Very concerned

ButterflyRN90, ASN, RN · Aug 29, 2018

True, but my hospital acted like new nurses are the only ones and should be reprimanded harshly. I read of a nurse who killed a pt for giving 10x the dose of digoxin and her punishment was transfer to a different floor. I wish I could ask what made that hospital give the benefit of the doubt to the nurse vs how my pt is alive and home and her nurse (me) was fired. What a load of confusion for me.

Horseshoe, BSN, RN · Aug 29, 2018

True, but my hospital acted like new nurses are the only ones and should be reprimanded harshly. I read of a nurse who killed a pt for giving 10x the dose of digoxin and her punishment was transfer to a different floor. I wish I could ask what made that hospital give the benefit of the doubt to the nurse vs how my pt is alive and home and her nurse (me) was fired. What a load of confusion for me.

Could you please use the quote feature so that we know to which post you are replying?

ButterflyRN90, ASN, RN · Aug 29, 2018

Could you please use the quote feature so that we know to which post you are replying?

It was NormaSaline's reply

Guest219794 · Aug 30, 2018

True, but my hospital acted like new nurses are the only ones and should be reprimanded harshly. I read of a nurse who killed a pt for giving 10x the dose of digoxin and her punishment was transfer to a different floor. I wish I could ask what made that hospital give the benefit of the doubt to the nurse vs how my pt is alive and home and her nurse (me) was fired. What a load of confusion for me.

Honestly, this is not a great argument.

Convincing the hospital that they are mistreating you because you are a new nurse just isn't going to go very far. Even if you tell them that another hospital you heard about didn't fire a nurse even when a patient died. The fact that a patient survived despite your care isn't really all that strong a case.

"I wish I could ask what made that hospital give the benefit of the doubt to the nurse vs how my pt is alive and home and her nurse (me) was fired. What a load of confusion for me."

I am not familiar with the case you mentioned. I did find find Charles Cullen, who apparently had issues with calculating Digoxin, but I don't think he is the best example.

But- let's look at a hypothetical Digoxin overdose, and compare it to your situation:

As you know, Digoxin can be dosed mcg/kg. There are any number of math errors that could lead to a mistake, but the most obvious would be a misplaced decimal point.

.012 is very different from 0.12, and is the reason for nursing rules regarding how certain numbers are expressed. But, a calculator follows mathematical rules, not nursing rules.

Hypothetical nurse Jim made this error at the end of a busy night shift. As the patient was crashing, Jim realized his mistake, and let the Rapid Response team know. Then, Jim stayed late to let his boss know, and ask what the next steps should be. A root cause analysis showed some systemic problems in the unit. For example, there was no mandatory double check on a critical calculation. Jim acknowledged the systemic error, as well as fully accepting personal responsibility. Jim has been there for 4 years, and has consistently positive evaluations. Jim is going to be coming off nights for a while, and will have the day charge nurse as a resource nurse which will both ensure patient safety, and allow him to re-build his confidence.

The error you made showed a fundamental lack of understanding of some basic nursing. You failed to do serial BG checks after a hypoglycemic event with no known cause, and no intervention to prevent recurrence. At the time, your understanding was that a lack of observable mental status changes could reliably rule out a downward trend in BG in a PT who ultimately went to sleep. The fact that this occurred shortly before being allowed to work independently should be extremely concerning. The good fortune that the patient survived this life threatening error has no bearing on the situation that allowed it to occur.

Those are the simple facts as you described them. I am not judging, just laying it out.

This was either a result of poor training, poor retention of information, or some combination of both. Nobody on this forum has any real way to know. Clearly, from your description, there were some real problems with your preceptor and the work environment.

From your perspective, you are a nurse with a good work ethic and strong potential who was put in a lousy learning environment, but would do well in properly structured environment. this would be your strongest case to keep your job, though that gate sounds like it closed.

You are asking for insight as to what might have led to your firing. Please don't take this as criticism- I am explaining it from how management may be viewing things.

It is possible that from their perspective, you are not accepting responsibility for your role and decision making. When they initially shifted you to days, you portrayed the move as being disciplinary rather than educational and safety oriented. Management does not see it this way- they could have fired you outright, but they put you in a safer environment as clearly the one you were in was not working well. You have portrayed yourself as being bullied and victimized (your words) by senior staff and management. Believe me when I tell you, they don't see it that way.

