Fired from first hospital job

[nurseblondie26]

Young nurse recently fired from big name hospital for med errors. extra unit of insulin for a patient, gabapentin dose was changed for a patient but higher dose still active in computer and Pyxis but scanned, 25mg instead of 12.5mg of phenergan. All errors self reported. Doctor reassured me that these were learning experiences and that I was doing a good job otherwise.

I want to say my floor was super catty and cliquey. Mixture of very kind nurses and mixture of women who won't even acknowledge me (and several charge nurses not willing to help a newbie out). I expressed my concerns to my managers about a couple of charge nurses. Then suddenly was fired for phenergan error.

I understand med administration is serious business but these were all minor and I emailed my manager about all of them. People make tons of mistakes on my floor daily but are too dishonest to report them.

I have my most recent preceptor telling my manager I've improved and she's proud of me but it makes no difference. I feel like it has been a witch hunt from day 1 because I don't engage in friendships with these petty women. my reputation is tarnished now and I am deemed incompetent by those nurses I reported to my manager.

I am knowledgeable and I am safe. I've just had a few hiccups. I had a year LPN experience passing meds before this with no issue.

now I am ineligible for rehire in this hospital system that dominates the state and I feel hopeless. How can a new nurse learn from her mistakes and get back on her feet into a hospital again ?

[MrNurse(x2), ADN]

You functioned as an LPN, med administration is not new to you. The unwritten part may be that your preceptor pointed out these errors which made you a.) aware of your error and b.) made you report. Only you know the answer to that. I would take this time to reflect on your attitude. Many LPN's have chips on their shoulders that RN's make more and in LTC, have the same "jobs" and therefore, when they do become RNs feel they don't need to learn anything. Again, only you know these answers, but now is the time to assess your heart and grow. This could be a defining moment in your career.

[Ruby Vee, BSN]

I had a flashback to my very first chaotic job where we had to check three places in the paper chart for new orders and we were responsible for getting those into the system...

You can check the hospital's policy regarding the number of medication errors and corrective action taken. You can also review any contract you signed - I think 5 months puts you out of probation and into regular status. If you were still on probation they can do anything they want. If you were in a regular contract in a right to work state...they can still do whatever they want.

I am still unclear about how you found out you were a no-rehire. Unless you're on probation, they have to follow certain rules and document that they've attempted to help you with your practice but that you are still not succeeding. If you're really concerned, have a discussion with HR or consider an employment attorney.

A previous poster suggested taking a medication refresher course and that is a good idea. Moving forward, you can say you identified an issue in your practice and fixed it. If you make a mistake in public, it's always best to report that mistake yourself.

Good luck.

I've worked just as many places where probation is six months as I have where it was three months. And the first med error or two may have extended the probation.

[Wuzzie]

I am still unclear about how you found out you were a no-rehire. Unless you're on probation, they have to follow certain rules and document that they've attempted to help you with your practice but that you are still not succeeding. If you're really concerned, have a discussion with HR or consider an employment attorney.

Unless the OP was in a union with such stipulations her employer doesn't have to do anything to prove anything. "At will" employment means just that. I think calling an attorney for this is an overreach. She made three med errors in 5 months. That's all they need.

[JBMmom, MSN, NP]

You're early in your career and you can learn from this and be successful. But there are a few key points that are based only on you that will determine your success. There are plenty of people that don't find close relationships at work a necessary part of their job, I'm one of them, but you have to take care to not sabotage other people and the overall morale of a unit. I see plenty of people that choose to spend time at work on their cellphones. Mine stays in my locker the whole time I'm working, but it's not really my business to the police that actions of my coworkers. Whether my charge nurse chooses to sit around and do nothing or not, it doesn't really affect my ability to do my job. If I need help, it's my responsibility to ask for that help, and it's unlikely that any of my nurse colleagues would refuse a direct request for help. Have you really founded coworkers unwilling to help you? And what is it that you think would have been avoided if they were there to help you?

The three medication errors you mention may have indeed been minor, but look at them in a bigger sense. You say you entered the blood sugar incorrectly and that resulted in an extra unit of insulin. What if you had transposed the number and ended up with a dose 10 units higher? Are you certain that would have triggered you to stop and look closer before administering the insulin? Then the pyxis had the wrong dose still active, how long does it take for your pyxis machine to catch up with current orders? Are you trying to administer before the pharmacy has verified the order? It's fortunate that no harm came about because of these errors, but certainly adopting a defensive tone about how you were wronged is probably keeping you from accepting and learning from them.

You mention other people make errors "all the time", how do you know this? Again, how do the actions of other nurses really impact your ability to be a competent nurse? You need to concentrate on your own best practice, and not be as concerned with feeling superior to nurses that have already proven their ability to work in the field.

Good luck, you can find success in nursing, but I recommend moving forward with a slightly more humble attitude.

[chacha82, ADN, BSN]

Even if the wrong dose is in med dispense, aren't the orders updated in your MAR? I'm not sure what program you use but when you scan or check the orders wouldn't it alert you that the med dispense dose was wrong?

[HermioneG, BSN, RN]

I made a medication error recently. What made it so terrifying was the deficienes in my awareness and the critical thinking failures I made leading up to the mistake. To me, there's never a minor med error and I think that's important to recognize. The problem was the med error, yes, but even more so the error was in the thought process and actions leading up to the med error. Thats why there's no such thing as a minor med error. While both you and I got lucky and the type/dose of the medication involved in the error didn't hurt the patient, the error is enormous nonetheless.. and everything leading up to it needs to be evaluated as such. Same with near misses. That's what I learned, at least.

Otherwise if you just look at it as a minor med error and not look at the mistakes leading up to it you're high risk for repeating the same error over again and you may not be so lucky next time.

I also do think that in the future it's important to show that you understand the seriousness of your mistake. I would avoid using words like "minor" and instead say that thankfully no harm came to the patient. I think that for a lot of people, if someone makes a medication error and seems to be trying to downplay it whether self reported or not some trust is lost. Someone might question if you understand the seriousness of it and if you're going to actively make a plan to try and prevent it in the future or if you'll keep doing what you're doing and hope it doesn't happen again. You have to show that you take it seriously and understand where it went wrong.

Good luck with everything. Meds are hard and like you said, it's serious business. Its going to take me a long time to get my confidence back from my mistake awhile ago. But you've just got to learn from them.

I hope that the next place that you work is a better environment for you and that learn, grow and find success in your nursing career!

[gemmi999]

My first nursing job, I made an error that could have really harmed a patient! My hospital didn't do BCMA so when I got a new CP patient in my bed that had computer orders for ASA and Clonidine, I administered both medications. When I went back to chart them, they had been signed off by triage nurse (who late charted the medications so it didn't show as administered for me) Two ASA 81s, MD said okay, not a big deal. Two 0.1 clonidine for a BP that was 170s/90s was a bigger deal. I self reported to the MD, to the charge and management.

Three years later I just applied for (and got) a new job. During the interview I used this example about how I have made mistakes, self reported, and have learned as an RN. Later one of the people on the panel said that this example was the main reason they were hiring me--because I accepted responsibility, reported, and learned from my actions. Mistakes happen, and it isn't *okay* but its something that is known.

3 mistakes in a short time period though, and the charge nurse comment, are probably a bit much. Just remember that this is temporary, you'll get another job. Maybe not a hospital, but another job,and in a year or two you can use these examples in interviews to show how much you have grown!

[Shellaaay10x]

I remember in nursing school to always check the Md order and the mar before patient administration just in case orders change.

It has been a while since I did med admin like this, since I am a school nurse and med pass is quite different. Lol