I got fired today...

Guest343211 · Dec 8, 2012

OP, I'm very sorry you were fired. It seemed that your workplace did not have an effective plan to nurture and train new grads. I can relate somewhat to your post. I made mistakes during my time in ICU, but my primary preceptor was awesome and we worked out the kinks.

It does seem like that to me as well. Although, I have seen things applied inconsistently; so likeability and favoritism is also a sad factor.

Objective systems, applied consistently, invoving everyone--NM, preceptor, nurse, and nurse educator, should all be on board and consistent.

Personally, I don't agree that a nurse on orientation, should be necessarily discussed, in terms of behavior and evaluation, apart from that nurse being present as well.

Keep things uniform, objective, consistent, and reduce the levels of subjective nonsense. MAJOR PROBLEM IN NURSING. . .MAJOR. Orientation and "precepting" programs have seem to have gotten worse over the last several years. If there is not a system that is primarily objective in analysis and evaluation processes, it is JUNK. UTTER BS.

Time must be allocated for extra documentation from all parties--that's another problem I see. There is overload during the orientation process for the preceptor and the preceptee. It's funny that nursing so often fails to use the nursing process when it comes to educating and orienting their own.

So remove the stumbling block of adding more or higher acuity patients, until things get more streamlined with the new orientee. That means meeting certain criteria--specified, and objectively analyzed. But still keep things objective, uniform, consistent, professional. Don't put off prognostic indicator evaluations for this week until next week. Nurses on orientation, please hear me. DO NOT let them turf these evaluations. If they aren't willing to invest the time, objectively, professionally, consistently each and every week, THAT IS A HUGE RED FLAG. I don't care what is happening on the floor or unit. If one day it's kill-zone, make sure it gets done the next day. Scan everything for subjectivity. Yes, you can't avoid it entirely, but it's important that it be limited. IMHO, too many decisions are made in nursing mgt with people on orientation based predominately on subjective nonsense.

gr9153 · Dec 8, 2012

So you made some errors...and I'd say they were pretty "minor" ones and def no grounds to have been fired. Ur preceptor and u d/c the pt's O2 2 hrs ago which meant the preceptor was aware of the change. You took the pt for a walk, she/he got SOB, you got help, sat the pt down and wheeled her back to bed. Which is the right thing.

Ur preceptor def failed you I wld say...feigning ignorance or memory loss when interrogated....as a preceptor, she sld be equally responsible. Ur in orientations where mistakes are EXPECTED TO HAPPEN, not encouraged obviously, but it is expected and when it happens, your preceptor sld help you learn from it.

I agree with the others who said that there were other reasons they dismissed you...you prob did not fit in their "clique" (yes some ppl never leave high school).

I had a preceptor who I was positive wanted me fired, spoke to me so condescendingly, and wld write a full blown essay about what i did wrong. Then there was the other who told me that I din have to bother counting liquid narcotic from the Pyxes (I blame myself for this) and o'cos my dumb ass didn't and the next day my manager interrogation me like i was a drug dealer. Ugh awful.

But don let this affect you negatively. You are still learning and it is a shame that more experienced nurses on a power trip cldnt be bother to guide us newbies more effectively. Better urself as a nurse, think hard n think smart of every task u do...it will become second nature eventually and will only improve ur nsg skills. Appear confident, not cocky, at all times, even when asking questions and always let ur preceptor know what u know so that they know that u are thinking hard n smart about it.

Fake it till u make it they say. But remember, pt safety comes before everything!!!

Not the most diplomatic or cohesive comment but hope you get my point. All the best you u!

imintrouble, BSN, RN · Dec 8, 2012

That strikes me as a system problem. If it's happening all the time then perhaps there needs to be an alternate BID standard administration timetable.

You and I are on the same page. The default is 0900 and 2100, but there are other selections such as 0600 and 1800, 0900 and 1500....

that have to be entered manually. The problem is unit secretarys that don't pay attention to the prior order and administration times.

