Fired from my first nursing job, before one year

[mightynurse1]

I am a lost for words, I never thought this could actually happen to me. This was my first job, on the telemetry floor of a major hospital, with an outstanding reputation, one that consistently ranks among the best. During preceptorship, I was learning so much, I got to the point where I really felt confident.

I was quickly handling a full patient load and developing my efficiency. I was building my intuition, patient outcome prediction skills, and patient and family rapport skills. I was 6 months into the job (5 or so on the floor by myself after preceptorship) and I was already floated to the ICU step down unit, and given an excellent 6 month review for my performance. And through it all, I never had a patient code on me, this was by design, not default. My intuition allowed me to closely monitor patients that "didnt look right", and intervened before it got worse.

However, I could not help but notice how an average of 1-2 nurses would leave to get work in another hospital! I would always ask myself: why? this is supposed to be one of the best hospitals?

Anyways, leading up to my 6 mo review, I would find myself at work every single shift 15 mins ahead of time 6:45- 6:50am (which has always been the case) and leaving right on time because of how well I managed my patient load. I even put together a powerpoint presentation to educate the nurses on the floor about a pain management team I was planning to head, as was asked of me by my asst. director. I was not feeling very challenged anymore though. Im sorry if my being frank can be interpreted as arrogance but it is just the truth. I wasn't feeling challenged. I was getting bored.

So I enrolled in an EMT course to challenge the paramedic exam and have those extra credentials. Working 12 days a month, and not going home with baggage or "worries" put me in a position to feel the need to reach out for professional development opportunities to increase my chances of getting into the ER.

WOW WHAT A MISTAKE! After I told my other asst. director about enrolling, and asking for certain days on my schedule to accomodate the classes, EVERYTHING CHANGED!!!

My director then got fired, and i'm assuming it was because of the very low patient satisfaction scores (HCAPP), and high nurse turnover rates.

Just a couple of weeks later, I was written up for using a pair of sciossors to cut a pill instead of using a pill cutter. WRITTEN UP! a written counseling for this? Really? Oral medication administration is not an aseptic technique, so it stands to reason that if your in a pinch (which I was at the time) a sciossor could do the trick. Isn't that what nursing is all about anyways? A constant, moment to moment evaluation of your priorities based on the acuity of your patients needs? BELIEVE ME, there where more important things going on at that time.

I let it slide, I simply refused to let it bring me down. I figured "hey, maybe they are big on that stuff".

However, it didn't stop there. A couple of weeks after that, I get called into my managers office to be placed on a "performance improvement plan" I could not believe it!! They were taking (I put 2 and 2 together based on the conversation) this one nurse's advice about my performance. This nasty, miserable, with a history of getting other nurses in trouble, nurse's account of my performance, and it was enough to place me on a performance improvement plan. Unbelievable!!! I felt sooooo betrayed!!!

I couldn't help but approach her and ask her why she would do such a thing without having spoken to me about any heart felt concerns (if they were so sincere) in order to work with me to correct any legitimate problems with my performance? About a minute into the conversation she not only admitted to having "reported me to administration", but also cut off the conversation and insisted on resuming discussion in our managers office.

Needless to say the conversation got pretty nasty in there, she accused me of retaliating against her, and I ended up getting suspended.

I returned approximately 2 weeks later and was given a heavy patient load. It was complete with a patient that had been discharged 3 times (during the same hospitalization) before the head M.D. of internal medicine asked me to call security to have her escorted out of the room, three discharges, two admissions, and a training on insulin pumps. They even tried to give me a direct admit (which is much more involved than a regular one or a transfer). Talk about a nice homecoming huh?

The next day I report to work and halfway through the day Im called into my managers office, again. They said I left an IV port on one of the patients I discharged the day before. They said the patient returned to have it removed. As such, my employment ended that day.

How sad, I gave this place my every last ounce of heart, soul, and passion. I promise you that I have never dedicated sooo much to something in my life, and now it is over, done. There are no words that can describe how frikin painful this feels.

I just want to know where I go from here? What should I do now? Will I ever get hired by another good hospital, let alone a major one? Does this mean that Im basically black balled from nursing? being that I was fired during my first year? (because that one year mark seems to be such an important milestone) Is there some unwritten code that states that if a nurse doesnt get past the first year they are basically not one of the "good nurses" or am just being upset and paranoid.

