I got fired today...

Guest343211 · Dec 7, 2012

I'm officially fired from my first RN job today. My manager suspended me starting from last Thursday due to my medication error, which happened on Sunday, 25th. I made two errors during my orientation period, and those two errors are something that didn't teach in nursing school.
The first incident happened around 4 weeks ago. This patient was admitted due to SOB and was getting better. When I was providing medication to the patient, the doctor walked in and assess the patient for a bit. I stayed and listed to what the doctor said to the patient. Doctor said that patient is getting better and told me to walk the patient around the unit. So I agreed and walked the patient. On the half way, patient started showing SOB and wanted to sit down. I called help and many nurses helped me to sit the patient and escort the patient back to the room using a rolling chair. One of the nurses pointed out that I should grab a portable oxygen tank with me when walking this type of patient.

Confused. The O2 issue was an error in nursing judgment and using the nursing process for that particular patient. Not sure, however, how it is a medication error per se. I mean oxygen probably should be viewed as a medication of sorts. Hmmm.

Depending upon the medication issue, I am not sure the above alone is something for which you should have been fired.

They probably did teach you about the above, if you were effectively taught was the nursing process in, what it involves, and how it is applied to each particular patient and the current circumstances.

Again, I don't necessarily think that is something to be canned over. You will just learn to think things through a little bit better in the future. In nursing, a big part of it involves thinking ahead and active planning--it is the ongoing and effective usage of the nursing process to the particular circumstances and needs of the patient.

What was the medication error?

I would think it would have to be a doosey, b/c that alone is not enough to can a nurse IMHO. Now if he or she refused to learn from it, that's a different matter.

delawaremalenurse · Dec 7, 2012

Oxygen is considered a medication. In fact, it's the most common medication administered in hospitals.

Eventhough you want to blame the school for not teaching you this...I have no doubt you learned the concept of oxygenation throughout your nursing program (medsurg, peds, fundamentals, you name it). What you didn't develop was the ability to critically think and apply your base-line knowledge learned in theory to practical applications such as this one.

There's no one to blame in this scenario except yourself.

AlaBro2010 · Dec 7, 2012

There's no one to blame in this scenario except yourself.

I find that incredibly harsh for a new nurse. You made a mistake. Learn from it and move on. I'm sorry you didn't think of bringing the 02 with the patient.. I would've been cautious and asked another nurse but you live and you learn.

patrickh_rn · Dec 7, 2012

Sorry, it seems like I can't edit my entire thread right now, chrome is acting up. How about I just post the whole story here.

I'm officially fired from my first RN job today. My manager suspended me starting from last Thursday due to my medication error, which happened on Sunday, 25th. I made two errors during my orientation period, and those two errors are something that didn't teach in nursing school.

The first incident happened around 4 weeks ago. This patient was admitted due to SOB and was getting better. When I was providing medication to the patient, the doctor walked in and assessed the patient for a bit. I stayed and listed to what the doctor said to the patient. Doctor said that patient is getting better and told me to walk the patient around the unit. So I agreed and walked the patient. On the half way, patient started showing SOB and wanted to sit down. I called help and many nurses helped me to sit the patient and escort the patient back to the room using a rolling chair. One of the nurses pointed out that I should grab a portable oxygen tank with me when walking this type of patient. I never had this type of patient before and this is the first time I heard you are supposed to use a port. oxygen tank. So my manager called me into her office and told me that I shouldn't perform task without my preceptor around me. She gave a verbal warning and there, the second incident happened 4 weeks after

Sorry, Chrome was acting up. Stories continue..

The second incident happened last Sunday. Patient required Solu-Medrol 20mg/ml (IV). This is an incident that I could have used my critical thinking or my common sense to prevent this from happening. The first order was TID and I gave it to her at 0900. The doctor changed the order to BID and the first dose for BID starts at 11. Our eMAR shows the first dose of BID is available. When I was going to give the BID dose around 12, I somehow doubt the order a little bit. I did consult with my preceptor but did not pull out the eMAR in front of her. I just told her that the frequency for Solu-Medrol has been changed and if it was okay to give patient this medication. My preceptor gave me a okay and I administered it. Around 1500-1600, I opened the eMAR again and Solu is required during that time. I was like.. I just gave her this, why am I giving this to my patient again? I already drew the medication but thank god I realize something is wrong. So I asked my nurse and pulled out the eMAR in from of her. She checked it and asked me why I gave it twice in the morning. I want to say "you said okay", but it seems like she doesn't really remember. Instead, I silenced myself. She told me it shouldn't be a big deal but she still called pharmacy to confirm. Pharmacy said it's alright, just writing it up. So she wrote a simple incident report and that's it. Patient is okay and nothing happened afterward. The manager came in on last Thursday morning and it seems like the incident reported left on her desk. When I was providing patient care in the afternoon, the manager assistance was following me around and said he's going to provide me support while my preceptor is not around. I figure something is weird cause' he was watching my every move. I got called into the office afterward and she asked me what happened. I explained to the manager and she called in the preceptor to confirm if I ask her, and still she doesn't seem to remember I told and said I didn't tell her. Now I have to say that in real world... you gotta protect yourself. Stay silent or unable to fully express your is a NONO. I wasn't able to fully explain to the manager at the time and I got suspended for two days. (I didn't work for a week actually) I wrote her a apology note and she read and thought it was really sincere, and want to meet with me Thursday (today). And today, I got a "sorry but" and got terminated. She thinks that this unit is not really a fit for me due to high intensity. She thinks it will be better for me to go DOU or less intense unit.

