Nervous over possible termination

Nurses General Nursing

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So I haven't posted in a long time. Since my first thread, I have graduated, worked in a crappy job for 6 months, and since leaving there, I have been at a facility for one year this week. So this is what I am worried about:

I found out that I had made a med error five days in a row, ( I didnt check the dosage listed on the pill card). I was taken of the schedule for sat, and sun., and asked to meet with the DON on mon(holiday). She was not in on monday (my normal day off). I arrived to work on tuesday and was not on the schedule. I am terrified that I am going to get fired, is that likely?

backstory: I work on an acute rehab floor. We had been pretty empty for a few months, but there suddenly was a surge of admissions which really threw us off. Many having some pretty serious issues, one even being returned to the hospital for elevated potassium that the hospital missed (he seemed the most healthy out of all of my pts). Several of my patients require A LOT of nursing care, I have two MR patients, one is non-verbal and has bolus GT feeds, I have one psychotic patient on dialysis who is 90 years old and not doing well, yet refuses to sign a DNR, I have a woman with expressive aphasia who now has a GI bleed, A pt with hepatitis B+C with 4x daily blood sugars and behavioral issues, a 80yr old new gt patient with recurrant aspiration pneumonia running a temp of at least 100.0 for 3 days, and lastly, one with PTSD and severe anxiety who, despite 'wishing she were dead' for needing one, requests an enema every morning, and those are just the heavy ones.

For my end of the unit, I am one nurse to 18pts, I have two CNA's ( who arent allowed to do much more than AM care and toileting per the facility). I am responsible for all treatments, meds, and skilled notes on 17/18 of them. There is a charge nurse (who I consider my mentor) who has every intention of helping, but she is so bogged down with orders that she cant get away from the desk.

We also have a new MD and a team of NP's that work with him. One NP comes in daily to take off some workload from the MD. This new doctor has most of the patients on the unit, approx 30pts. For some reason, they stopped giving the other two MD's (one being the medical director for the floor, the other is the former director) admissions. Well once this NP came in, instead of checking patients and ordering things, she began overhauling how we do things. She even hijacked our part-time unit clerk, keeping her on the floor at all times (and now she has no time to do medical supplies, her primary job).

So this made a mess of everything and caused confusion for the staff. We finnally started getting the hang of it though after a few days. So she wants: VS and weights as soon as she arrives on the floor. (of course this is done before meds anyway, but my cna's havent done vitals at this facility, and its like pulling teeth to get weights done.) So When I arrive on the floor in the morning I (personally) have to: take VS on all 18 patients, make sure weights are done before breakfast (the 11-7 shift wont do them) get report, count, check the breakfast trays and help pass them out, check the bm book, check the apointment book, then I can start my med pass. Then, once the NP arrives, she tears through things, bombarding us with questions that I usually dont have the answer to, then gets really annoyed with us and 'throws us under the bus' to the DON. Then I can finish the rest of my work, but I havent been able to get done on time for a few weeks now.

I have so much to do and so little time (I have never taken a lunch break since I started BTW), that I have to rush through everything, and having ADD, I already dont have a good attention to detail all the time. (not to mention it is really hot on the floor, I sometimes think they are doing a study on our behaviors related to intense temps.)

On thursday we had staff meetings, the State had just done our survey, and then returned to investigate problems they found. After the meeting I attended, the DON asked me and the charge nurse to stay behind. She told us what needs to change on our floor and that we are not up to her standards of quality at that time. She even told us to change our handwriting becaus its 'too loopy'. She said she was trying to motivate and not push people out of the facility. (she told me that I was going to be the death of her).

So later that day It was discovered that I had been giving a patient too much digoxin for five days. He was supposed to get 0.125mg but was getting 0.25mg. I checked his AP before each dose and held it on the day that the error was discoverd since his AP was 55. The NP was looking at his labs and discovered he was in dig toxicity, she asked my nurse manager to investigate. When my manager asked about the med, it clicked. I knew that the dose ordered was 0.125mg, but the med I had was 0.25mg, I had been rushing through the meds and I never got to check the dosage on the pill card. (the pharmacy also never sent the correct card, and the old one was never removed from the cart). So I felt terrible, cried my eyes out once I was home, and was worried sick about the patient. (I found out this morning that everything is ok and he is out of toxicity). It was all my fault, I am the primary nurse and missed this error for days. (there was only one other nurse who gave him the med on the weekend, but I dont know if anything happened with her).

So on friday (my day off) I was very nervous to return to work on the weekend, expecting the worst for the patient. But at 7:30pm on Friday, I get a call from a coworker (turns out to be the nurse who trained me a year ago), telling me that the DON called her from home, and decided to take me off of the schedule for the weekend, and wanted to meet with me on monday. (monday being a holiday and my normal day off). So before ending the conversation, the nurse passing on the message wished me a 'good little vacation'. I didnt know if she knew what had happened on thursday so I just shrugged it off. So now, again with the waterworks. Fearing that I will be fired

I prepared for my meeting with the DON. I listed what I need to improve on, where I need help, and problems on my work floor that directly affect my work. I also posted my resume online and applied for jobs just in case.

