This is very hard to be honest about but I know that I need to in order to move past it and to show that I know that what I did was wrong.
So I'm a relatively new grad (got my RN in Jan 2012). I took my first nursing job at a pediatric dual diagnosis hospital where the patients have both a medical diagnosis and behavioral diagnosis. I worked there for just over a year. In that time I was written up a total of 3 times for cursing, but only 1 of which actually occurred.
The first time, one of my co-workers wrote a letter to the DON stating that I had made a statement at the nurses station about "punching that ******* ***** in the face" and I was brought in and questioned, which I completely denied. The second time is the 1 time it actually did happen, I had a patient call me lazy because I refused to heat up her butter and I stated that I would be damned if anyone is going to call me lazy.
I immediately apologized to the patient and when my supervisor questioned me, due to having been informed by a co-worker, I told her the complete truth. I also used this as a teaching moment for my patients to show them that even adults are not perfect and we all have stuff we have to work on (mine being cursing). The last time never happened.
It started out with a co-worker being upset about the way I treated a patient and the co-worker lied and said I cursed at a another patient. I was working with a patient who had conversion disorder and he would attempt to get the staff to do everything for him. When he was admitted we were given instructions from the doctor and his PT that he was a minimum assist patient. I was trained that if our patients were not up by 8am then they would get cereal on the unit and if they were not up by 9am then the kitchen was closed, the whole time I was there this is how I ran the unit. I had gotten an order from the doctor that this patient be gotten up before 7am, since it took him extra time to get up and out of bed, which ment the night nurse would have to get him up and he would be out of bed when I got there (this never happened).
So that day he was ready to get out of bed when I woke up the other 17 patients. He never said anything about having to go to the bathroom to anyone who went in his room. By the time I went in to get him up, he had gone in the bed. To make a long story short, he didn't get out of bed and to breakfast until after 915. Following the unit rules he wasn't going to get breakfast due not being ready before 9am. The other nurse got rude with me and stated if it were her she would give him the food because he had been awake. She was very upset and I told her that she could give it to him but I felt he should have been up earlier and the rules apply to everyone else.
She went to the DON and complained and told them that I had cursed at another patient saying "stop your ********" which I deny because it didn't happen. I was called in and questioned about the patient's breakfast to which I replied that this was not the first meal he would have missed and I was not the only one who followed the kitchen rules. Also that I had told the Doctor and his Dietitian that he had been missing meals due to not assisting with his activities and such and not one person said anything about not giving him his food.
The DON said we could not do that and we could not deny patients food, I stated then someone, anyone should have said something and that this needs to be told to everyone. They then questioned about the cursing and said that since I have a history that they were letting me go.
I feel like I was targeted. I've tried to find another job but have had no luck and it seems that this issue is why. I have asked interviewers if their are any red flags during my interview and have been told the cursing. I have no idea what to do and how to show people that this was an isolated incident. I mean I worked in customer service for years and never had any issues like this. Any help would be great.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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Dishes...the pat. wasn't denied food, the rules were in place that the patient missed the opp. to eat, by his/her own actions.
The patient missed the opportunity for breakfast due to an episode of incontinence in bed. Was it the patient with conversion reaction disorder choice to be incontinent?
The rules were not in place, as the DON advised the OP that they cannot deny patients food.
As part of our base nursing education we are taught the nursing practice act and nurses code of ethics and we are expected to use them to guide our practice. Even if there was a rule in place, the act and the code supecede a facility rule, if a facility's rule contradicts the act or code than the nurse needs to question it, not follow it. A new nurse doesn't always have enough understanding of ethics to analyze these type of situations and will be at greater risk to be disciplined or terminated. I don't think termination is the solution in this case, I think remediation and further education on the code of ethics would have been a better solution.
Since I haven't worked adolescent psych. I will defer to the two posters that have already explained that this is common on such a unit.
The patient missed the opportunity for breakfast due to an episode of incontinence in bed. Was it the patient with conversion reaction disorder choice to be incontinent?
The rules were not in place, as the DON advised the OP that they cannot deny patients food.