Look at it from their perspective- what do they see? What would their incentive be to continue your employment?

You may well be the victim of an abusive work environment. It certainly happens. Just not as often as perceived victims believe. When you are well away from this situation, and able to look back on it with some objectivity, it would be worth some self examination as to how you reacted, how you were perceived, and the action management ultimately took.

ButterflyRN90, ASN, RN · Aug 30, 2018

Honestly, this is not a great argument.
Convincing the hospital that they are mistreating you because you are a new nurse just isn't going to go very far. Even if you tell them that another hospital you heard about didn't fire a nurse even when a patient died. The fact that a patient survived despite your care isn't really all that strong a case.
"I wish I could ask what made that hospital give the benefit of the doubt to the nurse vs how my pt is alive and home and her nurse (me) was fired. What a load of confusion for me."
I am not familiar with the case you mentioned. I did find find Charles Cullen, who apparently had issues with calculating Digoxin, but I don't think he is the best example.
But- let's look at a hypothetical Digoxin overdose, and compare it to your situation:
As you know, Digoxin can be dosed mcg/kg. There are any number of math errors that could lead to a mistake, but the most obvious would be a misplaced decimal point.
.012 is very different from 0.12, and is the reason for nursing rules regarding how certain numbers are expressed. But, a calculator follows mathematical rules, not nursing rules.
Hypothetical nurse Jim made this error at the end of a busy night shift. As the patient was crashing, Jim realized his mistake, and let the Rapid Response team know. Then, Jim stayed late to let his boss know, and ask what the next steps should be. A root cause analysis showed some systemic problems in the unit. For example, there was no mandatory double check on a critical calculation. Jim acknowledged the systemic error, as well as fully accepting personal responsibility. Jim has been there for 4 years, and has consistently positive evaluations. Jim is going to be coming off nights for a while, and will have the day charge nurse as a resource nurse which will both ensure patient safety, and allow him to re-build his confidence.
The error you made showed a fundamental lack of understanding of some basic nursing. You failed to do serial BG checks after a hypoglycemic event with no known cause, and no intervention to prevent recurrence. At the time, your understanding was that a lack of observable mental status changes could reliably rule out a downward trend in BG in a PT who ultimately went to sleep. The fact that this occurred shortly before being allowed to work independently should be extremely concerning. The good fortune that the patient survived this life threatening error has no bearing on the situation that allowed it to occur.
Those are the simple facts as you described them. I am not judging, just laying it out.
This was either a result of poor training, poor retention of information, or some combination of both. Nobody on this forum has any real way to know. Clearly, from your description, there were some real problems with your preceptor and the work environment.
From your perspective, you are a nurse with a good work ethic and strong potential who was put in a lousy learning environment, but would do well in properly structured environment. this would be your strongest case to keep your job, though that gate sounds like it closed.
You are asking for insight as to what might have led to your firing. Please don't take this as criticism- I am explaining it from how management may be viewing things.
It is possible that from their perspective, you are not accepting responsibility for your role and decision making. When they initially shifted you to days, you portrayed the move as being disciplinary rather than educational and safety oriented. Management does not see it this way- they could have fired you outright, but they put you in a safer environment as clearly the one you were in was not working well. You have portrayed yourself as being bullied and victimized (your words) by senior staff and management. Believe me when I tell you, they don't see it that way.
Look at it from their perspective- what do they see? What would their incentive be to continue your employment?
You may well be the victim of an abusive work environment. It certainly happens. Just not as often as perceived victims believe. When you are well away from this situation, and able to look back on it with some objectivity, it would be worth some self examination as to how you reacted, how you were perceived, and the action management ultimately took.

No offense, but I wasn't really asking for advice on what to write. I already have appointed people assisting me in this. The moment you mentioned that horrid person, Charles Cullen I stopped reading. He was NOT the example. Thanks but no thanks. Have a nice day.

ButterflyRN90, ASN, RN · Aug 30, 2018

I'm going to informally close this topic as it is no longer necessary and I will no longer respond to these comments. Thank you to those who reached out to me with supportive words. I can't thank you enough. Now to fight back. Thanks again!

