I have good news and something that bothers me...(long)

**alarosalpn** · 08-08-2008, 05:21 PM

I went back to work yesterday after a week off (vacation). I picked up my paystubs and discovered that I got a raise of $2!
Then today... I was coming out of a residents room and saw a woman I used to work with many years ago when I was a CNA and she was my DNS... She was walking around with the Administrator and my DNS.. She was telling my Administrator how I used to work for her and he told her that I was one of the best nurses he has in the facility at this time! I thought I was going to pass out! All I could do was turn 10 shades of red and say Thank You! I couldn't believe it! He doesn't compliment anyone like that!
I just thought I'd share my good news.
The bad part of it though is that they called me to the office yesterday and asked me to try to orient a nurse. She has been a nurse for over 20 years and has already oriented with 3 other nurses but just isn't getting it....
I worked with her yesterday, I noticed that she was shaking like a leaf. I got her to relax and started teaching her and letting her do the afternoon med pass with me by her side watching.
She made several mistakes... I had to keep stopping her and helping her figure out what she did wrong... So, at the end of the day, I went over the things that happened and educated her on how to correct it. I thought about today all last night knowing that she would be with me again. (Back track a bit) When they called me to the office, I was informed that if I couldn't help her, then they would have to fire her...)
So, move on to this morning.
I decided that I would take her back to square 1.. I told her that she was going to watch me do a few residents medication administration and then she would take over.... I showed it to her the easiest/safest way for her NOT to skip any meds....
Well, let's just say that long term care might not be for her...
I had to report back to my DNS today and report how she was doing... I'm hoping they give her another week to try to improve..
I told my DNS this: She worked as an OB/GYN nurse on a maternity ward for 20 years.. That is totally different. ALOT less meds and the meds are in a machine. The machine pretty much spits out the meds you need( I've never worked in a hospital so please correct or elaborate on this if you've had experience-I'd be real interested in knowing) I think going from a hospital setting to a long term setting,pushing a med cart and administering up to 20+ meds to a single resident must be a huge difference... So it's a whole new world for her... I also had to explain the errors she has made today alone. She seems to have difficulty doing simple math and reading orders correctly. This could potentially have a bad outcome..
I feel so bad. I don't want her termination on my shoulders! I know I need my job as well as anyone else but if I didn't tell the truth and she was cut loose on her own, I would also have that on my shoulders... I feel so bad. She is really nice and caring. I really think she just needs alot more orientation and someone patient (luckily, like me) to stand by her side for a while. I am willing to train her. She is very comfortable with me. She did better today than yesterday. It's just, I don't get how she doesn't read or carry through the orders correctly..
Ugh, sorry, I'm rambling. I'm just so distraught over it. She's been orienting for a week now. She should at the very least have the med part down. ya know?
Was I wrong? Should I have fibbed a bit to my boss? I think I did the right thing because we are dealing with PEOPLE.. I'm sorry to say but I wouldnt' want a nurse like that(skill wise) taking care of MY family.

I just feel so bad....
Any words of advice from fellow nurses? Maybe even a DNS out there? I would really appreciate it.
Should I talk to my boss Monday and ask her to let me try more? I understand that it is costing them alot of money to keep paying someone who isn't "getting it". She is an RN.
My heart is heavy for her.

**itsahumanzoo** · 08-08-2008, 05:25 PM

Congratulations on the raise! I don't have any advice about the other nurse, but maybe it's just not the job for her. Hopefully she finds her niche soon. :/

**LexTysMommy** · 08-08-2008, 05:26 PM

First off congrats on pay raise!! YAY!!!

Then onto her. I think that telling the truth is the right thing to do in this situation. She gives medicine to people on a daily basis that could potentially be life threatening to many people. She needs to get it right, and do it properly. Its not your fault at all if she does not work out. You are trying and being patient. (hugs)

**jas** · 08-08-2008, 05:29 PM

I am not a nurse. For whatever is keeping her from catching on I have no idea but, she can't be left to medicate anyone on her own.

I can see that you don't want the feeling of her job being on your head. Better her job than someones life.

I have no doubt you already know that though. It can't be a good feeling wanting someone to succede and they just are not getting it.

**Cricketlegs** · 08-08-2008, 05:32 PM

That is surely a dangerous situation.

I wouldn't want her to be giving me or my loved ones medication.

Congrats on the raise!

