New Grad Ethical Difficulties

I just graduated and passed my boards, and I got a job working at a nursing home. My problem starts with the facility only offering a couple of eight-hour shifts of orientation. Frankly, I don't believe this is enough to ensure my competency in the field. And while nursing school was great, I believe it's true that the majority of learning happens on the floor after you graduate.

After a couple of days of orientation so far, I've noticed a number of violations of HIPAA as well as safety issues at the facility. One big one is passing meds in the dining room. I know this is pretty common practice, but technically a violation and as a new grad, I'm not sure I want to jeopardize my license by working at a facility where this kind of practice is expected. It's become so ingrained in the resident population that I don't think it would even be possible for me to do it any other way at this point.

So my dillema is this - do I take the job and possibly risk not only my license, but learning how to do things the right way? Or do I pass and play it safe? I'm very torn over this and I would love some opinions. Thanks
I've never known any facility that doesn't pass meds in the dining room....Only two days of orientation for a new grad?? *that* is scarier then the pills in the dining room. O.o

You're going to find HIPPA violations everywhere you work, for example admitting a patient to a room that already has a patient in it....all that patient's business is out there for the other person to hear and we think pulling a curtain will keep it so we aren't violating HIPPA. Short of cutting someone's ears off, what are you going to do? That's not advice to perpetuate a bad practice but feasibility of practice is a consideration. We simply don't have another place to go through admission with someone. I find a good rule to follow is, if you wouldn't want something done to you personally or your close family member, then you probably shouldn't be doing it to someone else. Also, if you set a tone for your own practice, I find others follow blindly so your actions may effect change without making a big stink about current practice.

I wouldn't take that job, if it were me, but not because of the pills in the dining room thing....it's not safe or fair to you to only offer two shifts of orientation. NOT a good situation. As to HIPPA (HIPAA, whatever) try working in a small town where everyone knows about your patient's issues before YOU do...fun times......the smaller the setting, the less it works. Just use your common sense, and you should be fine. Worry about your own practice before worrying about the practice of others. Passing pills in the dining room isn't dangerous...just not supposed to be done. There is a difference.

My friend just started at a SNF as a December grad with NO orientation. She has been told to ask questions if she needs to (that is her orientation). Many of her patients are end-RF, and cancer patients. Difficult patients to say the least. This job was her only interview and only offer. The job market is bad!!!! She does get help when she asks, and says all are friendly to her, but, she worries about how much she can really ask... they all have way too many patients.

I agree with the previous poster who said the job market is bad for new grads right now. I say take what you can get for now, and in the meantime keep looking for something better. I worked at first at a LTC facility where I didn't agree with many things that were being done. When patients would ask for something/to do something in a certain way that I didn't agree with, I would tell them what I could or couldn't do.... then when I of course got the "but nurse so and so does it all the time" my response was "nurse so and so may do that, but this nurse will be doing it this way". People were always ok with it. As for the orientation, maybe you can ask for more orientation, just tell them you don't feel ready? I had 5 shifts of orientation before they put me out on the floor by myself... I definitely depended on the other nurses working to answer a lot of questions! I'm sure they would understand.Liz

we were recently cited during our survey because a nurse gave an eye drops to a patient in the hallway. during our inservice, we were told we can give oral medications in the hallway but not the others. with more than 20 number of patients, its not possible to give meds on time if meds are not given in the dining room. also i try to give meds close to meal time so they are not taking meds on empty stomach becuase i've seen too many patients with gi bleed. some diabetic medications needs to be given 30 minutes before or with food so how can you do that without giving medications in the dining room? to op, your employer is not going to care about you unless you speak up for yourself. if you dont feel comfortable then ask your boss to give you more orientation. if they stil say no then i think its time to find a new job.

I manage to give most of my meds not in the dining room. I also don't prepour, although it's a common practice in part of my facility. As a new grad I got 2.5 days orientation. I get that I risked my license when I started. But frankly it was either risk the license I had just earned, or don't bother to use the license at all and get a job slinging burgers or something. The market for new grads is really that bad here. It was scary at first and I struggled a LOT. But I managed.

