Improper Termination

[FeelGDRN]

I start at the Beginning of this situation. I manage a 60 bed skilled unit. Last Wednesday I was called into the room of a patient who complained of itching and a rash. I assessed the resident and found the rash to be in the arm and trunk area. Raised red macules. Resident reported that the itching was severe. I made the DON aware of this and called the MD. The attending told me it sounded like scabies and gave me an order for elemite. I asked him for an order for his roomate. I then went to assess a resident down the hall who had a similar rash,and complaints of itching. I called her doctor and the attending for her roommate and got orders for them both. The order was to administer the ointment and let it sit overnight before washing the resident. The DON did not believe it was scabies. We followed the orders. No other action was taken. I talked to an evening shift cna that had gone to the ER and was dx'd with scabies. The next morning during the am nurses meeting, I told the DON that the 3-11 staff had requested treatment for scabies. The DON sent the Education/Infection Control nurse, the new ADON, and an MDS coordinator to see the rash. I read the definition of scabies from Tobers and everyone agreed that it did not sound like what we saw. I left at 3:30pm that day. The next day I was told that the institution had been reported to the state becuase there was an outbreak of scabies and that we did not act to treat the patients. I was told that the MD had come in and seen the orginal case and said it was definitely scabies. Two staff members were given treatment. The ADON ran the nursing meeting because the DON went out of town to New York. I left the meeting and grabbed a weight sheet because it had room numbers and boxes for information. I was asked to inspect residents for signs and symptoms to make sure we had identified all the cases by the administrator. I went room to room. I found a room on the same side as the other cases and found a resident who complained of itching for the last three days on his arm. I identified him as very high risk. At the end I had a list of room with residents that complained of itching and they were found to match as a group of rooms assigned to a cna. In other words the assignment for cnas on all three shifts had that set of rooms. I wrote a list of staff for all three shifts that provided direct patient care for that assignment. I had one side of the sheet with the rooms and residents that were dx'd and which ones had been treated with medication. I also used the same paper to identify the rooms which needed to cleaned per policy. I reported this to the Infection control nurse and the ADON. The director of housekeeping was there and we decided to treat the rooms on the assignment. Meanwhile I would get an order from the medical director for bottles of elemite. My plan was to treat residents in the assignment, clean the rooms and treat the staff who provided direct patient care. I called the adminstrator abou the order, she did not believe we needed to treat all the staff. I said we should do what the state would look for us to do. I said it sounded like we were treating selectively. She started screaming and said she was coming up. She was screaming because I "accused her of selectively treating staff, because we didnt follow the policy to begin with, and because we did not have plan. I told her what the plan was and she said to meet with the staff and treat on request. I coordinated the room cleaning with housekeeping and met with my staff. Several of the staff reported symptoms of itching and a rash. One cna was very upset because the night before the DON was yelling at her because she was complaining of itching. The DON said its not scabies and she did not need treatment. It was then that the MD went into the room and examined the resident and told the DON that it was scabies. I had 6 admissions coming that day. The elevators were out of order, and I ended up sending two residents out 911. I asked for help calling the families since I had all of this to do. The adminstrator told me to write a report of the events and turn it in to her at 3pm. I wrote a report of Days 1,2, 3 and the plan of treatment and communication to familes. No one called the familes, and I found out yesterday that two residents had not been treated. I told the DON that I was frustrated because I had informed the evening supervisor of the plan and no one got an order. I talked to the N.P. and had gotten an order for treatment. I called the families of all the residents and made sure the documentation was there. Today, I was going to report on a situation that had come up. The DON was talking to the administrator and a therapist. The administrator was screaming because she was told we treated two residents twice. The DON asked me about it and told her they were treated once. These were the residents that I had to talk to the NP about yesterday. She said the report that I had written for the state said they were treated yesterday and that it was "falsification of records"She said "Thats it, give me your keys." She had said prior that she was not comfortable with me. She has been hostile the last 2 months, despite our private discussions. I asked her yesterday point blank if I had her suport. She said yes. Today was a different story. I got no help with this from her. She seemed to antagonize my efforts. And of course everything is my fault. I called the nurses and told them they would have a new manager. I dont know what else "Give me your keys" could have meant. She never said your fired or terminated. She didnt say you were suspended. So if someone could give me some insight or advice Id appreciate it. I dont regret one thing I did on the unit. I was very determined to make it better. It seems like a cruddy set of events. I know now that I can function as a manager and perform well. I wonder how much easier it would have been to have a DON that was behind me. She had said herself, I have the brainpower, and determination to be a DON.

[elthia]

I am not legal savvy, but keep a copy of any records you have pertaining to this situation.

Secondly, if the DON was aware that you had a possible scabies infection and did not ADVISE staff to take action immediately, then she may have some legal liability issues and maybe trying to cover her own butt and making you a scapegoat.

In my state, the BON has a hotline for advice, I've had to call it before and was able to keep everything confidential till I submitted an official complaint.Check to see if this option is available to you, and make sure you get the name of who you spoke to.

Also, you might be able to file Hostile work environment, obviously if you and a CNA were subjected to being screamed at, well that fits the definition.

[NRSKarenRN, BSN, RN]

Sounds like you did all the things a prudent RN should do when faced with such a situation.

Administrator in over their heads with an INFESTATION that will now be part of state report so makes their running of the place look bad. Instead of thinking that an employee brought this infection into the facility and another one did the approriate actions to prevent further spread of scabbies!

Dust off that resume. Sounds like you got the beginning of how a manager should act. File a hostile report with corporations HR dept on the way out of dodge as you will not be supported in top boss acts this way.

[barefootlady, ADN, RN]

You did a wonderful job regarding this situation. You would be a manager many nurses, LPN's and CNA's would want to work for/with. File hostile work environment report, file a negliance report with the state regarding DON, ADON and administration. Keep records of everything you did to resolve this matter. Get a statement from CNA who c/o itching and was reprimanded. Take a day or two to sleep late and then look for another position. Good luck and let us know what happens.

[mattsmom81]

Looks like this DON needed to try and scapegoat this situation and you were it. Sounds like to me YOU were the one with everybody's best interests at heart. You know the old saying...being a good nurse is frequently at odds with being a good employee? I believe you were both...but she didn't want to deal with it upfront and honestly.

You do not want to work for this woman...and I agree with the posters' advice above. You are the nurse who did a standup job and you should be proud.

I know it angers and hurts when another ' so-called professional' does us this way, but the world is full of ugly vindictive jealous folks...and nurses. Hold your head high!

I've got a feeling you will not be the type to let this go without legal avenues being explored, in order to protect your reputation.

Good luck and keep us posted.

[FeelGDRN]

Man I appreciate the feedback on this issue. I wrote the DON back and said it was a bad situation for all involved. I told her that we had a bad relationship but that I did what I felt to be in the best interest of the patients and my employees. There was a letter of resignation following, which she accepted. Punch line. My job was advertised in last sunday paper as being a positive work environment. Friggin hysterical. But whatever, I can place the position on my resume and move on. Nursing does look different after this position. I owe every nurse manager I worked for an apology for my behavior. Now I understand.

[renerian, BSN, RN]

Wow I think you did a great job given the nature and severity of the problem. Instead of thanking you for caring and helping the residents, you get yelled at and treated like dog doo doo. Another example to learn from, about how not to act as a manager/idiots.

renerian