Published Jul 23, 2009
I took a per diem job about 2 months ago in a residential eating disorder facility. I have been an RN for two years. I spent the first year in L&D, and did well there, but when I was told they would be moving me to nights I had to resign. I was also scheduled to have a hysterectomy, and had not been on the job long enough to qualify for FMLA. I then took a job as a school nurse working with medically fragile children, and have been doing well with that. At both of those jobs I have received excellent reviews, and have been told that I am a good nurse. The per diem job I mentioned above sounded fine, but I began having doubts on the first day. I was so informally trained that I began doing research on my own to supplement my training. After 2 partial days of job shadowing, I was told that I was "trained", and that I was on the schedule as the RN. Since it was a per diem job I was only scheduled for 2 Saturdays per month. Everything was going well, and I was starting to feel comfortable that I could meet the demands of the job. I was on break from the school nursing job, so I asked the DON if I could work a partial night shift in order to learn the routine in the event that I was ever called to work nights. She refused, saying that as I was only scheduled for Saturdays, that it would be unnecessary for me to learn the night routine. Sure enough, last Saturday, the DON called me up frantically asking me to cover a partial night shift for that night as the agency nurse had called in. I reminded her that I had not been on a night shift before, but she assured me there wouldn't be anything I wasn't familiar with involved, and that the day nurse would be there at change of shift to answer any questions. I reluctantly said yes (wanting to be a team player), and showed up to work midnight to 6am. The day nurse informed me that of the 3 patients in the house at that time, the 2 diabetics were in the same bedroom. She told me which bed each one was in, and that they needed fingersticks at midnight and 4am. I was told not to turn on the bedroom lights, but instead to use a flashlight so as not to interrupt their sleep more than necessary. Furthermore, they each have their own glucometers, which we keep locked up in the med room, and they are identical. They each have a piece of masking tape on the outside with their names on them. So here is the incident that took place:
I took both kits into the room at 12:15am. I had the flashlight on and went to the bed where I was told patient A was sleeping. I called her by patient A's name and she woke up and sort of sat up and I told her it was time to check her blood sugar. She took the kit from me and did the fingerstick herself (which is company policy). When she handed me the kit back she looked at the kit and told me it was not hers. This shocked me, as I had been told that Patient A was in that bed, and I had called her by patient A's name and she responded. The problem is that the facility does not have a policy for making sure the patient's who do their own fingersticks change the lancet each time. No one knew whether the lancet was new or not. The rest of the shift was uneventful. When the day nurse came back at 6am, I told her what had happened, and she said she was unsure if the lancet was new or not. I filled out an incident report, discussed it with the day nurse, discussed it with the safety director (who just happened to be filling in for someone else), and then called the DON that day to report it. They all assured me I had done what was possible to be be safe in the circumstances. The DON told me she didn't think she would have done anything different given the situation. The doctor was notified, and the two patients had bloodwork done. The bloodwork came back clear. I had suggested to the DON that there should be some sort of label to show the name of each patient on their beds, and she agreed with me. She told me to chalk up this experience as a "learning curve". I just got a phone call from the facility manager today, informing me that risk management directed the facility to fire me due to the incident. I was very frustrated! I feel like I did all I could to deliver safe patient care, and that the incident was due more to the facility's lack of organization than my negligence. I am still within my 90 day probation period there, so they will not show it on my record as an involuntary termination, but I am still upset. The facility manager said he would send me a letter stating that the decision for me to leave the job was a mutual decision based on a scheduling conflict. I just don't know how to react to all of this. Any input would be welcomed. Thank you!
I am so sorry to hear that. Did you join a nursing union? From my experience, I know that the hospital cannot fire you unless the manager has a formal meeting with you and a representative from the union has to be there.
If I were you, I'll write a formal letter and explain about what happened and send it to the CEO/manager. However, it sounds like there's some problem with the management of the facility. Since you're an experienced nurse, you can find a job anywhere. Who knows, maybe something better is waiting for you...
Wow, hate to hear this and I am sure you are upset.Unless I missed something, I would have checked the patient's arm band first regardless of what the day shift nurse told me. I am just not familiar with patients using "home" equipment, we require them to use the equipment that belongs to the facility because of constant quality checks you must with the equipment. I would think your facility would not want allow an outside machine because most glucometers must have daily internal hi/low range testing to assure the results are accurate and to maintain sterile technique for patients.
I thought an employee had to be on the clock when they were terminated and not by phone but again, everywhere you go it is different.
