Bitter endings, sweet beginnings, and blessings in disguise.

[NeoPediRN]

I thought long and hard about posting this. I wanted to post it since it happened to me but I think bashing your employer makes you look foolish and them right, and what happened to me is so ridiculous, like one of those stories that can't possibly be true that I couldn't even gather the words together to even try. I was also really embarrassed because up until this incident I've never been in trouble for anything in my life, not even a detention. Let me backtrack. I started working on a surgical floor back in July. I worked on a pedi med-surg floor prior to that as well as a pedi psych unit, so my adult experience was limited. The nurse manager liked me and decided to take a chance on me anyway. This particular hospital has a 120 day probationary period and you are not in the union until the trial period is over though you pay dues from day one. All was well, I was off orientation after six weeks on the floor. In early October I took care of an elderly patient with a reversal of a Hartmann's procedure who had severe diarrhea and dehydration. She was at the very end of the hallway and the staff had moved her a few times closer to the nurse's station because she refused to call for help to go to the bathroom. We have fall risk protocols and she scored as a level 3, the highest fall risk. I initiated the appropriate procedures for this protocol, including bed alarm, assisting to the bathroom, etc...she was irritated by this. She had orthopedic shoes and a walker, refused to tie the shoes and would literally RUN to the bathroom when she had diarrhea without her walker, and her gait was very unsteady. She refused to have her room changed so everyone was doing the best they could to keep an eye on her. I would walk with her to the bathroom just keeping my arm behind her in case I needed to steady her. One time walking her she did lose her balance from walking too fast and if I wasn't there she would have fallen. Each time I put the call light cord in her hand in the bathroom and made up an excuse to stay in her room to be there when she was finished in the bathroom. The charge nurse was aware of the issues and we did the best we could for her to keep her safe. Other than her being annoyed with us helping her, she seemed fine and didn't appear to have issues with her care. I got cancelled halfway through the shift that night because of low census. Two weeks later my nurse manager pulled me into the office and asked me if I remember this patient. The patient had told my nurse manager the next day that I treated her like a child, told her to "Sit down and don't move a muscle!" and to "Sit down and eat your dinner!" and that "My brown eyes cut right through her." My nurse manager said she had tears in her eyes. She must have given an academy award performance because I NEVER said those things and would never speak to an elder that way let alone a patient. I wasn't even there when she had her dinner, the kitchen sent her the wrong meal and she waited over 1 1/2 hours for the right one and I was gone by the time the right one came up. The nurse manager said she was careful to make sure it was my description and not mixing it up with the next nurse that took over for me. I offered to call the patient and apologize but the nurse manager declined. She called the patient to follow up and apparently the patient was "still very upset."

Then!

About a month later I took care of a patient who had a total knee replacement. She was stable but very impulse, getting ahead of her walker and becoming unsteady, getting out of bed alone and tangled up in her equipment, etc...the night I took care of her she had a blood transfusion and I had also given her Vicodin for pain. It was a very busy night on our unit. I had two post-ops, a d/c, her, and a patient attempting to leave the unit AMA to go smoke with an epidural and a Foley. I was RUNNING and so was everyone else. I saw this patient's call bell on so I went down to her room and when I entered she was halfway out of bed and tangled in her SCD boots. She smiled sheepishly and said she was going to get out of bed alone but got stuck in them. I laughed and told her I was glad she called because I was pretty sure PT hadn't cleared her to get up alone quite yet. She pulled her walker toward her and went to get up using the walker a totally inappropriate way. I asked her if we could go over the proper way again and she said sure, that her bed at home is higher anyway and she wanted to practice from that height. We went over that, she did fine, and she walked to the bathroom, got ahead of her walker as she tended to because she likes to walk fast, went to fall and I caught and steadied her. I told her that worried me a little, that remember she's going straight home not to rehab so there won't be as many people around if something like that happens at home. I reminded her to go slow and steady and then she went into the bathroom. At this point she told me her grandson peed in her hat that was in the toilet. I emptied it and said something like "try to have visitors use the bathroom around the corner because we need to measure your urine." She was agreeable, I helped her back to bed. Assessed her pain a couple more times and she denied a need for pain meds until 11:15 pm. I couldn't medicate her at this point because I got another post-op, still trying to get out the last of my 10PM meds, and I was having serious problems with my AMA guy, so I asked the night nurse if she'd mind medicating her and she had no problem with it because she was heading in there first. The next day this lady told the nurse manager that I was wondering up until her grandson peed in the toilet and then my personality completely changed, that I got angry with her and she "skulked away with my walker like a hurt child" and that I told her she would have to go to rehab...I told her she was going home, not to rehab! She also said I withheld pain medication from her and neglected her for the rest of the night. Does it make any sense that I'd get angry over urine? I mean, seriously?

