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.

I am absolutely blown away that these kind of working conditions actually exist in the 21st century! There is a good reason I left USA to live in Europe where human rights seem to have higher priority in society.

Sounds like you work for NYS. They just don't get it and they never will.

You only have 24 patients? In my state, it is considered okay for nurses to have up to 50 patients per shift in LTC. I one night had 48 patients to do meds, treatments, blood sugars, etc with 2 STNAs for help. Thankfully it was agency and I never went back. I was yelled at by day shift for not having my paperwork done. I NO WAY think 50 patients is safe. And they don't wear name bands in LTC, so you just hope that they are in the correct bed, because many will say they are whatever name you ask them.

Specializes in CTICU.
That was not what this post was about. The OP did not shirk her accountability here. The OP took responsibility for the error. She state she feels terrible. She was just asking for support,advice, and what to expect. I think it is rather cruel to respond to such a post and to such vulnerability with comments such as this. I suspect that everything you just stated was heartbreakingly reinforced to the OP from this experience, and she did not need to hear you reprimand her for what she has already learned the hard way.

To the vultures so keen to jump on me - I wasn't even talking to or about the OP, as was clearly evident by the fact that I quoted someone else in my reply. Someone replied that it was bound to happen as it's impossible to do the "rights" of medication administration if you are short on time. This is what I was responding to (obviously).

If people post asking for input on discussion boards, they don't get to choose the responses they get. I did not reprimand the poster, and certainly do not find my post "cruel".

As to "joanie" calling me an "overbearing new grad eater, well you just have no idea and made my exact point for me when you stated:

"You don't think she knows how to give meds properly? Of course she does, that is basic bare bones nursing."

This did NOT get done. My point was that whatever you're short of - skills, time, experience - there is only one way to correctly dispense medications, and if you cannot do so, because of the facility etc, then leave.

For the person who inquired, yes I have indeed been involved with a serious med error - as a new grad - as a result of not following those rules of which I am such a fan now.

If you ask me, the type of snarky responses quoted above are what is wrong with nursing, not my input.

Tell your Don if the NP, MD or PA wants VS and all kinds of questions answered she needs to come and assist, because you have med pass to do.

Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
To the vultures so keen to jump on me - I wasn't even talking to or about the OP, as was clearly evident by the fact that I quoted someone else in my reply. Someone replied that it was bound to happen as it's impossible to do the "rights" of medication administration if you are short on time. This is what I was responding to (obviously).

In fact he was responding to me - although I believe I said it was "very difficult to impossible", a statement I will stand by. While working LTC I had on average 35 patients. Each patient had anywhere from 5-15 meds per run. I will be generous and say with completing the 5 rights each patient took 5 minutes or more to give meds to. That is 3hrs per med run. Not counting assessment, wound care, problems that occur, phone calls, new doctor orders, family visits and simply finding the people to give the meds to.

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.

The problem is you are skimping on both by completing the 5 rights - because it is taking almost 3hrs per run without distraction meds are being given late - you can't get around this. And if they are given late you have sacrificed one person's safety for another.

This did NOT get done. My point was that whatever you're short of - skills, time, experience - there is only one way to correctly dispense medications, and if you cannot do so, because of the facility etc, then leave.

This is the ideals of nursing - that if you don't find the perfect job just move on - you can always find another. However, based on the number of posts you can find regarding poor staffing and unsafe conditions it is very difficult to find that "great" facility that understands and provides the time and staff to do your job correctly and safely. So you end up jumping from place to place always searching for that one job that is ideal.

And when the constant jumping makes it difficult to impossible to get a job (places don't like hiring those who jump ship every few months) - then what? You have an intact license but no ability to use it. This is the reality of nursing that most experience. Every day you make judgements that impact the safety of your patients - from dealing with the demanding family over the sicker patient, from choosing whether to call the doctor over a specific vital sign or lab, from not picking up the phone for report on an incoming patient so you can finish charting, to skimping on the 5 rights with a patient you have given the same med to every day for the last month so you can catch up on all the you are asked to do each day - this is reality. It is why orientation should be long enough and have a strong focus on time management; it is why patient loads should be limited to reasonable numbers; and unfortunately it is why mistakes happen in the medical field, because when you make a choice to focus on one thing over another, you might make the wrong choice.

I am not advocating that anyone should skimp or cut out safety. I am merely saying I understand when it happens and place it in context with the rest of your nursing practice. One mistake does not a bad nurse make - patterns of mistakes that you take no ownership of or work to correct make a bad nurse. Unfortunately establishments and sometimes even colleagues focus on the "one" mistake to make a decision regarding one's ability to perform their job. The more negative the outcome of the "one" mistake, the more likely they will use it to determine your future.

