I too am so sorry about all that your are going through.
I have a question. When you made any changes to the gtt, did you immediately document them?
I won't say that it happens a lot, but I do know of weird things that have happened with some colleagues and me re: heparin gtt infusions. There are people that will sabbotage a nurse. Usually they won't go to the point of risk to the patient, but in some cases it can happen. I have NOT seen this kind of thing in pediatric ICU settings, but I have in adult ICU setting with elderly patients. It sucks when you can't prove anything or when admin or other will not allow you to explore further. These kind of things, at least in my experience, are quite rare. Fortunately, most nurses and docs I've worked with are ethical people.
When the "more ethical"people want to weed you out (The quotes mean the dubious other kind of ethics of working to weed someone out for invalid reasons.), they do it with things like issue of "communication style," he said, she said stuff, issues that fall along that fuzzy area called "fit." Really subjective stuff--or even by using weak systems of measurement--such as looking at one's speed in practice, but they are measured in a way that is inherently more subjective than objective. Preceptor input is often an area where so much subjectivity enters in to things without strong systems of evaluation through objective measures. I'm strongly against so much subjective evaluation; b/c it is often used capriciously, and it becomes more about "I like this one, she/he 'fits' more with our little group," then about buiding a highly efficacious staff.
If you like nursing, and if you feel that you are a competent, ethical, caring, and effective nurse, don't let the nonsense that can occur in nursing stop you. You may have to start from square one. That's OK too. Make a strong plan and see it through.
Also, my two strongest recommendations to people in this field are as follows:
1. Carefully document and keep it up-to-date/hour/minute. If you do anything in terms of tx or something unusual happens, don't wait to document if at all possible. If a code occurs, of course that is different. But I would rather miss lunch or break, and in general, that's not a good practice either b/c it leads to burn-out--and stay and document the change/s or certain observations.
This is especially true in any ICU setting or recovery setting. Anything you do has to be documented in the right manner immediatel
y. It just has to be done. Things in the unit can be fine one second, and all hell breaks out the next. It is different, however, from the ED, in that in the units, you are expected to be on top of the finest as well as the most comprehensive details associated with your patients at all times. This is what makes the unit stressfull. It's not merely cheif complaint focused.
Nurses w/ docs are critically analyzing everything, starting of course with the priority issues and moving down from there. You are accountable for all of it. It's a very anal-retentive environment. You have to think in terms of what are the focused, priority issues, as well as think globally
. And this is why, in general, you should only have 1, 2, and really no more than 3 patients. Some pts, as you know, are so sick, that they really need to be 1 nurse to 1 patient, period--and some recoveries I have been in have had 2:1 or even 3:1, nurse to patient ratio, although they are rare--depending upon whether you include the nurse/RT echmo specialists, etc.
It can be intensely treatment-response oriented, and since monitoring is continuous, so is what we do in terms of documentation. The biggest thing I've told new nurses on orientation in an ICU is document what you do immediately. That's why we have flowsheets.
In pedatric units, certain continuous med changes will require that a second nurse completes the calculation, checks the pump, and checks it off in the documentation. It is more time-consuming, but it allows for insight into trends--there are many kinds of physicians and fellows checking the flow sheets all the time--many have multiples of consuling docs, And this can be checked up to each hour or more frequently if the patient is unstable enough or is bordering on the precipice.
I've seen surgeons and fellows flip out if that documentation is not up-to-date for the hour or with any changes. They will look at the flowsheet and look at the pumps, and if there is a discrepency b/c you have been busy, or just made the change, and only have two hands, you will hear about it.
And there is no waiting to tally I & O's at the end of the shift in many peds ICUs, running totals are expected for each hour. When you have a lot of drips in, and many tubes coming out of a kid, just running these hourly totals can take some time; b/c they all have to be documentated accurately each hour. If you aren't careful, at the end of the shift, if you find your overall doesn't match with the running totals, Oy vey, what a mess. There are people that actually detest working some of these ICUs for these kinds of reasons.
