Cursed at a patient-fired

[sle9403RN]

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.

[dishes, BSN, RN]

sle9403 I have seen patients with conversion reaction disorder improve but before they could improve they had to establish trust in their health care providers first. I would not have stuck with the 10% assist guideline in the case of incontinence as it could jepordize their trust in me and impact their recovery.

[MrChicagoRN, RN]

The cursing and anger is one issue, the dining rules are another.

The OP came across as flippant & uncaring when she said it wasnt the first time he missed a meal. Are the dining rules designed to be therapeutic, or punitive? Sounds like there is some splitting between staff, some said feed him, others said not. I'm concerned that the OP stated she was "trained" to follow these rules. Sounds like they need to develop a consistent, humane plan to deal with someone who misses a meal, and under what conditions. Not feeding a kid isnt going to fly. Offering a simple nutritious cold BF to latecomers could address all concerns.

[LaRN]

seems to me that your management tried their best NOT to fire you, but ultimately they were left with no choice.

[TerpGal02, ASN]

I think some of you are missing the point about the whole "with holding food" thing. On medical units, you have dietary who comes and removes meal trays at a certain time right? What happens to the pts who have chosen not to eat? You can't force them to take I'm food PO right? In our facilities which includes adults too, they always have the opportunity to eat, food will always be provided, but they have to choose to eat it.

We are in the business of teaching patients how to function in the world. When you were a teen and decided not to wake up when you were supposed to and now were going to be late for school, guess what? You're missing breakfast. If you are running late for day shift because you slept through the alarm? Guess what? You're missing breakfast. You might be able to find a little something to tide you over until lunch, this is when snack comes in. We wake our pts at 6:30. Is it wrong to do that even if theyy just fell asleep at 2am? In our world, no. If you need to go to school or work, you wake up no matter how tired you are. Exceptions are made for pts admitted on night shift. Even of they CAN'T sleep. They know that if they need help sleeping, they just have to tell us. We have all sorts of tricks up our sleeve to help them.

In psych, it IS doing harm if you don't teach them these things. They won't function in the world if they don't. We give them a safe arena in which to practice these skills.

[BlueDevil,DNP, DNP, RN]

If I were interviewing you I'd expect to hear you be more accountable for the incident(s) and not to hear any of the blame shifting I am reading. You may not feel that you are doing that, but it reads to me as if you are, and if I'm interviewing you my opinion is the one that counts. YKWIM?

In my opinion, neither psych nor peds are good placements for you. I'd expect you to be cognizant of that and mention it in the interview. You may get back to it some day, but for now it seems that you aren't in the right place mentally/emotionally.

Also, I'd expect you to say you have taken anger management courses and are in cognitive behavioral therapy yourself.

The adult that recognizes bad behavior, owns it, goes out of their way to compensate for inadequacies while working on areas for self-improvement is someone worth hiring. That is who you have to appear to be if you want someone to take a chance on you.

[Anna Flaxis, BSN, RN]

I am not going to be one to dogpile on the OP and call her/him out as some kind of monster.

The one episode of swearing was mild, and the OP recognized IN THE MOMENT that it was not okay and owned up to it.

It is not unreasonable in a behavioral health setting that having a predictable routine and structure is part of the care plan. Having scheduled meal times is meant to be therapeutic. The OP simply enforced the rules of the facility. The physician was informed that the patient had missed breakfast. This does not the OP a monster make!

Jeeze.

[dishes, BSN, RN]

The OP enforced what she thought were the rules, but the DON clarified that they we not the rules and that they cannot deny patients food. For those who routinely follow the practice of denying patients food do you you have a written policy? Is it signed by your DON? Does the policy contains evidence based research references? Are you aware of your BONs stance on this practice?

[Anna Flaxis, BSN, RN]

I think there is a distinction between having scheduled meal times in an effort to provide a consistent structure and actively withholding food as a form of punishment (I also think that if a patient misses a meal time for any reason, a snack should be offered). I believe the OP that this is how their facility functioned, and that for whatever reason, the DON threw them under the bus.

[TerpGal02, ASN]

The OP enforced what she thought were the rules, but the DON clarified that they we not the rules and that they cannot deny patients food. For those who routinely follow the practice of denying patients food do you you have a written policy? Is it signed by your DON? Does the policy contains evidence based research references? Are you aware of your BONs stance on this practice?

OK, I am going to be as gentle as possible here but you just do not get it. Please see my post a few posts up. We NEVER deny the patients food. Three meals a day plus snack and dessert are offered to pts. They have to make the CHOICE to eat, and part of making the choice to eat is being ready to go downstairs for meal time (enuretic episodes another story)

If they don't get down to DH in time they get a tray and likely get a tray for lunch too. If they uavent eaten in time for group, they have lost the opportunity. I don't understand what is so hard to grasp here.

We are teaching them to make good choices and how their choices have consequences. I think behavioral health pts have MORE choice than a medical inpatient.

[dirtyhippiegirl, BSN, RN]

The OP enforced what she thought were the rules, but the DON clarified that they we not the rules and that they cannot deny patients food. For those who routinely follow the practice of denying patients food do you you have a written policy? Is it signed by your DON? Does the policy contains evidence based research references? Are you aware of your BONs stance on this practice?

Just curious, but do you actually have any real life references? Have you actually worked adolescent psych?