Got fired.. Need support

[uniqueguy34]

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.

[uniqueguy34, BSN, MSN]

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

The patient was admitted at 1 pm. To the hospital.. But came down to my floor at 5 pm. They shouldve verified whether they can obtain the drip or not way before it almost ran out and the patient was at risk of dying.

Whether they can obtain the drip or not.. It was out of my hand.. During the process when they were making their phone calls ( attempting to keep him for profit.. While they're not sure if they can obtain the drip) the family was in an angry upset position.. And I was there next to them in the room. I put everything aside to make sure they're ok. I even brought the wife juice.. She was thanking me for staying..

9 30 pm. I am very exhausted.. Burned out. After a long day.. I asked 2 nurses if I have to complete the rest of rhe admission.. They said no. So I went home. Had I known that I was supposed to do it.. I would never have left it. I'm not upset leaving this miserable hospital with poor management. Where people just work for the experience.. But what upset me is that it's a big blow to my confidence and belief in oneself.. I know time will heal all wounds.. It will take some time for sure.. In the meantime. I will be working in schools as a sub nurse to clear my mind.. I will also be doing Homecare..

Thank you so much for the message and support

[madricka, BSN, RN]

Aside from not being able to bill for services, as with everything in nursing -- if you didn't document it, it didn't happen. Not having assessment documentation on a patient admitted (even briefly) to a facility for several hours in a "critical" state sets them up for liability. Nursing notes are a legal document and are your priority after stabilizing the patient. This calls into question your professionalism and looks like you did nothing with the patient for several hours while under your care. Obviously you did care for him but on paper, you did nothing. This is bad for you and bad for the facility.

That being said, your situation sucks and I feel terrible for you. Being new and right off orientation, this whole thing was a mess from the moment someone decided it was ok to transfer the patient to your facility. They are disorganized at the least, negligent at the worst. And instead of owning that, they threw you under the bus because you're new and your documentation wasn't there (which gave them an excuse). Normally this would just be a remediation issue, not a termination. I'm very sorry you lost your job over this.

As for moving on, take some deep breaths and know that your nursing career will go on! Learn from this -- how you could have handled the situation differently, looking back on it -- and trust that you will absolutely be ok. Ultimately, the patient is ok, no one was hurt. It was a clerical mess, nothing more. These things happen. And if your employers were that scattered/disorganized and so quick to throw you under the bus -- move on! You want to work for someone who has your back, who will help you develop into a stronger nurse, and who is overall a more professional organization.

The others have listed some great suggestions for how to handle the "fired" part. I think it's ok to list it on your resume, you put the work in, it should count -- even if it ended badly. It doesn't mean the time you were there was bad. People lose jobs all the time, it doesn't mean you're a bad person or a bad nurse.

One thing to NEVER do -- if you are asked by a potential employer what happened or why you were let go, do not badmouth your former employer or blame them for what happened. Own your mistakes, talk about what you learned from the experience, explain that you were still learning and look forward to growing as a nurse in the future. Always positively reframe things -- this will help you psychologically and demonstrate your maturity and ability to handle pitfalls in life. If the new facility has a lot of in-services or educational opportunities, let them know this interests you. It shows you are eager to learn and develop your skills. Always a plus!

Getting fired sucks for sure. Take some time to let the bruises heal then shake the dust off, put your chin up, and get back at it.

[uniqueguy34, BSN, MSN]

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".

Thank you so much for the long supporting reply. I really appreciate it.. The patient was remodulin. And the ltach didn't have supply. It was the fault of the person who coordinated the transfer. How could they not verify availability of the med before transferring the patient.. The patient lost trust with the hospital and refused to stay even if they obtain the med.

I regret not quitting because I've always felt this hospital lacks good management and it was profit based..

I'm sure what pissed them off is that maybe me not completing the admission process made it difficult for them to show proof to insurance.. And since I'm. On probationary period. I'm considered a number.. Not much of a contributor yet.. And that make me more upset

I'm thinking that I will not go back to hospitals until I feel safe to practice where I can provide good care for patients.. I feel that I cannot practice good nursing with profit based healthcare systems.. .. Thank u again for understanding me..

[purplegal]

Sorry to hear about your experience. It never feels good to hear that you will no longer be working for someone.

It sounds like a bad case all around, admitting a patient without a medication they need. It almost reminds me of my own workplace, where most of the admits come in without their meds initially. But, the difference is we can usually find the med in our "emergency" kit and our meds do arrive on the same day.

It does seem over the top to fire you solely over not completing an assessment, especially when you were told by other coworkers that it wasn't necessary to complete it. At the same time, you did start it, so I am not sure why you wouldn't complete it. Also, documentation is always important, no matter how long the patient is with you. You always want to be able to back up whatever care you gave for the patient. Also, leaving with uncompleted documentation just because it is late and you have worked a long day, isn't really a good excuse. Staying longer than planned for shifts is a part of nursing. If needed, you should have found a private area where you could have completed your assessment without other distractions.

As for listing this job on your resume, I probably wouldn't. You were only there for two months, and didn't leave on good terms. You were barely off orientation. When I left my first nursing job after 3 months and not finishing orientation, I left it off my resume. Plus, you have two other jobs you can list on your resume. Plus, if this hospital doesn't have a good reputation and is known for safety issues, it may not benefit to list it anyway.

[KatieMI, BSN, MSN, RN]

I feel that I cannot practice good nursing with profit based healthcare systems.. .. Thank u again for understanding me..

The thing is, ALL healthcare systems in EVERY developed country in the world were, are and will be profit based. Whatever they say, they are first and foremost profit-based. It's reality. Unless you go to do Nurses Without Borders or some missionary work, it will be profit-based.

