Cursed at a patient-fired

[sle9403RN]

This is very hard to be honest about but I know that I need to in order to move past it and to show that I know that what I did was wrong.

So I'm a relatively new grad (got my RN in Jan 2012). I took my first nursing job at a pediatric dual diagnosis hospital where the patients have both a medical diagnosis and behavioral diagnosis. I worked there for just over a year. In that time I was written up a total of 3 times for cursing, but only 1 of which actually occurred.

The first time, one of my co-workers wrote a letter to the DON stating that I had made a statement at the nurses station about "punching that ******* ***** in the face" and I was brought in and questioned, which I completely denied. The second time is the 1 time it actually did happen, I had a patient call me lazy because I refused to heat up her butter and I stated that I would be damned if anyone is going to call me lazy.

I immediately apologized to the patient and when my supervisor questioned me, due to having been informed by a co-worker, I told her the complete truth. I also used this as a teaching moment for my patients to show them that even adults are not perfect and we all have stuff we have to work on (mine being cursing). The last time never happened.

It started out with a co-worker being upset about the way I treated a patient and the co-worker lied and said I cursed at a another patient. I was working with a patient who had conversion disorder and he would attempt to get the staff to do everything for him. When he was admitted we were given instructions from the doctor and his PT that he was a minimum assist patient. I was trained that if our patients were not up by 8am then they would get cereal on the unit and if they were not up by 9am then the kitchen was closed, the whole time I was there this is how I ran the unit. I had gotten an order from the doctor that this patient be gotten up before 7am, since it took him extra time to get up and out of bed, which ment the night nurse would have to get him up and he would be out of bed when I got there (this never happened).

So that day he was ready to get out of bed when I woke up the other 17 patients. He never said anything about having to go to the bathroom to anyone who went in his room. By the time I went in to get him up, he had gone in the bed. To make a long story short, he didn't get out of bed and to breakfast until after 915. Following the unit rules he wasn't going to get breakfast due not being ready before 9am. The other nurse got rude with me and stated if it were her she would give him the food because he had been awake. She was very upset and I told her that she could give it to him but I felt he should have been up earlier and the rules apply to everyone else.

She went to the DON and complained and told them that I had cursed at another patient saying "stop your ********" which I deny because it didn't happen. I was called in and questioned about the patient's breakfast to which I replied that this was not the first meal he would have missed and I was not the only one who followed the kitchen rules. Also that I had told the Doctor and his Dietitian that he had been missing meals due to not assisting with his activities and such and not one person said anything about not giving him his food.

The DON said we could not do that and we could not deny patients food, I stated then someone, anyone should have said something and that this needs to be told to everyone. They then questioned about the cursing and said that since I have a history that they were letting me go.

I feel like I was targeted. I've tried to find another job but have had no luck and it seems that this issue is why. I have asked interviewers if their are any red flags during my interview and have been told the cursing. I have no idea what to do and how to show people that this was an isolated incident. I mean I worked in customer service for years and never had any issues like this. Any help would be great.

[HyperSaurus, RN, BSN]

I'm not sure about your facility policy, but even if it was policy to not provide a hot breakfast because they were late getting out of the room, I would consider being incontinent in bed to be an extenuating circumstance and use my nursing judgement--allow him to eat.

I've accidentally sworn in front of my *adult* patient once (and apologized immediately), but if swearing has been brought up as an issue for yourself by management, I would take a good look at your speaking habits and work on adjusting them.

[jtmarcy12, BSN, RN]

I too have more of a problem withholding food from a patient, that is serious call for concern. The hospital could be sued if family found out food was withheld from their love one.

[TerpGal02, ASN]

Yes we do similar on our C&A unit. Everyone is expected to be up and ready to go down to dining hall by 7:30. If not, they are brought a tray on the unit and usually they get lunch on the unit as well (going down to DH is a privilege that must be earned. They have to be ready for group at 8:30. If they choose to not eat what's on their tray, that's up to them. We do have snack between breakfast and lunch as well. If someone is habitually missing meals, likely they will go down a level and not be allowed outside or down even further to where they can only leave their room for group (which is pretty much all day). We don't withhold food, but if they choose to wait until the 11th hour to eat what's on your tray, that's your choice. I swear like a sailor at home bit have always made it policy to not swear at work. My new catch phrase is "great Scott" at work lol. Cursing, IMO esp with teens/young children is unacceptable. We are trying to teach them what's acceptable behavior and what isn't. Furthermore, it would be hypocritical to redirect pts when they use inappropriate language if we're curing all the time.