Because I've been hung by the above scenario a time or two, I'm careful about checking those drugs that are customarily weaned. But it takes alot of time.

Mulan · Dec 8, 2012

You and I are on the same page. The default is 0900 and 2100, but there are other selections such as 0600 and 1800, 0900 and 1500....
that have to be entered manually. The problem is unit secretarys that don't pay attention to the prior order and administration times.
Because I've been hung by the above scenario a time or two, I'm careful about checking those drugs that are customarily weaned. But it takes alot of time.

It seems like the pharmacy should be responsible for knowing when it was last given and adjust the time accordingly, that's been my experience.

Pediatric Critical Care Columnist · Dec 8, 2012

You and I are on the same page. The default is 0900 and 2100, but there are other selections such as 0600 and 1800, 0900 and 1500....
that have to be entered manually. The problem is unit secretarys that don't pay attention to the prior order and administration times.
Because I've been hung by the above scenario a time or two, I'm careful about checking those drugs that are customarily weaned. But it takes alot of time.

Any way the RN can override the secretary's order entry? Or to note on the order in red ink that the new times should be 06 and 18 before the secretary gets it? If everybody does their due diligence then this shouldn't be an issue.

imintrouble, BSN, RN · Dec 8, 2012

It seems like the pharmacy sound be responsible for knowing when it was last given and adjust the time accordingly, that's been my experience.

Pharmacists go home at 7P. Arrive at 9A.

Small rural hospitals don't have the luxury of around the clock pharmacist. Therefore, what happens when they're not there, doesn't get verified until well into the AM.

Merenda · Dec 8, 2012

It's unfortunately that the manager of your unit didn't think about re education for you, instead of just termination. Many new nurse and experienced nurses make a medication error and mostly of the time education is what is needed. Also the preceptor should have been more focus on your professional development as a RN. As a new grad, you will need to speak up for yourself and always ask for clarification on things even it appears dumb or stupid to (you) new grad.

Pneumothorax, BSN, RN · Dec 8, 2012

The whole thing sounds screwy. Betcha somehow you weren't liked or they found someone they liked better for some reason, or there is some kind of game going on. Your mistakes were not Fire-worthy in the bigger scheme of things, especially for being a new nurse.There's a game afoot. I've seen this at other places.This sounds like a potentially toxic environment. Seriously. The whole thing is asinine, and I wouldn't want to work there....and I'm a very good nurse. Something is wrong there.Considered yourself blessed. Write a strong letter to admin and appropriate people w/i this place, and then don't look back.I'm not saying you were right, but I have seen much worse mistakes, and nurses and doctors that have made them grew to be great in their roles. This is a bad environment. The way it sounds, they would have just continued to make your life there miserable. You can do much better..seriously...I'm not talking sour grapes, sweet lemons.

a similar situation happend to me getting terminated in my first 90, i suspected there was some dislike of me for some reason...i dont know why, hadnt really been around long enough for them to get to "KNOW" me...

i was getting ragged on for MY documention. howwever the nurses who have been there for many years with MANY MANY years of experience, would not even do an assessment, well at least it wasnt charted but they were still around. whatever dude.

i think that things happen for a reason, and im destined for something better and so is the OP.

we just gotta keep our heads up so we see that great opportunity coming for us :)

kcmylorn · Dec 8, 2012

That strikes me as a system problem. If it's happening all the time then perhaps there needs to be an alternate BID standard administration timetable.

You are correct. This is a system's error/ FAILURE, which one single nurse paid dearly for. This is a Nursing Informatics problem. The Informatics nurse(MSN) needs to either redesign the electronic MAR or go to the IT department for them to make changes the electronic MAR.

Here is where a bigger blame lies- will that facility's nursing administration ever go to that nurse they fired and tell them that---NO!!! The admistration is never that accountable or responsible for their screw up's or mis judgments; Which we all know. This is why I post nursing administrations and hospital administrations are negligent. Never do they do any kind of self reflection on where they possibly could have screwed up or failed. It's always "the nurse"!! I call it like I see it.

