Almost Fired !

singleumm · Jul 1, 2011

onaclearday, I am glad you said what you said. And I just might do this when I have to call one of the bosses today. This IS one of those experiences where you have to be very humble indeed.

singleumm · Jul 1, 2011

pale pilsen you can get a job somewhere else with 6 months experience. Just when you apply for another job, tell them you are still employed and that you are looking to pick up extra time. Which is true. And then after you get the extra time on another job, drop the crazy one.

canesdukegirl, BSN, RN · Jul 1, 2011

One of the night nurses e-mailed her stating that a patient complained of "red and swollen IV site" and also that I left an antibiotic hanging for hours without infusion. The patient failed to mention that she wanted to get up and ambulate in the halls so I couldn't infuse the antibiotic I also assessed the site before and after infusion and saw no redness or swelling. The night nurse also complained about a dressing on a mid-line of another patient being soiled and not changed. I assessed the patents mid-line initially in the AM and dressing was CDI, there were no IV infusions that day so I didn't check again. She also complained that I failed to fill out paperwork for a patients calorie count when I delegated the responsibility to the nurses aid and she assured me she would take care of this. It was never done this is the second time I've delegated and it hasn't been done. I feel sick to my core! With 6-7 patients its so hard to keep up with everything!!!

Almost, I feel for ya, girl. It is VERY difficult to get your groove when you are first starting out. A few suggestions:

1. If you pt wants to ambulate in the halls, tell them that you MUST infuse the ABX first, and then she is free to ambulate. Explain to the pt that IV ABX are administered at specific times to ensure therapeutic levels. Pt's don't always understand the "whys and hows" of their treatment, but if you educate them, they are more likely to understand and subsequently not raise a fuss or think that you are "just being mean".

2. If your pt's dsg was CDI in the AM, you will still need to check the dsg again during your shift. When I was working on the med/surg floor, I checked my pts dsgs q4-basically the same time I took vitals or gave meds. I also educated my pts on the difference between frank blood and sero-sang seepage from the dsg and asked them to call me if they saw any drainage so I could check it out. Get your pts to help you out! Think of it as a team effort; you are both there for the same purpose...healing.

3. I am a bit confused about "there were no IV infusions that day so I didn't check it again". Was this pt heplocked? I ALWAYS assess an IV site more than once a shift. Was there an order to flush the IV site q8 to ensure patency?

4. Now you know the pitfalls of delegating. You gotta go back and check. You are the quarterback. You make the calls, but you still have to see the play through.

5. There is NO WAY that you should have 6-7 patients as a new grad. This is completely unacceptable, and is a management failure. Anyone would be in the weeds with this patient load.

My hope is that your NM will see that you have recognized your shortcomings and your willingness to improve. Eat some humble pie (as unsavory as it is now, it will show some maturity on your part) and listen to what they have to say. Before you go into the meeting, have a "punch list" of the things that you would like to improve upon in your practice. Write down a suggested solution to a particular issue. This will show that you have put some serious thought into targeting your challenges and furthermore have identified some potential solutions.

Ask if you can have a more reasonable pt load for the next couple of months so that you can develop your time management skills. It's sort of like making chocolate chip cookies...you add the flour GRADUALLY to the mix. If you dump it in all at once, you get a big freaking mess. I envision your plan to begin with 3-4 pts for the next 2 months and then add one more for another couple of weeks until you get your sea legs.

This is a rocky start for you, no doubt. But IT CAN WORK. If you can get over the "feeling like a failure" and put on your game face, you can do this, honey. I am pulling for you!:redbeathe

nurse4sale · Jul 1, 2011

Dear Almostbsn, what you are experiencing is how nurses like to eat their young. I'm sure you heard of this saying before. My best advise I can give you is to watch out for that ***** of a co-worker and don't trust her with anything. Watch your back and stay tough, you will get the hang of it. Keep protecting yourself and don't admit to anything. Once you gain experience and you are confident in your abilities, don't do to other nurses what these nurses, or that nurse has done to you. And never forget how they treated you. One day they will make a mistake and that's all I have to say.

Your supervisor/manager should understand you are new and she should also understand how nurses like to treat new nurses with disrespect and meanness. I hope she supports you and gives you the confidence that you need at this time.

