Got fired... again. Should I not be a nurse?

cjcsoon2bnp, MSN, RN, NP · Aug 15, 2009

The only other thing I wanted to add is that while home health is another option to consider I think that you might want a bit more experience before you go into home health. Home health is a very important area of health care but its an area where you would benefit if you had more experience because you won't have those same resources availiable to you when your in someone's home and at times experience is all you have to work with and at this point you don't seem to have enough confidence in your own abilities. Its something to consider, so think about it.

!Chris :specs:

navydad51 · Aug 15, 2009

70+ residents plus an admit? Did I hear that right? Give yourself a break on that one, WOW! Yes, do more homework on the next job, I would not have accepted the keys to that cart that day, no way. Not your fault at all. Where was the DON and ADON? They should have grabbed a cart and helped! And I think I have it bad. What a nightmare for you.

Scrubby · Aug 15, 2009

Yesterday I was termed from my job at a LTC facility (technically I "resigned"). I had only worked there a couple of months. I understood their reasoning for letting me go. Due to low census they sent home the nurse who was working the other end of my hall and so I then had 70+ residents to take care of (something I'd never done). On top of that I had an admit (never had done that either). I got confused b/c I thought one of the nurses from a different hall (there are 2 on that hall) would be coming up to cover the other half of mine, which turned out not to be the case. Anywho, so when it was all over and done with some people ended up getting their meds too late and some didn't get them at all. The nurse that had been sent home had already signed out the meds but hadn't given them. Apparently they were in little cups somewhere in the cart but I don't remember her showing me where. I tried to get some help from the other nurses but they were busy with their own stuff and I wasn't sure whether one of them was coming to help. I called my ADON, got her voicemail, and got a call back 1.5 hrs later telling me to do my best. I was quite overwhelmed by the end of the shift and may not have been thinking clearly.

I'm interested to know if you filed an incident report? I know I would if someone just left medications lying around like that and I was given an unreasonable workload. By reporting this as unsafe practice you are covering your behind.

VincentCCRN · Aug 15, 2009

My advice: Start over. From the basics. A nice small to midsized hospital on a medical surgical floor. Work for at least one year before transferring. The skills you will learn will benefit you greatly in the future.

Don't be hung up on becoming a nurse-midwife. There are so many specialties out there. Try med-surg. Beef up on your skills. Then reevaluate.

Good Luck.

JeanneRN83, BSN · Aug 15, 2009

Miss Sarah K. RN,

You are NOT a bad nurse. You have been in some very unfortunate situations with some of these situations precipitated by your quest to be a Nurse Midwife by yesterday at the latest :) Slow down, girlfriend, so that you can succeed in your nursing endeavors. By now, I imagine that you are totally frustrated. You've been trying very hard to succeed and realize your goal of becoming a Nurse Midwife.

So now it is time to re-group and form a plan. There have been many good suggestions for possible career areas. I agree with whoever said to get back to the basics. I would really recommend that your next position be in a hospital. You need the acute care experience. Forget any LTC's and definitely do not do home care or public health or private duty. Home care requires that you be on your own, assessing patients in their homes, formulating plans and possibly supervising LPN's. Sarah, you need experience, experience, experience if you want to be a Nurse Midwife. By that I mean lots of practice with IV's, phlebotomy, administering pain meds, physical assessment, organizational skills, communicating with other healthcare professionals and confidence. In an acute care environment, you will be working with alot of other people and amongst them there is going to be at least one kind soul who will give you some support. You will learn so much! I also recommend med-surg. Just for one year. One year goes by really fast. It will give you a solid basis. I think med-surg will help you to be more successful in L+D. And if you have already had to deal with being let go from a L+D position, don't put yourself back in that environment right now. Do an area of nursing that you have never done before. This will provide you with a "neutral" zone and a less stressful place to begin again. Going back to L+D at this time will set yourself up to worry about whether you are going to get term'd in L+D again. One suggestion that might be very helpful is talk to a Nurse-Midwife. Get her feedback on your plans. How did she realize her goal of becoming a Nurse-Midwife?

Sarah, I can tell that you are a true go-getter with lots of energy, aspirations, dreams. Use that energy to learn everything you can about L+D even if you do not work in L+D in your next job. Join the national organization for L+D nurses, learn the gyn anatomy really well, read all things L+D. I would recommend not doing any school right now. Focus your energy on the task at hand: having a successful work experience and developing a good med-surg knowledge base. I'm hoping that you live near a university affiliated hospital. There will have more units to pick from that will be "med-surg": GYN surgery, general surgery, medicine, cardiac pts, pulmonary pts, orthopedics.

Ok, one last observation. Think about your experience at the LTC. I don't think there is one nurse in this online community that could handle 70 patients. Totally unsafe and an unfair, ridiculous assignment. A lot of nurses who have left a post have said that they would not accept the assignment, would have talked to the supervisor, call JACHO. The first thing I would have done is ask the supervisor if she is in her right mind, sending a nurse home. I personally would have called the DON and told her to get her butt here ASAP. You were not able to do any interventions to make your situation more safe (this is not a criticism). My point is, when you are a Nurse-Midwife you are going to have to be confident, assertive, know when you are in over your head and be prepared to handle an emergency, amongst many other things. These qualities come with time and experience.

