Got fired.. Need support

Specialties LTAC

Published

Nurses Month 2024 | Discounts & Freebies AORN Celebrates Nurses Month

It was my first nursing acute care hospital critically Ill patients. I got fired yestarday.. It feels terrible a big hit to my already lack of confidence in nursing.. So after my 2 months orientation.. My second week on my own. A patient was admitted on a critical drip. Later 4 hrs after admission they couldn't find the drip.. That the patient needed to survive. Took them 3 hrs to make up their mind.. Finally they decided to discharge the patient.. At this time I was working on admission process, paper work etc.. I finished half of it.. Still I had to do the assessment in the computer. Since the patient is being discharged. I thought that I didn't have to do it.. It was already late.. I was in the patient room comforting the patient and his wife who was crying.. Then after the ambulance came.. I went home.. I didn't complete the rest of the admission process.. It was almost 10 pm. I worked since 7 am that day. Yesterday I get a phone call from assistant manager. I explained to her the situation.. Then half hr later the hr call me.. They said this was my last warning. Btw i never had any warning.. And she said I'm terminated.. I've been down.. Stressed. Thinking about it.. I wanted to put that position on my resume.. Btw this hospital lacks good management.. Bad review.. High ratios of patients.. Unsafe.. I never felt that I was providing good care.. I was working like a robot.. I was careful to not make med errors... Should I put this on my resume.. Working for 3 months? I don't know if hospitals would hire me.. I have 2 side jobs, school nursing and Homecare.. .. Please give me your input.. My confidence is shot.. I wish they had offered me to resign.. I really appreciate ur help and support.

Too late now, but even if someone is discharged 1 hour after admit, all admit assessments need to be completed because they were still admitted. This is to cover you and the facilities behind. If something happened to this guy that could have been found in an assessment or that would have been noted I. The admit paperwork, it makes it look like you admitted him and did nothing. It sucks and is a seemingly waste of time, but very important.

As for putting it on the resume, I would. You are a new grad and many hiring managers know a lot of new grads don't make it out of orientation for various reasons. When they question about it at interviews, just use the old "it wasn't a good fit" line and move on to how you have grown and desire a different kind of unit with better new grad support.

Dont nt beat yourself up. Not every unit is good and not ever nurse meshes well with each unit. You will find your niche.

Thank you out so much for the kind words. I realized that after it happened. . Lesson learned. I know it will take me sometime to feel better, be confident and get rid of my insecurity.

Up Vote Up Vote ×

Sounds like awful employers

do not list this on your resume unless they say something like "must be up to date", if they do list it in a tiny sentence. I had to do that with my current job (not fired from previous but left very quickly and in my country that could be disastrous) and did not want it to be a focal point. I explained in the interview that I was currently working at prev hospital but only because I had to.

You have two other jobs, this will make your resume look attractive. Also by not listing it the question of why you got fired won't be brought up and you can look good when you start another (if you want) hospital job (because you will go well very quickly). However as I am from a different country maybe there are different expectations. Someone has already stated

many hiring managers know a lot of new grads don't make it out of orientation for various reasons.

Doesn't work this way where I am, you can be reported to the equivalent of BON and loose your license. Not only that we do not have the same type/ length of orientation period.

But yeah I still would NOT list it on your resume.

Up Vote Up Vote ×
Still don't understand......do you mean that the hospital did not have the drug in pharmacy? Why not send out for it? I'm so confused.

They didn't have it in the hospital pharmacy.. So the patient was sent back from the acute hospital he came from.. Since its available there. The reason for them to fire me is because I didn't complete the admission assessment.

Up Vote Up Vote ×
They didn't have it in the hospital pharmacy.. So the patient was sent back from the acute hospital he came from.. Since its available there. The reason for them to fire me is because I didn't complete the admission assessment.

The LTACH failed in a major way by admitting a patient without ensuring they had the medication they needed. But you also need to know that "If you didn't chart it, it didn't happen" always, always applies. Even if you only had a patient for 4 hours, if you don't chart that you assessed and care for them, legally you can't prove that you did. If that patient went downhill on the way back to the hospital, that lack of charting would come back to haunt you.

As for being fired over it, it sounds utterly ridiculous. Maybe someone is worked up over losing their admission due to bad planning around that medication, and they're striking out at anyone they can reach who was involved in the process. Who knows.

Most applications ask if you've ever been terminated. The risk here if you leave this job off your resume is that no one will hire you if they catch you in that lie. There are two jobs I left after a few months for safety reasons and I do not list those on my resume. I do have continuous employment at other places, fortunately, and it hasn't hurt me yet. I think it's a judgment call. If you list that termination you will have to explain it and it may negatively affect your prospects, but if you don't list it and you're caught, you're definitely out of the running.

