I am very nervous, I am a new graduate RN- I currently work with a registry. I agreed to do a NOC shift at a SNF. When I got there I was briefly oriented and told I would be the only nurse along with three CNA's working with 25+ patients. The night was chaotic, the SNF was very disorganized, I got very behind on the meds... having to hunt them down.. I gave the midnight meds and 5am meds, did rounds, took the needed blood sugars and provided coverage for those as needed, I also gave pain meds PRN to two patients and I gave BP meds early to another patient who was running a high BP- per his physician. The reason I am scared of losing my license is because I totally got behind for one 5am med, and ALL the 6am meds AND all the 7am meds... I had a very hard time finding medications etc. and I didnt get any "nurse notes- charting done" :| When the LVN's came in to relieve me, they refused to help me with meds so I called the DON... well I only had a chance to give some of the meds late and I was told to leave by the DON- even though I offered to stay late- no charge to the facility- and write my nurse notes. I am terrified and I feel like a failure, I am so disappointed with myself for not doing a better job Please any advice would help I am sooo terrified of losing my license d/t this- I should have refused the assignment, but now its too late to do that :crying2: :crying2: :crying2:
I just wanted to add don't offer to chart for free! Your time is worth money!!!! I would have just stayed late and finished my charting. I've had to do it before and I'll have to do it again and I've been an LPN in LTC/SNF for 7 years.
When the DON told you to go home and you told her you were not done but she let you go; meaning you have nothing to worry about. Good call calling the DON since no one would help you. Welcome to the jungle!
no, you won't lose your license but you may get written up but who cares, you are not coming back to that facility, right? i am sure the don knows that sometimes (or most times) we cannot be in compliance with the 1 hour before and 1 hour after window specially in ltc.
The DON couldn't let you chart without getting paid because that's illegal. We were told to never clock out and then continue to chart or work because then they could be sued for having us work off the clock.
As the above poster replied, I don't think there would be many licensed nurses left if that was the case:) I just left a SNF as a new grad, because of the lack of support, the disorganization you speak of and just unsafe staffing in general. I also agree with the last poster that is not a place for new grads to start out. No one does anything by the book, they are berated and made to feel inadequate by supervisors when they ask questions and generally just get no support. Sorry you had to go through that. Unfortunately, in this job market, many new grads are having to settle for these SNF/LTC jobs that don't teach us anything, but to break the rules and to settle with less. I hope you find something better (as I hope to also).
Wow, you sweep a wide brush on LTC/SNF with an ugly color.
Please do get out of it as soon as you can.
Don't let the door hit you on the way out.
We don't need your atitude.
Everyone and everything in LTC is not ******. There are good people and places out there.
No you are not going to loose your license over the meds, the nurses notes, nothing...trust me I'm a long time SNF nurse and I know and I live in California. Also my suggestion as a new grad it's okay to go to a snf but don't do it at nights when you don't have another nurse to fall back on.
In order to lose your license, someone has to report you to the Board. I highly doubt that the facility you worked at for one shift only, is going to take the time and the effort to report you. Every nurse who works as a fill in there, is more than likely late with something. Do you think they report every one of them to the Board? No agency would be working with them if that were the case.
Another thing, as a new grad, do you think registry is in your best interest? It sounds like you're highly stressed right now with no apparant reason it sounds like you did the right things and didn't put anyone's life in danger. But seriously maybe get a job at one place so you can get your skills down, time management etc. I'm an experienced nurse with many years down my belt and I refuse to do registry at any SNF because it's all new and confusing and can get complicated in terms of policy etc.
Specializes in ICU, MS, Radiology, Long term care.
I agree with many of comments because I have worked at a SNF. But, will you lose your license? It depends on the relationship with your institution and the Board of Nursing. My story illustrates.
When I began my nursing career if I did what was the best for the patient, and I didn't step on the doctor's toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained 'not a good fit for our organization'. Then they can fire me 'for negligence or incompetence' as they were the ones deciding the definitions. The healthcare organizations can also 'weed out' the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can't find a job. There seems to be a disconnect.
I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse's notes, which could explain why the value wasn't entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn't include the physician's assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father's condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient's heart condition indicated it was more than probable. The treatment was the same regardless. No one died.
What the accusations didn't mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn't able to deliver quality care in this ICU. My patients and their families always come first and if I can't perform by own principles and morals; it is time for me to leave.
I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn't something I would make up. I was under oath.
To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years' probation. I didn't complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can't get a job anywhere (one business hired me, I was in orientation, then told I couldn't be hired without an explanation when I asked.) even McDonald's. I will soon be living on whatever social aid I can get and become a burden on society. This doesn't have any logic. If I am such an incompetent nurse: why didn't it come up before 30 years? Why didn't it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn't they contest my unemployment compensation?
These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.
I agree with many of comments because I have worked at a SNF. But, will you lose your license? It depends on the relationship with your institution and the Board of Nursing. My story illustrates.
When I began my nursing career if I did what was the best for the patient, and I didn’t step on the doctor’s toes too much, then everyone thought I was doing a fine job. Now, when my supervisor, a member of the ruling class in one of these healthcare conglomerates decides I no longer am doing what is best for the company or as is currently explained ‘not a good fit for our organization’. Then they can fire me ‘for negligence or incompetence’ as they were the ones deciding the definitions. The healthcare organizations can also ‘weed out’ the nurses who become too smart or compassionate or the personnel that require too much pay that would threaten the profit margin of the institution. Which explains why there continues to be a nursing shortage if nursing schools are churning out graduates at a breakneck pace? I continue to see ads for nurses and pleas from nurses who can’t find a job. There seems to be a disconnect.