(Add, the whole hospital use computer charting. When the medication is available, the eMAR will show yellow for that medication at that period of time.) So after the first order got d/c, the new order will be place on top of the older order. 11 med for solu-medrol shows available)

I understand that it is still my full responsibility to give the medication to the patient, and I understand that it is my fault for not using my common sense. I'm glad that nothing happened to my patient. But yet.. I.. sigh.. I don't know. Will those two incidents really severe enough to cause termination? I'm just wondering. I guess it's no use to fight for it since I'm already fired =S. Another question is, will this affect my future employment?

Delaware is right, it's harsh but true.. I don't blame anyone but myself. Yet.. hm, I don't know what to say seriously. I just want to share this to someone. We all make mistakes; you learn from it and move on. Just don't do it again in the future. I guess this will be the most memorable experience I will ever learn as an RN.

SquishyRN, BSN, RN · Dec 7, 2012

I would think it would have to be a doosey, b/c that alone is not enough to can a nurse IMHO. Now if he or she refused to learn from it, that's a different matter.

The OP is probably still in the probationary period, making it easier to be let go for less, but I do agree that alone is not enough to be fired. Perhaps management just does not feel the OP's critical thinking skills are up to par relative to other new grads, whether incidences have resulted in "errors" or not. Many new grads have come and go at my facility, and just because some haven't made any egregious mistakes, that doesn't mean I considered them competent in the job overall. The OP should just take this as a learning opportunity and move on.

patrickh_rn · Dec 7, 2012

Thanks Squishy. I actually did a lot of self reflect on this and I gotta say, I'm still too naive. My critical thinking is still developing, which is why it is necessary for one to ask great amount of questions. "There's no stupid question"... now I understand why people say that. Thanks for replying.

Meriwhen, ASN, BSN, MSN, RN · Dec 7, 2012

Moving to First Year After Nursing Licensure forum.

I'm sorry this happened to you, OP.

T-Bird78 · Dec 7, 2012

I'm sorry and it sucks to be fired but it happened to me for less. I, too, was in my 90-day probation period and all I was told is "it's not working out" and never got a more clear answer. The lead RN hated talking and I had questions (did I mention I'd only been out of school 2 months and licensed a week?) and I think she reported me to HR, then I got a nasty phone call from an irate pt who couldn't understand why our office couldn't page her doc out of heart surgery to talk to her and refused to be seen by another doc or go to the ER. When that pt called the 5th time and demanded to speak with someone else NO ONE took the call for me and I got a complaint from the pt even though I was following company policy and had the backing of the head doctor of the group. It does suck but they don't need a reason to let you go during your new-hire probation period. Just chalk it up, know how to handle that situation better next time, and good luck!

beachfashionnursing · Dec 7, 2012

I'm so sorry this happened to you. I think it was a little too extreme that you were fired over this. I work in an ICU and experienced nurses have made mistakes as well as new grads. To name a few...

1) putting a pressure bag on an EVD

2) ignoring arterial lines when it keeps on dinging, turns out patient had a clot

3) ambulating patients when they have a massive P.E.

4) oh! and another nurse got written up for not bathing a patient who is a walkie-talkie 30-year old man

5) administering the wrong blood products

No one got fired over these things but there is a nurse who got fired because she yelled at a transporter.

I really think they should have given you another chance..

beachfashionnursing · Dec 7, 2012

But every management is different I guess

dimi152 · Dec 7, 2012

I can't imagine what it's like to be let go so on early on in your first RN job. I feel for you. There will be another job and you will improve! I am working in an RN Residency program (unpaid, temp & no potential for a job offer, sigh...) on a telemetry unit. I ask a ton of questions. I sometimes ask the same question of different RNs because I appreciate different nurses judgement and approach. And it helps me develop mine. And I take the time to share that that is why I ask questions. It sounds like what may have been the most concerning aspect of your error is the way in which you communicated. We have to be accountable for our actions, even as new grads, even with preceptors training us. It sounds as though you didn't give your preceptor RN an accurate, full picture of the solumedrol order change. And that wasn't fair. That put your preceptor in an unfair position, especially when you say "but I told my nurse". That's kind of passing the buck to someone else. I have moments (sometimes a lot of them in one shift) where I feel my critical thinking could have been stronger or I missed an opportunity in terms of thinking ahead/anticipating potential complications, none of us are perfect. But if I were a manager, a lack of accountability & poor communication skills would worry me. You're patients were okay. And you will be, too. Keep your head up & communicate clearly!