Fired or Resign?

Nurses General Nursing

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Basically my unit has given me 2 weeks to improve or they will fire me,what would you guys suggest i do?...Is it better to resign now than to get fired?

Specializes in Acute Care Psych, DNP Student.
As many nursing job applications I've seen have questions like, "have you ever been asked to resign or fired from your job" and "have you ever had punitive actions taken regarding your performance", you may want to be able to answer those questions honestly. Resignation, in the world of nursing where there are jobs everywhere and collecting unemployement as an RN is kind of silly and lame (depending on your circumstances) looks better as you can save face and say, it just wasn't a good fit or that you are looking for a place that has a better orientation program or something to that effect.

One little thing I noticed - you cannot collect unemployment if you resign or are fired for cause. You can only collect unemployment if you are laid off without cause.

Specializes in ICU,ICU stepdown, Private Duty.

I will tell you from a person who went through an orientation in a rather "mean" environment. First, identify whether the preceptor is the problem. I "fired" a preceptor since he was teaching me nothing.

Secondly, if this is a genuine situation where you need to improve, here are some pointers.

Critical Thinking

Always try and look at the other side of a situation and find out an answer for it....for instance if you have a patient straight from OR, even they are not bleeding, ask yourself what if they are bleeding? What can I do, what can I recommend? If you cannot come up with an answer- ask the seasoned nurses or your preceptor....trust me it helps.When you get that pt in real life and they are bleeding, as soon as you mention- i think he's bleeding alittle too much and we may have to give some Packed cells and/or platelets etc etc, you are showing them your critical thinking skills!...so challenge yourself as much as possible.

Charting

Simple thing of if you didn't write it, you didn't do it. I carry a small pamplet esp when I have a busy day and jot little notes with time on the side. When you get a minute write it out and it saves you the problem of trying to remember what you did.

Shift Reports.

After I graduated, my preceptor taught me an easy way to do this.

1.Start with name, sex, age, then Doctors on the case.

2.State the history and make sure to highlight recent surgical interventions like bronchs, EGD's etc.(a date helps!)

3.Go through the systems-ALL! Get into the habit of writing this even when you take report.

Neuro & Musculo- they go hand in hand most of the time :)

Resp

Cardio/C.V-whatever you like

G.I

G.U

Skin

Access points- eg RT subclavian with NS @ 50 cc/hr,

Labs e.g INR, Q6 H&H, if K is low/high,replacements done etc.

Extra's

Physical therapy etc,bath, family, procedures to be done or anticipating to done in the future.

Good luck dear.

the areas they wanted me to improve were:

critical thinking

charting

shift reports.

could you please give me specific suggestions to improve in the above areas.thanks.

critical thinking - use your abc's.

airway- what are the sats- how fast are they breathing? if these are below the acceptable ranges notify the md immediately. look at how they are breathing....are they guppy breathing etc? can you hear inspiratory wheezes- if you can they are too tight- so either give a breathing tx or notify the md/rt and document it! look for jvd- jugular vein distention. this is a simple thing ....that can clue you in that houston there is a problem.!!!!!

breathing - if they are having difficulty stabilize them if you can by small interventions ...like adding o2 via nasal cannula, or a venti mask if they are a copder, or a nrb if it is emergent and call for help. usually if you are watching your patient closely they dont usually suddenly decline. generally without a airway history of problems if they have tight airways - that can be treated early with a bronchodilator before they get into real trouble. so alot of it is what i call " looking for little fires" to put out before they become infernos.again...look for jugular vein distention. also lie that pt flat for just a moment if you dont hear equal breath sounds. lie them flat on there back and put both hands on each side of their chest at the same time - right hand - left side left hand right side---- and see if you can feel equal movement. then look at the trachea is it midline.? have the head in alignment with the shoulders and look at the chin....and visually trace it down to the trachea...is their tracheal deviation? if there is it is a sign that a lung is not expanding.then raise the hob back up to 30 degrees unless contraindicated. the best thing for patients is movement...get them out of bed asap. if there is a problem...document and report it

circulation- cap refill - check it and document it! pulses in all 4 extremities- check it and document it! document vital signs......first on alll you patients before you begin completing a total chart assessment on any one. vitals on them all first.ecg - what is that rhythmn? is the rate above 130 or below 50? if it is.....it is a sign....it is a little fire. uop- a foley is a poor mans swan. if you want to know how your heart is doing - check out your uop. it must be at least 30 cc/ hr. if on a general care floor - watch it for 4 hours, if ur in a icu - the general rule is 30 cc/ hr ...and if it drops for 2 hours .....try t irrigate it with a little saline, or better yet....how long has it been in? change it out. if the uop is still to low - notify the md.

labs - review them. what are the ones that is going to kill them first? k level- is it wnl? plts- are they below 50k? na - are they too dry/dehydrated- is the na above 145? or are they too wet- a sign of chf- so then the na would be below 135.

