Fired AGAIN!! HELP!!

Tweety, BSN, RN · Dec 6, 2005

Good luck. Those "nothing serious" med errors were enough to get you fired and could lead to serious consequences or future errors if not nipped in the bud now.

Maybe they're right that medicating that many patients is a bit much for you. I can certainly understand how it would be.

Good luck to you.

diva_nurse · Dec 6, 2005

Have you considered working at a clinic such as dialysis or ob office..maybe you need a steady pace with not a whole lot of patients at one time

don't give up!!

pedinurse05 · Dec 7, 2005

Well, I just got terminated again!! According to the DON, I made too many med errors and charting mistakes. Nothing serious, just putting a pain patch on the wrong day, holding insulin [because another nurse told me she did, on this one pt]Charting midnight and earlier instead of the actual time. Basically, she said I have a good heart for nursing but that she felt I was overwhelmed by having 28 pts.
My first NM told me to go to a NH, now this one is telling me to go to a hospital or do home health care.
I need some serious advice here. I'm 44 y/o newly licensed [Oct. 4, 2005] Worked at the NH from the 18th of Oct to today. I don't know how to read the dr's orders and compare them to the MAR. I have problems seeing the actual times on the mAR. I am slow. I liked to talk to my pts instead of just going in and setting their meds down and leaving. I found out today that 2 of my pts were sick. [i did this on my own]. The female sounded like she has asperation pnuenomia and the male had a temp of 100.8.
In all fairness to the NH, I could have worked until the 16th of this month, but not as a nurse. I had lists of the pt meds. I had accu check lists. I even had my own charting page with the name, reason for the charting, and all vitals.
I feel like a failure and know that I have let my kids and husband down! I don't know what to do or where to go. How many RN's have been fired TWICE in less than 6 months?
Please give me some advice on what to do and where to go from here!!
Thanks!!
______________________________
In His Grace,
Karen

Karen,

I am sorry to hear about your jobs. I think maybe you should attend a refresher course that will allow you to do some more supervised clinical time. You could address the issues of comparing MARs with orders and documentation. As a rule of thumb, you should chart to time--don't chart a med if it wasn't given at that time. Although these errors seem minor to you, they could blow up into a big mess. Maybe you should consider an environment with fewer patients--like homecare. I did homecare for several years and loved the luxury of caring for 1 patient.

Good luck!

mandana · Dec 7, 2005

Very sorry for you. Sounds to me like your strengths are really in the patient contact arena and spending time. I agree with the other poster that suggested an office nursing position. My GYN has the most amazing office nurse - she's very smart and I love going there for my annual because she spends so much time seeing how I'm doing. Something like that might be ideal for you - and the world is wide open in terms of specialties.

Good luck,

Amanda

IrishItalianRN · Dec 7, 2005

What happened with your first job?

LoriAlabamaRN · Dec 7, 2005

I'm so, so sorry. I know that your confidence has taken a huge blow. Not to mention your self-esteem.

Remember that song "My Place in this World"? It sometimes takes time to find your "niche." Where were you most comfortable in school? What was your favorite clinical? Your favorite subject?

Have you considered psych nursing? School nurse? Doctor's office?

The wonderful thing about being a nurse is the diversity of the positions you can choose from. You are not the first to go through this pain. You won't be the last. Try to relax for the next couple of days. Eat ice cream, watch chick flicks. Let yourself have a pity party if that is what you need to feel better (works for me). Sunday, buy a paper and go through it. See what types of nurse positions are available. Be honest in interviews. Let them know that you are looking for something slower paced than 40+ patients. That you are very thorough and because of that your last jobs were poor fits. As a new nurse, that is perfectly acceptable.

Don't beat yourself up and don't give up on your dream. You are going to find your place in this world, and when you do, you are going to be fantastic.

Daytonite, BSN, RN · Dec 7, 2005

You already know one of your good points. . .which is talking with patients, so something where you are either teaching or advising would probably be a good fit for you. I think an eye exam and getting glasses, or a change in the prescription for your glasses if you already have them, should be something for you to consider as well. You didn't mention anything more specific about why you couldn't read the times on the MARs, but I would be very worried if I was consistently having trouble seeing what is written on MARs.

But, honestly, I think you've made some real serious errors of judgment even though you don't think they are serious. I am saying that they were serious. Think about their affect on the patients. I think an important concern to cogitate on is how do I correct myself from making these errors again. This self-analysis is how a nurse improves her practice. In changing jobs, especially if going to another clinical area, these same issues are most likely going to come up again because they are very basic nursing tasks. Something that hit me right away when reading this post is that in a couple of cases you followed what others did rather than check doctor's orders and rationalize out for yourself what to do. Do you now know how you should have handled those two situations?

