Being fired...long and weepy

[catlvr]

*Sigh*. I"m 40, and graduated from LPN school eight months ago. I had good grades, did well in clinicals, and passed boards the first time. However, the transition from being a very competent secretary who was the go-to person at her old job to being someone new and scared is really hard!

All during school, the instructors told us that most LPNs would be passing meds in a nursing home; I liked that idea since it would provide good training, but what appeared to be an awesome job fell into my lap - I worked for a residential treatment home for pregnant/mothering addicts. I left after three months because my case load was crazy, lack of mgmt support, and unsafe conditions (the previous nurse was there for the same amount of time; she told me in a round about way that I should get out asap). I loved working with this population, and was sorry to leave.

I took a job at a psych hospital as a med nurse on a geri-psych unit. Once again, I love the population, but am struggling to get my work done on time. I am scrupulous about admitting my errors, and have filed two incident reports of my mistakes, but have never heard from mgmt about them - they seem to go into a black hole. I have, of course, learned from them and that is the important thing; never made the same mistake twice, to my knowledge. I was told by some people that I shouldn't have even bothered to file the reports since there didn't cause any harm, but I am not comfortable with doing that.

Over the weeknd, I was scheduled to work 16 hours on Saturday, have Sunday day shift off, and then work Sunday 3-11. BUT - they offered me a bonus to come in on Sunday morning since they were short staffed and said that I could come in at 8 am instead of 7, and since I took such a huge pay cut from my great corp job and have a ton of debt from not working during school, I accepted. That was my first mistake.

A patient with very unstable BP was admitted on Saturday night about an hour before I left. Her admission was filled with a series of mistakes, some of which I caught and some of which I did not. To make a long story short, her meds were not in the MAR correctly. On Sunday morn, I gave a med that probably shouldn't have been ordered, no adverse effect other than sleepiness. I reviewed the cardiac meds with the RN, and she said that they need to be clarified again with the medical doctor (rather than the psychiatrist) since she wasn't sure how to convert them to items on our formulary.

Change of shift took place, and the new RN in charge told me not to give her the cardiac meds (since some are not on our formulary, we will use the pts own supply; our policy is that before we give the pts own meds, we are to send them to the pharmacy for blessing first). However, the pharmacy didn't bless these meds because they didn't pick them up from us. My error was that I didn't take them to the pharmacy (they only work from 7-2 on the weekend, and are busier than heck, so they didn't pick them up when they dropped other stuff off in our unit). I should have ensured that they were taken care of - that's my error, and my only excuse is that I worked nonstop the entire shift, so I didn't know that they were still there until 3pm; the oncoming RN was understandably upset about this, and let it be known pretty loudly. She told me to call our administator on duty to see if I could give the meds; AOD said not to do so since it against hospital policy. The MD arrived around 7 pm, and he to give her the meds without the blessing. He clarified all of the orders and corrected them. I told him that I had been told not to give the meds, and he said that's fine - he would give them. The RN was standing there and said - no, she (meaning me) will do it. And here is my next error: I was at this point so anxious about everything, that I didn't give the med for 50 minutes, since I had been specifically told not to do so by the mgmt. I don't know WHY I didn't do it right away, other than that I was so anxious about the entire sitaution, was over-tired and not thinking clearly, low blood sugar, racing pulse. But I did eventually get it together and give it. Her BP went down. When I went to pass my 9 pm meds, she refused the rest of her bp meds because she said that wasn't how she took them at home. Her bp was stable at this point. But here is my third mistake - I don't recall if I told the RN. I honestly don't. She had yelled at me in front of a patient about another matter, so I tried to keep my interactions with her at a minimum so that I could focus on my med pass for the rest of the pts without falling apart.

When I arrived at work yesterday, the client's bp was again high; the doctor was angry that she hadn't been sent to a medical hospital. The nurses wanted to know what happened and why it hadn't been passed along in report (I missed most of off going report, since I was finishing my computer documentation, which can only be done in the med room). The RN who I worked with at nights can be very hard on staff, but she is an excellent nurse, and I am sure that if I had told her, she would have either talked to the client about the meds, or passed along the refusal during shift report, so I must assume that in my anxious state of mind, I didn't tell her, esp since the pt was stable. If I was in her shoes, I'd be very angry with me as well.

My learnings are:

• I cannot work two doubles in a row.
  