At this point my nurse manager starts to question me about my work ethic. We wear GPS tracking devices and I told her to check that, it would prove I was in there multiple times. She refused saying "They're not meant to be Big Brother." But yet her checking would prove my innocence. I told her there was a witness in there, her daughter, who could confirm I checked in about her pain. She told me she thinks it's something about me that is making these women feel like children, that it's too many incidents too close together. She told me that patients who are A&O have the right to make bad decisions, and have the right to fall, and that if that's what they want to do I need to let them and document accordingly because it's customer service that brings them back. I told her I wasn't comfortable with that, that there is an argument that patients who are truly A&O wouldn't consciously make bad safety decisions, especially when dehydration and diarrhea come into play, and that it's my license at risk here. She then equated it to her relative who was on the floor and refused to have her catheter taken out for one extra day. She said that could have been a big deal if the nurse and doctor had decided not to let it slide, she could have gotten a UTI, and the patient was aware of that consequence but made the "bad" decision anyway. I told her it was very different, that patients have catheters for a month at a time with good catheter care, and that a UTI is a lot easier to fix than a broken hip, and the associated mortality rate was about 25%. I also nicely asked her who she thought the judge would side with, the family that lost their elderly loved one from a preventable fall in a hospital setting, or the nurse that was trying to give good customer service by letting the unsteady patient run in TEDS on a slippery floor assuming she's competent to make that decision?

My nurse manager told me she wanted me to think about myself for a few days and why these incidents might have happened and we'd meet again.

We met again and she asked me if I had any insight into why I said those things to the patients. I told her I couldn't defend myself against things I didn't say. I would never speak to patients that way, but that I can't change their perception of our interaction. I offered to apologize to them and she declined. I offered to make a safety brochure and she declined. I told her I've been working with children for over a year and maybe I need to work on my approach with adults more. I told her that I've never been sarcastic or mean, but maybe my tone or things I've said have been misconstrued as sarcastic. I'm very patient (overly patient at times) and gentle with a soft voice, maybe for some strange reason those two patients took that as mocking. She didn't seem impressed with those answers. I didn't have much to say because I honestly never said those things to those patients, I would swear on anything in this world. She said she would have to think about it more, but was considering termination. We met again and she said she didn't have an answer for me yet, she wanted the educator to follow me around for a shift. The educator followed me for one patient, and I'm sorry, but I have no idea how this lady has a job. If you ask her to do anything she needs you to pull up the policy on it no matter how many times she's done it. I had a post-op patient come up, the first thing he said was that he was hungry. I checked his diet orders, told him the plan which was to start with water, if he tolerated that then gingerale, if he tolerated that then a clear liquid tray (he had a PCA and anesthesia). We cleaned him up and got him comfortable. I got him gingerale and he got nauseous, so we backed off on the fluids and he did better. I met with the educator after to see what she thought and she told me she felt I did fine, but..."Think of it from the patient's perspective...." over and over and over she said this. "He told you he was starving, and what do you do for him?" I told her post-op patients can't eat (she should know this!) and that I informed the patient of the plan. She said "I understand, but do you think the patient cares about that? No, he just wants to eat. Think about it, he hasn't eaten since last night and all he wants is food and you didn't give him anything." I must have looked at her like she had six heads. I tried nicely to explain again that he couldn't eat, he had to tolerate water and gingerale, and he got nauseous with just gingerale. She said "I understand, but you're just not seeing it from his perspective." Then she moves on and says "Also, think about it from the patient's perspective, you and the tech are two young pretty girls, he's this old guy, and you take the blankets off him to give him a bed bath. He must feel pretty exposed." I don't know any other way to give a patient a bed bath, do you?? We didn't take his gown off, but last time I checked you can't bathe someone through sheets! The last thing she told me was that I shouldn't do his nursing assessment because he just came from PACU and his priorities are elsewhere, and that he probably doesn't want to be bothered with medication questions that he's answered before. UM, HELLO! IT'S MY JOB! IT'S PROBABLY ONE OF THE MOST IMPORTANT THINGS I'LL DO FOR HIM POST-OP! She's so out of touch with reality. All of the nurses on my floor were so upset after she shadowed me because she's nearly gotten people fired for less.