So besides learning and doing and following frequent labs, meds, all the other stuff, not to mention admissions and codes, you have to become this hyper-anal recorder of everything all the time. And believe me, there are nurses going over your flowsheets all the time as well. Therefore, any freaking thing you do or anything different you observe in a critical care unit, do yourself a favor and document it right away on the flowsheet in pen. (I recently saw some notes in pencil from a nurse and was preplexed by this.) Verfiy everything in the computer with your initials and always log out under your own UN and Password. Always check and make sure you log-out. If someone asks for your password in a pinch--it happens, even though it shouldn't--call IT or helpdesk or whomever, and get a new password ASAP. I've given passwords for emergency labs in a pinch to those I have trusted, but you have to be careful with this. I have also had people allow me to use their passwords when mine would not work. In general, it's a bad idea, but in a pinch, when you need to get something, well, you do what you have to do for the patient.
2. The second thing I recommend for nurses is to always make sure they have a secondary position. Sure, it means more work for you. You may have to give up yet another weekend for the per diem or PT nursing position. Having it,however, serves to main purposes.
First, if anything goes wrong in your one position, you have another position in which you are current,where you can continue to work and make an income.
Second, you have current experience that you can use as a reference, in case the other job puts out a so/so or questionable reverence. If you have another employer showing that you are doing strong work for them, this can help put into question the dubious reference from the other employer.
Now, if it's an incredibly lame situation, such as you ripped out someone's chest tube and let them bleed out, and there are witnesses to this, well, obviously that is going to the board of nursing for review--and you would probably be brought up on legal charges as well, so, in such an extreme case, having another position may not help you. ( I used something outrageously extreme to make a point. Of course this is not anything that you would do.)
If, however, in general, you can show that you are safe, ethical, and an efficacious practitioners, having another position when another employer may suggest or hint other wise will work in your favor.
I have said this several times at AN. In order to stay working as a nurse, you have to be like the sharks that have to keep moving in order to survive--meaning, you have to keep current with your work, and you have to always be able to demonstrate that you are a competent, safe, ethical, and efficacious clinician.
It also helps to demonstrate you work well with others, and when you have the other place showing that you clearly do, the first place's claim about "fit" or "working with others" will be brought into question. Thus, if an interviewer finds that you meet certain requirments, and they find that you may be a good candidate for a position, if the reference from say job 1 is hazy or dubious, in light of job 2 and your overall presentation, the dubious reference from job 1 carries less weight. See what I mean?
There are people, who, despite the given protocol of "not giving bad references" will say things that could lead a potential employer or HR person to questions your abilities and candidacy. It's a PR game as much as anything else. If references are followed up by way of say phone calls, who is to say how someone might phrase things or the tone they use or a sense of hesitanc??? These games occur all the time, and nurses need to be aware of them. All someone has to do is ask something like, "Is so and so eligible for re-hire?" Well, if a manager says no, is it b/c of something as fuzzy as "fit" or is it b/c of issues of safety or dependability?
You see the predicament with that?
Managing your career involves PR skills and contingency planning in my view. If you work in journalism and someone didn't like you work, maybe it's an issue of style. If, however, you are a nurse or a physician or allied health provider, and someone at a place isn't keen on you for highly subjective reasons, the other party doesn't know if it is from safety issue or ethical issues.
The implication is stronger in the negative for people that work in direct patient care.
If issues of safety and efficacy in practice are one unclear, it would make a potential employer wonder many times. Who is going to hire you if they wonder if you are somehow unsafe? So nurses and docs have to go hard after any hint or suggestion of competence and safety--when of course it is baseless--in order to protect their livelihoods.
Protecting your reputation requires vigilance. I have seen a number of nurses and even some docs (though not nearly as often as with nurses) get pushed out of positions or even healthcare for nonsensical crap. I'm talking about people that were good clinicians.
After witnessing this happen to enough nurses, I say always have another job; b/c the politics in the hospital can be 10X as bad any office politics that happen in any company.
Being let go or leaving a place can leave unfair implications, which may ensue from the politics. And these can be 10X as hurtful, b/c people may well assume the break in employment relationship may be due to issues of safety. In fact, that is not often the case, and this is one reason why there are many less board investigations against nurses as compared with terminations.
like to cover their arses with the use of the term "fit." It seems like a good term on the surface, but it is more often than not used in unfair ways against employees.