PLEASE HELP ME!! I need answers from you guys! I need answers from experienced nurses out there.

At one point I was at the top of my game, things looked great at work, I even saved the hospital Millions of dollars in what would have ended up in a medication related sentinal event. A drip that was labeled with the five rights of med adm., but attached to a Lasix vial! I caught that error, saved the hospital from certain doom!!!!

Please help me I dont know what else to do!

[NutmeggeRN, BSN]

Nursejuvie,

If I could get a do over, I wouldnt change a damn thing! What to know why? Because nobody knows for sure, nor will they ever, but, I might have saved that patient from having a really serious F'in problem..Im not there to sing coombaya with fellow nurses, or play nursing politics. I know now that humility goes a long way, but I found at this place that a "hater" has more influence than even your greatest contributions. Its sad as hell, but I WILL rise from this, just like you did. Thanks again sweetie.

Wow.....me thinks you need to take a deep breath and re evaluate a lot of things......

[klone, MSN, RN]

seems as though nurses are getting fired at a higher rate than fast food employees these days.

Or maybe it's confirmation bias. Or because "these days" we have a forum with a bajillion nurses who can share their experiences, where 10 years ago we didn't. Personally, I don't think it's happening any more frequently, just as it's been proven that violence in the public, violence against children, etc. is not happening more frequently (it's actually happening less frequently than 30 years ago) - we just HEAR about it more because of the internet, because of the media, and because of forums like this. I have never been fired from a job, nor have any of my nurse colleagues that I know personally.

[klone, MSN, RN]

when you say "I COMPLETELY disagree, you are being rude and condescending. especially on the 'net were tone can not be heard. you are saying she (jade) has no basis for her thoughts, only your' s are valid. Is this what you meant, perhaps not, but is one potential take on your post, and I was not the only one to read it that way apparently.

I completely disagree (Ha!) that she was rude and condescending by disagreeing, even completely! She was not rude. She was simply not agreeing. Disagreement, even vehement, in and of itself, is not rude. I think it's an interesting study of communication styles (especially gender-based) that people infer rudeness out of disagreement.

BTW, the OP is a male, not a female. Just wanted to clear that up, because I've seen several people refer to him as "her"

[Ruby Vee, BSN]

Based on your original post, I get the impression that your previous experience was as a CNA or some other nursing support staff. If that's the case, you may have felt -- in school -- that gave you an edge, because it probably did, especially in clinicals. Otherwise, as someone else said, I don't see how you could have 2 yrs experience but only 6 months on your first job.

Here's the thing: wherever you go, you will work with experienced nurses, some of whom will be bitter, nasty, unpleasant people, and enduring their presence will be a chore, if not sheer agony. They will not be up to date on everything, maybe not on most things. Maybe they graduated 20 or 30 years ago and haven't picked up a book since except for required continuing education and certifications.

That doesn't mean you can't learn from them. Every experienced nurse, no matter how much you can't stand them, probably has something to teach you. You just have to be OPEN to this -- and you have to ask. You can even learn from the CNA's/nurse's aides -- IF you're open to it.

By thinking that you were completely on top of things and handling it, you were closed off to learning from experienced coworkers. When people sense you're closed off to them, they close you off.

Nursing is a people oriented job. Your ability to get along with people (coworkers as well as patients) is just as important as your knowledge, experience, clinical expertise, etc. -- maybe more important. That is the foundation on which your work experience will be based, because nursing is a team sport.

If you act like a lone wolf, you will be treated as one; you'll have no support from your coworkers. They will give you enough rope to hang yourself -- and it sounds like that is what happened.

A normal reaction for a brand new grad -- at least, one who doesn't think he or she knows everything -- would be to ASK another, experienced nurse, "Can I use my scissors to cut a pill if I can't find the pill cutter?" New grads are famous for asking dozens of seemingly obvious (and annoying) questions of their more experienced coworkers.

It's not the fact that you did it that matters, it's the fact that you didn't even bother to ask anyone if that was okay to do. Had you asked, coworkers might have told you not to do it, or might have told you where the pill cutter was.

The big question is: why didn't you ask?