The next day my nurse manager calls me and tells me she doesn't have a decision yet, but that she was putting me on administrative paid leave for the night and wanted to meet with me the next morning. I knew exactly what she was doing and told her I was able to work for the past week she'd been stringing me along, why was this different? She couldn't answer me and said she really just wanted to meet. I called HR and told them what had been going on, but they never responded and the next day they were at the meeting. The nurse manager told me she has nurses on the floor that patients feel neglected by or who feel are abrupt, but not a nurse that patients feel treat them like children, and that she thinks I'm just a pediatric nurse and need to go back to it. At this point I interrupt and say "I'm sorry, you're saying you'd rather have nurses who are neglectful and abrupt than one who takes the time to educate her patients and genuinely cares about them and their safety?" The HR manager did not let the nurse manager speak any more after this and told me that it just isn't the right fit, that this is why they do a long probationary period. I was 118 out of 120 days. The nurse manager asked me if I needed to clean out my locker and if I felt comfortable to walk down the halls by myself after what just happened. I told her that I did nothing wrong, not to worry about me, I could hold my head high through these halls. The HR manager pulled me aside and told me if I needed a reference or help finding a job don't hesitate to ask her, that I was rehireable at this hospital and if I saw anything I liked to apply. I was like what the heck?? I'd never apply there again! Interestingly, I later found out that my floor has been losing a lot of business since the competing surgical center opened, and our census has dropped significantly. There was always a nurse getting cancelled on my shift, and come to find out the float pool nurses were not getting their hours. My position was never reposted! Even more interesting, two days after I was let go there was a company wide email that went out that recognized 64 nurses in the whole corporation (3 hospitals) for excellent customer service for a patient letter or press ganey that reached the executive level. My name was on that list and I was one of the only nurses on my floor to be recognized.

I was really upset to be fired. I'd never been in trouble for anything, and not only that, but I honestly didn't do anything wrong. I never said those things, and I really felt indignant because if I hadn't been there for those two patients they would have fallen and the situation would have been much worse. Part of me wonders if she made the complaints up to get rid of me because she had to eliminate my position...but that doesn't really make sense.

I was devastated to be fired but relieved to be gone. I did not enjoy working with adults at all, but jobs are extremely scarce in my area. Prior to this job I commuted two hours to work in pedi.

I went back to pedi psych full-time per diem for a month before I started interviewing again. I had one crappy interview in pedi I knew I didn't get. Then one morning I had an email from the HR manager at a children's hospital I interviewed at last year inviting me back to interview. I interviewed the next day and didn't tell anyone, didn't get my hopes up. I love this hospital, it's been my dream to work at. I didn't hear back for almost a week and then finally emailed because my current work was wondering about my schedule. I got a call a few hours later with a job offer! I was so excited!! I AM so excited!! It's a pediatric rehabilitation hospital and I'll be working with preemies/feeder/growers, NAS babies, FTT, and helping babies wean off vents. I'll also be working the pediatric rehab side which includes pediatric oncology (my absolute dream job and hopeful future career), brain injury and pulmonary rehab. I start January 11th. I can't believe how everything fell into place. My dad died this summer, and after this job interview, I laid in bed and talked to him for the first time and prayed to get this job. So special. Everything has come full circle and I couldn't be happier. This was a blessing in disguise for sure. I still can't believe that people can hold other peoples' jobs and lives in such little regard to be so manipulative, but my faith has been restored. I can't wait to start this new chapter in my life. I hope I found my niche for a long time to come! If you made it this far, thank you. If you have any tips for this kind of pediatric position I'd love those too!

[KalipsoRed]

What you described is something I hate so much about nursing. I know that all jobs are political games that must be played. I really hate that. My nursing Director has accused me several times of trying to start a union at my hospital baised on the fact that I have tried to make suggestions to improve our floor. I have no idea how one goes from hearing suggestions that could improve floor function to I'm trying to start a union. Not to mention the fact that I've never been a part of a union, no one in my family has been in a union, and I wouldn't have the slightest CLUE of how to start a union. I have to stay at this hospital for six more months so that I don't have to pay back the sign on bouns. I've been working nights for a little over a year and would really like to try to switch back to days, but the fact that she visits the floor during the day is a HUGE reason that I continue to work nights. I'm afraid I'll say something or look at her in a way that my cause incident.

I'm sorry you were singled out and used as a scapegoat. I think it just proves that we are all out for our selves out there. Yes, I do my best to help my fellow coworkers, but I don't doubt the fact that even my closest RN friend would turn her back if it came down to the line. We are in a crappy field that way.

[Acosmo27]

wow! Long :) but very great post! I cant believe you had to go through that.. your (Ex) manager and educator sound horrendous... blessing in disguise for sure, congrats on your new position!!!!

[deToxTech]

place i used to work was real good about slash and burn policies whenever managerial incompetence was the cause of a possible legality.