NaomieRN · Dec 7, 2005

Well, I just got terminated again!! According to the DON, I made too many med errors and charting mistakes. Nothing serious, just putting a pain patch on the wrong day, holding insulin [because another nurse told me she did, on this one pt]Charting midnight and earlier instead of the actual time. Basically, she said I have a good heart for nursing but that she felt I was overwhelmed by having 28 pts.
My first NM told me to go to a NH, now this one is telling me to go to a hospital or do home health care.
I need some serious advice here. I'm 44 y/o newly licensed [Oct. 4, 2005] Worked at the NH from the 18th of Oct to today. I don't know how to read the dr's orders and compare them to the MAR. I have problems seeing the actual times on the mAR. I am slow. I liked to talk to my pts instead of just going in and setting their meds down and leaving. I found out today that 2 of my pts were sick. [i did this on my own]. The female sounded like she has asperation pnuenomia and the male had a temp of 100.8.
In all fairness to the NH, I could have worked until the 16th of this month, but not as a nurse. I had lists of the pt meds. I had accu check lists. I even had my own charting page with the name, reason for the charting, and all vitals.
I feel like a failure and know that I have let my kids and husband down! I don't know what to do or where to go. How many RN's have been fired TWICE in less than 6 months?
Please give me some advice on what to do and where to go from here!!
Thanks!!
______________________________
In His Grace,
Karen

Hello, Karen

I know been fired is a horrible thing for anyone, specially when you feel you have let others down. In order to prevent future failures, one has to look at their mistakes and make corrections. We all make mistakes, no one is perfect, but when we make them over and over we must acknowledge the errors, so we wont make the same mistakes in the future. You should thank God, that no one died has a result of your mistakes. The supervisor had a right to fire you because of liability. It was easier to let you go, than to face a lawsuit of million of dollars. Rightnow, you have to think about the future. If I were you, I would consider other areas of nursing or take a refreshment course asking your previous instructor to help you. Also, maybe that particular floor in the hospital was too much for you. You are not a failure, you just need more training in the area you are weak. We all have weaknesses. Just try to improve yourself, for the sake of the patients. Put yourself in the patients shoes, would you want a nurse who is constantly making mistakes, taking care of you?

Once you can do that, you are on your way of improving.

Also, next job, pray before you start working, so God can guide you throughout your shift.

Marie_LPN, RN, LPN, RN · Dec 7, 2005

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CoffeeRTC, BSN, RN · Dec 7, 2005

I posted on the other thread too. Why can't you read the right times or the mars?

As far as the patch, I think you explained it better on the other thread. It was late or missed so you put one on when you noted that? What I would have done was call the doc, do a med error/ incidient form, put a new one one the pt and assess the pain. (BTW, we have on our mars that each shift checks that it is on)

The insulin miss, if the BS was low you should have treated it per policy, call the doc then I would have retested later.

When ever a med is held or not given until later you should always circle your inital and make a note of why it was held, what you did for treatment and what the outcome was.

Charting.....chart the actual time that you put the pen to the paper. If you are charting late, say 12 am for 3-11, I put down, DATE, 12am note for 3-11 shift on DATE. Never falisfy times or dates. EVER.

All that being said....how about a refresher class? I think something like that would provide more reinforcement of what you learned. Some hospitals offer a better orientation that LTC homes. Another thing is order youself some journals. Nursing 2005 is good. Review you fundamentals of nursing books, carry a nursing pdr with you and above all, if you are unsure or don't know something, Ask or look it up?

BTW..do you live in PA? I'd love to have a student:wink2:

kwagner_51 · Dec 7, 2005

This is not a matter of ripping but this part of the original post bothered me:
Like most medication, insulin is a serious business. Too much, too little, or none at all can kill someone.
The facility saw this as something serious, and i really can't say i blame them for seeing it that way. A thorough orientation is needed, but if a medication is viewed as "nothing serious" beforehand, you can't necessarily fault the facilty for this line of thinking.
I can't tell if this means early charting, or not?

When I took her BS it was 65, so I took it again. The second time it was 58! She was on thickened liquids. I gave her 30 cc's applesauce and 4 oz of Ice cream. If I had given her her insulin she would have bottomed out. I was afraid that I would send her into severe hypoglycemia. Her BS runs right around 250. I was trying to use critical thinking. I KNOW insulin is serious medication. I meant that I hadn't forgotten to give heart, B/P meds etc. Yes insulin is serious. Would you have held her insulin until after she ate? Or would you have given it KNOWING she would bottom out?

To me a person is not going to die if they don't get their pain patch, but they sure as h*** can die if their BS drops too low. This is a Nursing Home. There is no telemetry, no IV pumps, and 28 pts to one nurse. I was on my own for about 10 days. Why didn't they tell about these problems sooner? I admitted to every mistake I made. I didn't think that holding her insulin was wrong. I just wanted to make sure the on coming nurse was aware of what happened and what I did to prevent what very well could have been a diabetic crisis. By the way she had no signs or symptoms of diabetic distress.

Yes, I know that uncontrolled pain is bad. I tried to the best of my ability to give pain meds as ordered. I TRIED to do the right things by my patients. I can't stand to see anyone in pain and I felt really bad when I realized that I deprived this man of much needed pain relief! :crying2:

None of things I did were done maliously, I just didn't know that they write scheduled meds on the last page of the MAR, past the PRN page! I have to search the MAR for the sliding scale. It can be anywhere from the first page clear to the back! Some of these patients had 5 pages of meds. I'm not trying to make excuses, I WAS WRONG! I am just trying to explain so that maybe y'all can help me come up with abetter plan on how to figure out where the scheduled meds are versus the PRN's.

Thanks!

______________________________________________

In His Grace,

Karen