Advice please!!!!
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This is a rather long so bear with me on this. I'm not sure what the do at this point, if I should file a grieveance or just suck it up, keep on moving and improve on my performance. I've been working at this hospital almost a year and love working with the patients, but my fellow co-workers seem to keep getting me into trouble and in the end it appears that you don't get written up for giving bad advice, but only if you take the bad advice.
The first warning I got was understandable and deserved. I had a patient coming in for questionable febrile seizures and she became febrile overnight!! I paged the resident at least twice waiting for an order for tylenol, but she must've been dead to the world because she took a very long time to call me back. While waiting for the resident to call, another nurse told me to hurry up and give the tylenol or my patient would begin to have a seizure. I waited and waited, still no call back. All I needed was a T.O.R.B and that would've been the end of it. So this other nurse proceeded to write out the telephone order before the resident called back, since she, and we, all assumed the doctor would just write the order anyway when she arrived. To make a long story short I ended up giving the child tylenol before the doctor arrived and was written up for working out of the scope of my practice. My manager counseled me on going with my gut and if it feels wrong don't do it. She understood that as one of the new kids I was under a lot of pressure from the more senior nurses, but that if it I feel it in my gut, don't do it. I don't know if the other nurse got reprimanded or not and I didn't ask.
This last written warning came from a combination of things that happened on just one night, with different patients. This is the discipline that I feel should be partly be grieved because I feel like I was the fall guy. My first patient was a newborn admitted for hypothermia but ended up having hyperbilirubinemia. Now I've only assisted in setting up bili lights one time, so I knew I would need help. I asked for help and was told to print out the protocol, but the blanket under the baby, put the googles on, and set up the lights so many inches away from him, with the temperature measured with the bili meter. To make a long story short I fumbled with the lights and the dad asked that someone else set up the equipment because he didn't feel I was capable of doing it. I didn't take offense to it, I just said that's your right and I understand. Again, I asked for help and was told to call the NICU. The NICU nurses did it, and felt themselves that the dad was a little uptight, but they were older first time parents so I didn't fault them for anything. Well apparently afterwards, the parents kept asking if the NICU nurses to do everything, but we're not a NICU floor, and the baby didn't need the NICU, so it became an issue. The parents even met with the director of our unit to discuss what was going on with their child and the bili lights and NICU, so even the director knew (this isn't unusual, the director from time to time does go and listen and talk with the families on the unit to see how things are going). Another issue with this patient was that the Admission Screening Tool was not completed, which is done on admission. I discovered this at 5am that morning and passed on to the next nurse that it hadn't been done. Mind you the patient had had two nurses before me and neither had done the AST. I wasn't going to wake up a breastfeeding mother who was already up every 2 hours feeding, to wake her up to ask her 30-35 questions about her child.
During that same shift, I got an admission, and was so busy with a rectal irrigation and a transfer that I missed my own AST!! So I passed on the next nurse that it wasn't done and they didn't seem to care. Also this new patient had an order for a pulse ox and no EKG leads, and I had the patient on EKG leads and no pulse ox. I also realize this was my boo-boo and I should've corrected it, but I have walked into countless patients rooms and patient isn't attached to anything and should be. I just told the nurse and thought she could take the two extra seconds and stick the kid on a pulse ox.
So my write up was for all these combination of things: I was basically blamed for not doing 2 ASTs, when in fact one AST went through two nurses before me. I was also written up for leads and pulse ox monitors being backwards, and written up for asking the NICU to set up the bili lights when I could've utilized my resources on the floor. If I asked for help initially before the set up and after the parents asked for someone else and I'm sent off both times, what was I suppose to do? I don't know what my next step would've been. Apparently the charge nurse that night was capable of setting them up, but she was either too busy or didn't want to bother, either way I was disciplined for it. IN FACT, the nurse who told me to call the NICU is the same nurse who told me to give the tylenol to my febrile patient above. The monitors and pulse ox issue was could've been corrected the the day nurse, it take two seconds to put a pulse ox on, but instead she thought she'd report it. I go through countless pulse ox and lead stickers in a night, and alot of times because the day nurse before me doesn't have them on right, or not at all, but I don't report it everytime. As for the ASTs, I don't understand why I'm being held responsible for something that went through two nurses before me and neither one of them could do it during the day shift? As uptight as these parents were, would it have been wise to wake them up and ask them to answer a bunch of questions for me at 5 in the morning? Why am I the fall person because the previous nurses slacked off?
Now don't get me wrong, I understand all this involves some self-reflection on my part and I need to look in myself and see where I need to improve on my performance. My manager told me herself that some of these issues were simple tattle tales, but I get in trouble nonetheless. Now I'm in danger of losing my job all because I did things that I've seen done all the time. I've had the reporting nurse tell me the AST is incomplete, or that they didn't bother to put the child on monitors because they look good, but there are doctor's orders for monitors. At one point, some nurses were worried that I wasn't asking enough questions during my orientation, but now I ask questions and ask for help all the time and when I do what I'm advised, I'm still at fault. Please help me understand what it is I'm doing wrong and what I need to do to correct it. I've considered finding another job due to my co-workers and their attitudes towards me at time ( I feel ostracized at times, and left out of the cohesion of the group, a whole separate thread), but I really like my kids and want to make the best of it. AT this point, I'm so on edge from the fear of losing my job that I'm afraid I won't be able to do my job.