The situation you got into is, in fact, extremely common and will be even more so in the nearest future. No provider, and no unit is equally equipped to care for every pathology you know. So, where 85 y/o, full code, on heparin and cardizem drips, deeply demented, spry and aggressive, on weekly chemo for breast cancer should go if she fell, got compressive spinal fracture and got into Afib/RVR after that? (update: it took 24 hours of transferring her back and forth between ortho, cardio and onco floors before she ended up in LTACH and did just fine there;)).

The number of patients like the above is high and will get higher. Only one thing we as nurses can do is to provide the best care we're able to, constantly educate themselves and, sorry, document as if our lives depend on it (and you see now that they really do). Do not be afraid of complexity - tomorrow, you can get the very same guy on Remodulin for home care. What you would do then? Right, get someone or something to give you lesson in PPH management, 101, then smile and walk there with confidence.

[uniqueguy34, BSN, MSN]

Aside from not being able to bill for services, as with everything in nursing -- if you didn't document it, it didn't happen. Not having assessment documentation on a patient admitted (even briefly) to a facility for several hours in a "critical" state sets them up for liability. Nursing notes are a legal document and are your priority after stabilizing the patient. This calls into question your professionalism and looks like you did nothing with the patient for several hours while under your care. Obviously you did care for him but on paper, you did nothing. This is bad for you and bad for the facility.

That being said, your situation sucks and I feel terrible for you. Being new and right off orientation, this whole thing was a mess from the moment someone decided it was ok to transfer the patient to your facility. They are disorganized at the least, negligent at the worst. And instead of owning that, they threw you under the bus because you're new and your documentation wasn't there (which gave them an excuse). Normally this would just be a remediation issue, not a termination. I'm very sorry you lost your job over this.

As for moving on, take some deep breaths and know that your nursing career will go on! Learn from this -- how you could have handled the situation differently, looking back on it -- and trust that you will absolutely be ok. Ultimately, the patient is ok, no one was hurt. It was a clerical mess, nothing more. These things happen. And if your employers were that scattered/disorganized and so quick to throw you under the bus -- move on! You want to work for someone who has your back, who will help you develop into a stronger nurse, and who is overall a more professional organization.

The others have listed some great suggestions for how to handle the "fired" part. I think it's ok to list it on your resume, you put the work in, it should count -- even if it ended badly. It doesn't mean the time you were there was bad. People lose jobs all the time, it doesn't mean you're a bad person or a bad nurse.

One thing to NEVER do -- if you are asked by a potential employer what happened or why you were let go, do not badmouth your former employer or blame them for what happened. Own your mistakes, talk about what you learned from the experience, explain that you were still learning and look forward to growing as a nurse in the future. Always positively reframe things -- this will help you psychologically and demonstrate your maturity and ability to handle pitfalls in life. If the new facility has a lot of in-services or educational opportunities, let them know this interests you. It shows you are eager to learn and develop your skills. Always a plus!

Getting fired sucks for sure. Take some time to let the bruises heal then shake the dust off, put your chin up, and get back at it.

Thank very much h for the reply.. I really appreciate it so much. I do admit I made the mistake.. Thankfully it wasn't involving the patient. And there was no harm done.. But at this point I feel that I cannot work in such facilities where I feel there is a risk of being fired and making mistakes all the time because it's very hectic and all they care about is profit.. I'm going to carefully rethink my upcoming options..

[caliotter3]

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!

ITA. The time you spent with the patient's wife should have been spent on completing and documenting the assessment. In other words, you should have been attending to your patient, not a third party who was not in the room to receive treatment from the facility.

Regardless, your management did a poor job of handling this situation, to include your participation. Your immediate supervisor should have followed up with you before you left. They bear some responsibility here as well.

[LoveRNBSN]

Don't beat yourself over it. You'll find a unit that's a good fit for you. Learn from this bad experience and allow this learning process to make you a better nurse.

[uniqueguy34, BSN, MSN]

bravo to the rest of you, I didn't make it past the first few run on sentences. hope her documentation wasn't like that.

Not nice to say that.. Judging me when I was in mental breakdown writing it from my mobile phone.. Thanks for the "support"

[Horseshoe, BSN, RN]

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.

I personally don't tell families that "all will be ok." We don't ever know that to be the case. I think there are ways of comforting families that don't involve making guarantees about the future. JMO

[uniqueguy34, BSN, MSN]

Don't beat yourself over it. You'll find a unit that's a good fit for you. Learn from this bad experience and allow this learning process to make you a better nurse.

Thank you so much.. I consider this reply to be very supportive.. Very sweet of u.. Eventually that's what I will do. It will just take some time.. Not easy to heal lack of confidence in oneself.. And just becoming the person who is secure and feel that they won't be fired.. It will be at least 2 weeks for my stress to be relieved.. I appreciate all supportive people on here

[uniqueguy34, BSN, MSN]

ITA. The time you spent with the patient's wife should have been spent on completing and documenting the assessment. In other words, you should have been attending to your patient, not a third party who was not in the room to receive treatment from the facility.

Regardless, your management did a poor job of handling this situation, to include your participation. Your immediate supervisor should have followed up with you before you left. They bear some responsibility here as well.

Thank you.. You are absolutely correct.. And seem to understand where I come from. It took them few hrs to figure things out.. And it was already end of shift. I endorsed the patient to the night nurse and stayed at his bedside.. The wife was there. I felt that was a priority. I feel that as you said. Since its my second week on my own after orientation.. They shouldve directed me Better. Imagine it's my second admission I barely know what to do.. And I was asking different people on what forms to fill out.. I do feel the guilt as well.. I feel that it's part of the past.. We make mistakes to make us grow.. I'm sure I will overcome it.. Thank you so much for the support