**Mo-BayMom** · 08-08-2008, 05:41 PM

Congrats on the raise! And a big KUDOS to you for trying to help this woman. You're right working the OB ward is totally different then working a gen med floor or any other floor..and the machine you are talking about is just a locked cabinet in the 'med room' you basically type it what you need and how much and who it's for and bada boom it spits it out..all labeled and ready to go! Very easy but remembering the ever changing code is a pain the butt. LOL

Do you think with time she might improve? I mean 20 yrs is a long time to spend in one spot and then have to relearn and start over....maybe if you stuck with her since she's comfortable with you and I love that you went back to square one..it's usually easiest to do that and work your way forward. I personally think they should give her at least 4-6 wks ( they may have already)

But..don't you dare feel guilty if this lady doesn't make it..you can only do so much..it's up to her. Can you befriend her? She's probably scared poopless...I know I would be!! and she just might need an honest friend.

**cheapskate 49** · 08-08-2008, 05:44 PM

Yay for your raise...I used to love looking at my pay stub after I got a raise.
As a nurse you are a patient advocate and you are responsible for the patients under your care,if you know of a medication error you are duty bound too report it, and as a patient advocate you cannot leave your patients in the care of someone who will harm them.You did exactly the right thing.With your description of this RN's actions I can't even imagine how she functioned in a hospital environment(yes we had med dispensing machines but there was much more involved than just popping it out and giving it)has she been away from nursing for a time before applying to your LTC? I also have worked with really nice folk who I hated to see in trouble BUT your patients are your first priority.It sounds to me that she needs a medication refresher course

**Mo-BayMom** · 08-08-2008, 05:46 PM

Originally Posted by Cricketlegs

That is surely a dangerous situation.

I wouldn't want her to be giving me or my loved ones medication.

Congrats on the raise!

Then don't go to the hospital because nurses are humans too and sometimes do make mistakes. Even seasoned nurses make mistakes.

And ask any nurse who works a med floor about the mistakes dr's make...that would make you never ever want to get sick. Trust me on that.

**alarosalpn** · 08-08-2008, 05:53 PM

Originally Posted by Mo-BayMom

Congrats on the raise! And a big KUDOS to you for trying to help this woman. You're right working the OB ward is totally different then working a gen med floor or any other floor..and the machine you are talking about is just a locked cabinet in the 'med room' you basically type it what you need and how much and who it's for and bada boom it spits it out..all labeled and ready to go! Very easy but remembering the ever changing code is a pain the butt. LOL

Do you think with time she might improve? I mean 20 yrs is a long time to spend in one spot and then have to relearn and start over....maybe if you stuck with her since she's comfortable with you and I love that you went back to square one..it's usually easiest to do that and work your way forward. I personally think they should give her at least 4-6 wks ( they may have already)

But..don't you dare feel guilty if this lady doesn't make it..you can only do so much..it's up to her. Can you befriend her? She's probably scared poopless...I know I would be!! and she just might need an honest friend.

Yes, I do think that she would improve in time. She 1) needs to have time to get used to the 'new to her' system. 2) needs to feel comfortable doing it. She did alot better today than yesterday. I think it will be a long,slow improvement and then one day it's just going to click... ya know? She's only been on orientation this week! I do not feel it is long enough for her. The bosses had to of known that she came from a totally different setting. Again, from their perspective (I think) it's costing them alot of money to keep her on orientation. I have asked the DNS for at least a week. She kind of snickered at me. Maybe she'll give me my request.
As for befriending her... I could. But then I would feel even worse if things don't change and they end up firing her. It's like I would be two-faced. Being her friend and then reporting her mistakes (as well as accomplishments) to our boss. ya know? I couldn't do it... It's like back stabbing. She thanks me all the time for being so patient with her. (that's because the nurse she was with for the first 1/2 of the shift yesterday was very crude at the end.

I know I shouldn't feel guilty, but I do.

I hate saying anything bad about people. If I come on shift and find something not done I usually just do it myself and correct the problem. Of course, if this "something" that wasn't done could cause harm to someone, I WOULD say something...
ugh, rambling again. sorry

**alarosalpn** · 08-08-2008, 06:02 PM

Originally Posted by Mo-BayMom

Then don't go to the hospital because nurses are humans too and sometimes do make mistakes. Even seasoned nurses make mistakes.

And ask any nurse who works a med floor about the mistakes dr's make...that would make you never ever want to get sick. Trust me on that.