Up Vote Up Vote ×
Specializes in Med/Surg, LTACH, LTC, Home Health.
They didn't have it in the hospital pharmacy.. So the patient was sent back from the acute hospital he came from.. Since its available there. The reason for them to fire me is because I didn't complete the admission assessment.

Admission assessment??!!!!? Is that the straw or were there other subtle mentionables leading up to the straw? There are a lot of times we don't get a chance to complete the admission assessment depending on the patient condition. In this case, each shift obtains bits and pieces of info until it's completed, as long as it is finished within 24 hours, and that the most important info needed to begin treating the patient is obtained initially.

In your case, if the patient came in and was discharged before it could be completed, then it should have been noted as such, since it was imperative that the patient get out and get to critical treatment.

Up Vote Up Vote ×
Specializes in Reproductive & Public Health.

Wow, I cannot believe they accepted the transfer without ensuring they had the necessary medications in house. That is really bad. Clearly you should have done an admission assessment, but also-did you get report from the transferring nurse directly? Was it not communicated to you that the patient needed the specific drug in question? Because with a critical issue, I will make sure I am ready to jump on that patient as soon as they walk through the door. I don't wait for them to show up before getting supplies, speaking to pharm to get a med that's not on the floor, pulling in equipment etc.

Did the patient not need the drip during the transfer? I have never worked outside OBGYN and know zero about the clinical situation you are describing, but whenever I have had to transfer a patient, they left with any needed infusions in place. I mean geez. We don't even d/c the NS.

ETA- it just occurred to me that they probably did have the line running, and you guys just didn't have the med to continue it. I was imagining this poor guy who needs a supposedly critical med, sitting around for 4 hours while management tries to figure it out! Still, I think my point stands.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

If a patient goes from a hospital to an LTACH, is it a transfer or a discharge if they go back to the hospital from the LTACH? Just wondering, for my own knowledge. I've only worked ED. :)

Up Vote Up Vote ×
Specializes in ICU, LTACH, Internal Medicine.

OK, I got it finally.

So, the patient was on a life-supporting drug not carried by pharmacy. It was not "critical" in the sense of Levophed or dobutamine, but still infusion must not be interrupted. If we speak about PH, these folks can be walkie-talkie as long as the Flolan, or Remodulin, or Veletri, and oxygen are flowing into them. After recognizing the fact that the unit has no resources for the patient, the common logic finally prevailed and the guy was sent whence he came from and where the drug was available. The OP did not complete assessment and the paperwork because she felt like the admission did not actually happened while it did, as well as the transfer ( how exactly to name it, depends on local policies: in my place, since we're "acute" and have "host hospital", everybody is got to be "preliminary admitted" in LTACH as well as in "host facility" and all future moves are considered to be "transfers". It can be different in free - standing LTACH). Even if nothing happened with the patient after all, the LTACH lost good chunk of muneys on admission and the Powers got all pissed off.

My conclusion (and I am in "acute"LTACH too):

1). there is at least one more person who should rightfully be fired. It is clinical/admission coordinator or whoever who authorized the admission before turning his or her brains on.

2). Lesson for the OP #1: the patient is your priority. During the three hours he was on floor (ok, in life it would be more like than 1 1/2 hours) there was time for at least one full assessment and couple sets of vitals, to prove that the guy left the floor in the same status he came there. The second priority is paperwork. Crying wives, etc. come as distant third ones.

3). IMH (umble)O, the OP was left with the patient and situation she had little idea of how to manage with no support and was promptly trown under the bus when someone was asked the first-line question of "what exactly happened while he was there, and how much can we charge for that?"

The OP firing could or could not be justified accounting for what eventually happened with the patient, although lack of any evidence of nursing assessment for 3 hours doesn't look good in any case. Should it happened with me, I would get on the any available higher-up neck and stay there till I got direct instructions of what to do and I would write a "War and Peace" size nursing note. The OP's former unit, on the other hand, well deserves wide publicity as unsafe place concerned only about $$$.

To put this employment "experience" on paper or not, is a question. Yes, all places of former employment can be found out if there is enough digging done but the digs cost time, effort and money. Providing the fact that the OP had two more jobs lined up, I would not mention it and attempt to apply for acute care within next year or so, but obviously not in another LTACH, and not in that particular LTACH's "host facility".