Hope this helps to clarify my position

Pat

To Ghillbert, It's called "prioritizing"!! And making choices, it's what nursing is all about. Using your skills to make decisions regarding life and death every day, every hour, every minute. So if one of her patients falls and cracks their head open, she should keep going with her 5 R's, because that is what the books say. What kind of experience do you have? Of course you have to make sure you have the correct patient and the correct med, and you have to plow along until the meds are given, but you cannot work in a bubble without any distractions.You wouldn't be doing your job. It's called multitasking. We all have to do it, and it takes experience and intelligence to be able to prioritize.

What I was trying to say is that instead of criticizing and chastising, offer her suggestions as to how to get the job done (med pass), run her unit, give direction to the ancillary personnel and in the meantime get those sneakers on so she can run away from that place before something bad happens.She does not have to work like that. She can makes choices, the world is her oyster. She is probably young, enthusiastic, full of energy, and now is time to make the decision not to come down to that level of nursing. And yes, I do know for a fact that we nurses eat our young. I don't understand why but we do.

I was a DON at a 120 bed SNF and I specifically hired new grads because of the reasons I just stated. They wanted to prove themselves, they were bright, ambitious and wanted to be the best that they could be, and they received all the support they needed and every single one of them became top notch. I don't claim to have all the answers, but we must mentor our new nurses and build them up not break them down.

Oh and by the way, not sure what "snarky" is but it doesn't sound good, I am just trying to have a healthy debate and really and truly meant nothing personal, I am sure your intentions are very noble and for that I tip my hat to you.

probably not!!!!!!!!!!! I can honestly say that after 32 1/2 yrs in the profession that I do not know of any nurse that hasn't made a med error...including myself. And yes, you feel horrible when it happens, but you admit it, try and figure out what went wrong and how to fix the problem so it won't happen again.

Specializes in CTICU.
To Ghillbert, It's called "prioritizing"!! And making choices, it's what nursing is all about. Using your skills to make decisions regarding life and death every day, every hour, every minute. So if one of her patients falls and cracks their head open, she should keep going with her 5 R's, because that is what the books say.

In no way, shape or form did I suggest or imply that medication administration takes precedence over any other patient issue. Would ANYONE continue to give meds if a patient cracked their head open?

My point was that IF you ARE giving meds, give them correctly. If you can't, go work somewhere that you can. Why do nurses put up with the ridiculous workload in LTC? If they refuse to work there, it will have to change.

What kind of experience do you have?
I have 12 years experience as an RN (ortho, geriatric rehab, critical care), and 3 years before that working in a nursing home. I am almost done with my 2nd graduate degree and working on my 3rd. I work fulltime as an RN in a US hospital.

Of course you have to make sure you have the correct patient and the correct med, and you have to plow along until the meds are given, but you cannot work in a bubble without any distractions.You wouldn't be doing your job. It's called multitasking. We all have to do it, and it takes experience and intelligence to be able to prioritize.
Again, you're making up things I did not say. Nowhere did I say that you cannot multitask or prioritize, or that anyone must work without distractions. I just don't know where you're getting this.

I don't claim to have all the answers, but we must mentor our new nurses and build them up not break them down.
Well, good job - you're working on breaking down the old ones, instead? You really need to reread my post as you have clearly misunderstood something. I said NOTHING to "break" anyone down.

I am just trying to have a healthy debate and really and truly meant nothing personal, I am sure your intentions are very noble and for that I tip my hat to you.
Yeah, right. Calling someone an "overbearing new grad eater" is obviously a term of endearment for you...
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

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Thanks!

Medicare rehab units are rough- that's for sure.

When I was a new grad LPN, my first job was in such a unit. I was the only nurse on the floor, and there was an RN at the desk. There were 28 pts.

I got an excellent 90 day review, and state surveyers watched me do a (huge) med pass and I got zero deficiencies. However, I was worked into the ground and hated the job. When I told the DON that I felt it was impossible for one nurse to give good care with the acuity of the pts. She said "It's an impossible job, and it can't be done, but you'd better do it." She then gave me a card with the phone number to "Co-dependents Anonymous" and told me to call the number and talk to them about how I felt about the unit.:confused:

I gave my notice at 4 months.

The administrator said "So, you just waited until you got your sign-on bonus and now you're leaving."

I informed him that I had only been there for 4 months and that the bonus is not paid until 6 months, but that it was not worth it to me to stay long enough to get the bonus.

This apparently pizzed him off, because he had my excellent review pulled from my employee file and had a new one written which said I was a terrible employee. Oh well. It never hurt my career any.

I hope the OP was able to have a better time on the Alzheimer's unit.

I am a member of a nurses' union and this is why.

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