h/h. a good rule of thumb is - if the hgb is below 8 they usually may need blood or at least make sure the md is aware- and document!!!!! after i jot down my vitals on my patients every day....i check their labs next. i look at the labs that are going to show me they are not going to bleed out on me ,,,and that the heart has enough juice to pump...or isnt water logged. also look at the wbc,....is it above 12 k...if so are they on atb?

after all this ...begin jotting down your assessments. if they are in pain- medicate them now ...that is a small fire.

if therei s a change in loc - vitals , the blood glucose....then notify the md. it may be they took there o2 off and the sats are a little low- put the o2 back on and make sure they return to a acceptable baseline o2 level.

make a list of your meds, times due and as you complete them x them off.

shift reports- name , reason for admit , admitting dr, other medical hx- like htn , dm, gerd, other surgeries, lines, drains, wounds, baseline vitals , o2 or vent settings, isolation, diet, blood glucose levels on your shift,baseleine resp status- if they were copder before - you arent going to cure that - so tell them they are on o2 at home and have had several hospital stays for resp failure, baselien neuro status, baseleine cv status - like did they have a echo done that shows and ef of 20%- that is important or a h/o mi, ins and outs- not just that day review the last 3 days - bc over the course of three days they may have had retention of 8 liters....and that is over 18 pounds of fluid. a liter retained= a kg gained! so watch the weights also.

the best thing is... who are they , whose their dr , whya re their here, what are their other problems, where and what are their iv lines, what is going through those v lines, do they have drains> are they walking , talking eating peeeing , pooping, what lines are in , are they febrile, what are the labs that will kill them- k, hgb, plt na etc etc etc. are they on telemetry - if so what is there rate and rhythmn.

hope this helps!!!!

my best advie is make you a work sheet on each pt - name dx, dr name , labs, meds due.vent settings, , abg results, and then use it as a check off list. put blood glucose checks , labs due, vitals due,meds due, drips - i put them on my to do list every 2 hours to check the remaining volume. if they are on levophed - this is not a pretty picture when your levo drip runs dry. it should neve happen. when you get down to the last 1/3 of your drip , get another and put it on the iv pole behind the one running, if they are on drips what is your goal blood pressure /hr, write the meds due and times and when they are complete make a light x over it. this lets you know what is left to do.at the end of each one - put what you need to do before you leave that night/day. like leave the oncoming nurse with enough fluids to run for 2 hours +, check the lab results you drew etc etc . what is there goal for discharge? are there any major family issues?

breathing

First of all thank you so much for all of your replies.I was wondering how do you all feel between resigning or asking for transferring to another unit, since looks like i will most likely heed all of your advice and not get fired.

i HAVE A SHEET i give to new grads that helps them get organized. It is basically a fillin the blank report sheet and a to do list for the shift. If u want a copy PM me and I will send it to you tomorrow. It is a small concise sheet that helps you get organized , get the important info passed on in report etc etc .

The OP has given us very little in the way of details. We've had to drag them out one by one. Maybe that tendency is part of the problem.

You know I was a faciltator in a hospital where we intervewed new grads each month during their 1st year to see why most of them were leaving , as they tend to do. The one thing I heard month after month from them is how fearful they were in being perceived as incompetent in ICUs. They said they were often reluctant to ask questions because of the other seasoned staff would stop what they were doing and look at them like they were idiots instead of answering their questions and giving rationales. So ...thye learned to not ask questions. Unfortunately ......this is what some nurses do. Rather than share their knowledge ......they eat their young by placing them in an environment that isnt really condusive to learning. The term " nurses eat thier young - esp in an ICU" ....didnt come from the fact that this profession is known for loving to educate / inform new nurses. WE.....not all...but you know alot of nurses......when questions are asked ....they stop and stare and deliberately make them feel incompetent. That was the main fear of all the new grads I interviewed.....fear....not of hurting a patient......fear of how their coworkers would treat them if they asked too many questions. I think.........unless I am mistaken........that is what has happened to this OP.

Hi Guys,

Thanks again for a lot of great suggestions, would you guys recommend asking for a transfer to another unit(i am currently in ICU) or resign and apply for jobs elsewhere?Also i am part of Union, i wonder how they could help me?

Specializes in ICU./CCU/SICU.

The union won't help you if it's a legitimate clinical concern, which is what is sounds like. Like i wrote before, the ICU isn't for everyone, and I think a poor starting point for most new grads. You need to learn how to hone your assessment skills first.

The union won't help you if it's a legitimate clinical concern, which is what is sounds like. Like i wrote before, the ICU isn't for everyone, and I think a poor starting point for most new grads. You need to learn how to hone your assessment skills first.

so would you suggest i ask for transfer or just resign?

Guys please help me out would you guys suggest i transfer to a different unit or resign?

Specializes in Nursing Professional Development.

If you can transfer to another unit in the hospital, then I would transfer. Now is not the time to be jobless and job hunting without a track record of success behind you.

What really saddens me is that i have been in orientation for about 2 months now...instead of giving me 2 weeks i wished they gave me more time..i am so close to go to night shift orientation.I have been working really hard..i wish i had gotten some other preceptor

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