I have a full-time position as a school nurse, so I'm not going to be scrambling for a job. I am mostly upset that I am being fired. I am the first tp admit that I used the wrong kit on the wrong patient, but I feel that more was involved her than just my error. The facility manager told me that terminating me was just one of many things that the corporate office is requiring the facility to do. They will be making changes in how nurses are oriented to the facility, how patients are identified, how nurses are scheduled, how glucometers and lancets are used, etc. The patients at this facility do not wear arm bands, as the facility is trying to create a "home-like" atmosphere. I do not have union coverage at the per diem job, unfortunately. . .
Valerie Salva, BSN, RN
Try not to let this get to you. This is the new standard for dealing with nurse errors. People are reporting left and right they are getting fired for the slightest things. Used to be they would use education and retraining to deal with errors. Now they seem to go straight to firing. Next time you get a bad feeling about an institution you fire them before they fire you. I know I have.
Great advice- and remeber the nursing mantra- no good deed goes unpunished!
The next time you ask for orientation to nocs, are refused, and then asked to work nocs- don't do it.
i'm sorry to say this, but this place is a joke. what kind of place is this? a hospital, nursing home, group home? i mean they should've put a name band on every patients if this is a health facility. second of all, what kind of place doesnt allow to turn the light on and insist that you use a flash light so you can identify the patient and you can actually see what you are doing? and so far with every lancets i've used i can only use it once. once a needle inside lancet have punctured a skin i cannot use it again and we must discard it. i've never worked in a place where patients must check their own blood sugars either.
this place doesnt seem to be too concerned about safety of patients. maybe they are waiting for something bad to happen. what are the risk managements doing to prevent from anything like this happening again?
Thank you all for your replies! I really appreciate the feedback. I feel like I am the scapegoat that the corporate office is using to alleviate their own culpability. While the corporate risk management department is evaluating the facility and requiring them to make extensive changes in their procedures, that doesn't change the fact that they fired me for being put in a situation and set of circumstances that they were responsible for. This group home treatment facility just began accepting diabetic patients about 2 months ago, and I can tell that they were not prepared to do so. I guess I should have quit when I realized that, but I was assuming that things would improve with time and experience. To think that I was actually spending time and energy trying to teach the staff how to care for diabetic patients safely! I had never worked in a group home facility, so this was an eye-opener. If I had been more experienced with these types of clinical settings, I probably would have reported them for unsafe practice. Live and learn I guess. . .
Be GLAD you do not work at this place anymore. It sounds like I wouldn't want to be part of it either. Keep up your stellar performance at your current job.
Thanks again for all your feedback. I just got a call this morning from the director of the facility. He said that he spoke with HR about the letter he told me he would send me, and that he "is not able" to send me the letter stating that the termination was mutual and due to scheduling. I guess I'm not suprised. I think it's ridiculous that the director of the facility makes promises without knowing what he can and cannot provide. I guess I am just wondering if I should make a thorough statement and ask them to add it to my file? The incident report only had a small space for me to write up my description of the incident. I feel I should also have on file in written form that the DON refused to train me for nocs, and then a week later begged me to work a night shift. I'm certain from talking to the director of the facility, that if an inquiry ever comes up that they will simply state that they terminated me due to the use of the wrong glucometer kit. They won't go into detail about how their facility was negligent. I just don't want a black mark on my record over this. Any advice would be appreciated. I do have a friend who is a lawyer, and I am wondering if I should contact him about this. Thanks for your help everyone!
I am horrified to know such a place exists. no armbands, no pt. name labels on the headboard. so verbal communication is the only way to identify the pt.? And I have yet to see a reusable lancet and work with flashlights. This looks like a setting of a the most rural region of a third world country hospital.
Brenda4, at least you have the school job and i'm sure it's far better than the one you just encountered. Anyways, however bad an experience, we can all use it as a learning experience.
This place sounds just like a facility I was at for 11 shifts! Half ass "training" (I followed an LPN around for 1 shift, no idea what she was doing because she didn't have time to explain because they were so short staffed) The scheduled staff on the posted schedule had staff scheduled-but no longer even worked there! I should have listened to that little bell going off inside my head when I was hired. I didn't know that the average staff stayed about 5 months. A revolving door! Some of the diabetic patients there reused thier lancet needles because of cost, as they had to buy thier own supplies. This grossed me out, but the patient is always right at that place. There were no wrist bands-privacy they said. Now I have to file an appeal with unemployment as they said that just because I didn't agree with the facilities policies was not a reason to quit. There were no written policies or procedures and no training and no job description and few nurse staff! Beware, listen to that little bell!
By using the site, you agree with our Policies. X