• I may not be cut out for nursing, or at a minimum, certainly not for this position.
  
• When the doctor says do it, regardless of policy, DO IT, especially if it is in the pts best interest.
  
• Scrupulously over-communicate.
  
• Trust my instincts when accepting a job. I knew when I accepted it that it would not be a good fit since it wasn't really what I wanted to do, but my sister works there (we went to nursing school together, she's much younger than me and had worked for this hospital for three years as an aid). I didn't even have to interview for the job, they just made me an offer, based on my sister's excellent reputation.

I am certain that I am going to be terminated from this job, as I have lost the trust of the RNs and no doubt the physicians as well. I showed poor judgement, didn't act in the pts best interest, and failed to properly communicate. While there were any number of other errors in this poor client's admission, these were my parts of it, and I accept responsibility for them.

I had been intending to leave this position anyway, since I really want to learn wound care and have the opportunity to help patients in a more hands on fashion (our med pass is so long that I don't have much time for therapeutic conversation). Since this is a psych facility, most of our clients are generally medically stable, so my medical assessment skills for have gone stale; I now totally understand why everyone says that you need at least one year of med surg experience to cement your knowledge before moving to psych.

I have an intereview for a job on Thursday, and just hope that don't get fired before then, so that I can honestly say that I haven't ever been fired from a job. This is all so out of character for me - my work record before nursing was exemplary - and I have lost all of my confidence. I am trying hard to take my learnings to heart so that I can move on. I know that I need a job where there is support and training (and that will be hard to find). I am very scared that I won't find one since this will be my third job in seven months.

I'm grateful for those who have read this; it was helpful to write it down. I am not looking for sympathy, but boy, do I need a hug.

e

[ukstudent]

{{{{catlvr}}}}:redpinkhe:redpinkhe

[smak60]

:icon_hug::icon_hug::icon_hug::icon_hug: Hang in there!!!!!!

[MelBel]

[*]When the doctor says do it, regardless of policy, DO IT, especially if it is in the pts best interest.

e

I would NOT do it if it was against the policy, unless it was a truly life or death matter for the patient. If something had been wrong with the meds, you would have gotten in a lot more trouble for not following policy. And as nurses, we have to be able to stand up to the doctors in some cases. If the doctor wanted that med given, he should have given it himself.

And **hugs**. I don't think you should or will get fired over this...at least I hope not!! Everyone makes mistakes, and if whoever you are working with doesn't understand that, then you need a new job anyway! :)

[SuesquatchRN, BSN, RN]

AH, catlvr, {{{{{}}}}}

[nursemike, ASN, RN]

{{{hugs}}}

You're new and nervous, and that's understandable, and you've made mistakes, and that's understandable, too. I would also be surprised if you were terminated over this. Frankly, I think you're being too hard on yourself, and probably too easy on your RN. With the out-of-policy med situation, when the doctor offered to give the meds, the correct answer was: "Thank you, Doctor." He'd made the call, he was within his scope of practice, and he was offering to accept the responsibility.

When the patient refused her meds, she was exercising her right to do so, but I think it would have been appropriate to notify the RN. The RN was wrong to berate you in front of another patient, but when you have a little more experience under your belt, I don't imagine you'll let that throw you as much. You're right about the importance of communication, and you simply can't let someone else's unprofessional behavior interfere--even though doing so is natural and understandable. It would also be prudent to chart the refusal.

You may be right about needing to find a new job. It sounds like they may not deserve you. But nothing you've described suggests you aren't cut out to be a nurse. It sounds like you're well on the way to being a darned good one.

Edited to add: Plus, it just dawned on me what "catlvr" probably means, which right there proves your intelligence, integrity, and character. Unless you mean, like, smothered in onions with a nice cabernet...

[RoyalNurse]

catlvr: you sound very conscientious, they're lucky to have you!

That is a tricky situation, it is well within a doctor's scope of practice to give a medication that he prescribed for the patient, but you do need to follow hospital policy.

I think the first year of nursing is just tough, and I think a lot of people question whether or not they should be a nurse during that first year. I know I do!

<.>

<. :redbeathe>

(I'm a catlvr too!)

[november17, ASN, RN]

I'd be more irritated with the poor communication but I don't think you'd lose my trust or anything. Especially if further down the line you were trying to redeem yourself. I think the appropriate action would be to confront the RN, acknowledge the miscommunication, and maybe work out a plan to increase communication in the future. A simple statement like, "I'll make sure I tell you in the future!" would certainly suffice, especially if you followed through with your statement.

