Fired AGAIN!! HELP!!

Nurses New Nurse

Published

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

You were correct in withholding the insulin, but did you put that on the MAR or just left it blank? Any drug not given needs to be recorded with a circle around it and a reason given, such as BS too low and what it was, HR too low, BP to low. Pt NPO for procedure, etc.

But giving a new grad 28 patients for meds is just too much in my opinion and is definitely not a safe thing for you or anyone.

Do not give up, you will find your niche where you will feel like you belong and you will excel at that. You made it this far, so we know that you can do it.:)

I have been a nurse for many, many years and there is absolutely no way that I would consider a position with 28 patients.

But giving a new grad 28 patients for meds is just too much in my opinion and is definitely not a safe thing for you or anyone.

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I'm still a student, but I think you are absolutely correct. That is extremely unsafe...how on earth could you take care of 28 patients and make sure they were all safe?! How can you even get everything done in one shift with that many patients? I'm pretty sure that's insane.

I'm sorry about what happened. I agree with whoever suggested hospice...you sound like you enjoy spending time with the patients instead of the usual giving meds and getting out of the room as quickly as possible. It sounds like you didn't have time to do any kind of patient care anyways! I've talked to some nurses who worked hospice and they all really enjoyed it. It sounds like it'd be a depressing place, but they have told me it's not at all.

Good luck with whatever happens, I'm really sorry.

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!

Sigh...I always have to shake my head when someone makes this suggestion. Hospice pts. are very complex and it takes a nurse who is very solid with assessment and knowledge of meds to work in hospice.

It's not an area to go into if you're not 1) very committed to working with hospice patients, and; 2) a nurse with a good foundation in nursing fundamentals.

I think the suggestion to go through a refresher course is right on target. And I also think that there is still too much rationalizing going on for some of these mistakes. (Try forgetting about a pain patch on a hospice patient and you will see how huge a deal it really is...severe pain is a major stressor on the body.)

Specializes in CCU,SICU,CVICU,Burn Unit.

I am sorry that you were fired. I agree that 28 patients are too many. In nursing there are many directions that you can go. I know that you will find your area and excell. Don't give up! Good luck.

First: Big Hug!! I'm so sorry about you going through this. Sometimes it takes a while to find your niche but don't give up. Nursing has so many different paths. My advice is to find a position with a good orientation program especially targeted for new grads. You just got your license. You need a place that can give you the support you need as a new nurse. 28 patients after just a few weeks of having your license is way too much no matter what the setting.

Oh and by the way someone recommended psych nursing b/c maybe they thought it was easier. I'm a psych nurse and don't think someone should go into it bc they think it's easy, especially a new grad. That might end up in physical injury. Again, find a setting with a good new grad program and don't let them rush you off of orientaion until you're ready! Oh and here's another hug!:)

Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Sigh...I always have to shake my head when someone makes this suggestion. Hospice pts. are very complex and it takes a nurse who is very solid with assessment and knowledge of meds to work in hospice.

It's not an area to go into if you're not 1) very committed to working with hospice patients, and; 2) a nurse with a good foundation in nursing fundamentals.

I think the suggestion to go through a refresher course is right on target. And I also think that there is still too much rationalizing going on for some of these mistakes. (Try forgetting about a pain patch on a hospice patient and you will see how huge a deal it really is...severe pain is a major stressor on the body.)

I totally agree with everything you said. I have also worked Hospice. I started working Hospice after I was a nurse for 15 years and I thanked God I had the experience!! I worked with some new grads that definately made some iffy decisions. Mostly because they did not have the experience.

karen

you will benefit from employment in a smaller less demanding setting like a doctors office or walk in clinic... good luck...your not a bad nurse for being fired twice,, you made errors that you will learn from...

Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

I'd just like to offer some support. You've been given some good advice as to refresher courses and alternative places to work. I too have been fired twice in 6 months and I know it feels like hell, but what helped me is writing down what I liked about nursing and what hurt me in those jobs. The first list gave me an idea as to where I should apply again and the second helped me to avoid the same mistakes.

For instances, I'm not a good fit in a nursing home -- it doesn't appeal to me, I feel stressed from the workload, etc. However, I like dedicated time to patients, so I've been working in an ICU for over a yr as an agency.

Being fired doesn't make you a bad nurse, failure to learn from mistakes does. Keep your head up and try something other than high pt loads :)

As an aside high pt loads is one reason I always stress to people to go on for their RN license, I find often LPN's have trouble getting jobs in hospitals but are frequent in nursing homes which is like throwing them to the wolves, most that i have seen have terrible orientations and unsafe pt loads.

Pat

You might enjoy working in a clinic if you can find a doctor you will match up with well. I've seen it mentioned that you'd get more time to spend with your patients in a clinic setting, and speaking from my experiance that isn't necessarily true. It depends on how the doctor wants the schedule. We have one physician who will see patients every ten minutes from seven AM to three-thirty, and another who insists on 45 minutes minimum with each patient. Some docs are very good at running on schedule, and then there are others who don't care if they come in a hour late every day. It will pay to ask a lot of questions when you are interviewing for the job.

I wish you luck on finding your nitch in nursing, and I hope that you don't give up. Everybody makes mistakes, it's just important to learn from them and move onward and upward.

Specializes in PeriOp, ICU, PICU, NICU.

Sorry to read this, best wishes to you.

I posted on the other thread too. Why can't you read the right times or the mars?

As far as the patch, I think you explained it better on the other thread. It was late or missed so you put one on when you noted that? What I would have done was call the doc, do a med error/ incidient form, put a new one one the pt and assess the pain. (BTW, we have on our mars that each shift checks that it is on)

The insulin miss, if the BS was low you should have treated it per policy, call the doc then I would have retested later.

When ever a med is held or not given until later you should always circle your inital and make a note of why it was held, what you did for treatment and what the outcome was.

Charting.....chart the actual time that you put the pen to the paper. If you are charting late, say 12 am for 3-11, I put down, DATE, 12am note for 3-11 shift on DATE. Never falisfy times or dates. EVER.

All that being said....how about a refresher class? I think something like that would provide more reinforcement of what you learned. Some hospitals offer a better orientation that LTC homes. Another thing is order youself some journals. Nursing 2005 is good. Review you fundamentals of nursing books, carry a nursing pdr with you and above all, if you are unsure or don't know something, Ask or look it up?

BTW..do you live in PA? I'd love to have a student:wink2:

where in PA? just curious in case I decide to relocate...

Have you considered working at a clinic such as dialysis or ob office..maybe you need a steady pace with not a whole lot of patients at one time

don't give up!!

I work dialysis and am usually the only nurse for 32 pts a day, and the only nurse at the facility.

I did nursing home for years, and dialysis is much more demanding as far as critical thinking and acting to anticipate and prevent problems, imo.

Recommending dialysis to someone who is overwhelmed in LTC is not a good idea.

Also,to the OP: The med errors were serious. You would not hold a long acting insulin in that situation, only a short acting. And- holding insulin because "another nurse told me she held it"?

Come on.

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