Horseshoe, BSN, RN · Aug 30, 2018

I'm going to informally close this topic as it is no longer necessary and I will no longer respond to these comments. Thank you to those who reached out to me with supportive words. I can't thank you enough. Now to fight back. Thanks again!

If you would please follow up on the outcome of your appeal, that would be appreciated. Obviously a request and not a command, as you have no obligation to do so.

FeliciaRNCPN · Aug 30, 2018

That was a concern for me. In this appeal process I'm going to write as much as I can about my experience. What comes up as a red flag was that maybe I should've refused to work those 2 last night shifts with my day preceptor because by the last shift it was her 7th shift in a row. HR mentioned my not being safe around patients, however working 7 shifts in a row with an orientee isn't safe at all, especially if the two shifts are not your regular shifts. I had a feeling she was running on autopilot because she gave me the whole team when I was still only supposed to have 3 pts which originally didn't include that pt with the ARDS. She added her on to my load at the last minute. During day shift she'd check the pt MAR to the point it would annoy me how meticulous she'd be. She'd comment how this med was given 15 min late or how could I have given this med with this bp. Yet, I never heard her catch my "error" until shift change. That's how I knew she wasn't on her game, so to speak. I'm the baby nurse and instead she threw me under the bus. I'm going to see if I can at least have the opportunity to complete my orientation on another floor/unit. I shouldn't have been crucified this way. They actually questioned if I was a safe nurse. That was a huge blow. Let's see how this appeal turns out.

I've following this post. It sounds like you are not taking responsibility. In all honestly you were not acting safely. I know from my experience in the hospital setting, when you get fired it is generally because of how you respond to your own mistake rather than just the mistake itself.

Guest219794 · Aug 31, 2018

No offense, but I wasn't really asking for advice on what to write. I already have appointed people assisting me in this. The moment you mentioned that horrid person, Charles Cullen I stopped reading. He was NOT the example. Thanks but no thanks. Have a nice day.

No offense taken. I wasn't giving you advice on what to write. (?) I was answering your question about why you might be treated differently despite the fact that your patient survived your care.

I didn't think you were like Cullen- he is the just one that dominates any search on digoxin overdoses, so I couldn't find the incident you referred to.

But, I bet you did not stop reading, and suspect you read what I wrote about how you present yourself, and your role in the incident. But. I don't think you are at the point you can look at this from another perspective. Do yourself a favor, and save this thread, tuck away for five years, then look at it. Would you want somebody in a hiring position to read it?

But, I am sure you are getting great advice, and will do great in this process.

Best of luck.

RNikkiF · Sep 3, 2018

I'm sorry that you're going through this. As for what do you do now? Learn everything you can from this, even write a little paper for yourself to reinforce the information if you need to. Then, when you have your meeting with your NM, you can point out where things went off track and show what you learned from it. If your preceptor really did yell and glare... that was very unprofessional, but I would leave that alone for now. If it were to occur again, you could make your NM aware that instead of teaching you, your preceptor is yelling at you.

Was your preceptor aware the patient's blood sugar dropped so low? If so, why wasn't she guiding you? You mentioned that the patient refused food and drink and (I don't recall your exact words) had fluid in her lungs and showed swallowing issues... Never, ever give anything by mouth to a patient showing those signs. A call to the MD would have been in order for the blood sugar combined with the signs of swallowing difficulties.

Also, don't hesitate to wake a patient during bedside rounding, especially after a situation such as this.

Bottom line, just learn from it and grow as a nurse. Good luck.

ButterflyRN90, ASN, RN · Sep 22, 2018

Hello all, I just came back to update you all that even though I will not be working on that same floor, my appeal went through and I am eligible for rehire with them! God is good! The Levemir wasn't the deciding factor as much as how I began tanking after I began this preceptor. After their investigation they believed its best for me to have a fresh start in a lower acuity unit within the hospital system. Thank you all for your support as I had gone through this. Now for the next chapter of my life and career to begin! â¤ï¸

DextersDisciple, BSN, RN · Sep 22, 2018

If you keep up with the attitude you have now, you're going to have a really hard time with your new floor too.