As part of our base nursing education we are taught the nursing practice act and nurses code of ethics and we are expected to use them to guide our practice. Even if there was a rule in place, the act and the code supecede a facility rule, if a facility's rule contradicts the act or code than the nurse needs to question it, not follow it. A new nurse doesn't always have enough understanding of ethics to analyze these type of situations and will be at greater risk to be disciplined or terminated. I don't think termination is the solution in this case, I think remediation and further education on the code of ethics would have been a better solution.
I saw the posters who explained it was common practice, all I can say is the reasons "that's the way I was taught" and "its common practice on the unit" don't go over very well with nursing regulatory bodies like BONs.
I'm not sure about your facility policy, but even if it was policy to not provide a hot breakfast because they were late getting out of the room, I would consider being incontinent in bed to be an extenuating circumstance and use my nursing judgement--allow him to eat.
I've accidentally sworn in front of my *adult* patient once (and apologized immediately), but if swearing has been brought up as an issue for yourself by management, I would take a good look at your speaking habits and work on adjusting them.
Thank you for your response. I feel that I need to clarify the reason that incontinence with this pt was an issue because with other patients at that facility is was not. I'm not sure if any of you have ever worked with a conversion pt? These pts typically have some kind of emotional issue caused by outside factors that leads them to believe they can't do certain activities (walking, seeing, taking care of themselves) when in reality they can. If it goes on for too long they can lose some of they ability due to lose of muscles in the leg for example. I've a had 4 of these pts in my time the facility, all of who were w/c bound. When this patient came in I argued that he needed to go to the acute unit to get accustomed to how things worked there but I was told no because he was conversion that he needed to be pushed to do things and we were to give him minimum assist (10%) with all activities. He had incentives to do things we asked, he loved Gameboy and we had one he could use if he moved himself and did as much on his own as possible. That particular morning he was awake in bed at 7 but between 7-8 he never once told any staff he needed to use the restroom. The issue was that if he needed a new game for the Gameboy he would ask peers to tell staff but he would not do so when he need the restroom. I went in at 8 to get him out of bed and realized what had happened. Going by the 10% assist we were to give him I reminded him that he needed to be up out of bed by 9 several times so we could get his breakfast. He refused to assist me at all. I kept letting him know how close we were to 9 and he still did as little as he could so when we finally got him out of bed it was almost 930.
I didn't refuse his meal due to being angry for any reason. Why would I be angry? I've cleaned butts, bodies and ostomies. It's nothing new. If it had been my child I would have followed the rules just as I had done with all the kids. I think the facility needed to check in on the units more often, then they would have realized what was going on and could have changed it. But even in the rules book the facility gave the units to give the kids it said kitchen closes at 9, didn't say we will give snack if you miss a meal. If anyone involved had said anything about him not eating I would have been more than willing to give him whatever food was allowed. The Dr stated we just had to wait him out when I told him that the pt was missing breakfast.
I can't take it away and go back, all I can do is take it as a lesson learned and move on. I will always check with the facilities on policies and rules on issues such as these with these type of patients. I also will try to find a substitute to cursing if only we could chew gum on the floor lol.
I worked in adolescent psych as a PCT before and during nursing school. We had scheduled mealtimes. We would wake the patients and let them know that breakfast would be arriving and they were to start getting ready. Breakfast was delivered to the dining hall. If they didn't come, we went to their rooms and told them breakfast was here. They could not go without being dressed appropriately in daytime clothes. Breakfast was run for a specific amount of time and then all trays were cleared and removed from the unit. If patients didn't come for breakfast, they didn't get breakfast. We did have a snack time between breakfast and lunch. It was a very strict policy. Without a specific doctor's order, we could not get any extra trays or snacks from the cafeteria other than what was scheduled. As a PCT, I would inform the nurse about patients who were missing meals and he or she would write a note and call the doctor as indicated.
Given that the patient had been incontinent and need to be cleaned up, causing the missed meal, I would have called the doctor to get an order and would have written a note if the request was denied, if I were the nurse.
