Got fired from a contract; should I take their reason seriously?

[allthesmallthings]

Hi.

Today, at 530pm, my recruiter called, said that the home health company I work for was terminating my contract because of "multiple Pt complaints...poor bedside manner."

I'm about 2/3 of the way through 13-week contract. This is the first I've heard of Pts complaining about me..

(Although I did have two patients in the last week who seemed unhappy. One was a lady who was unhappy that I asked to see her mom's pill bottles, and then when I pointed out that the hospital wanted her mom to stop one med, amantadine. But that lady seemed unhappy about a lot - she kept complaining about former healthcare workers, and seemed suspicious - "you must want to see my mom's meds because you nurses don't communicate." And then a Pt today, who told me to discharge him because "you home health people don't get to know me. None of you nurses have asked me to walk around so you can see my dyspnea on exertion." This was despite the fact that I'd educated him on COPD. At the end of the visit, he walked me out, said, "Thank you. You have terrible bedside. Goodbye." I was surprised, because I'm pretty sure that I've spent more time with him than any other nurse, sorting out his meds, calling his MDs, trying to keep him out of hospital, and the prior visit, he thanked me. So I kind of just chalked up today's visit to the Pt having some mental weirdness.)

But...I've worked in home health for 4 or 5 years (about 3 years in travel). I've never been fired from these jobs (staff, or travel). I suspect that a  few patients have asked not to have me again, but I don't remember a boss ever giving me feedback about Pt complaints in all those years.

If I have terrible bedside manner, wouldn't that have popped up, some time in the last 4 or 5 years?

I kind of wonder if it was just those two kind of strange Pts who complained about me to the client company. Plus, I know that one of the staff nurses has told me for a few weeks now that the office has trouble finding her enough Pts. Is it possible that the client company didn't really need a travel nurse (me) anymore, and used those two patient complaints to can me?

I've been a nurse for 15 years, and sure, in the first few years (say, 2013), my boss told me that some patients called me "robotic." I had a concussion when I was seven (I'm 40 now), and this evening, when I was talking over the firing with my sister, she said, "Your affect changed after that 1992 concussion. Before then, you were happy and smiling. After the concussion, you got more serious. I think some people take you the wrong way - like, you maybe come off as blunt or abrasive to them. You need to smile more, make jokes, make people think you enjoy spending time with them."

I am process-oriented and detail-oriented. I'll get very into doing a thing correctly (sterile technique, woundcare, medication reconciliation, calling MDs). And I like being efficient (although I will spend plenty of time when the situation warrants). But...before I got fired this evening, I didn't get the feeling that my patients didn't like me. At the end of the visit, they walk me to the door, smiling, saying, "Have a good day."

Has anyone else had a "blindness" to the fact that they have a possibly bad bedside manner? If so, how do I fix it?

Is there any effective way for me to ask the client company for feedback?

Thanks.

 

[NedRN]

Not a clinical complaint so not an immediate danger to your career. If your agency gets similar feedback, or already has from prior contracts, they could decline to use you again, but that is the worst that can happen. There are hundreds of agencies, just move on. Try to put this completely out of your mind. Easier said than done, but you really don't want to be thinking of this daily for years. It would be healthy to reflect on your patient interaction skills and see if you can identify any improvements, but otherwise attempt to put this behind you.

I will sound like a broken record for those who have followed my past posts, but taking charge of your career will make it much easier to move on to another agency. You (and all travelers) should maintain a professional portfolio. Besides basics like health documents and a work history, the really important part is a collection of written references, Agencies collect these from each assignment but seldom share as this makes agency switching rather easy, which is not in an agency's business interests. Instead collect your own written references from every assignment you are on. Go up as high on the facility food chain as you can, start after two weeks on a job (for protection against an actual clinical complain), and get several. I personally try for at least 3 from every assignment. Now instead of providing a telephone number for references and being dependent on what a random person says to your recruiter on the phone (it is often hard to find the person who agreed to act as a reference), you have the content under your control. Pick the references that are well written and reflect your skills and abilities.

PanTravelers has a very easy one page form reference that will just take a couple minutes (or less) to fill out that you can present in person on the assignment. Have them check a few boxes and ask them to write at least one sentence and you will have a valuable asset for the rest of your career. Sign up with PanTravelers, choose the free tier, and go to Resources>Downloads.

