Fired AGAIN!! HELP!!

[kwagner_51]

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

[madwife2002, BSN, RN]

I work dialysis and am usually the only nurse for 32 pts a day, and the only nurse at the facility.

I did nursing home for years, and dialysis is much more demanding as far as critical thinking and acting to anticipate and prevent problems, imo.

Recommending dialysis to someone who is overwhelmed in LTC is not a good idea.

Also,to the OP: The med errors were serious. You would not hold a long acting insulin in that situation, only a short acting. And- holding insulin because "another nurse told me she held it"?

Come on.

This thread is from december, so it would be interesting to see how things turned out for Karen, well I hope

[tatgirl]

You were correct in withholding the insulin, but did you put that on the MAR or just left it blank? Any drug not given needs to be recorded with a circle around it and a reason given, such as BS too low and what it was, HR too low, BP to low. Pt NPO for procedure, etc.

this happened to me last nite! I had a pt who was scheduled to receive a dose of insulin at 630pm. I took her blood sugar and it was 72. since I am a new nurse, I verified with the supervisor that the insulin should be held. I circled it, put my initials, and on the back of the mar put the med, time, date, and reason why I held it. this particular pt becomes unresponsive when her blood sugar drops, and I sure wasnt going to give her insulin knowin what her bs was, and the fact that she sleeps all nite and wouldnt be eating anything. I work in ltc and have a pt load of 27, most of the mars for these folks are pages and pages long. When doing med pass I go through every page to make sure I am giving all of the scheduled meds. If I give a prn, I note it on the back with the date, time, reason for giving, and outcome. I also make sure that d/c meds are highlighted, and pulled from the cart.

Wendy

[NJNursing, ASN, RN]

I agree, I hope that things turned out well with Karen. I couldn't see, however, why a new grad would go into a nursing home with such a high nurse/patient ratio. For someone learning the ropes, it's can be too much. I know that from all of the nurses I talked to while going through school ALL of them pretty much advised we start doing a general med-surg floor. The ratio is generally 1:6. Or even better, do an intern/externship - this way you're not exactly thrust into the job of being a nurse because you have someone to guide you along the way and it's a couple of months long - very good for an orientation into nursing.

[NRSKarenRN, BSN, RN]

Thanks everyone for your input.

Closing this thread as OP has found employment in a LTC facility.