You don't mention your preceptor. Did you have one? Or did you get paired up with whoever was most experienced on your shift? If the hospital kicked you out onto the floor, on your own, after only 6-8 weeks of orientation, a) that was too little, and b) you should have asked for more, not happily gone off on your own as if you weren't a new grad.

Not asking coworkers, not mentioning your preceptor -- to me, these are red flags. I'm utterly perplexed that with six months on the job you actually believed you were handling things and were as confident as you say you were. All the new grads I started with were as bumbling and confused and constantly uncertain as I was, constantly feeling like they weren't cutting it, and afraid they'd picked the wrong career. (We were hired directly into ER as new grads.) We were stressed, we were prone to backing off and letting the experienced nurses take over when we got critical ambulance runs, we were about as UNconfident as you could be.

An experienced nurse, the sister of one of my fellow new grads, told us this: In your first year, your first job, you just do what you're told, and you don't understand why you're doing it. By the second year, you still do what you're told, but you start to understand WHY you're doing what you're told to do.

And that is pretty much how it went for us. I didn't feel really confident until my third year on the job. So I can't understand how you could have felt as confident as you did. That's just... bizarre to me.

It sounds like your perception of your abilities was very different from others' perceptions of your abilities, and that the gap between them was widening as time passed. That kind of a disconnect is troubling. As others have said, you need to think about how and why all this happened.

If your hospital is part of a chain, being fired at one in the chain means you can't get hired at others. You have a tough row to hoe, here. Most hospitals do not want to hire nurses who worked less than 1 year in their first job.

Agencies will hire you, but be aware that agency nurses are often thrown into assignments with little or no orientation to the hospital or unit, and expected to hit the ground running. You may also be resented as an agency nurse, which means coworkers will be less likely to help you out. (You may also be welcomed at highly understaffed facilities; it's not all bad.)

If you are resented, you will not have as much opportunity to absorb "by osmosis" the knowledge and tips experienced nurses could give you. Despite that, DO NOT tell your coworkers that your experience is less than a year unless you've known them for at least a few months and you truly feel you can trust them. Most staff nurses are (understandably) suspicious of agency nurses, because in many facilities, agency nurses do not have good reputations and are not considered good nurses. Many people think that agency employees (whether nurses, pharmacists, or physicians) "couldn't cut it" in a staff position at a hospital, or can't get hired as staff somewhere because of bad references or lack of experience. In your case, that would be at least partly true.

You're between a rock and a hard place. It's hard to see how you got here except by your own behavior. Your best option -- which is not a good option, but it's maybe the only option -- is to seek agency work. Apply to as many nursing jobs as possible at hospitals not affiliated with the one you were fired from. But, the economy is only slightly better than it was, so you will likely face an uphill battle trying to get a staff position.

As others have suggested -- you need to reflect on this experience. Defensiveness is natural as your initial reaction to getting fired. But don't wallow in defensiveness. You really need to examine your own actions, every step of the way during those first 6 months, in order to see where you started to go wrong. Because it probably was a number of little things at first that started to accumulate before the write-up over using scissors to cut a pill.

In addition to cultivating some humility, you need to develop better people skills. This is especially true if you're a male RN surrounded by females, because then you're not only dealing with people, but gender specific communication differences. I worked in IT for 12 years before being laid off and going to school for nursing. I was used to working with nearly 100% men. When I started my first nursing job out of nursing school, working with nearly 100% women was a huge culture shock for me. Huge. Especially since I was never particularly 'one of the girls' because I had been 'one of the guys' for so long.

All of that nonverbal communication stuff they taught you in nursing school or any transcultural nursing classes you may have taken -- it's not just useful for working with patients. It's necessary for getting along with your coworkers. You need to be able to recognize people's social cues and clues. I suspect there were many that you blew past before the write-up and before the firing.

Good luck.

ETA: Forgot to say, agency nurses also sometimes get the heaviest work loads and assignments, the most complex patients. Staff nurses often figure, "Let him/her have this train wreck; they're getting paid more than me anyway." I say this having worked both as a staff nurse AND as an agency nurse (and as an agency nurse that got hired on as staff after a 3 month contract assignment). That's just the way it goes. But, like I said, it's not all bad. Some chronically understaffed hospitals are profoundly grateful to have the help, and some staff nurses are too, because then they get breaks and lunches they might otherwise not get if there weren't agency nurses helping out.

