Fired AGAIN!! HELP!!

Nurses New Nurse

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Well, I just got terminated again!! :crying2: According to the DON, I made too many med errors and charting mistakes. Nothing serious, just putting a pain patch on the wrong day, holding insulin [because another nurse told me she did, on this one pt]Charting midnight and earlier instead of the actual time. Basically, she said I have a good heart for nursing but that she felt I was overwhelmed by having 28 pts.

My first NM told me to go to a NH, now this one is telling me to go to a hospital or do home health care.

I need some serious advice here. I'm 44 y/o newly licensed [Oct. 4, 2005] Worked at the NH from the 18th of Oct to today. I don't know how to read the dr's orders and compare them to the MAR. I have problems seeing the actual times on the mAR. I am slow. I liked to talk to my pts instead of just going in and setting their meds down and leaving. I found out today that 2 of my pts were sick. [i did this on my own]. The female sounded like she has asperation pnuenomia and the male had a temp of 100.8.

In all fairness to the NH, I could have worked until the 16th of this month, but not as a nurse. I had lists of the pt meds. I had accu check lists. I even had my own charting page with the name, reason for the charting, and all vitals.

I feel like a failure and know that I have let my kids and husband down! I don't know what to do or where to go. How many RN's have been fired TWICE in less than 6 months? :(

Please give me some advice on what to do and where to go from here!!

Thanks!!

______________________________

In His Grace,

Karen

sounds like they are disorganized... they should have had an orientation for you first of all. And secondly the method they are using for meds and PRN meds sounds sloppy based on the posts you left.

The nurses where i used to work held Insulin often esp if the patient refused to have his BS checked which happened a lot in the LTC facility i was working in...

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
I just didn't know that they write scheduled meds on the last page of the MAR, past the PRN page! I have to search the MAR for the sliding scale. It can be anywhere from the first page clear to the back! Some of these patients had 5 pages of meds. . .maybe y'all can help me come up with abetter plan on how to figure out where the scheduled meds are versus the PRN's.

I understand what you are saying about the MARs. I've worked in many, many homes and know how just one patient can accumulate so many sheets of MARs over a month's period of time. It's due to many, many medication changes. What you have to do is start with the first page that is up in front of you and read each entry carefully as the PRNs will say they are PRN (I hope) and continue doing that with each page. Look across to see if the med is being charted as being given. If not, you have to ask yourself (1) was this med d/c'd, (2) is this medication being held, or (3) is it possibly a PRN. Check the chart to confirm which it is. When you have the answer then mark the MAR accordingly so other nurses don't have to go through the same investigation. I'd also check through the remainder of the MARs for any entry of the same medication. I found that nurses sometimes re-wrote a medication on a MAR because they decided to change the administration times, but would forget to d/c and yellow out the previous entry.

What I used to do with these multiple page MARs that were confusing was to sit down during a quiet time of the shift with the MAR and the chart. The chart is always going to be your final source for orders. The latest medication order on the chart is the one you follow. I often did the monthly reconciliations before the new MARs were put onto the nursing units on the first day of the month and got very good at tracking these things down. I would often make a list of med orders with their order date in descending order on a scrap sheet of paper as I went through the chart. Any medication entry on a MAR that had been d/c'd got yellowed out with highlighter, and I clearly marked "D/C'd and the date" where the nurses would be doing their initialling so it was clear that they shouldn't be giving this medication. Just another little thought. . .when you discover a medication has been d/c'd, pull those meds out of the med cart so someone won't make the mistake of giving a med they shouldn't.

With regard to the Insulin. . .it makes a difference what insulin you are giving. Giving a medium or long acting insulin like NPH or Lente is not going to be affecting the patient's blood sugar for many hours.

Hello Karen, I'm very sorry that you lost your job. Have you ever considered public health or community nursing? Such as Pre natal clinics, immunization clinics. Communicable disease clinics. This is just an suggestion. Or how about a school nurse or home health care.

be blessed:saint: :saint: I really think that you need a good orientation, from a good and well trained RN. Be very careful in your documentation, You do not want med errors and poor documentation to show up in a court of law if someone files a law suit.

Be encouraged

Specializes in LDRP; Education.

I think the poster is looking for guidance and how to proceed; I don't think she's looking to defend herself at this point. We're not the BON.

I would suggest taking a refresher class, just for some principles. I don't think the area of nursing you're working in is going to help you if you don't nail some of these other issues down. In other words, moving on to an immunization clinic won't be any better until you figure out exactly what is contributing to your med errors. It sounds like you didn't get a great orientation at the NH which probably contributed to your mistakes.

I wouldn't look for a new job yet; look for a nursing refresher course (taught at a local nursing school) and go from there.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think the poster is looking for guidance and how to proceed; I don't think she's looking to defend herself at this point. We're not the BON.

I would suggest taking a refresher class, just for some principles. I don't think the area of nursing you're working in is going to help you if you don't nail some of these other issues down. In other words, moving on to an immunization clinic won't be any better until you figure out exactly what is contributing to your med errors. It sounds like you didn't get a great orientation at the NH which probably contributed to your mistakes.

I wouldn't look for a new job yet; look for a nursing refresher course (taught at a local nursing school) and go from there.

I think this advice is right on target. Get refresher courses. Not only will they help but this action will show your are earnest in improving your situation PRIOR to getting another job.

Hilarious post! You've got the makings of a good Nursing Supervisor. It is incerdible that some thought you are serious.

Not everyone is right for NH or hospital. I hated working the hospital. But that is what is great about nursing, there is a spot for us all. SOmething a little slower paced where you can actually pend time with your patients. Have you thought of home health or wound care? Might be areas to consider? DR offices?

Hello...Who on EARTH can do a good job with 28 patients?????? Holy Cow. I would be looking for places that don't have that kind of patient load and that have a thorough orientation program.

wesraue~

who were you referring to when you said

"Hilarious post! You've got the makings of a good Nursing Supervisor. It is incerdible that some thought you are serious."

Specializes in Med Surg, Hospice, Home Health.

28 patients!!!! YIKES

what about a md office? you can spend lots of time with patients!

I couldn't do 28 patients

linda

Have you considered hospice? Generally, you can spend more time with each patient--not to say that it can't get stressful. I really enjoyed my hospice time and it was much different than both a SNF and hospital-setting. Good luck!

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