Good Luck my friend being new is not pretty.

Ruby Vee, BSN · Jul 1, 2011

tokmom, i agree with you a 1000%. yes she admits that she has made some mistakes but it also sounds like they are looking for stuff to knick pick on.

she admits she's made some mistakes, but doesn't say what they are. a mistake in hanging blood could have serious ramifications. reporting "an issue" with hanging blood may not be nit picking -- it may be patient safety. i thought i gave the op some good advice. i'm sorry you didn't think so.

nola1202 · Jul 1, 2011

It's hard to know from a post what the situation was, not remembering to fill out the paperwork correctly or glue the blood slip in the chart...or something big. I noticed I totally didn't take the side of a nsg assistant who posted about a mean nurse who was terrible clinically because, I was bullied once by a CNA who pulled the same kind of stuff on me. I'm looking more critically at what I respond and don't resond to based on my mental filter. I admire the posters who are able to respond with concrete advice not just warm happy thoughts, it'll all be ok. I wish I'd had access to a forum like this when I was just learning nursing.

Ruby Vee, BSN · Jul 1, 2011

dear almostbsn, what you are experiencing is how nurses like to eat their young. i'm sure you heard of this saying before. my best advise i can give you is to watch out for that ***** of a co-worker and don't trust her with anything. watch your back and stay tough, you will get the hang of it. keep protecting yourself and don't admit to anything. once you gain experience and you are confident in your abilities, don't do to other nurses what these nurses, or that nurse has done to you. and never forget how they treated you. one day they will make a mistake and that's all i have to say.
your supervisor/manager should understand you are new and she should also understand how nurses like to treat new nurses with disrespect and meanness. i hope she supports you and gives you the confidence that you need at this time.
good luck my friend being new is not pretty.

i'm pretty sure this is horrible advice. perhaps it served you well in avoiding the wrath of your kindergarten teacher, but it flies in the face of anything resembling patient safety. if you're a nurse, your mistakes can kill someone -- maybe even someone you know. when a nurse makes a mistake, the only honorable and ethical thing is to immediately admit it and set about mitigating the damage to the patient. if you've made a lot of mistakes, your supervisor will be involved. that's not meanness or disrespect, that's not only accountability, it's patient safety.

no doubt the supervisor or manager understands that the op is new, and from what was written, it appears that she is willing to work with the op rather than just firing her. the op should take advantage of that with a well-thought-out action plan.

as far as the idea that "nurses like to treat new grads with disrespect and meanness" -- i can assure you that is not true. we were all new grads once, and most of us remember how painful that first year of nursing was. new grads inevitably make mistakes. mistakes need to be corrected rather than allowing the new grad to make the same mistake over and over. that's not meanness or disrespect, and the new grad should not take it as such. old grads and seasoned nurses make mistakes, too -- and if i haven't caught it myself i'm happy to have someone point it out to me so i can be hyper-vigilent about that particular issue in the future.

if someone were taking care of your grandmother, wouldn't you feel better knowing that mistakes were addressed and taken care of? these patients are someone's family member; they deserve to have the best we can give.

in order for the situation to have progressed to the point where the op is being asked to sit down with her manager and the manager's supervisor with a written action plan, there have probably been many mistakes made. the op has an opportunity to address these mistakes, learn from them and move on. that's a gift, no matter now much of a mixed blessing it seems right now.

as for giving the op the confidence she needs right now -- i've seen more bad outcomes from a new grad (or a student) with lots of confidence and nothing to back it up than i have from a new grad with very little confidence who asks before she does something incorrectly.

nola1202 · Jul 2, 2011

The one thing that is crucial is a unit manager who knows her unit and how to sift through the information provided. Consider the source. I worked with a peer who I really admired, but she could get focused on one person and criticize, write up, and nit-pick. That kind of focus can really destroy confidence and create so much anxiety about mistakes that it makes the situation worse not better.

I've also seen one or two nursing students (one was former EMS, the other a former LPN that talked more than they listened, went off to do a complex proceedure without checking in the their preceptor (this was the 1st day) didn't look up the policy and proceedure first (hadn't done clinical or worked there as a student)

and yes, did mess it up. It was fixable, but annoying. Their orientatation was more stressful for them because they were in such a hurry to prove how worthy of our respect they were, they shot themselves in the foot.

