Nervous over possible termination

[funsizedliv]

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.

[Meriwhen, ASN, BSN, MSN, RN]

I'm glad you weren't fired. Unless the Alzheimer's unit is an amazing improvement over where you just came from, I'd still go looking for a new job. As they keep pounding in our heads at school, no one is going to protect your license for you--you need to do it yourself.

[leslie :-D]

It is one of the great tragedies of the nursing profession that those who goal is to help people are often placed in such a position that actively hinders achieving that goal.

Here's hoping for change

Pat

thanks, pat.

i agree that some things i do, are indeed 'risky'.

but i draw the line betw risky and downright unsafe.

after rereading my post and yours, yours spoke to the realities of nsg, where mine spoke to the ideals.

and so yes, i have to agree with you...

although, with profound dismay.

leslie

[ghillbert, MSN, NP]

The OP missed a med change due to not following the 5 rights. Was that wrong? Yes. Should she know better? Yes. But the process of having so many patients makes it very difficult to impossible to follow.

No doubt. There are things that should be done that are missed every day due to time constraints. However, I do NOT feel that medication administration is the place to skimp on time or safety. There is NO instance in which it is okay not to follow correct drug administration guidelines. None, no matter the circumstances. Not ever. That is not being an idealist. That is just non-negotiable.

[meluhn]

Dear Nervous,

I am sorry for all this trouble you are having. I also work in acute rehab and I know how hectic it can be. I can't imagine having 18 patients. That sounds like an accident waiting to happen. There is nothing like a med error to kill your confidence and make you feel 1/2 in tall. You should not get terminated for a med error. Even if it was several days in a row, it was a series of errors involving pharmacy and other factors as well. The type of patients I have sound similar to yours except that I only have 6-8 of them on my assignment. 18 patients is alot of patients. This sounds like an abusive situation for you!! If they don't fire you, I would look elsewhere anyway. I am lucky b/c the NP and all the MDs and therapists that I work with are fabulous. We all work as a team. That is how rehab is supposed to be, not people throwing you under the bus.

[leslie :-D]

No doubt. There are things that should be done that are missed every day due to time constraints. However, I do NOT feel that medication administration is the place to skimp on time or safety. There is NO instance in which it is okay not to follow correct drug administration guidelines. None, no matter the circumstances. Not ever. That is not being an idealist. That is just non-negotiable.

agree w/you 1000%.

leslie

[Scrubby]

OP I'm sorry that this has happened to you BUT it may just be a valuable lesson.

When you feel that you are so rushed that you can't even verify a med dose (as you said you knew the dosage on the pill card was different than the med) properly you need to speak up and ask for help because it's clear that your patients are at risk.

I would never work in an unsafe environment without ringing management and asking for more assistance. Because if you don't and anything goes wrong then you as the RN will be still be held accountable despite being given an unreasonable workload because you just accepted it without question.

I know it's hard being a new grad, feeling overwhelmed by other nurses and management and not wanting to rock the boat. But unfortunately in nursing if you don't say anything, work yourself to exhaustion day after day because your workload is too much then you'll end up with burnt out and could potentially harm a patient. It's just not worth it.

[Vito Andolini]

I appreciate your reply Leslie and hope you did not take my post as an endorsement of unsafe behavior. Often times due to the constraints we must exist under we operate on a continuum from safe to unsafe. We do so because the we have no choice - to complete our jobs often require that we take shortcuts where we can - especially when dealing with a large number of patients at once (it is much easier I believe to keep closer to the safe end when working critical care and having only 2 patients than it is in LTC and having 30+)

So we choose the shortcuts that allow to do our jobs. Hopefully the ones we pick will balance the needs of seeing all patients cared for and the safety of each one. But when we are forced to make those decisions - sometimes they won't.

You are quite correct that we should not allow ourselves to be bullied, but often it is a choice between being bullied and having no job (hence no food, shelter, etc). If everyone got together in a facility and said "NO!" we will operate only in a safe manner they might get better results. But as long as the facility can fire anyone for any reason and hire someone else the very next day - there is no incentive to change. There is a large enough supply of unprepared nurses and out of work nurses and nurses just looking to try something different that they can keep rotating through without repercussion. And since we are usually the type of people who struggle to stay on thinking we "owe it" to our colleagues and patients - often times the facility will have us for longer than they should.

