Work Update

OrganizedChaos, LVN · Feb 10, 2018

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).

I didn't expect to be a rockstar because I have 8 years as a nurse but I also didn't expect to get treated like this. There are a lot of days (well most, tbh) where I don't even want to continue in acute care. I can see why new grads feel the same way.

I don't know, it's hard for me to want to stay. There are so few positives but a TON of negatives.

beekee · Feb 10, 2018

I didn't expect to be a rockstar because I have 8 years as a nurse but I also didn't expect to get treated like this. There are a lot of days (well most, tbh) where I don't even want to continue in acute care. I can see why new grads feel the same way.
I don't know, it's hard for me to want to stay. There are so few positives but a TON of negatives.

It's okay if acute care isn't for you. There is no shame in that. It doesn't mean you suck. I spent the first 2 months crying (yeah, on the floor) and repeatedly saying I wanted to quit. It was awful. Horrible. I hated it. Immensely. I'm just saying it gets better, but that doesn't mean you should stay. You know what is best for you, so listen to you. I'm just some random person on the internet who has never met you. Big hugs. í ¾í´—

Been there,done that, ASN, RN · Feb 10, 2018

You are new and an LVN. You will be tested, and it will not be nice. Keep your cool and maintain eye contact with any confrontation.

Going to the manager was not necessary, you blew it going to HR. Not only does HR not care, they are NOT your friend.

Keep your head down, your mouth closed, and your eyes open. You should have got that TPN going. Would you want YOUR loved one to miss a day of nutrition due to a series of oversights?

Best wishes, it's a jungle out there.

Oldmahubbard · Feb 10, 2018

Hopefully, you have learned that you sometimes need to call doctors at night, despite the inevitable ass chewing.

As far as snide remarks and eye rolling, I am an NP and it still happens once in awhile.

OrganizedChaos, LVN · Feb 10, 2018

It's okay if acute care isn't for you. There is no shame in that. It doesn't mean you suck. I spent the first 2 months crying (yeah, on the floor) and repeatedly saying I wanted to quit. It was awful. Horrible. I hated it. Immensely. I'm just saying it gets better, but that doesn't mean you should stay. You know what is best for you, so listen to you. I'm just some random person on the internet who has never met you. Big hugs. ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½

Thank you. *hugs* Yeah. I know I should give myself time & all but, for the pay but I miss corrections. It is what I honestly enjoyed. There's nothing about acute care that makes me want to stay.

OrganizedChaos, LVN · Feb 10, 2018

You are new and an LVN. You will be tested, and it will not be nice. Keep your cool and maintain eye contact with any confrontation.
Going to the manager was not necessary, you blew it going to HR. Not only does HR not care, they are NOT your friend.
Keep your head down, your mouth closed, and your eyes open. You should have got that TPN going. Would you want YOUR loved one to miss a day of nutrition due to a series of oversights?
Best wishes, it's a jungle out there.

I hadn't gone to my manager about the petty drama between my former preceptor & nurse #2. But when nurse #3 threatened me & yelled at me I had had enough. That was the straw that broke my back. I know HR doesn't give 2 ***** about me & will only brush this under the rug. That is why I haven't written a statement to her, I'm not THAT stupid. I only went to HR to see if I could get a transfer due to the situations that had happened. I plan on emailing HR & telling her I don't want anything to progress any further. I know if it does I might as well just hang myself at work.

My mother? Lol. Bad choice. But I wouldn't want anyone else missing nutrition due to an oversight but *I* realize this is the real world & we are not perfect.

But I shouldn't be tested at work, it shouldn't be like this for anyone.

OrganizedChaos, LVN · Feb 10, 2018

Hopefully, you have learned that you sometimes need to call doctors at night, despite the inevitable ass chewing.
As far as snide remarks and eye rolling, I am an NP and it still happens once in awhile.

Yeah, I know. I just am tired of my ass being used as a bone. That's all that has been done to be so far & I'm starting to get depressed. The thought of going back to work brings me to tears. I haven't felt that way since I was a new grad. It's not the complexity of the job, it's not the work load, it's the fact that I know I will get my ass chewed out by someone in some form or another. I'm not down for that, especially for how little I'm making.

Well I'm getting snide remarks & eye rolling every day I see this person. Which makes me not want to go to work. Ugh.

cleback · Feb 10, 2018

Yeah, I know. I just am tired of my ass being used as a bone. That's all that has been done to be so far & I'm starting to get depressed. The thought of going back to work brings me to tears. I haven't felt that way since I was a new grad. It's not the complexity of the job, it's not the work load, it's the fact that I know I will get my ass chewed out by someone in some form or another. I'm not down for that, especially for how little I'm making.
Well I'm getting snide remarks & eye rolling every day I see this person. Which makes me not want to go to work. Ugh.