Up Vote Up Vote ×
Specializes in Med/Surg, LTACH, LTC, Home Health.
The LTACH failed in a major way by admitting a patient without ensuring they had the medication they needed. But you also need to know that "If you didn't chart it, it didn't happen" always, always applies. Even if you only had a patient for 4 hours, if you don't chart that you assessed and care for them, legally you can't prove that you did. If that patient went downhill on the way back to the hospital, that lack of charting would come back to haunt you.

>>>>>> As for being fired over it, it sounds utterly ridiculous. Maybe someone is worked up over losing their admission due to bad planning around that medication, and they're striking out at anyone they can reach who was involved in the process. Who knows.

Most applications ask if you've ever been terminated. The risk here if you leave this job off your resume is that no one will hire you if they catch you in that lie. There are two jobs I left after a few months for safety reasons and I do not list those on my resume. I do have continuous employment at other places, fortunately, and it hasn't hurt me yet. I think it's a judgment call. If you list that termination you will have to explain it and it may negatively affect your prospects, but if you don't list it and you're caught, you're definitely out of the running.

^^^^^^^^!!!!!!!!

Up Vote Up Vote ×

I would say this admission was a failed admission.

1. The patient was not critical but needed a critical Med.

2. As admitting nurse, I would have reviewed the paperwork to ensure the medication was in stock. Reviewed the policy for this medication. You should have had the patient referral prior to the patient presenting to your floor.

3. Where was the admitting physician, once you realized this was not a viable plan the patient needed to go back ASAP.

4.where was nursing management, did you call them?

It sounds like you are better off not being in that place, as others have stated it is unsafe. You seem to be unaware of the bad situation and the need for Documentaion, what is going to come down, is that you did not assess your patient and left them is an unsafe situation, you should have stayed until the events where all documented

Up Vote Up Vote ×
Wow, I cannot believe they accepted the transfer without ensuring they had the necessary medications in house. That is really bad. Clearly you should have done an admission assessment, but also-did you get report from the transferring nurse directly? Was it not communicated to you that the patient needed the specific drug in question? Because with a critical issue, I will make sure I am ready to jump on that patient as soon as they walk through the door. I don't wait for them to show up before getting supplies, speaking to pharm to get a med that's not on the floor, pulling in equipment etc.

Did the patient not need the drip during the transfer? I have never worked outside OBGYN and know zero about the clinical situation you are describing, but whenever I have had to transfer a patient, they left with any needed infusions in place. I mean geez. We don't even d/c the NS.

ETA- it just occurred to me that they probably did have the line running, and you guys just didn't have the med to continue it. I was imagining this poor guy who needs a supposedly critical med, sitting around for 4 hours while management tries to figure it out! Still, I think my point stands.

It was the hospitals fault admitting the patient without ensuring that the med is available in their pharmacy.. Throughout the time I was with the patients family the wife was crying, and I was near her comforting her and assuring her that all will be ok.. And that they will figure it out. There was lots of delinquency with the hospital.. I think they tried to borrow it from nearby hospital.. The piggyback drip that he's on is very expensive and new drug. Until the patient finally was ready to be discharged.. I left the hospital.. Thinking that I didn't have to complete the admission since he's going bk to the hospital that he came from..

It was my second week off orientation.. Still on probationary period. I'm sure what pissess them off is that they wanted to send the admission assessment to the insurance company.. And they didn't see it done.. Maybe lost profit..

Thank you so much for the response.. I know it will take me long time to gain back some confidence. Until then I will stay off hospitals.. And fast paced stressful jobs.. Until I slowly feel that I'm capable.. I'm still struggling with building self confidence and feel secured in a position. I know it will take some time

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Throughout the time I was with the patients family the wife was crying, and I was near her comforting her and assuring her that all will be ok..
First of all, I am so very sorry your employment was terminated.

Here's a tough lesson: administration, management, and the powers that be don't give a rat's booty about whether you soothed your patient's fears or comforted the family in their time of emotional need.

They care about the paperwork and accurate documentation of billable procedures that will generate revenue. They care about the quality and completeness of your charting because this is what keeps the facility out of legal turmoil in the event of a bad patient outcome. They care about preventing litigation because it is costly enough to cut into the profit margin.

Healthcare is a business first and foremost. Hand-holding and comforting is always secondary. I know I sound like an unfeeling Nurse Ratchett, but you do not have the luxury of soothing tearful people's anxieties until the 'T' letters are crossed and the 'I' letters are dotted on your admission packet and paperwork. This is the cold reality of the healthcare sector.

Good luck to you!

Up Vote Up Vote ×
+ Add a Comment