Work Update

[OrganizedChaos]

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.

[Triddin]

As a general rule of thumb, if something seems wrong from the report you received, and you don't investigate/ try and fix it, the error is equally on you.

I would have also called the doctor. He might have given the order to run d10 and clarify in the am, or continue with what she was already receiving, but atleast you would have covering orders.

She shouldn't have responded the way she did.

I like to write out major points I need to pass on to the next shift in my cheat sheet as they happen. It serves as a good reminder about what happened and helps with report flow

You will never get along with everyone. Just remain professional with nurses 1-3. I personally wouldn't have gone to hr, I feel that would put a bigger target on your back. You best bet is to continue to learn and improve

[TriciaJ, RN]

I'm sorry you're having such a crappy time of it. Your best bet is to own up promptly to any errors and fix what you can. As for the inappropriate behaviours, I always find it helps to be the adult in the room. "You realize your voice is raised, right?" "Did you just roll your eyes?" These are said with perfectly calm demeanour and quiet, steady voice.

When you calmly refuse to be flustered and defensive, it will take away their toxic power. Let them slink off like naughty 12-year-olds; you don't need to.

[inthecosmos, BSN, MSN, RN, APRN]

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.

Recognize your error, take responsibility, and move on.

[OrganizedChaos, LVN]

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

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.

She "taught" me like that throughout my whole orientation. Apparently it was just me & I don't know why.

[OrganizedChaos, LVN]

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.

No, it wasn't something I didn't think I needed to do. The off going nurse told me in report but I had a busy night so I didn't remember it.

[OrganizedChaos, LVN]

As a general rule of thumb, if something seems wrong from the report you received, and you don't investigate/ try and fix it, the error is equally on you.

I would have also called the doctor. He might have given the order to run d10 and clarify in the am, or continue with what she was already receiving, but atleast you would have covering orders.

She shouldn't have responded the way she did.

I like to write out major points I need to pass on to the next shift in my cheat sheet as they happen. It serves as a good reminder about what happened and helps with report flow

You will never get along with everyone. Just remain professional with nurses 1-3. I personally wouldn't have gone to hr, I feel that would put a bigger target on your back. You best bet is to continue to learn and improve

I went to HR just to see if I could transfer, I know it will paint a bigger target on my back. That is why I plan to email HR to scrap the whole thing.

Giving report is my weakest area right now. I'm trying my best to improve but I really don't know how to give a good report.

I know I messed up, I just hate being treated like a kid when I do.

[OrganizedChaos, LVN]

I'm sorry you're having such a crappy time of it. Your best bet is to own up promptly to any errors and fix what you can. As for the inappropriate behaviours, I always find it helps to be the adult in the room. "You realize your voice is raised, right?" "Did you just roll your eyes?" These are said with perfectly calm demeanour and quiet, steady voice.

When you calmly refuse to be flustered and defensive, it will take away their toxic power. Let them slink off like naughty 12-year-olds; you don't need to.

I need to start doing that. It's great advice! They just catch me so off guard & I'm so tired of being treated like a toddler that I just give up. I can't tell you how many times I've cried on the way home. I haven't done that in years!

[Tenebrae, BSN, RN]

I know I messed up, I just hate being treated like a kid when I do.

Yip thats just dooshy behaviour.

None of us are perfect and IMO we should be treating our colleagues as we would like to be treated, In other words if you spot a mistake or something missed it is possible to bring it to the outgoing nurses attention without being a five year old todler about it

[OrganizedChaos, LVN]

Recognize your error, take responsibility, and move on.

Uh, I did. When I have not taken responsibility? Never have I said it wasn't my fault. All I have ever said is I didn't want to wake a doctor in the middle of the night to clarify the order. The doctors we have on call are all *******s & I didn't feel like another ass chewing session.

[OrganizedChaos, LVN]

Well, yes. There is that as well.

I mean, I guess it could be but on nights everyone gets along so well & I have ZERO/NONE/NADA issues with anyone. In fact, a surgeon came through & said O was a great nurse. That would've NEVER happened on days.

[OrganizedChaos, LVN]

Yip thats just dooshy behaviour.

None of us are perfect and IMO we should be treating our colleagues as we would like to be treated, In other words if you spot a mistake or something missed it is possible to bring it to the outgoing nurses attention without being a five year old todler about it

Yes I am an experienced nurse but I am brand new to acute care & this was my SECOND day on my own. SECOND! I'm not going to be perfect & remember everything. Especially when I have a discharge & admission at night. I don't know what she thinks we do at night but we certainly don't sit on our asses.

[beekee]

You are new to acute care, so what you are going through is a lot like what new nurses go through when they start their first jobs. It sucks. It's HARD. You make mistakes, even though you've been a rock star nurse for years previously. It's just a different beast. And it takes time - lots of it - to feel comfortable. On AN, many people say it takes a year. It took me longer. But the crying, the stress, the self-doubt, etc., gradually eases in that year. And as I personally know, if you transfer, that year process starts over.

Hold your head high, keep on learning. Ask questions! If you see something off and it wasn't covered in report, go to the charge nurse. Hey, why is the TPN not running? If nothing else, they can help you decide if the issue needs to be escalated to the MD. My philosophy is to be able to tell the next shift that I investigated and tried to fix whatever needed it. The MD night not know either, but if you ask, you are, in effect, passing the buck. In report, you can say, "the patient had orders for TPN to run overnight, but the order was written without a rate. I paged the doctor, who said it would have to wait until the day team was on in the morning. Can you follow up this morning?" Same result (no TPN), but the oncoming nurse now can confidently answer the question as to why the TPN wasn't given.

Another example, if an urinalysis has been ordered several shifts ago, but has not been collected because the patient is incontinent, I'll get an order for a straight cath (I may or may not straight cath someone in the middle of the night). Then, I can at least say in report "the patient is incontinent, so I got an order for a straight cath. She slept through the night, so I wasn't able to obtain the sample." The sounds so much better than "I didn't get the sample because she is incontinent."

Whatever the issue is, SOMEONE has to solve it (get a rate for the TPN or get a straight cath order), so be the nurse that tries to solve any problems that come up. It's generally frowned upon to realize there is an issue and do nothing about it, at least where I work.

It sounds like you are doing great for being just off orientation. If it wasn't so identifying, I'd tell you a story about my first week off orientation (it wasn't pretty, to say the least). You will only get better. And the coveted year or two of acute care opens doors in the future, so I hope you stick with it. (Your coworkers were also new at some point, and most likely, felt exactly the same as you do now).