It's not acute care... just where you work unfortunately. I get that from one of the clinic docs where I work, not at my acute care gig. Some people just aren't great at people skills.

ThePrincessBride, MSN, RN, NP · Feb 10, 2018

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.

That is unfortunate, but lesson learned: call the doctor, even if you will get chewed out.

I used to work nights on med/surg and it was pretty standard to call the doctor if it was something that couldn't wait until tomorrow or needed to be clarified. TPN would definitely qualify as going without TPN for even a day could cause serious issues (dehydration, hypoglycemia leading to brain damage, etc).

That being said, your coworker behaved extremely unprofessionally, and I'm sorry you went through that.

KelRN215, BSN, RN · Feb 10, 2018

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.

I agree.

This reminds me of a situation that I encountered when I was working acute care. I came in for a day shift and took over a patient admitted with fever, neutropenia and G-tube cellulitis from a nurse who was newly off orientation. The patient was ordered for double IV antibiotics, one was vanco which had been started in the clinic before admission. We shared a computer system with the clinic so in one view of our eMAR, it showed the dose that was administered there. However, since the admission was a "separate encounter" when the patient was admitted to the floor and the inpatient team wrote an order for vanco q 8hr, it automatically timed the first dose for now. Let's say he'd gotten a dose at 3pm in the clinic and now it was 5pm. It was something like that. So the default schedule for the meds would have been 5pm-1am-9am. The nurse who admitted the patient (a very experienced nurse) charted "not done" for the 5pm dose because the patient had just received a dose in clinic and then went to reschedule the next dose for 11pm. I believe that what happened is that because the next dose after she charted the 5pm dose not done was due at 1am, it had the date of the next day attached to it and when she re-timed it to 11pm, the system put it at 11pm the next day. The night nurse who took over did not notice that she did not give the child one dose of vanco in her 12 hr shift despite the fact that it was ordered q 8hr or that she wasn't giving vanco despite giving the benadryl that was ordered as a pre-med.

When I came in the next morning, I immediately noticed that the patient had an active order for IV vanco but that the next dose wasn't timed until 11pm. So I asked the off-going nurse "what's going on with the vanco?" and she had no idea. She hadn't noticed it at all because it wasn't timed for her shift. I didn't want her to feel like I was throwing her under the bus because she was a new grad just off orientation but this was a big deal. The child went 17 hrs without getting a dose of a q 8hr med that was needed because he had an active infection and an ANC of 0.

Just like it's a big deal that the OP's patient didn't get TPN all night. I have had some of my home TPN patients get readmitted to the hospital with severe hypoglycemia because of errors at home where the home nurse or parent accidentally hit the wrong button on the home pump which led to it not starting the program over and running KVO all night or mixing up the pumps (some of our patients run their PN and lipids separately either because of how small they are or because they're on an investigational lipid) and running PN on a lipid pump that's rate is like 5 mL/hr. If you notice an error with a TPN order, like that's it's missing a rate, you don't just not hang the TPN all night. You must clarify the order, even if it's the middle of the night by the time you notice it. That the patient had IV fluids running isn't a reason not to call. Maybe the nurse was rude in the way she called the OP's attention to it, or the OP interpreted it as rude, but she was right to point out the error.

Workitinurfava, BSN, RN · Feb 10, 2018

It is deeper than day vs night workers. Change is not easy for anyone. People are comfortable with the usual. You are disrupting that usual . You have to be taught, learn and hopefully not make any major mistakes. It is not your fault, it is a system failure because you are supposed to operate as an experienced nurse, who has been given plenty of time to learn and absorb, the material. However the reality is you have not been given sufficient time and the conditions have not been favorable for you to learn. After I got my bachelors degree, I planned to stop going to school but I am back in school to go higher in my education. What keeps me going are the conditions of nursing. Thankfully, I have been able to balance school, work and home. Not knocking people who take 1 class a semester but I did the BSN in a year and a half. People thought I was crazy for doing it so fast but I know where I am headed and I needed to hurry up and finish the BSN so I can go on to get a higher degree. I plan to work for myself one day. I did the bachelors when I started my new job on a oncology med-surg floor. I didn't have med-surg prior so it was a huge learning curve. I worked on this unit for a year for the experience but after I decided to do psych. I will stay with it and transition into another role where I can still do psych. Only complain or report if it is absolutely necessary. You will burn a lot of bridges and nurses are running in circles to escape some of the craziness of nursing so chances are you will work for someone who is not your boss now later on in life.The people you see where you are at now, you will see at another job. You may need a reference. It is a big wheel.

OrganizedChaos, LVN · Feb 10, 2018

It's not acute care... just where you work unfortunately. I get that from one of the clinic docs where I work, not at my acute care gig. Some people just aren't great at people skills.

Ugh. It just makes me dread going to work. I've never dealt with this level of immaturity before. They need to pay me more if they expect me to stay.