I'm hoping the OP has a great manager that can look at the situation, use it as a teaching oportunity, and that she in turn will precept. It really is hard to be a good preceptor with the high pt acuity and staff turnover/less staff assigned to unit these days. The best hope is to get into a hospital that understands the need for a strong new grad orientation program.

singleumm · Jul 2, 2011

Yes you did give some good advice. But I was not referrring to the blood incident because that is a patient safety issue - no ifs ands or buts about. There were other things I felt were knick picking. Because she is new and a professional, it is best to address the issue with the newbie first instead of going to the higher ups. Even with nurses whom have been nurses for a while should be given the benefit of the doubt. None of us are perfect and we will continue to make mistakes.

canesdukegirl, BSN, RN · Jul 2, 2011

Dear Almostbsn, what you are experiencing is how nurses like to eat their young. I'm sure you heard of this saying before. My best advise I can give you is to watch out for that ***** of a co-worker and don't trust her with anything. Watch your back and stay tough, you will get the hang of it. Keep protecting yourself and don't admit to anything. Once you gain experience and you are confident in your abilities, don't do to other nurses what these nurses, or that nurse has done to you. And never forget how they treated you. One day they will make a mistake and that's all I have to say.
Your supervisor/manager should understand you are new and she should also understand how nurses like to treat new nurses with disrespect and meanness. I hope she supports you and gives you the confidence that you need at this time.
Good Luck my friend being new is not pretty.

I agree with a lot of what you wrote, however one sentence bothers me: "Don't admit to anything." I know that Ruby already addressed this statement, and I have to agree with her wholeheartedly. You MUST admit your mistakes in this profession.

Yes, we must protect ourselves, but we must protect our PATIENTS first.

I don't agree that nurses "like" to treat new nurses with disrespect and meanness. Wow. There are a few here and there that are not very nice to new staff members but on the whole, I think that we welcome our new staff.

melmarie23, MSN, RN · Jul 2, 2011

I work in Med Surg-Tele floor and I feel your pain. I just finished my orientation not too long ago and I feel like i've been thrown in a pack of wolves on my own. I hated this floor. There is barely a room to breathe. I sometimes skip lunch to do so many things all at once. I usually clock out on time but ended up staying hours to finish my charting (company doesnt like to pay for overtime!). There are other nurses who floats to our unit and called it a "jungle." I dont even know why im sticking it out here. I just want to get my experience. Do you think i can get a job with 6 months of experience in med-surg? Is that enough? I really dont know If i can stick it out for a year. I feel that since i've worked there, i became depressed and my physical health deteriorated. Please help me with suggestions. Thanks.

absolutely! definitly apply if you are thinking about leaving (but keep your current until you have another lined up). Whats the worse that is going to happen-they say no? I've just come off orientation myself two weeks ago as a prn float between a med/surg and a acute rehab unit and I just interviewed and got a per diem L&D position (what I want to do). I wasnt even looked at at this hospital for the L&D position until I had some other experience under my belt.

melmarie23, MSN, RN · Jul 2, 2011

and to the OP, its been said already, but you are not alone. The learning curve for a new grad is steep. I just recently came off orientation and regularly have been given 5 patients and its HARD. So hard to stay organized and on top of things. I always tell the oncoming nurse that I apologize in advance if my report is all over the place as all my patient care info seems to be haning off in space and I cherry pick them from in front of my eyes as I report off, LOL. I've been lucky though...most of my co-workers have been extremely helpful and supportive and have not even batted an eye at my gazillion questions. I already come into work with my anxiety level high (I am my own worst enemy) but leave feeling better knowing that I made it though another shift. If I didnt have this supportive environment though...who knows how long I would have lasted. Med/surg and rehab is not my passion, and without a doubt I'd have quit by now.

There are still things I miss from time to time. But I admit to them and move on. The whole point is to learn. Additionally, one of the hardest things to learn is how to delegate and then follow through. We'll get there. Its just going to take some time.

Don't be so hard on yourself. And when you meet with admin and your NM, be honest. Tell them you are doing your best, but need more support. Its the only way you are going to learn.