This says a lot -- I hope the OP pays attention to it.

Frankly, I've never seen a new grad who was ready to head a committee at six months, or who was even barely competent. That the OP thinks he was such an expert in such a short time is frightening! It's very difficult to teach a new nurse anything when they already think they know everything, and that's what the OP looks like from here. I hope he takes some time to think about the points you mentioned and apply them to his situation.

[Ruby Vee, BSN]

Straight up? I threw up in my mouth a little when I read you cut a pill with scissors!!!! I know where my scissors go and what they do and no way in HE!! would I pop a pill in my mouth that had been cut with those babies!

I know you said it wasn't arrogance, but dang, that's certainly something that through itself at me as I read...

Maybe they were sterile scissors?

[Ruby Vee, BSN]

This is not the time to blame the victim.

Rather than "blaming the victim", this is about giving the OP some perspective to help him understand what he did wrong.

[Ruby Vee, BSN]

You are the victim of lateral violence. This is why you saw so many nurses leaving such a "wonderful" facility.

Your accuser knew exactly the response to take when you approached her , because she is the instigator of much of this violence.

You cannot just talk to your accuser ( now you know) , it's viewed as inflammatory, etc.

You needed to go to the grievance committee to document/attempt to resolve it. (now you know).

In order to preserve your reputation, talk to a lawyer. Lateral violence is well known now. I would imagine a lawyer's communication with the facility will improve YOU'RE outcome.

Not everything you don't like is lateral violence, and I didn't see it in the original post. Of course, if you look hard enough, I guess you can find lateral violence anywhere. Seems like you're looking pretty hard.

[Mulan]

Confidence that you are progressing at a rate a new grad should is a good thing. But, I'm not hearing confidence. I'm hearing cockiness. You very well may have been progressing well. Honestly, you sound like the type of new grad that makes the rest of us new grads immediately disliked by experienced nurses. Whenever I hear an experienced nurse say that new grads are cocky, I get so irritated, thinking "Surely there are not really new grads acting so cocky." Well, I guess you are written proof. You placed more emphasis in your post on the few positive things you did for the hospital, than the INCREDIBLE error of discharging a patient with an IV port. We all make mistakes, even bad ones. And that was a bad one. But, where is the remorse? Where is the train of thought of "How did I do that, and how will I make sure that never happens again?" You are asking if you will be hired again by a major hospital. (I personally would be wondering if any medical facility will hire me.) Yes, you can get another job, IF you can answer those questions especially in a non defensive way. But, for goodness sake, learn some humility.

In the overall scheme of things, there are a lot worse things than leaving an IV port in a patient being discharged.

That has happened to at least two people that I know of over the years, the problem was taken care of, and neither of the nurses were fired.

[morte, LPN, LVN]

and I expected you to say that, but why did you bother? no self reflection going on, eh?

Well I completely disagree that I was being rude and condescending!

[morte, LPN, LVN]

precisely! another agenda going down here.

In the overall scheme of things, there are a lot worse things than leaving an IV port in a patient being discharged.

That has happened to at least two people that I know of over the years, the problem was taken care of, and neither of the nurses were fired.

[wooh, BSN, RN]

Ok, somewhat related question: How do you even cut a pill with scissors without crushing it?

Sharp scissors will cut a pill just as well as a pill cutter. I finished nursing school with clinicals at a hospital that didn't have pill cutters. Yet they managed just fine with scissors. Perhaps it doesn't make TJC happy (for whatever reason) but it's certainly possible, quite easy, and convenient if you always have scissors on you.

Straight up? I threw up in my mouth a little when I read you cut a pill with scissors!!!! I know where my scissors go and what they do and no way in HE!! would I pop a pill in my mouth that had been cut with those babies!

I know you said it wasn't arrogance, but dang, that's certainly something that through itself at me as I read...

Interesting, perhaps you should try cleaning your scissors now and then? Mine are cleaned after every use and before I would use them to cut a pill, I 'd swipe them with a wipe first. Certainly just as clean as the communal pill cutters most of us used until very recently.

[Mulan]

Some people even soak their scissors, in a betadine solution (do they still have that?) for instance or something similar.