I am a new grad too, just barely a year, and I just got a new job a about two weeks ago I was given two days in a classroom setting orientation plus 5 days on the floor orientation. I was also told if I needed more, ask. ...(and I have worked in LTC as a CNA for years as well). I have seen pre pour meds, meds given in the dining room, treatments done in the hallway. During my orientation, I was told how to do things per policy. IMHO, there is no perfect nursing home. State will come in and find mistakes. Sometimes, you have no choice, but to give meds in the dining room or in the hallway. In my current facility, the residents are rarely in their rooms. Most of my patients cannot take their meds laying down. My med cart stays in one spot and I catch them as they go by. There is a small office off to the side for our volunteers and I usually go there to do eye drops or give insulin. As far as giving meds in the dining room, there is no way around it. I have several patients that only take their meds with their meals. I never leave meds with the patient. I always make sure they take them. The job market is extremely tough. If you feel you need more orientation, ask for it. As far as giving meds in the dining room, sometimes you just cant help it.

Quote from theycallmekingI just graduated and passed my boards, and I got a job working at a nursing home. My problem starts with the facility only offering a couple of eight-hour shifts of orientation. Frankly, I don't believe this is enough to ensure my competency in the field. And while nursing school was great, I believe it's true that the majority of learning happens on the floor after you graduate.After a couple of days of orientation so far, I've noticed a number of violations of HIPAA as well as safety issues at the facility. One big one is passing meds in the dining room. I know this is pretty common practice, but technically a violation and as a new grad, I'm not sure I want to jeopardize my license by working at a facility where this kind of practice is expected. It's become so ingrained in the resident population that I don't think it would even be possible for me to do it any other way at this point.So my dillema is this - do I take the job and possibly risk not only my license, but learning how to do things the right way? Or do I pass and play it safe? I'm very torn over this and I would love some opinions. Thanks

Meds, eye drops, diabetic meds, etc,etc,. I found the LTC facility I worked herded them all like sheep. They didn't care a whit about them as people. There are just too many patients to one nurse, to do things effectively and with any humaneness. It broke my heart to work there.

I am a new nurse and LTC was the only work I could find. Its at times overwhelming but many times I feel like I am losing everything I learned in school. Maybe its because I work nights. I have struggled with my nightly medpass but find thats its much easier once you've been doing it for like a month. You get to know who wants thier meds early, who you can reach in thier rooms if its a med like eye drops or insulin, who can wait til last and who will keep you in the room talking forever lol. Its all about prioritizing for me and now its a little easier. My DON actually did a medpass check with me when I started to let me know what i was doing wrong and that helped out, maybe you can ask for them to just do a check up and ask how you can improve. I only worked the day shift a few days and the medpass is greater but luckily we have med-techs on most wings. It takes about 3hrs for about 30 residents.

I feel you girl! I graduated a year ago. I found a job working in a post rehab SNF. I had 27 residents and 3 CNA's helping. I had 4 days of orientation. You hit the ground running. I lost 15 lbs working there. Do what you have to do and just be sure to be a safe nurse. You will master time management working there. Take the job as jobs are scarce for new grads like us. This job will help you find a new job. I now work at the VA (I am still in my 6 wk orientation) and have 5 pts. Trust me the same short cutting and HIPPA violations occur here. There is no perfect nursing, and nursing is not like school in any way, shape, or form. You will learn to choose your battles, and med pass in the dinning room is not a major one. If you don't get it done in the dinning room it will take you 3 times as long to pass meds, time that you do not have. Definitely DO NOT pre poor. I straight up had nurses tell me that I needed to. That was a battle I picked. Pre pouring is just down right unsafe. After about 2 months I could do the dinning room med pass for about 22 people in just under an hour, which is freaking unbelievable. It took me the next hour to get the 6 others in their rooms. You'll hit your grove. Make sure you ask for help even if you feel like a pain the ass, it is the only way to learn. I still ask for help all the time. Even worse, the VA is a teaching hospital and most of the interns (I call them baby Dr's) have no clue what they are doing. I literally am learning everything a doctor knows so that I can advocate for my pts and make sure they are receiving the tests, meds, and procedures they need.Once again, TAKE THE JOB! you will learn fast. you will get by. be safe. follow your gut. This will help you in the long run.