This is exactly the case with this facility. However, we did not have a snack between breakfast and lunch. I went against the rules and let the co-worker give him his breakfast so there was no need to call the dr for an order because he had eaten. And as I previously stated the Dr and dietitian always were aware when pts missed meals.
In the beginning you started by attempting to claim responsibility for your actions, but with every comment you responded to you were defensive and made excuses for your actions. If this is how you acted in the work place, it may be the reason you say you were singled out for things like cursing. As a nurse, it is our job to be advocate for good practice and critical thinking should lead you toward with holding food being inappropriate.
I own my mistakes. I learn and try to make it 100% better. Trust me this will never ever be an issue for me again. When I wrote this I was just wanting advice on how I could show interviewers that I have learned from my mistakes and want to prove it. I think that the comments got me defensive and I felt I needed to show where my mind was at the time. That may have come off as an excuse. For that Im sorry. Putting myself out there for all this open criticism is extremely hard and something I've never done before.
I own my mistakes. I learn and try to make it 100% better. Trust me this will never ever be an issue for me again. When I wrote this I was just wanting advice on how I could show interviewers that I have learned from my mistakes and want to prove it. I think that the comments got me defensive and I felt I needed to show where my mind was at the time. That may have come off as an excuse. For that Im sorry. Putting myself out there for all this open criticism is extremely hard and something I've never done before.
What steps have you taken to ensure it will never happen again?
Specializes in Med/Surg, International Health, Psych.
I applaud you for having the courage to bring this situation before a community of your Internet nursing peers. I can only imagine that the reception of responses have not been easy to digest. However, the ultimate bigger picture is your willingness to seek the advice and input of others. From this point forward, the most important issue is whether you have learned from this experience? Admit your mistakes without the need of defensiveness and prepare to move on. It will be helpful to note, like the previous poster has asked: "What steps have you taken to ensure it will never happen again?" For example, what are your internal controls in place to check your attitude and language. If your first nature in challenging patient encounters is to respond to someone disingenuously, perhaps you need to develop some professional pleasant and compassionate scripts that you can employ. Fake it until you can make it.
Also, seriously consider that perhaps working with children and/or any patient population with behavioral issues may not be your forte. Nursing is vast; you can push paper and limit yourself from real patient encounters altogether. The field of nursing accommodates all sort of personalities, but find a niche where you are not likely to do any further harm. Good luck to you!
You sound like another Anthony Weiner. Sometimes "I'm sorry" isn't enough and you need to drop out of the race, or at least seriously reassess your life and get help before jumping back in.
I wish you the best of luck in finding a new job . I believe there should have been a chance for remediation. Everyone makes mistakes, just think before you comment next time...
I saw the posters who explained it was common practice, all I can say is the reasons "that's the way I was taught" and "its common practice on the unit" don't go over very well with nursing regulatory bodies like BONs.
I agree that "common practice" and "legal" unfortunately aren't always the same thing.
My state's DOH/BON had an initiative a couple years back to try and undo pervasive practices that also happen to be illegal. Their main two targets were (1) the belief that fluid restrictions are enforceable even if a patient is competent to refuse and is refusing, and (2) that withholding fluids or nutrition can be used as punishment in mental health care.
We had a Nurse who lost her license due to enforcing a fluid restriction so we had to come up with a lengthy remediation plan. There was no finding against us for using nutrition/fluids as a punishment in our inpatient mental health, but as part of the initiative we still had to submit our plan for making sure it didn't happen in the future. The mental health's medical director made an argument that was memorable: The inpatient mental health population typically suffers from some degree of emotional lability as well as difficulty maintaining focus, which is an ever present challenge to staff in working towards care goals. If you take anyone of good mental health and deny them breakfast, they're going to experience decreased focus and emotional lability as a result, so obviously doing this to people for whom this is already a challenge is counterproductive (as I remember it the medical director didn't use the term counterproductive, I seem to remember "idiotic" was the term he used).
Esme12, ASN, BSN, RN
20,908 Posts
MODERATOR NOTE:
While this is a thread about profanity......profanity is strictly prohibited by the TOS
This thread is about the OP's termination for the use of profanity and NOT the profanity used by patients.
Please stick to topic