Got fired.. Need support

NotAllWhoWandeRN, ASN, RN · Aug 15, 2016

Can I just say, we don't discharge with patients on critical drips? We don't transfer from icu to the floor with a patient on a critical drip much less to long term care. There's more to this.
OP, you left without completing your work because you felt it was late. Guess, what? I'm fairly new. I stay late many, many nights to finish my charting.
You were wrong. Nobody else can complete your assessment. Nobody. Admit that this wasn't the right job, and move on. Your charting is vitally important. Vitally. This isn't most jobs where you get to call it a day at 6 and leave. Sorry.

OP worked LTAC, not LTC. Having worked LTAC I can see someone coming in on a drip (yes, we took people directly from ICU on occasion) and I can picture an admission being handled that poorly and none of the experienced staff providing guidance. I agree that the facility played a major role in that event and that termination was unjust.

But I also hope that OP has absorbed that a nurse is obligated to know some things based on our education and critical thinking skills, and must be able to complete legally expected documentation to protect their own license. You are responsible for proving what condition the patient was in when they came to you, and what you did (or were not able to do, e.g. procure further medication and the effort you went through to do get it) for them while they were under your care.

Take a minute to feel sorry for yourself, then dust yourself off, LEARN from this experience, and move on. If/when you are ready to return to acute care, make sure you will get a good orientation, and think about what you are doing and why, every step of the way.

Here.I.Stand, BSN, RN · Aug 15, 2016

Can I just say, we don't discharge with patients on critical drips? We don't transfer from icu to the floor with a patient on a critical drip much less to long term care. There's more to this.

This pt wasn't sent to long term care -- he was sent to an LTACH; the "A" being for "acute," and the "H" being for "hospital." Patients get sent from ICU to LTACHs all the time, if their acuity is too high for a stepdown unit but are out of "typical/short-term" acute care days. LTACHs can also take patients on drips.

Based on what the OP says, he (I'm assuming "he" based on screen name) was thrown under the bus. If nothing else, the nurse manager could have advised him he needed to do a late entry... the patient's chart would at least be in the facility's HIM department, or if using an EHR still be accessible. I would think from a risk management standpoint, that would make more sense for the hospital as well; since they fired the OP, that info will never be documented.

Clearly the OP has learning to do as far as what needs to be prioritized (in this case, comforting wife vs. investigating how the heck the patient is going to get his PH med)...he's a new grad. And LTACH is an absolutely BRUTAL environment for a new grad. I had a hard time in that environment, and I was an RN for 10 yrs when I worked in one. But the way I see it, CABs would dictate that the pt's #1 need is his PH meds. Why was the OP fired for not completing an admission of

OP, this sounds like a place you should be glad to be rid of. I'm sure its stings, but you'll get through this.

GM2RN · Aug 15, 2016

Can I just say, we don't discharge with patients on critical drips? We don't transfer from icu to the floor with a patient on a critical drip much less to long term care. There's more to this.
OP, you left without completing your work because you felt it was late. Guess, what? I'm fairly new. I stay late many, many nights to finish my charting.
You were wrong. Nobody else can complete your assessment. Nobody. Admit that this wasn't the right job, and move on. Your charting is vitally important. Vitally. This isn't most jobs where you get to call it a day at 6 and leave. Sorry.

Nobody can complete HER assessment, but the OP can't have been the only nurse to lay eyes on the patient and I guarantee the manager isn't going to let incomplete documentation like that blow in the wind. SOMEONE documented enough of an assessment on that patient to satisfy reimbursement and JCAHO if there's an audit!

blondy2061h, MSN, RN · Aug 15, 2016

Can I just say, we don't discharge with patients on critical drips? We don't transfer from icu to the floor with a patient on a critical drip much less to long term care. There's more to this.
OP, you left without completing your work because you felt it was late. Guess, what? I'm fairly new. I stay late many, many nights to finish my charting.
You were wrong. Nobody else can complete your assessment. Nobody. Admit that this wasn't the right job, and move on. Your charting is vitally important. Vitally. This isn't most jobs where you get to call it a day at 6 and leave. Sorry.

