that has earned a good reputation for safety.

On the other hand, your priorities may be more focused on pay, commute time, and other factors.

What are your priorities?

The license is a nurse's livelihood. Fragile is not the word I would pick. You make it sound like it's nothing.

OP stated her priority. Surviving as an RN. Why would you think she is more concerned about other things?

I really don't understand how you can be so relaxed about licensure and keeping one's record clean.

On 5/22/2019 at 11:18 AM, Emergent said:

7 patients is too much for an experienced ER nurse!

It depends on the patients. but for a new grad it is surely too many, even with 2 whole weeks of O.

MunoRN specializes in Critical Care.

While there certainly are cushier staffed small ERs, but 2 RNs for a 14 bed ER is not exactly unheard of. And in this case it was 2 nurses plus a new grad, so 3 nurses for 14 beds. Experience levels of new grad nurses varies significantly, unfortunately, but there are those who graduate already taking a full acute care load, with a preceptor RN as backup, so that shouldn't be too much to ask of a new grad even after just a couple of weeks orienting.

I wouldn't be took quick to assume the grass is always greener on the inpatient side, you may end up with 7 acute care patients rather than a mix of 7 acute care patients and some outpatient walkie-talkies just waiting for the MSE before being directed towards their primary care physician.

9 hours ago, rzyzzy said:

Excellent advice, except for the part about licensing being anything other than “fragile”, which is highly state-specific.

In my state, a simple accusation made to the state makes your license info turn red & puts an “under investigation for XYZ” within a day or two of the accusation being received by the state. Six months or a year later, sometimes two or three years later, you’ll have an opportunity to prove yourself innocent. My state’s board meets three times a year, for two or three days at a time & you can count on one hand the number of nurses who walk away without at least a “letter of concern”, which they don’t consider to be discipline - tell that to a jury when you really do make a mistake!

please don’t be flippant about the BON unless you have first hand knowledge of how the process works. I do - I was falsely accused and one of the handful who walked away “unscathed” - if you don’t count the scarlet letter on the licensing site for seven months, the lost wages for seven months or the $2000 in attorney’s fees to clear my name.

Anyone can make a complaint to the board & if that complaint isn’t glow-in-the-dark “innocent”, you’ll have at least six months of anal-puckering to deal with. (In my state).

What state are you in?

9 hours ago, Kooky Korky said:

The license is a nurse's livelihood. Fragile is not the word I would pick. You make it sound like it's nothing.

OP stated her priority. Surviving as an RN. Why would you think she is more concerned about other things?

I really don't understand how you can be so relaxed about licensure and keeping one's record clean.

When I was first licensed, I pretty much assumed that I would survive as an RN, and focused on learning skills and developing competency. We have no kids, no debt, so I have the luxury of focusing on job satisfaction and personal growth. Many don't have that luxury, and focus on a salary and a commute that allows them to fulfill other needs. No judgement on either choice, or anything in between.

As far as the license- Just like my commercial driving license,and my guiding license, I need to abide by particular rules. While some nurses have been unfairly disciplined by BONs, the fear is generally overstated. This is why I encourage those concerned to go to their local BON and see what nurses are disciplined for.

I just went through mine, and had a look, randomly picked these:

  • Lying about an OUI
  • Stealing a computer from work
  • BAC 0.39 while passed out at work
  • Dealing illegal hallucinogenics
  • Diverting narcotics
  • Diverting narcotics
  • Diverting narcotics
  • Unfit to practice, evidenced by 15 or so documented disciplinary actions by her employer
  • Using a physician DEA number to obtain narcotics
  • Diverting narcotics
  • Lying- charting an assessment not done

I am not casual about my license. Without it, I would be taking a drastic pay cut- none of my other skills make much money. And, I like being a nurse. I do think that while one needs to be concerned about maintaining any lisence, understanding how they are put in jeopardy is important. I know that there are occasional outliers, but go to the BON and look at what the overwhelming disciplinary actions are about.

Edited by hherrn

13 hours ago, hherrn said:

Good news- Your license is far more durable than you think. There is a really weird and inaccurate belief among many that our licenses are fragile, and need protection. Go to your BON web site and have a look at how nurses get disciplined in your state.

This nurse, like me, is from PA. Not sure about other states, but PA is hostile to licensed nurses. The discipline taken is posted monthly on the Dept. of State website. The hostility toward licensed nurses is found when the other 15 or so licensing boards lists their discipline monthly as well. Compare the records. Each board has none, a few, maybe a handful each month. Then look at nursing, and it makes me want to barf. The list each month is long and growing. People are losing their livelihoods left and right in this state. I'm not sure what to tell this new nurse, because the market is saturated here, and her chances of finding another job are slim to none.

31 minutes ago, hherrn said:
  • Lying about an OUI
  • Stealing a computer from work
  • BAC 0.39 while passed out at work
  • Dealing illegal hallucinogenics
  • Diverting narcotics
  • Diverting narcotics
  • Diverting narcotics
  • Unfit to practice, evidenced by 15 or so documented disciplinary actions by her employer
  • Using a physician DEA number to obtain narcotics
  • Diverting narcotics
  • Lying- charting an assessment not done

Other states put things into much broader categories except for things which basically are also felonies.

The much broader categories are things that could be anything and there is no further delineation of what exact "crimes" they consist of.

Do you really sincerely believe that someone being reported and investigated for, say, "negligence" only ever means what it might have meant twenty years ago?

**

So anyway, sometimes when I read these challenges to "go look at what people actually get in trouble for," I do it.

Today I have picked a random state I haven't checked out before. I randomly clicked on someone's name in the list of disciplinary actions. The link took me to the copy of the complaint/board order, etc.

So this random person was disciplined for having administered a common medication by the wrong route (though a route by which said medication is known to commonly be administered). There was no mention of any harm nor was there any mention of a pattern of behavior or any other such thing. The complaint and discipline appear to be based on the fact that incorrectly following orders can harm patients.

That's all fine and good. Just don't misrepresent things to new grads wondering about whether hospital dumpster fires are generally safe or not.

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