Didn't matter how good an employee you might have been to the company or how long you'd been there-if they wanted you out, they'd find a way. Usually saying you weren't keeping up with your 15min checks. And it usually took an act of god (i.e. multiple physicians) or selling your soul to the devil (does this really need explaining?) to keep your job there. Then again, as long as you were really lucky and never had any accidents during your shift, you were unnoticed.

And as far as being recognized for excellent service, the only people who ever seemed to be were those closest with the day mngt.

I'm glad I'm not there anymore. I miss the pay to a certain degree, but I don't miss the hypocrisy. I do get to talk to my old coot of charge nurse from time to time (he's an awesome man). And my night supervisor makes a wonderful reference.

[PostOpPrincess, BSN, RN]

You lost me at "I thought long and hard...."

Regardless, I give you kudos for your patience in typing this up.

Good luck!

P.S. I read it...took a while, but yes, yikes..your manager and educator = not so good.

Hope you like your new position......

[NeoNurseTX, RN]

WOW. This kind of stuff scares me so much. I love my job and would hate to be cut for admisitrative BS and I know I'm a good nurse. Sorry you had to go through that and I hope your new jobs works out for the best! Thanks for sharing!

[ONCRN84]

Similar things happened to me in a clinic situation. Only I never had actual patient complaints. Just a supervisor who wanted to rehire one of her friends who left for a manager position she hated. I was told that "conversations were overheard" but no one had any examples. Patient's were mad and a couple cried when they found out I was gone and my coworkers were livid. I had a good rapport with the doctors and other staff, as well as patients. It's pretty well known around there that I was axed to rehire this person... it's total karma though. The supervisor got demoted and her friend took her position.

I now have a MUCH better job that I'm starting to enjoy more and more. There is much less political BS where I'm at now. ENJOY your new position!

[kids]

You sound very disappointed in the experience.

I'll be honest, some of the things you mentioned in this post do come across in such a way that I feel like you could use some more practice communicating with adult patients.

In all the situations you described it's obvious that you and the patient(s) had a different hierarchy of needs. I can see things in the situations you posted that I would have done differently. Maybe it's a matter of more experience in general, maybe it's just more experience with adults.

If Peds is where you want to spend your career it's a non-issue. If you have plans to try adults again at some point in time you might consider a more mentored position that is more supportive of your gaining more experience in communication with adult patients.

As for this:

that there is an argument that patients who are truly A&O wouldn't consciously make bad safety decisions,

Alert and oriented adults make poor safety decisions every day

By the way, I'll never understand why in health care we insist on giving people who have been NPO carbonated beverages, it's a slightly acidic, concentrated sugar that foams...think about what it does to the production of gastric secretions .

[nursel56]

At this point my nurse manager starts to question me about my work ethic. We wear GPS tracking devices and I told her to check that, it would prove I was in there multiple times. She refused saying "They're not meant to be Big Brother." But yet her checking would prove my innocence. I told her there was a witness in there, her daughter, who could confirm I checked in about her pain. She told me she thinks it's something about me that is making these women feel like children, that it's too many incidents too close together. She told me that patients who are A&O have the right to make bad decisions, and have the right to fall, and that if that's what they want to do I need to let them and document accordingly because it's customer service that brings them back.

I got him gingerale and he got nauseous, so we backed off on the fluids and he did better. I met with the educator after to see what she thought and she told me she felt I did fine, but..."Think of it from the patient's perspective...." over and over and over she said this. "He told you he was starving, and what do you do for him?" I told her post-op patients can't eat (she should know this!) and that I informed the patient of the plan. She said "I understand, but do you think the patient cares about that? No, he just wants to eat. Think about it, he hasn't eaten since last night and all he wants is food and you didn't give him anything."

These are common things for a Nurse Manager and Educator to say? Beam me up, Scotty. :uhoh21: :uhoh21: :uhoh21:

Sorry you went through such a horrible experience, SarahBeth. It's very hard to see what motives were behind their actions, but it certainly sounds like there was an agenda there-- also that the union you had paid dues to for 3 months couldn't do squat for you for the want of 2 days from 118 to 120. Best wishes .:)

[roser13, ASN, RN]

What a great post. Yes, it's long but well written and well worth the read.

I am so sorry that you were a victim of this. But you have won in the end! You sound like a great nurse and you have obviously found your fit. Good job for hanging in there.

[Katie5]

Congrats Sarahbeth. When a door closes, God is always working behind the scene to ensure that a window definitely opens. Everything always has a way of coming around in ways we never thought possible. Thanks God, everything worked out s well for you.

Congrats on your new job. What a beautiful way to start a new year:)

[DeeAngel]

Paragraphs please! Most people will not bother to read your post because the solid blocks of text are too difficult to read.