Patients with heart failure and pulmonary hypertension can live on these drips long term. They can go home with them. And they're absolutely critical. They become symptomatic immediately if they stop.

TheCommuter, BSN, RN · Aug 15, 2016

We don't transfer from icu to the floor with a patient on a critical drip much less to long term care.

As other respondents mentioned, this patient was sent to an LTACH (long term acute care hospital), not long term care. The differences in patient population are massive.

Many LTACHs have ICUs, pulmonary units, med/surg floors, cardiac rehab floors, and specialized wound care units. The patients are just as sick, if not sicker, than what you'd see at a general acute care hospital. They've often vented, on multiple drips, receiving dialysis, and plagued by several non-healing wounds.

LTACH is the go-to place for ICU patients who have been deemed 'unsuccessful vent weans.' They are patients in limbo: they're too darned sick to discharge to a lower level of care, yet they take up valuable bed space at your local community hospital's ICU when their condition hasn't improved. Therefore, off to LTACH they go...

Editorial Team / Moderator · Aug 15, 2016

A transfer will either be within the same facility or outside (but within the same system). A discharge is when there is little chance that the patient will return to the facility prior to going home, or to an entirely different healthcare system. However, some people do use the two terms interchangeably.

Yeah, we use the lingo a bit differently in the ED. A transfer goes out of the facility to another facility, with a doc-to-doc report, accepting physician, and a nurse-to-nurse report. A discharge just goes to the house! (Or the jail, etc., whatever "residential facility" the patient chooses/has chosen for them.)

uniqueguy34, BSN, MSN · Aug 15, 2016

I want to appreciate all the kind nurses on here who commented with kind words and lots of supportive statement.. I'm a big believer that we nurses should stick together and support one another in times of crisis. It makes me sad when nurses try to hurt their colleagues aren't we always fighting so hard to gain better working conditions, more lenient laws and regulations..

I know this experience has made me more aware and cautious about where I work.. And to have the courage to just walk out and say. I'm resigning. This is not a good fit.. With courage.. Instead of saying.. Ohh. I feel bad I don't want to leave.. But guess what. When you get fired. Noone feels bad for you. So I will use this to my benefit. I choose where to work and decide early if I'm going to stay or not.. And life goes on. We can't make things influence us quickly.. I know this bumpy time will pass...

BuckyBadgerRN, ASN, RN · Aug 15, 2016

Who agreed to accept this man knowing that your facility couldn't provide the care he needed? And yes, like everyone else has said, you STILL need to complete the admission. Even if he had died, you need to complete the admission.

I was still on probationary period. I worked in LTACH where he was transfered. The patient came with a critical iv drip from an acute care hospital. While being admitted. They couldn't find the drip to give him. So they decided after 3 hrs that he gets transfered to the hospital where he came from. I started the admission process. However I didn't complete it. Thinking that he is discharged.. But I was wrong. I hope this makes it clear.. Sorry I've been really down.. Especially when I wrote the post.. My apology..

Ruby Vee, BSN · Aug 15, 2016

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.

I apologize for my inability to quote the original post without resorting to this cut and paste work around. Can the moderators do anything about the fact that the first post in a thread often lacks the Quote button?

First, I am sorry you lost your job. It's demoralizing, and I'm sure you feel awful. Hopefully you'll get the virtual hugs you crave. I'd like to offer something else.

