Nervous over possible termination

Nurses General Nursing

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So I haven't posted in a long time. Since my first thread, I have graduated, worked in a crappy job for 6 months, and since leaving there, I have been at a facility for one year this week. So this is what I am worried about:

I found out that I had made a med error five days in a row, ( I didnt check the dosage listed on the pill card). I was taken of the schedule for sat, and sun., and asked to meet with the DON on mon(holiday). She was not in on monday (my normal day off). I arrived to work on tuesday and was not on the schedule. I am terrified that I am going to get fired, is that likely?

backstory: I work on an acute rehab floor. We had been pretty empty for a few months, but there suddenly was a surge of admissions which really threw us off. Many having some pretty serious issues, one even being returned to the hospital for elevated potassium that the hospital missed (he seemed the most healthy out of all of my pts). Several of my patients require A LOT of nursing care, I have two MR patients, one is non-verbal and has bolus GT feeds, I have one psychotic patient on dialysis who is 90 years old and not doing well, yet refuses to sign a DNR, I have a woman with expressive aphasia who now has a GI bleed, A pt with hepatitis B+C with 4x daily blood sugars and behavioral issues, a 80yr old new gt patient with recurrant aspiration pneumonia running a temp of at least 100.0 for 3 days, and lastly, one with PTSD and severe anxiety who, despite 'wishing she were dead' for needing one, requests an enema every morning, and those are just the heavy ones.

For my end of the unit, I am one nurse to 18pts, I have two CNA's ( who arent allowed to do much more than AM care and toileting per the facility). I am responsible for all treatments, meds, and skilled notes on 17/18 of them. There is a charge nurse (who I consider my mentor) who has every intention of helping, but she is so bogged down with orders that she cant get away from the desk.

We also have a new MD and a team of NP's that work with him. One NP comes in daily to take off some workload from the MD. This new doctor has most of the patients on the unit, approx 30pts. For some reason, they stopped giving the other two MD's (one being the medical director for the floor, the other is the former director) admissions. Well once this NP came in, instead of checking patients and ordering things, she began overhauling how we do things. She even hijacked our part-time unit clerk, keeping her on the floor at all times (and now she has no time to do medical supplies, her primary job).

So this made a mess of everything and caused confusion for the staff. We finnally started getting the hang of it though after a few days. So she wants: VS and weights as soon as she arrives on the floor. (of course this is done before meds anyway, but my cna's havent done vitals at this facility, and its like pulling teeth to get weights done.) So When I arrive on the floor in the morning I (personally) have to: take VS on all 18 patients, make sure weights are done before breakfast (the 11-7 shift wont do them) get report, count, check the breakfast trays and help pass them out, check the bm book, check the apointment book, then I can start my med pass. Then, once the NP arrives, she tears through things, bombarding us with questions that I usually dont have the answer to, then gets really annoyed with us and 'throws us under the bus' to the DON. Then I can finish the rest of my work, but I havent been able to get done on time for a few weeks now.

I have so much to do and so little time (I have never taken a lunch break since I started BTW), that I have to rush through everything, and having ADD, I already dont have a good attention to detail all the time. (not to mention it is really hot on the floor, I sometimes think they are doing a study on our behaviors related to intense temps.)

On thursday we had staff meetings, the State had just done our survey, and then returned to investigate problems they found. After the meeting I attended, the DON asked me and the charge nurse to stay behind. She told us what needs to change on our floor and that we are not up to her standards of quality at that time. She even told us to change our handwriting becaus its 'too loopy'. She said she was trying to motivate and not push people out of the facility. (she told me that I was going to be the death of her).

So later that day It was discovered that I had been giving a patient too much digoxin for five days. He was supposed to get 0.125mg but was getting 0.25mg. I checked his AP before each dose and held it on the day that the error was discoverd since his AP was 55. The NP was looking at his labs and discovered he was in dig toxicity, she asked my nurse manager to investigate. When my manager asked about the med, it clicked. I knew that the dose ordered was 0.125mg, but the med I had was 0.25mg, I had been rushing through the meds and I never got to check the dosage on the pill card. (the pharmacy also never sent the correct card, and the old one was never removed from the cart). So I felt terrible, cried my eyes out once I was home, and was worried sick about the patient. (I found out this morning that everything is ok and he is out of toxicity). It was all my fault, I am the primary nurse and missed this error for days. (there was only one other nurse who gave him the med on the weekend, but I dont know if anything happened with her).

So on friday (my day off) I was very nervous to return to work on the weekend, expecting the worst for the patient. But at 7:30pm on Friday, I get a call from a coworker (turns out to be the nurse who trained me a year ago), telling me that the DON called her from home, and decided to take me off of the schedule for the weekend, and wanted to meet with me on monday. (monday being a holiday and my normal day off). So before ending the conversation, the nurse passing on the message wished me a 'good little vacation'. I didnt know if she knew what had happened on thursday so I just shrugged it off. So now, again with the waterworks. Fearing that I will be fired

I prepared for my meeting with the DON. I listed what I need to improve on, where I need help, and problems on my work floor that directly affect my work. I also posted my resume online and applied for jobs just in case.

Monday comes, I call work and leave a message for the DON to call me when she wants to meet up. (it was a holiday so she didnt come into work that day, as I expected. ) So, no call back on monday.

Tuesday (today) arrives. I get ready for work and prepare myself again for my meeting with the DON. I get there, and my name is off the schedule. The DON is not in yet, but I happen to bump into my floor manager. I tell her about the weekend (she seemed blank expressioned so I couldnt read if she knew something or not). I asked about the patient, and she informed me that he was fine, back to baseline and the med was d/c'd. So I asked her to have the DON call me when she see's her so I can meet with her. That was at 7am (its now 8:42a).