OH BOY! That IS true! Even in long term care.. It's the nurses responsibility to catch the doctors mistake and report back to them for a correct order! If we give the medication or carry through the order, knowing it is wrong or just doesn't sound/look right, we are the ones who are at fault.... not fair but true.

And yes, we ALL make mistakes. It's just usually not a routine thing such as the nurse I am speaking of. But, again, I'm thinking its just because this line of nursing is a whole new world for her. It's like trying to ride a bike but knowing how to roller skate.. Does that make sense? She was in her 'world' for 20 years. Then took a year off and just came to us in LTC.. A whole new world.

With that said, I don't think Cricketlegs meant the comment to be harsh. I stated originally that I wouldn't want her to care for my family... at this point. But give her a few more days or weeks and she might be the best nurse you ever met! She is very kind and caring.

**Michelle** · 08-08-2008, 06:14 PM

Originally Posted by LexTysMommy

First off congrats on pay raise!! YAY!!!

Then onto her. I think that telling the truth is the right thing to do in this situation. She gives medicine to people on a daily basis that could potentially be life threatening to many people. She needs to get it right, and do it properly. Its not your fault at all if she does not work out. You are trying and being patient. (hugs)

I agree completely.

**Mom23boys** · 08-08-2008, 06:17 PM

First, congratulations on the pay raise!!!

Second, I think you did the right thing by not telling a lie about the nurse's performance, especially since she is risking the lives of her patients. You are a wonderful person to want to teach her the right way. Hopefully, since she feels more comfortable around you, she will begin to pick up the right way to adminster the meds. Good luck to you and to her!

**DJ1972** · 08-08-2008, 06:46 PM

Not everyone is cut out for long term care nursing. The med pass alone is exhausting. You had to give an honest assessment on her skill level, so you shouldn't feel guilty about that. It is your duty to report anything that could result in patient harm. I would suggest that the DNS observe her during part of the med pass, then she can make a more informed decision.
Congrats on the pay raise!

**smk0817** · 08-08-2008, 06:58 PM

Here's my 2 cents on this one (I was a DNS for years so I know what I'm talking about here):

-I wouldn't personally want her as a liability on my nursing license. As DNS, I'm responsible for everyone who provides patient care in my facility. That many med errors is simply unacceptable. Granted, we all make mistakes from time to time. Repeatedly in one day...it doesn't cut it.

-How in the world would she handle a typical 7-3 or 7am-7pm shift on her own? Meds do take a long time, even for those of us who have done it forever and a day. What about her treatments, doctor orders, emergencies, admissions, etc?

-Have they tried putting her on a slower shift, like 3-11?

You did the right thing by telling the truth. You shouldn't feel responsible for her shortcomings.

Stephanie

**alarosalpn** · 08-08-2008, 07:16 PM

"Here's my 2 cents on this one (I was a DNS for years so I know what I'm talking about here):

-I wouldn't personally want her as a liability on my nursing license."

That is exactly what the Administrator said...
Thank you for giving your opinion as a DNS... I wouldn't even let her do accuchecks this afternoon(as reccomended by my supervisor) so I could do something else because I was afraid that she wouldn't administer the correct amount of insulin...

"That many med errors is simply unacceptable. Granted, we all make mistakes from time to time. Repeatedly in one day...it doesn't cut it.

-How in the world would she handle a typical 7-3 or 7am-7pm shift on her own? Meds do take a long time, even for those of us who have done it forever and a day. What about her treatments, doctor orders, emergencies, admissions, etc?

-Have they tried putting her on a slower shift, like 3-11?"
She could never get through even the first med pass (at this point)in a whole shift... I did over half of them and let her do the rest(with me watching and correcting) and it took us almost 4 hours! ( I can do the morning med pass in 2 hours.. but I know these people, it's my floor.) The afternoon med pass (with me doing the accuchecks) took 2 hours. ( It takes me 1/2 hour).
I had her do vital signs on 3 people while I did my treatments. She came to me and told me that a residents blood pressure was 148/100 with a pulse of 97... I had to tell her to go take a MANUAL bloodpressure and apical rate.. When she came back the bloodpressure was 140/78 with an apical rate of 82. She is an RN and she should know that when you get a 'high' or 'low' with a battery operated cuff, you always go back and take a manual one! I explained that you can't call the doctor with that because he'll ask if it was manual....
It's little things like this that bothered me.