I had to chuckle with the person who said that she wanted to do ICU and people would tell her not to and she'd get mad. I think some of us had that experience when we graduated: "I'm an official RN now, I have graduated and passed the NCLEX, so don't tell me I can't work in critical care, ED, etc.". I am wondering if this rings true for you? Jumping from new grad to Nurse Midwife school is quite a jump.

You will be able to obtain your goals. Just take it slow, don't spread yourself to thin.

Keep us posted on what you decide,

Jeanee

PS-Why did the supervisor say the "census was low" and send a nurse home? Certainly, if you ended up with 70 patients, I would have to say that the census was not low. Can you tell me more about this. Jeanne

Ruby Vee, BSN · Aug 15, 2009

about being fired from your ltc position: it seems as if 70 patients is a lot for any one nurse, plus an admission, too. but the real problem i see with that situation is the other nurse pouring all the meds, then going home, leaving them in little white cups. big problem there.

i don't know you. i don't know if, as others have suggested, you're really a very good nurse who got some bad breaks, or if your employment history tells the story. unless i've misinterpreted, you've been fired from or asked to leave three jobs. that seems like a lot. if you still want to be a nurse, go back and start from scratch. get a job on a med/surg floor of an acute care facility and learn the basics. find yourself a mentor and then concentrate on learning everything you can. be willing to study at home. don't take on anything else new during this time period unless it's unavoidable. this isn't the time to buy a house, get married, plan a wedding, go to grad school, whatever. this probably isn't the time to learn all you can about being a nurse midwife, either. one step at a time. ask your mentor for feedback on a regular basis, and then take it to heart. hopefully, this will improve your critical thinking skills (and not, as someone up thread has suggested, your critical care skills). don't get real hung up on the year time period that others have suggested. of course you should stay for at least a year, but it may take you longer to feel as though you have a good foundation in the basics.

after you've mastered the basics is plenty of time to think about advanced practice and specialties. and if you aren't able, despite your best efforts, to manage the basics, perhaps then it's time to rethink your career choice.

good luck.

tencat · Aug 15, 2009

All good advice. Personally, I hated med-surg, but I'm not sorry I did it. It set a good foundation for me by giving me good hands-on experience and prioritizing experience. So I'd echo what others have said and say get that experience in med-surg, work your way into L&D, then go for the CNM. None of it will be time 'wasted' as you will gain the skills you need, and learn a lot if you are open to it.

Koperen · Aug 15, 2009

My most profound sympathies. I once worked a shift as a temp nurse in a LTC where I was given 70 patients to pass meds on. I didn't know them and there were no notes regarding who could swallow and who couldn't. I was passing 1600 meds at 2100 and that was working full out without breaks! When I got home I called my agency and, with their agreement, I reported the facility for very unsafe practices. If you haven't done this yet, you should seriously consider it. It's not about recrimination, it's about safety.

PostOpPrincess, BSN, RN · Aug 15, 2009

Start fresh.

Go to Med/surg. LEARN it well. Don't skip steps and FOCUS on one thing at a time. I have a feeling that too much too soon without learning the basics is your weak link.

I think you have the potential--just chalk just up to experience and slow down.

greenfiremajick · Aug 15, 2009

I agree, med/surg experience is very beneficial. When I came out of nursing school I wanted to go straight to the ICU. Many people told me to do the med/curg first, for at least a year but I didnt want to and resented them for implying that I couldnt do well in the ICU without that experience. Lucky for me, the hospital I wanted to work in didnt have an ICU position open when I gotmy license. So, I worked the med/surg floor for 18 months and learned more there than I knew I needed to know! When I finally got to ICU I could appreciate everything I learned on the floor, amd I missed med/surg so much I went back after 8 months in ICU. That time on med/surg taught me sooo much and boosted my skills and self-confidence up to where I needed to be. I encourage every new nurse/nursing student I meet to do that time on med/surg. Bet they resent it as much as I did :)

Think you could list (in detail, please) the important skills you learned in Med/Surg? I am interested!

Txangel791 · Aug 16, 2009

Think you could list (in detail, please) the important skills you learned in Med/Surg? I am interested!