[allthesmallthings]

NedRN said:

Not a clinical complaint so not an immediate danger to your career. If your agency gets similar feedback, or already has from prior contracts, they could decline to use you again, but that is the worst that can happen. There are hundreds of agencies, just move on. Try to put this completely out of your mind. Easier said than done, but you really don't want to be thinking of this daily for years. It would be healthy to reflect on your patient interaction skills and see if you can identify any improvements, but otherwise attempt to put this behind you.

I will sound like a broken record for those who have followed my past posts, but taking charge of your career will make it much easier to move on to another agency. You (and all travelers) should maintain a professional portfolio. Besides basics like health documents and a work history, the really important part is a collection of written references, Agencies collect these from each assignment but seldom share as this makes agency switching rather easy, which is not in an agency's business interests. Instead collect your own written references from every assignment you are on. Go up as high on the facility food chain as you can, start after two weeks on a job (for protection against an actual clinical complain), and get several. I personally try for at least 3 from every assignment. Now instead of providing a telephone number for references and being dependent on what a random person says to your recruiter on the phone (it is often hard to find the person who agreed to act as a reference), you have the content under your control. Pick the references that are well written and reflect your skills and abilities.

PanTravelers has a very easy one page form reference that will just take a couple minutes (or less) to fill out that you can present in person on the assignment. Have them check a few boxes and ask them to write at least one sentence and you will have a valuable asset for the rest of your career. Sign up with PanTravelers, choose the free tier, and go to Resources>Downloads.

Wow.  You really know what you're talking about!  Ty.

 

I took your advice on improving Pt skills by checking out Dale Carnegie's "How to Win Friends and Influence People (in the Digital Age)" from the library.    I'm checking out PanTravelers, too.  

[Listening Ear]

First off.....I empathize with you!

I work alongside the medical community and I am often side-by-side with homecare nurses. What I think is the problem is two fold. What I've noticed is that the younger and newer nurses/medical staff truly are not equipped with the same foresight, social ability, logic or proper bedside manner that was once ingrained and expected from nurses back in the day.

What's happening is that the older nurses are retiring right along with the work ethic. Today's new nurses are not empathetic and yes, their bedside manner can be daunting and insincere and I think this is why your patients are weary and suspicious and apprehensive because they've probably dealt with their fair share of incompetent and neglectful "new era" nurses and medical staff.

 

Unfortunately majority rules....and that's unfortunate!

[DolceVita, ADN, BSN, RN]

My observation is every nurse has their moments at "bedside". Before this, you, yourself detected that some patients may have been unhappy in the past. Now you have  external supporting data. As someone who has had feedback like this is the past, listen and act on it. 
I am culturally more formal in my dealings with patients than American nurses. I am also older and probably a bit more serious and thorough in my interactions. It is possible I might be on the spectrum.  Also, I have an issue with my spine which makes my body language look stiff which I think people pick up on.  These things have bit me in the bum with patients and colleagues.   Not a lot but enough that it has been professionally painful occasionally.
There is a reasonable difference in the experience a patient will have  between me and a mid-twenties or even mid thirties nurse. 
I have had to slow down and pay much more attention to non-verbals. Patients don't give verbal feedback on the spot but their nonverbals can scream. If I think a patient is annoyed, they are, and I try to deal with it at the time. I'll also apologize unreservedly if necessary. 
When you go into a room (or patient's house) spend a moment or two being cordial (“is that a picture of your family"? "Where was it taken”). Try to see and be interested in the person as a person and not a patient. Don't call them "dear", "hun", "bud" etc. because these are reductive, depersonalizing  and offensive  to some. Know their name before you enter and ask permission to call them by their first name.  Review what you are required to do during your visit and ask if that's OK. They may decline some care, want to do it in a different order or want something else completely. Educate gently and document. Patients get extremely annoyed if they think you're going to blast through a checklist or they feel rushed. In home health I know that time management can be challenging. 

I've even taken to reading a couple of junky, gossip type magazines, knowing how the local American Football team is doing etc so I can have some small talk with patients. 