Most folks who get fired get some sort of warning, whether or not they recognize it as such. Has anyone ever sat down with you and pointed out errors in your practice that you needed to improve, spoken to you about your interactions with your colleagues and whether or not you are fitting in to the team or given you a performance plan of any kind? Many new grads who lose their jobs do so because they failed to understand what shaky ground they were on and didn't scramble to make the necessary changes. Many say they never saw it coming despite multiple counseling sessions and the signing of one performance plan after another. Think back over your interactions with management and try to recall whether or not they actually gave you a warning that you missed noting at the time. The wording "This is your last warning" makes me think that you actually HAVE been warned. It won't do you any good now, but the exercise in recall may help you recognize warning signs at your next job, and it may give you valuable insight into where you may need to improve.

Second, your written communication skills are sub par -- possibly because English is your second language? Please work on polishing up your writing skills -- AN is a good place to practice. As you work on your writing, you will notice that it becomes easier to write. And what is charting, but writing? (OK, and clicking on little boxes.). You'll find it easier to complete admission forms, discharge forms and assessments if you practice writing clearly and coherently and professionally.

Completing your charting is always important, even if, as you've learned, the patient only stays a few hours. As you work on. your writing skills, you'll find charting is quicker and easier. I'm sure by now others have explained to you the importance of charting, especially in this instance where your charting could have been (and now isn't) all that stood between. your institution and a lawsuit. If harm came to the patient during his stay because your institution didn't have or couldn't get the drug he needed, you have no leg to stand on. If you had assessed him on arrival and before leaving AND CHARTED IT appropriately, you would hat least have a record of any changes in his condition that occurred on your watch. Because you didn't, it is possible for attorneys to go after YOU as well as the institution.

While we nurses get sold a bill of goods about how we'll make a difference in people's lives by holding hands and comforting the crying, we just don't have time for that anymore. Get her a glass of juice, which takes two minutes -- that's great. But you didn't have the time to endlessly comfort the crying spouse -- you had work to do, which you didn't do.

Only AFTER you told us all about how you got fired and how it wasn't really your fault because you got no warning and besides you were comforting the patient's crying spouse, you mention that the institution has bad management. Pardon me if I'm a bit skeptical on that front.

And finally -- TWO side jobs while you're acclimating to a new career? When you get your next job, please put the side jobs on hold and concentrate on learning your main job and on doing it well. Perhaps you were just too exhausted from all the work to process what was going on at the job you were fired from.

I sincerely hope this situation is a learning opportunity for you, and that you thrive in your next nursing opportunity. But before you take that next job, make sure you've done some self examination and some serious reflection to understand exactly what went wrong in this one.

TheCommuter, BSN, RN · Aug 15, 2016

I apologize for my inability to quote the original post without resorting to this cut and paste work around. Can the moderators do anything about the fact that the first post in a thread often lacks the Quote button?

I always see the 'QUOTE' icon on the first post of each thread, but it probably relates to the fact that I usually post from a desktop PC.

Lilypad15 · Aug 15, 2016

Hey!

Don't stress too much about it. we have all been new nurses and have done things we shouldn't have...... and haven't done things we should have. None of us are perfect. It is scary being on your own the first time.

You will be fine!

CardiacRNLA, BSN · Aug 15, 2016

While I will agree that this seems to be a disorganized facility, there are certain things that universal for all nurses. Yes there were others at fault, like the person who agreed to admit the patient without ensuring a vital medication was needed. There are probably politics at play as well. However, there have been some statements in your OP that lead me to believe you think it is totally the fault of the facility. Yes, the nice thing to do is to comfort the patient's wife, etc. However, that is not the priority. If you are completing an admission assessment, your priority to be relatively quick (always exceptions sometimes), and always concise and accurate in your assessments. Just not completing an assessment is never an option. Your assessment is to protect you and show that you assessed your patients. No amount of blaming the facility can fix that. You will have to take ownership of that. If you, don't you will make a similar mistake.

I have only been a nurse for over 2 years. It has been hard. Like another poster stated, I would focus on ONE job and learning how to function effectively as a nurse before taking on additional roles. You will learn and move on, if you acknowledge errors, learn from them, be confident and hold your head up high.