I have recently found out that my state Board of Nursing has the same investment in these healthcare conglomerates. I recently had a hearing to determine if I was negligent and incompetent. The accusations were: 1) I neglected to write down one value in a list of vital sign values present on the evidence. The evidence did not include the nurse’s notes, which could explain why the value wasn’t entered (the wave form could have been abnormal or the value could have been faulty). The evidence also didn’t include the physician’s assessment of the patient at that time. The accusation also implied my inaction caused the patient to die 7 days later. 2) That I had knowingly disabled monitoring alarms. Alarms are going off all the time in an ICU. When I respond I turn the alarm off since it has served its purpose in alerting me. There was no death mentioned with this accusation. 3) That I had responded to an alarm only when the daughter of a patient alerted me. I was documenting the care delivered to this point and was finishing a sentence. The daughter was very aware of her father’s condition and I considered her interest in his condition as more than mine. And, since I was sitting in front of the patient I was quite aware and expected this alarm to happen as the patient’s heart condition indicated it was more than probable. The treatment was the same regardless. No one died.
What the accusations didn’t mention was my supervisor threatening me with Board of Nursing notification when I told her I would quit because I wasn’t able to deliver quality care in this ICU. My patients and their families always come first and if I can’t perform by own principles and morals; it is time for me to leave.
I was more than a little surprised at the hearing when the Board of Nursing objected to my statement that other nurses declined to be my witness as they feared retribution by the healthcare organization. I wasn’t something I would make up. I was under oath.
To complicate employment matters even more for me was my self-reporting alcohol addiction treatment to the Board of Nursing, as required, and placed on 5 years’ probation. I didn’t complain. I just wanted to do the right thing. I was dismayed to discover no healthcare organization in this metropolitan area would hire anyone on probation. I have been without a job for over 2 years. I am working on another degree in another profession, but can’t get a job anywhere (one business hired me, I was in orientation, then told I couldn’t be hired without an explanation when I asked.) even McDonald’s. I will soon be living on whatever social aid I can get and become a burden on society. This doesn’t have any logic. If I am such an incompetent nurse: why didn’t it come up before 30 years? Why didn’t it come up previously at mentioned healthcare institution before being employed there 4 years? If, indeed, I was incompetent and negligent why didn’t they contest my unemployment compensation?
These are the questions that keep me awake at night and fear for the quality of healthcare in this state and country. The current rankings by various healthcare monitoring organizations make perfect sense to me. I have been present and seen the changes.
Wow I'm appalled at the unfairness of your situation. My jaw literally dropped to the floor. And yes in the past few years I'm also concerned about quality of healthcare in this country. My father last year in march was brought to the ER by my mother with ALOC. I feel he had tia's as the night before he was extremely confused, not understanding questions etc, why my mother didn't call me that night for advice I do not know, why she let him go to sleep I do not understand. The care my father got at ICU was appalling. I couldn't go down when he was in ICU because my boss almost had a stroke when I asked her for my two days off (I work two on four off), and lookign back I should've told her I was going whether she liked it or not. I won't go into details but the ICU nurses were really bad, to the point where I would ask my mom questions such as, and this after being in ICU for over seven days if they were tube feeding him.."no" she said, I'm like uh he needs to be fed, knowing my father like I do he doesn't get fed he's going to die...I just assumed okay it's ICU they know what they are doing. He stayed in the hospital longer than he should've becuse they were giving him Haldol which had the total opposite effec and no one would listen to my mother, or myself an experienced RN. Eventually I told my mother to demand to the docs and the nurses no more haldol as he was while on it trying to get out of bed, wanting to leave etc. She had to sit with him 24/7 and hold him down when he had those fits. They rudely said fine but if he breaks a hip you're responsible to which she said fine I'm responsible. He's okay now. But I really think if a) my mother took him in asap that night they would've caught the TIA's, and b) if it weren't for my mother's and my intervention he would be dead right now.
It just sad .... really sad...
And i"m sorry you're going through this, it must be hell for you....I'm really sorry.
Just so you know the story about my father isn't related to you at all I just wanted to make a point about how healthcare has gone downhill. Also my father being a lawyer, sent a legaleeze letter to the nurse manager of the hospital about what had happened, I told him when I read his letter that if I were that nurse manager I'd quit, and sure as you know what she quit one week after receiving the letter.
Please remember, and this goes for all new grads, you are not upheld to the expectations of the facility, but rather to what a prudent other new grad would have or could have done. If anything, the facility will be on the hook, because of failure to provide care. By not helping you, the facility denied or delayed care to the residents. A lot of nurses do not understand how wrong it is ( morally, ethically and LEGALLY) to say "it's not my shift", or "it's not my patient".
Please any advice would help I am sooo terrified of losing my license d/t this- I should have refused the assignment, but now its too late to do that 
:crying2: 
DizzyLizzyNurse
1,024 Posts
I just wanted to add don't offer to chart for free! Your time is worth money!!!! I would have just stayed late and finished my charting. I've had to do it before and I'll have to do it again and I've been an LPN in LTC/SNF for 7 years.