I'm not going to tell you to smile more or any of that BS. But know that every patient, even ones with mental health issues, know if we have their best interests at heart. When we are in their homes or in hospital they are vulnerable and need control. So it is a constant negotiation. Some say "do what you like" others feel insulted over a review of their pill boxes. 
The fact that you're asking about this and not dismissing it shows real courage. We have to constantly change and grow as nurses and the most important assessment we do is our self-assessment. 
Good luck!

 

[Ruth E. Raleigh]

I have had approximately 30 years of experience in doing home health/hospice nursing care.  In 2016 I had 2 contracts for the same large HMO company here in California.  I was at 2 different locations.  In California, employment is at will.  At both locations, my contract was terminated suddenly and without warning.  With the last position, that particular director was a very strange and foreboding person.  She called me in and told me that she had had a physician complaint and told me that I had not properly assessed this physician's patient.  I knew it was baloney and for whatever reason she wanted to get rid of me.  When I let a couple of the people who worked there know, they told me that I was awesome and that they couldn't see why this happened.  No could I.  I chalked it up to experience.  I since then finally found my niche again at another home health agency where I am in demand not only for my skills but for my bedside manner.  After the second termination of a contract through the same health care entity, I decided it was the company and NOT me.  Hold your head high.  There are definitely better things that await you.  BTW, I stopped doing contract nursing as after this second experience, I realized that these companies that have contract employees are just too darned difficult to work for.  Best to you.

[allthesmallthings]

DolceVita said:

My observation is every nurse has their moments at "bedside". Before this, you, yourself detected that some patients may have been unhappy in the past. Now you have  external supporting data. As someone who has had feedback like this is the past, listen and act on it. 
I am culturally more formal in my dealings with patients than American nurses. I am also older and probably a bit more serious and thorough in my interactions. It is possible I might be on the spectrum.  Also, I have an issue with my spine which makes my body language look stiff which I think people pick up on.  These things have bit me in the bum with patients and colleagues.   Not a lot but enough that it has been professionally painful occasionally.
There is a reasonable difference in the experience a patient will have  between me and a mid-twenties or even mid thirties nurse. 
I have had to slow down and pay much more attention to non-verbals. Patients don't give verbal feedback on the spot but their nonverbals can scream. If I think a patient is annoyed, they are, and I try to deal with it at the time. I'll also apologize unreservedly if necessary. 
When you go into a room (or patient's house) spend a moment or two being cordial (“is that a picture of your family"? "Where was it taken”). Try to see and be interested in the person as a person and not a patient. Don't call them "dear", "hun", "bud" etc. because these are reductive, depersonalizing  and offensive  to some. Know their name before you enter and ask permission to call them by their first name.  Review what you are required to do during your visit and ask if that's OK. They may decline some care, want to do it in a different order or want something else completely. Educate gently and document. Patients get extremely annoyed if they think you're going to blast through a checklist or they feel rushed. In home health I know that time management can be challenging. 

I've even taken to reading a couple of junky, gossip type magazines, knowing how the local American Football team is doing etc so I can have some small talk with patients. 

I'm not going to tell you to smile more or any of that BS. But know that every patient, even ones with mental health issues, know if we have their best interests at heart. When we are in their homes or in hospital they are vulnerable and need control. So it is a constant negotiation. Some say "do what you like" others feel insulted over a review of their pill boxes. 
The fact that you're asking about this and not dismissing it shows real courage. We have to constantly change and grow as nurses and the most important assessment we do is our self-assessment. 
Good luck!

 

I literally just copy-pasted your post and put it into a word document.   Your post is very helpful to me.  It didn't tell me 100% what I WANTED to hear, but it probably told me a lot of what I needed to hear.   And I think my future patients will be grateful to you, too!  🙂 

Thanks!

[allthesmallthings]

Ruth E. Raleigh said:

I have had approximately 30 years of experience in doing home health/hospice nursing care.  In 2016 I had 2 contracts for the same large HMO company here in California.  I was at 2 different locations.  In California, employment is at will.  At both locations, my contract was terminated suddenly and without warning.  With the last position, that particular director was a very strange and foreboding person.  She called me in and told me that she had had a physician complaint and told me that I had not properly assessed this physician's patient.  I knew it was baloney and for whatever reason she wanted to get rid of me.  When I let a couple of the people who worked there know, they told me that I was awesome and that they couldn't see why this happened.  No could I.  I chalked it up to experience.  I since then finally found my niche again at another home health agency where I am in demand not only for my skills but for my bedside manner.  After the second termination of a contract through the same health care entity, I decided it was the company and NOT me.  Hold your head high.  There are definitely better things that await you.  BTW, I stopped doing contract nursing as after this second experience, I realized that these companies that have contract employees are just too darned difficult to work for.  Best to you.