So we make decisions on how we care for our patients - and like Maslow's hiercharchy we do so from the bottom up. Ethical decisions will unfortunately take a backseat to basic needs - like do I have a job to pay me to eat and have a home. Some people have the resources to weather those decisions and the confidence to know that they can find another way to meet the basic needs so the ethical decision comes into play - unfortunately others do not have those resources.

It is one of the great tragedies of the nursing profession that those who goal is to help people are often placed in such a position that actively hinders achieving that goal.

Here's hoping for change

Pat

Pat, you can hope from here to eternity but what is required is action - on the part of every nurse who is in the dreadful situation you describe so well.

All, let's remember we're talking about a pretty new grad, in a job where they don't even bother to tell her she's suspended, and she learns this only after the fact, and then not even from the proper source.

OP: I guess it's in vogue today to start every sentence with "So", but it is annoying to me. Guess I'm just behind the times on things like that and re: tattooes and teamwork.

[Torchwood]

If you never make mistakes, your not really a nurse. That being said, for 5 days in a row of errors, you are either careless, or overwhelmed. It sounds like overwhelmed. To many, to much, of everything, and to little time. Find a new job before a serious accident happens that costs you, and a patient. It sounds like to much for anyone, much less a new nurse. I wish you luck, and don't let it get you down.

[Katmat]

Hey, GOOD LUCK!!! Wow, that's an unbelievable work load!!! Sounds like what I've experienced. I worked labor/delivery, postpartum, and nursery for 5 years. Our OB unit was stretched to the limit. We had no CNA's, ward clerks, or any help. We had to not only do one on one labor/delivery, but we had to admit the pt., set up the charts, place all the orders, set up the delivery table, deliver, then take care of the NB, plus take care of the Mom. Oh yeah, we also had other pts. on the floor that we had to do VS and meds for. Then after we were finished, we had to clean our room, including the trash, change bedding, mop and set up for the next delivery. After all of this, or during, we had to move our mom to another room for postpartum. Then make sure they had time to bond with the baby and that breastfeeding was going well, then pass meds to the other pts. you had on the floor. Then, we got to catch up on all of the charting. After 5 years, you make it a point to be charting all the time you're working with the pt. You just pray that everything goes well and you don't have a bad baby, because then you get to ship it to another hospital, and then do 2 more hours of charting. All of this sounds crazy, IF you only have one delivery per shift. But I've had as many as three per shift. We had one night when we had 5 c-sections back to back and 2 vag deliveries. Yes, we had to clean the room between each surgery. This was with 2 RN's and an aid in the nursery. Needless to say, after a 12 hr night shift, I didn't get out of there until 1pm. the next afternoon just catching up on all of the charting. Excuse my language, but nights like that, SUCKED THE BIG ONE!!!

[Katmat]

Are you kidding me? Yes, you made mistakes, but where is the charge nurse that set up this schedule? Was she reprimanded or docked pay? I have to agree with the other posts, GET OUT OF THERE!

[joaniej231]

This sounds dreadful for you and I would be looking else where for a job where nurses are held in higher esteem. It sounds to me like you are way overworked and stressed and they are lucky that there wasn't a worse error or multiple errors. you sound very conscientious and I applaud your professionalism. I would get out of there before they eat you alive and If by some idiotic chance they decide to terminate you, consider yourself lucky.

You should have no trouble finding a new job and remember, they need you much more than you need them. There is a huge chronic shortage of RNs and you are a very valuable commodity and don't forget that. You approach them with the attitude that you have valuable service and THEY NEED YOU.

You did nothing wrong, they overwork you and cause mayhem. Remember that. I have been in nursing for a million years and I know of what I speak. Hold your head high and remember your tremendous value. You are a jewel and if they let you go they are fools.

[joaniej231]

Also, the elitist who said the med error should never have happened is living in la la land. With 18 patients she is lucky she got any meds right for any patient on that unit. That is outrageous staffing and outrageous leadership. You need to look for a hospital that is organized in the "UNion" kind of way. They do not tolerate any of that nonsense and that is what it is. Total ridiculousness. Don't chastise her for not following the dispensing policy, give her encouragement and support instead. You don;t think she knows how to give meds. She is totally overwhelmed, she needs to breathe and have a lunch and maybe even take a break.