[jtmarcy12, BSN, RN]

I have been a travel nurse and I have never heard nurses curse at the nurse's station! On breaks they may have "let one fly" but never at the nurses station. Unfortunately, I would have terminated you also, for withholding food from the patient and advised you to seek counseling. Never, ever under any circumstances withhold food from a patient just because they were not following the "rules". I see lawsuit all over this if the family becomes aware of food being withheld from their family member.

[dirtyhippiegirl, BSN, RN]

The no-food if you don't get up on time was a policy at several treatment centers I stayed at as a teen...

[dishes, BSN, RN]

sle9403, cursing and witholding food are considered abusive conduct and both behaviours are inconsistent with our professional obligations as nurses. To better recognize abuse and learn abuse prevention practices, suggest you review nursing ethics and abuse prevention guidelines.

[BostonFNP, APRN]

I feel like I was targeted. I've tried to find another job but have had no luck and it seems that this issue is why. I have asked interviewers if their are any red flags during my interview and have been told the cursing. I have no idea what to do and how to show people that this was an isolated incident. I mean I worked in customer service for years and never had any issues like this. Any help would be great.

Based on what you have told us, I would make the followings deductions:

1. You were targeted. You were targeted as a dangerous nurse and appropriately fired.

2. It does not appear to be an isolated incident.

3. Very few employers are going to "roll the dice" and hire you.

[dishes, BSN, RN]

If a treatment center has a policy that contradicts the nursing practice act, the nursing practice act supercedes the policy. The BON does not care about a kitchen policy, they expect nurses to know their professional obligations and advocate for patients.

[lmccrn62, MSN, RN]

As for cursing, angry or not it is highly professional. As a director I have no tolerance for cursing. You need to find another outlet when you are frustrated other than cursing. Good luck!

[jadelpn, LPN, EMT-B]

Then the patient gets a granola bar and juice box if they are not in time for breakfast. Especially kids with conversion d/o, they believe themselves to be sick enough, nevermind food with holding.

Additionally, couldn't this child get up to use the bathroom? It may have been in the way that you presented that part but "never told anyone he had to go to the bathroom" why would a nurse assume that after a night's sleep, a kid would NOT need to use the bathroom? And does the patient have to ask permission? That was what struck me--that no one bothered to get this kid to a bathroom until he was incontinent. Seriously?

And this whole warm butter business. I just am floored that this even occured. Getting into lively debate with a child about warming butter is something that should not have occured to begin with.

Lots of stuggles with food. With pediatric psych patients. Unreal. If these are the rules, then perhaps best you did go when you did. None of it seems theraputically appropriate from the get go. As a pp stated priveledges yes, food--no way.

Swearing is never professional. If it is something you can not control, then you need to see someone to develop an alternate plan. Unfortunetely, like a number of habits, it can happen without even realizing it. If it is that bad, r/o tourettes. Seriously. It sounds as if perhaps you have no control over the swearing when you are stressed. Something to consider.

[dirtyhippiegirl, BSN, RN]

Then the patient gets a granola bar and juice box if they are not in time for breakfast. Especially kids with conversion d/o, they believe themselves to be sick enough, nevermind food with holding.

But food is routinely used as a privilege on pediatric psychiatric units. And as a punishment on adolescent eating disorder units.

Going without breakfast isn't going to unduly harm a patient -- certainly not an otherwise healthy tween/adolescent who probably goes without breakfast routinely at home. Even as someone who was routinely on the receiving end of said punishment as a patient years ago, I wouldn't think to question the policy or wonder if it's against the nurse practice act as a nurse now.

The OP probably could have used some better judgment and a touch of common sense but s/he should have also been in a working environment where other more experienced professionals could say "maybe you should re-think this" or "I would have done it like this..." like would hopefully be the case if the OP was in an acute medical setting and had made a med error.

[dishes, BSN, RN]

Remediation would have been a better way to go, maybe the OP was given advice from management the three times she was reported, but was feeling so defensive that she did not absorb it.