Monday comes, I call work and leave a message for the DON to call me when she wants to meet up. (it was a holiday so she didnt come into work that day, as I expected. ) So, no call back on monday.

Tuesday (today) arrives. I get ready for work and prepare myself again for my meeting with the DON. I get there, and my name is off the schedule. The DON is not in yet, but I happen to bump into my floor manager. I tell her about the weekend (she seemed blank expressioned so I couldnt read if she knew something or not). I asked about the patient, and she informed me that he was fine, back to baseline and the med was d/c'd. So I asked her to have the DON call me when she see's her so I can meet with her. That was at 7am (its now 8:42a).

I am hoping that I was given the weekend off because the DON recognized that I was overworked and that led to the med error, but I fear the worst, and that I will be out of a job. (they reciently have 'cleaned house' and escorted staff out of the building, the charge nurse I work with thinks she and I will be next)

Any thoughts are appreciated.

Wow, your 1st job was worse than this one???

I would leave that job before it costs you your licence. This could be the red flag warning that saves your career.

Specializes in CTICU.

I agree the workload is too much and contributed to your error. HOWEVER. No matter how busy you get, NEVER NEVER NEVER skip the steps to correct medication administration. To miss it one day is unfortunate. To miss the same thing and give a double dose of a drug with a narrow therapeutic index FIVE times in a row is a problem.

so, I just had my meeting. those days I had off will count as suspension without pay. then tomorrow I have to redo orientation with the staff educator. then they are transferring me to the alzheimers unit. they think that since my current floor is so crazy right now and since I'm a fairly new nurse, the alzheimers unit will be good to help me learn assessment at a slower pace. I actually started out on an alzheimers unit when I graduated. but I dont know if i will be staying at this facility.

Whether or not you have been terminated, you need to start job hunting now. Also it is not the DONs responsibility to call you, you call her. Leave the message that you will call back at another time and do that. I think that you have already been given the message by being left off the schedule. As I said before, even if only suspended at this point, you need to look for another job. Good luck.

Specializes in Emergency/Trauma/Education.
I agree the workload is too much and contributed to your error. HOWEVER. No matter how busy you get, NEVER NEVER NEVER skip the steps to correct medication administration. To miss it one day is unfortunate. To miss the same thing and give a double dose of a drug with a narrow therapeutic index FIVE times in a row is a problem.

I agree with previous posts and offer my support.

That being said...no matter the outcome of today's meeting, please take heed of the post above. Employment is one thing, but licensure is another. If your situation was investigated by the Board of Nursing, it would all boil down to you making the error. The system issues wouldn't likely be factored as part of your defense.

Good luck to you. Take a second to exhale...the patient is safe...and learn from your experiences. :icon_hug:

Specializes in critical care; community health; psych.

I'm glad you got your message. It's not the worst thing that could happen. You are doing the right thing to seek other employment. It's very hard to protect one's license and safely care for patients in the current culture of turn and burn nursing.

Specializes in ICU/Critical Care.

Congrats. I'm glad you did not get terminated from your job. Take this opportunity though to look for new positions elsewhere. Even though they transferred you to the other unit, you will still be under the microscope so to speak.

Specializes in Oncology.

I generally have 2-3 patients and have made mistakes. You're being too hard on yourself. They have unrealistic expectations and dangerous staffing.

Was the suspension soley due to this med error? Or was it a string of incidences? While the Digoxin error was your fault, you do NOT work in a supportive environment. You mentioned that your DON stated that you'd be "the death of her". She considers that being motivational? It's discouraging and unprofessional. If there was a problem, your facility should have taken the proper steps to help you make the changes needed before now. Instead, they let you continue in a toxic environment where a mistake was bound to happen, suspend you (without telling you for days), and THEN decide to provide you with education and re-orientation.

You need to look for a new job ASAP. Your current facility is not safe and you need to protect your hard earned license!

If you don't get fired from this job, you need to run screaming from it!!! That level of care for 1 RN is, in my opinion, extremely dangerous! Maybe being terminated will be a blessing in disguise. At least you know that you'll never make this mistake again! Good luck!

That is a typical work load in subacute or LTC. Is it right....Heck no.

You know how and why you made the error and I'm willing to bet you've learned from it. Don't think the Alz unit will be easier. yeah, different, but sometimes just as hard.

I'd look around for a more put together place.

Specializes in CVICU, Burns, Trauma, BMT, Infection control.
That many patients to provide all those cares for is unsafe and that facility is practically begging for something bad to happen. I wouldn't want to work under those conditions.

God bless! I know jobs are hard to come by now but that sounds like the job from hell to me too and I've worked in some very busy places and had tons of responsibility but the description of that one would send me running the other way. Bless you for trying to do the impossible but send your resume out and walk into the interview with your head held high and know that you left because it was unsafe and impossible for anyone. Don't let the DON give you any #### either,if she fires you stay calm say you did your best and leave and I'd seriously consider calling the state about that incredible pt load and the responsibilities on one nurse. That's absurd! :angryfire

:heartbeat

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