Thanks!    I'm glad things worked out for you.  Yeah, I'm flirting with the idea of going back to a staff position where I'll have some more rights and ability to speak up for myself.   And the opportunity to get two-way feedback from my managers on what I can improve on.   

[NedRN]

allthesmallthings said:

In California, employment is at will. 

Not if you have a good contract. However, most contracts favor and protect the agency (their lawyer wrote it) so travelers may be fired without cause. A decent contract requires termination only for just cause. And a good agency will protect the traveler. A bad hospital or agency may make up a "just cause" - so even with a fair contract you can be terminated and believe me, it is not worth fighting. Generally filing a legal claim is more about emotions than money.

I did file suit against a major hospital who terminated me for not having a permanent license in DC. In fact I held a temp license signed by the very director who fired me (they do things very differently there from most state boards). I won (and even collected), but no, it wasn't worth it. Those of you who know TravelTax, perhaps the most famous guy doing traveler tax returns (he also serves in an advisory position for the association who represents agencies), has a similar winning a lawsuit story from when he was a travel RT before getting his accounting degrees. But these stories are rare because travelers seldom win. Too hard to file suit and carry through with it. As an aside, typically allied health and advanced practitioners have better contracts than travel nurses.

[Ruth E. Raleigh]

What was interesting to note is that for each location, I was placed by a different nursing agency.  In both instances when I called the agency to let them know that I was called in, both agencies who were not at all linked, told me that they never got a complaint about me.  Both placement counselors were shocked.  I didn't fight it because the particular HMO outfit was very difficult to work for.

[NedRN]

Ruth E. Raleigh said:

In both instances when I called the agency to let them know that I was called in, both agencies who were not at all linked, told me that they never got a complaint about me.  Both placement counselors were shocked.  I didn't fight it because the particular HMO outfit was very difficult to work for.

One out of ten travel contracts fail to complete. This is an industry aggregate number and some agencies do better, and some do worse. Same thing on the traveler side, I've met some who have such good people skills that in 20 plus years of travel they have completed every assignment. Now me, in 30 years of travel, I'm right there at being terminated one out of ten assignments, and I'd place the blame square on my strong personality (pretty much you need one to work in CVOR). I've never been fired for cause and my evaluations have always been great (remember what I said earlier about getting references early?).

So I have some great war stories and each one would result in "you were terminated for that" by readers! But I have one similar to yours and was inspired to share. Arrived at one assignment, and everyone loved me but one fellow traveler. I was completely unaware that she was gossiping and complaining about me just because. Had a meeting with the manager and charge nurse where silly allegations were aired. They were well satisfied with my answers, and everyone (perhaps other than this other traveler) were happy with the air cleared. A week later, I got a call from my agency (which was owned by me) that HR called them with the same issues and requested termination. HR never asked for my side. Turns out that my termination was a surprise to the manager and charge nurse! I didn't fight it, but I likely could have worked a few more days before HR found out I hadn't left. And yes, I have good references from even this hospital, but I'm not going to put a terminated contract on my work history.

[allthesmallthings]

I'm filing for unemployment insurance.  Like a couple people here have said, it's about emotions, not about money.  (If I get UI, then the max they will pay is about 22% of my salary.)   

But I feel that it's what I can do, to stand up for myself.  Best-case scenario, the client doesn't fight it, or can't prove that they fired me for a good reason.  Worst-case scenario, I get the new experience of filing for UI (which I've never done before). 

I do want the client to get maybe just one notification that I didn't just let them treat me unfairly, and maybe they have 5 minutes of their day disrupted by answering an email/phone call from the Department of Labor.  Not a very Christian attitude, but I'm going with it.   

Anyway, maybe just that five minutes of disruption in their day will make them think twice about their termination process, for the next travel nurse that they hire.