I am hoping that I was given the weekend off because the DON recognized that I was overworked and that led to the med error, but I fear the worst, and that I will be out of a job. (they reciently have 'cleaned house' and escorted staff out of the building, the charge nurse I work with thinks she and I will be next)

Any thoughts are appreciated.

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Specializes in Nephrology, Cardiology, ER, ICU.

Whew! First, take a deep breath. It sounds like a very heavy load and perhaps you would be better off somewhere more supportive. However, if (like where I live) jobs are scarce, I think it sounds like you are trying hard to salvage this job. Good luck.

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Specializes in ICU/Critical Care.

Why can't they give you another RN instead of having you do all of the workload. I wouldn't worry about the NP, she can get the VS when you are good and done with all of them. Put in applications elsewhere if you like. I'm sure there is something better than this.

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Specializes in ICU.

I would be looking for a new job NOW.

First of all, this sounds like the nightmare job from HELL. How could you possibly be responsible to do ALL THOSE THINGS FOR 18 patients????? That is very dangerous! Very! You should be at the most, working with half that many, or less! Since they've gotten away with it for so long, they think they can use you for 18 patients instead of having two or three nurses in your place.

I think that being fired would be a blessing in disguise. I know that sounds mean, but wow, how could they possibly think that it is alright for you to have such a huge patient load? I am just flabbergasted.

Find a new job. I am not sure where you live or the situation with jobs in your area, but you are bound to find a job SOMEWHERE that is better than this. You risk your license and your livelyhood for this place and when s**T hits the fan, I bet you they will not back you up.

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Why can't they give you another RN instead of having you do all of the workload. I wouldn't worry about the NP, she can get the VS when you are good and done with all of them. Put in applications elsewhere if you like. I'm sure there is something better than this.

Because another nurse would cost more, it all comes down to that. What I love is that they spent a huge amount of money to put in new carpets, security cameras (probably some hidden ones too!) and a new fancy sliding glass door, when they could have added more staff and fixed the actual broken things before the state came.

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Specializes in ICU/Critical Care.

Listen, you need to put in applications elsewhere. Go to interviews if you are called. Hey, if they fire you its a blessing in disguise, just don't lie about it if you go to other job interviews. What they have you in a dangerous situation where YOU are putting YOUR license on the line. In your discussion, you need to say that you cannot possibly pass ALL the meds, do ALL the treatments on these patients. State that it is not safe, that your charge nurse is unable to help you because she is tied up doing numerous orders all day and that YOU don't feel safe working in this environment. You need to make it know that you don't feel safe. I wouldn't feel safe and I don't think anyone else here would feel safe. If they don't budge, it's time to find a new job. Start looking now.

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Specializes in cardiac.

That many patients to provide all those cares for is unsafe and that facility is practically begging for something bad to happen. I wouldn't want to work under those conditions.

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Specializes in ED, ICU, PSYCH, PP, CEN.

This is why it is so important to take time to give meds carefully and look at the 5 rights.

That said, no nurse could handle this type of load. I would run like hell from this job. This is the type of job that causes people to lose their licenses.

If they keep you, and you don't get fired you must think about what aspects of your job are the most important.

Providing safe care (and that means being careful during med pass) should be first on your list. All the other crap can wait. Dressing changes etc just have to wait.

Up to this point there was no way they would let go someone who is willing to accept responsibility for this many pts (whether you got everything done or not).

Unfortunately your willingness to work under deplorable conditions may have put you in jeopardy.

I hope all goes well with you.

Keep us informed, we care.

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Specializes in general medicine.

I feel so bad about your situation. So many nurses are working in these hell holes...and made to feel guilty about all the things that don't get done.

That NP and DON should have to walk a mile in your shoes.

People always moan about how crap nurses are, if only they knew about these kinds of working conditions and how much it takes to survive a shift with that kind of a patient load Thepeople you work for sound insane. Poor patients. Poor nurses.

I hope you can get out of there and find something better.

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So I just noticed that I had a voicemail from 9am (for some reason my phone didn't ring or vibrate and it was in my pocket) So I will be meeting with the DON at 11am. Dont know what is going to happen, and I'm pretty nervous. Ill try to update afterward.

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Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

First off - you need to repeat after me "You are a good nurse!" Keep saying that a few times. 1 mistake does not a bad nurse make.

The problem I am seeing here is one of process. As nurses we know we are supposed to double check the MAR with the med to verify the 5 rights. So when we fail to do this we automatically assume it must be our fault - after all "we know" what we are supposed to do.

But. . .the process of the facility does not support this. You have 18 pts, you must get report, vitals, weights, and review books on all before breakfast (which is what 0800 or 0830?). The process sets you up to fail. It is too much to complete it all and follow every step we know we should.

So what happens is that the nurses beat themselves up and try harder and harder to meet the standard they know they should, regardless of if it is possible in the situation as set up.

So wait for your meeting, go in and listen to what they have to say - decide before hand if this is a place you want to stay. If so make an action plan to take in with you detailing what you are going to do to learn from this mistake. Then try your hardest to get the "process" of the place changed - because if it doesn't, odds are that another mistake will be made and it might not have such a neutral outcome.

And if they decide to fire you, hold your head up high and go find a place where you are not subject to such conditions. I am hoping for the best for you.

Pat

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It sounds like the job from hell. The patient suffered no permanent harm and they would be foolish to off a nurse for one medication error.

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