I am not a writer, so sometimes what I am trying to say does not come through, but I will try :)

When I was in nursing school, there were skills that I read how to perform, and saw other students perform, but never got the chance to do it myself because the opportunity never came during clinicals. And there are other tasks that I did once or twice with my instructor right there to help me if it didnt go as planned, but that I never had to troubleshoot on my own. I mean, like an NGT. Did that a few times in nursing school, but working med/surg I learned how to do that with an unconscious, uncooperative pt. I learned how to get it done better, easier. I learned how to do foleys in school, but on med/surg I learned how to do females from behind due to contractures, I learned how to do males with prostate problems. I learned how to start IV's in school, but at work I learned how to finesse spider veins, and hit what I cant see on heavier pts. I learned how to bathe a pt in class, but at work I learned how to do it alone, how to help maintain modesty, how to be sensitive. I learned how to manage my time, how to prioritize my pts, how identify the best way to communicate with each pt based on their personality and current situation- not mine. I learned in school what tasks i COULD delegate, but learned on the job what tasks I SHOULD delegate, and to whom. I think what I want to say is that in school you learn how and why you do certain things, but by working med surg you broaden your education with real world experience in a setting that will expose you to many different kinds of pts, diagnoses, co-workers, families, situations. When you come out of school and go straight to a specialty you learn that specialty. What if you went straight to L&D and learned it and worked it well for 2 or 3 years, then were pulled to the floor to help, or wanted to work some PRN agency for extra money? Knowing pitocin rates, fetal heart tones, and such wont be much help to you with an 80 yr old from the nursing home with stage III decubs who's contracted and needs a foley change, right? I just think it makes for a well-rounded nurse with a solid knowledge base that will support you throughout your career, no matter where you are working at any time.

Make sense? I hope so...lol :)

nursemike, ASN, RN · Aug 16, 2009

Think you could list (in detail, please) the important skills you learned in Med/Surg? I am interested!

I started, and still work, on a neuro/neurosurg floor, so one could argue I didn't take my own advice, but it was where I was working before nursing school, and there's a good case for working in a place you know. Besides, neuro is a medical service, and neurosurg is surgical, and we do get a wide variety of off-service patients.

I don't have time to list in great detail what I've learned, but I'll try to give it in a nutshell. 1. Assessment. I've done a lot of assessments in 4 years, on patients with a variety of problems. All nurses do assessments, of course, but six patients three times a night adds up. Not long ago, I sent a patient to the ICU because she just didn't seem right. We did tests and had a better reason than that by the time she went, but the initial finding was more intuitive than scientific. The science came after the instinct. I've had patients with pancreatitis, trauma patients, pediatric patients, one OB patient (and a couple of others who were pregnant with neuro problems). Our ED nurses undoubtedly see even more variety, but they don't follow a patient for days and see how they progress. ICU nurses follow 1-2 patients very closely, sometimes for extended stays, but if an ICU nurse gets floated to my floor, we put them in our stepdown, because it seems inordinately cruel to ask them to take six floor-status patients. Not saying there aren't many who could handle a floor assignment, because a lot of them did so for years before going to the ICUs, but I've known a couple who admitted it was tough to keep up with three in stepdown (it can be for me, too--the step down from ICU status can be kind of a small step, at times).

So, 2. Time Management. I don't pretend I can tell an LTC nurse with 30-40 patients a lot about time management. But I've had a good deal of practice prioritizing care on a variety of patients. A lot of times you'll have one with a fresh stroke, one rule-out MI, a tib-fib fracture ready for discharge, a post-op brain tumor, and you have to figure out who needs what first, while the ED is calling report on a trauma with ETOH. Any med-surg floor, and especially a true med-surg floor, will teach you to juggle.

3. Nursing interventions. As Txangel observed, you get to practice a lot of skills. Most of those skills apply anywhere. ED and perioperative nurses start a lot more IVs than I do, but I've done a bunch. I might not even quite remember what a Swan-Ganz is for (heck, I'm not entirely sure how to spell it!) and my ventilator skills consist of paging Respiratory and praying, but I can get an NG or a Foley at least 8/10 tries, do a variety of dressing changes. I've managed a seizing 6 year old, kept a fibromyalgia patient from going AMA because they couldn't have Demerol, done tube feedings and trach care, and passed routine meds, all in the same night. (Not every night, thank goodness--but still, you never know what you'll run into). And, at least on my floor, you get to learn these things working alongside other nurses who have done them for years, most of whom had to learn the same way.

There's more, but it's time to get ready for work, and my brain is starting to hurt from all this thinking. One last thing, though. When I was in school, a co-worker (not a nurse) said I should go into critical care, because I'd be wasting my talents as a floor nurse. It was nice to hear, at a time when my confidence was at a low ebb, but once the cerebral edema began to ease, I asked myself what my talents were. I came up with, I'm a good listener. And it turns out I was right. Nearly every shift, at least one of my patients just needs someone to talk to, and a lot of timesI can find a few minutes to be that someone. I've had patients I've assessed last not so much because they were my most stable (although, usually, they are), but because I knew they'd want to BS for ten minutes, afterward. And, as you might be able to tell from the size of this "nutshell," I really enjoy gabbing. A lot of the time, I'm glad my patients aren't intubated. Sometimes, you can really help someone feel better just by pulling up a chair and listening to them explain that they aren't drug-seeking, they really are in pain, and they wouldn't be asking for morphine if they didn't need it. And, you know, listening doesn't depress respiration...

One last bit of advice for the OP. If you can manage it, try to work nights, at first. It's still hard work, but there's less confusion with people coming and going, most of the "suits" are home in bed, and from what I've seen, more comaraderie among the staff. We don't have a lot of the resources days do, so we have to work together. And some patients do actually sleep a little, when we let them.