Oh, The Nursing" powers that be" that manadated in my area that all nurses must have their BSN's to gain employment, are going to be sorry they shoved this old diploma RN into getting their BSN. I now know about the world of Nursing Informatics, I'm getting "edgiee cated".

kcmylorn · Dec 8, 2012

It’s unfortunately that the manager of your unit didn't think about re education for you, instead of just termination. Many new nurse and experienced nurses make a medication error and mostly of the time education is what is needed. Also the preceptor should have been more focus on your professional development as a RN. As a new grad, you will need to speak up for yourself and always ask for clarification on things even it appears dumb or stupid to (you) new grad.

Here's another novel though- Wouldn't it have been more logical and more ECOMONICAL to get the education depart on this and have them spend time with this new nurse- Oh NO, We have to give the nursing managment practice in filling out termination paperwork because isn't that what it's all about, filling out the papers correctly and spending/wasting more healthcare dollars on orienting a second nurse to fill the same spot so we can continue to cry and belly ache to the government and Congress that we are not getting enough money from the CMS for reimbursement. And go have some horses's behind from the American Hospital Association tell the Congress how poor we hospitals are. We need more money to run a hosital and need larger reimbursement from the CMS- I say get out the ink pen and slash some more funding to these hospitals. Find out what hosptial all those AHA members who signed that pertion this week and slash some more money, budget cuts to their hospitals for wasting taxpayer time and money listening to this dribble.

I can remember screaming about this very thing on this site months ago.Cost them less money to remediate a nurse than to fire and replace. ( these a word we haven't heard in eonons- REMEDIATE) Gotta love these hospital CEO's and administrations. Spend spend spend and waste waste waste and cry baby, cry baby, cry baby. I hope they have lots of tissues in these budget hearings so these snot balls don't have to use their expensive suit jacket sleeves. This is why we don't have any money to hire more nurses and take care of patient's- Customer survey forms aren't going to fix it folks.

And I look at it also this way, How many of us are going to continue to sit back and watch these multimillion dollar CEO wage earners bleed our Medicare money out of the system so there won't be anything left for us in 2,3,4,5,years when we need it. The hospital CEO's will have it all spent on their fiscal waste, mismanagment and continued frivilous spending sprees. Boo Whoo

kcmylorn · Dec 9, 2012

This seems like a good reseach project. Cost of termination and replacement of a nurse VS remediation of a nurse.

Where's "Commuter" from Cowtown, she likes to do research projects. I think the results of this might be very interesting reading.

kcmylorn · Dec 9, 2012

I'm not disagreeing with the role development comment. However, students are (repetitively) given critical thinking questions, scenarios, and simulations (the Sims we do in our school are often more about thinking and problem solving than physical tasks, yet they all are dying to 'give' something.
All new RNs are deemed (minimally) competent. Questions are so situational these days, requiring much more than memorization. While I don't dispute Benners theory per se, the current healthcare culture demands much more of new grads, do they need to be forced out of that task-oriented mentality.
Regarding how competent the preceptor is: we'll never really know. We also cannot assume that this preceptor does not enjoy her job. perhaps she was given a full and/or heavy caseload, on top of precepting. the $value in many hospitals in inconsequential. I still maintain that the time change is something that is out of the realm of the recent graduate RN.

ProfRN4- in the simulation labs, is it not the perfect time to be 'intensely' working on and right on top of these students if need be, to molding these critical thinking skills. Should that not be the repetitive drills. Put the breaks on their wanting to jump to "giving" something but drilling them over and over of why they are thinking in that direction, why are these things happening senarios. These drills in critical thinking should be as grueling as learning nursing tasks were in my nursing school days.I can remember back then, being asked why are you putting in that foley in this patient( the answer was not because the doctor said so)? , why are you inserting that NGT?, and what equipment do you need to do those things- right down to the safety pin for the patient gown for the NGT. Do you ever use Second Life in your instruction? Have them create the entire day in the life of an RN on a hospital unit from start of shift and on going.