Missing a BP med isn't that big of a deal, really...how high did the BP go? Were the symptomatic? If you didn't give a BP med and the patient got a nosebleed or an aneurysm or something that'd be one thing to be concerned about.

If their blood pressure was simply high the next day than that'd be kind of ...well...expected. Sounds like a bunch of drama queens to me. Like you said, the patients are generally stable but just because a patient's blood pressure goes up doesn't really mean a whole heck of a lot (especially if they have a history of hypertension, which if she's on BP meds then I guarantee she does).

It sounds like you have some issues with anxiety at this job (high work load, intimidating supervisor, questioning your abilities). Even though you are planning on leaving, I guarantee this is probably an issue that will arise in your next job - it even sounds like you had similar issues at your first job. You sound like an introspective person; take a step back and think of ways to reduce anxiety within yourself? I'm not talking about meditation or your zen, I'm talking about confronting your fears and overcoming them (as in, your fear of communicating with that nurse on the day you miscommunicated, prioritizing what needs to be done and doing it). Make a list of goals and tackle it.

[imanedrn]

My learnings are:

1. I cannot work two doubles in a row.
   
2. I may not be cut out for nursing, or at a minimum, certainly not for this position.
   
3. When the doctor says do it, regardless of policy, DO IT, especially if it is in the pts best interest.
   
4. Scrupulously over-communicate.

My thoughts:

1. I think this should be policy for nurses. My dad's a pilot and they have hourly restrictions. That's because they're responsible for a couple hundred people though. It's a shame that, because we're only resposible for a handful of people, that these policies aren't in place for us.
   
2. I think #1 cancels this out. Working WAY OVER TIME doesn't make you NOT cut out for nursing. I think, at ANY job (even a secretary!), your abilities become compromised after working that much time!
   
3. Absolutely not! Didn't you learn in school to ALWAYS question dr's orders that seem wrong. Yes, if something is in the pt's best interest, then it should be done. But, if it's against hospital policy, there should be a better reason than "just because the doctor said so."
   
4. Communication is important, but you can go overboard. Obviously, you noted important information that you forgot to mention. That happens. I may forget to mention a wound because I listed 10 others and forgot #11. I'm not going to run down the pt's history if it's not vital to the pt's care, though, esp. if it's going to run far into the oncoming nurse's shift.

In any case... good luck!

[SCDOHJohnRN]

catlvr,

I agree with what others have said. It can't be said enough that just because the doctor said it just do it. NEVER. If the doctor said it QUESTION it. If he/she wants to give the med fine, that is within the scope of his/her practice. You must abide by hospital policy, thats the scope of your practice. It is very difficult to chnage from the go-to person to the can't do person. Don't be so hard on yourself. Nursing expertise comes with time. Orvil and Wilber did not get off the ground on their fist attempt!!

Besides communication, documentation is your next best defense. If the pt refuses her meds, chart it! Even if you communicated with the RN she may forget that. Having something in writing is much better then verbal. The best thing is communicate and document. CYA

I don't think you will get fired. The RN should be reprimanded for berating you in front of a pt. That is NEVER acceptable!!

Sounds like you are the poor tuna who landed in a school of sharks!

Remember in a Psych ward the only differance between staff and pt is that staff has keys!!

Good luck Oh yea, XOXOXO

[catlvr]

THanks so much to all who took the time to read and respond. I really appreciate it. I haven't been fired, and don't think anymore that I will be (at least, over this issue!). Our hopsital is "cleaning house" - they've fired quite a few long-term employees, including two nurses who I really looked up to, so the atmosphere is very uncomfortable for everyone. Anxiety is high, and the gossip mill is in full force. I do my best to stay away from it.

I had an interview for a position in a nursing home that semounds pretty good - they do a fair orientation, and the staff seem very helpful and supportive.

I do agree that I'm very anxious and that is something that I've taken to heart; I think that as I grow more comfortable with nursing, it will get a bit better. Until then, I've cut back on caffiene, exercise faithfully, and do my best to remember to breathe (:

I am grateful to the kindness from the allnurses members!

e

[sunny261]

ctlvr:

Nurses are not machines...remember that no-one is perfect and everyone makes mistakes....keep your spirit up and walk proud. :icon_hug:Good luck!