Work Update

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I thought I'd update you guys on my work situation.

I'm working nights for February & March, I love it! I even picked up some OT. The night shifters are so amazing & helpful. It's not that nights is easy, I know I have an amazing crew to fall back on if I need help.

But, 3 day shifters are giving me issues.

My former preceptor is still a royal thorn in my side. I had to give her report one day & woof! Giving report is my WEAKEST area by FAR! So I gave her report & the patient was suppose to be on TPN. She asked me why it wasn't going. After I finished giving report to the other nurses she called me to the patient's chart & rudely said it's in the patient's chart so why doesn't the patient have the TPN going, huh? Again, I didn't know. The prior nurse who gave me report didn't tell me why. She isn't like that with anyone else. I oriented under her so I watched her give & take report.

Day shift nurse #2 is totally petty with me. Will roll her eyes at me, make snide comments & such.

Finally & most recently is day shift nurse #3. She is orienting a nurse to our floor. I didn't know that we don't pass our ascoms over until we give report. That was never once told to me. So when the orienting nurse came on the floor I handed him the ascom to hand to the main nurse, not thinking it was a big deal. Well when she saw this she came after me. She starting yelling about how it was wrong, that nobody did that to me (uh hello, YES!) & (this is where it gets hairy) if I do it again she will make work hell for me. I remember that part bright as ******* day. But apparently when my boss asked everyone it was pretty coincidental how "nobody" heard her say that. What the ****?

I did go to HR & she gave me the typical HR spiel. I don't know if I want to continue this or not. I know they say there shouldn't be any repercussions but I'm not stupid. HR also told me I couldn't transfer because I've only been working for 3 months.

I'm also wondering if it's me. Like, did I do something or say something? I have ZERO issues with anyone else at work.

I hate working acute care for so many reasons. This just adds to that list. I need insurance so I can't just quit. If I have to work until my husband can add me to his, I will. Then my plan is to go PRN. Plus I miss my kids so much.

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Specializes in Med/Surge, Psych, LTC, Home Health.

Glad you were able to get to nights and that you are kinda liking it,

except for the giving report part!

Did that patient have an active order for TPN, or had it been DC'd?

Make sure you are checking your orders, left and right, back and

forth. Nurses that you follow will neglect to carry out orders

sometimes, whether they mean to or not.

That second nurse sounds like someone to just not even pay

much attention to. Geez.

What is an ascom? I'm guessing that it's a little cell phone/

walkie talkie, beeper, thingie? :) That third nurse was so

terribly out of line! So you went to your boss, boss asked for

other witnesses, and everyone denied that they heard that

nurse say that to you?

I say, enjoy your night shift coworkers. Keep learning and

working hard. In the mornings, have your report all ready

to go, have your facts all gathered together, give that

report and get the heck out. :)

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I'm only on nights Feb & March. I wish I could switch permanently but there are not open spots. :(

Yeah, there was an active order, it was scanned in & everything. It turned out there was no rate. So all that attitude for literally, nothing.

I totally know they will, you have so much on your plate & even though we are there for 12 hours it doesn't feel like enough time.

I know, she's older than me but emotionally she's stunted.

Ascom is our work phone thing. Yeah, I went to our boss & my boss interviewed everyone who then denied she said that. Why would I make that up? Right after that happened I was venting to a male dayshift nurse about what she said & what happened. So did everything just not happen?? :D

I spoke to HR about everything that has happened but I don't know if I want to pursue this any further because I'm afraid of retailiation.

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Specializes in Critical Care and ED.

If there was an active order for the TPN but the rate was not specified, then it would be your responsibility to clarify that order and hang the TPN, unless there's some kind of rule that says LPNs can't hang TPN, in which case you should have gotten an RN to hang it. TPN is a very specifically timed order and is usually hung at the same time every day, so delaying it can seriously mess up the schedule. Did you just ignore the order or did you think it wasn't something you needed to do? Honestly, I would have mentioned it too if I had been taking over from you.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
If there was an active order for the TPN but the rate was not specified, then it would be your responsibility to clarify that order and hang the TPN, unless there's some kind of rule that says LPNs can't hang TPN, in which case you should have gotten an RN to hang it. TPN is a very specifically timed order and is usually hung at the same time every day, so delaying it can seriously mess up the schedule. Did you just ignore the order or did you think it wasn't something you needed to do? Honestly, I would have mentioned it too if I had been taking over from you.

It was put it, scanned & everything before my shift. We do 24 hour chart checks & the night nurse who had the patient before me noted the chart & didn't do anything. By the time we do chart checks, I wouldn't be waking up a doctor to clarify a PPN/TPN order.

It would be one thing to mention it, but she threw the chart down & was very rude about the whole thing. She had been my preceptor previously & had never done this to anyone else. So, what the hell?

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Although her approach wasn't great, I also think you should've called to clarify the tpn orders. For some patients, going a day (or more?) without any kind of nutrition (and possibly less fluids) isn't great and probably would've been an easy fix. You may also want to incorporate line reconciliation in your hand offs so fluids/tpn/infusions don't get missed.

But glad nights are going well. I've noticed too night shift crew are not as tightly wound.

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Specializes in LTC.

That work environment sounds toxic!

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Although her approach wasn't great, I also think you should've called to clarify the tpn orders. For some patients, going a day (or more?) without any kind of nutrition (and possibly less fluids) isn't great and probably would've been an easy fix. You may also want to incorporate line reconciliation in your hand offs so fluids/tpn/infusions don't get missed.

But glad nights are going well. I've noticed too night shift crew are not as tightly wound.

I realize I should've done that (after the fact) but she was on IV fluids so I didn't find it necessary to bother a doctor in the middle of the night for that.

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Specializes in PACU.

I the three different states I've worked, an RN has needed to run the TPN.

I realize I should've done that (after the fact) but she was on IV fluids so I didn't find it necessary to bother a doctor in the middle of the night for that.

You actually should have bothered the the doctor in the middle of the night, that is why they take call, so someone can be bothered. It happens a lot in acute care.

TPN is not like getting a g-tube feeding... or just eating... it has to be administered on a regular basis or else the patient may have severe changes in blood glucose levels. So a significant delay can cause real problems, even if she has an IV running.

But the nurse should not have yelled at you. She should have quickly checked on the patient and done a BG test. If patient was doing well, then checked the order, gotten it fixed or had you do it and then had it up and running. Afterwards she should have talked with you calmly about the reasons it was so important and how to handle that situation if it ever happens again.

You will know if you ever find someone else mistake to treat it as a teaching opportunity and not like this nurse did.

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Specializes in Nurse Leader specializing in Labor & Delivery.
I realize I should've done that (after the fact) but she was on IV fluids so I didn't find it necessary to bother a doctor in the middle of the night for that.

Then what you should have done is mention it to the oncoming day nurse "Hey, there is a TPN order but no rate - I didn't want to call the physician in the middle of the night, so can you follow up on that or would you like me to do it before I go off the floor." What you don't do is just ignore the order and not mention it to the oncoming nurse. That's kind of a big deal, and the fact that you didn't think (or realize) that it is a big deal, is possibly why the other nurses seem to have issues with you.

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Specializes in Nurse Leader specializing in Labor & Delivery.
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Well, yes. There is that as well.

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