Just got fired from my first real job as an lpn and need some advice

[Crystal-Wings]

Hey all. I've always lurked on this board but never made an account. Anyway I desperately need some advice! Just as a bit of background info, I suffer from anxiety, depression, and ADHD for which I am seeing a doctor and have been for years and am taking meds. Anyway, I just got fired from my first real job as an LVN doing pediatric home health care. It took me 2 years to find this job, and I relocated to take it. When I was hired, I was told by the owner of the company (who is an NP) that it didn't matter that I had no experience as a nurse or in pediatrics because I would get on the job training. I thought this sounded ok, and I stupidily thought it would be similar to my old job as a home health aide working with elderly clients (I loved that job and the people I took care of dearly, and I also had really good working relationships with my supervisors; the only reason I left was because the pay was low and I was pressured by family members to find a job as a "real" lvn).

The on the job training consisted of another nurse who worked with the same client to orient me for a couple of hours at the clients home. All the nurses I worked with were people who although very nice, had only been working as nurses for a 3-6 months and were expected to know how to orient a new grad for a client. After that, I was on my own for night shifts) Things were going ok for a month, and I felt like I was getting used to the job and felt more comfortable. Then during one of my shifts, the kid I was working with's j port came out and it surprised me. The child was fine, and the mom said it was ok that it had happened before with other nurses but I still felt extremely bad and apologized profusely. Something like that had never happened to me before, and although I was taught before I started working there how to insert a temporary g port until the j port could be replaced in case it ever fell out, it was only on a doll. I finished my shift without incident and thought things would be ok. The next day however, my nurse manager called me and told me that I couldn't work on that case anymore because the mom had told her she didn't feel comfortable with me working alone with her kid because she travels a lot and I'd be alone with the kid and I didn't appear to have any confidence in my job or would know what to do if an emergency occured. I don't blame her, because I'd feel the same way if it was my kid. So my manager made me sign a document that said I was aware of the reason I was being removed from the case.

At this point, all the confidence I had been building up was gone. However, I didn't want to give up and was willing to try again. I asked for more training and they said they would put me with another client and another nurse to orient me. The next patient I received was a kid with both a g port and a j port and suction and had seizures. I knew I was in over my head but i needed this job and was willing to stick it out and try harder. The nurse that oriented me had never oriented anyone before, and although she seemed to know a lot and was good at her job, I don't think she was the best teacher. I tried my absolute hardest to try and learn everything in the 2 days I was with her but I was still nervous and unsure of myself because I didn't want to make a mistake and risk the child's safety. I asked if it was possible to have more training so I could get more comfortable, and my manager said that would be fine and not to worry. However, she called me yesterday and said I needed to come to the office again because there was another problem. So I went in today and I was told me I would be taken off the case because the parent felt I didn't have enough training or confidence, and that I was fired because I didn't seem to be a good fit for the job. I worked with a new client yesterday that was an autistic kid and it went great, so I was pretty shocked.

I don't know what to do! I moved away from home for the first time to take this job because I couldn't find anything else where I was living except the elder care job that I already had. I can't go back home, and I'm so ashamed with myself for failing. I'm afraid to work in LTC because of a bad experience I had as a CNA and couldn't keep up with the work load. Nursing school was horrible and I hated clinicals, but I worked my ass off to get through it. I feel so lost and alone right now and I have nobody to talk to, as I haven't lived where I've been living long enough to get to know anyone. I don't even know where to begin looking for work. I already know now pediatrics is not for me, and I do much better working with older people. In a way I'm relieved I got fired because I didn't want to put the kids or my license at risk, but at the same time I'm panicking because I don't have a job! Does anyone on here have any advice to give that would help me???

[LadyFree28, BSN, LPN, RN]

I too think you were set up for failure, through no fault of your own. Caring for peds in home care may sound low key but kids don't mess around when they go 'bad' between one moment and the next!

I've been a nurse (in a variety of settings) for 24 years and after blowing my right knee out (and wanting a change) I went from the hospital to home care with kids and adults. So far, I've just worked with kids. I had ZERO peds experience except with my own adult children and grandchildren lol. Kids aren't miniature adults, and my experience may have kept me somewhat calm, it also served the opposite because my imagination for what could go wrong is quite strong.

I agree that nurses working outside a hospital or LTC environment need at least a year of experience, primarily to GET that sense of self-confidence. Even if it is fake . Parents/family really depend on their perception of YOUR confidence, which goes without saying.

With your anxiety/depression/ADHD, your have some additional obstacles to overcome to get to that confidence, but you CAN and once you do, you'll find that your symptoms are diminished overall, in other areas of your life.

I suggest you get direct, specific help for your symptoms as they relate to work. You may have to do this yourself, by learning and applying cognitive/behavioral techniques to your thought processes, become aware of them and work with them (or around them!) until it becomes a HABIT to not just go off at the first feeling of anxiety.

Just to make it as a nurse with these conditions, you'll need to work hard on yourself with your symptoms. It will be totally worth it in the long run. One of the things that comes up with depression and anxiety is 'helplessness', where it doesn't occur to you to grab yourself by your bootstraps and get into 'conquer the anxiety' mode. It's hard to see that things are NOT as terrifying as your anxiety/depression make them appear. In fact, nursing itself is actually a good 'treatment' for these conditions. As you learn to manage your symptoms, and get nursing experience under your belt, you will begin to have 'success experiences' where you 'did it right' and then your confidence will improve. It's a bit like being thrown in the water to learn to swim, but that's where YOUR personal efforts to manage your symptoms comes in. Depression and anxiety are one of the rare mental illnesses that can be 'cured' or at least diminished greatly, with or without medication.

There are a lot of people 'just like you' and you are far from alone. Nursing tends to draw anxious, sensitive types of persons anyway, so some of your symptoms may actually become strengths once you get a grip on them.

You will never find a job, as a nurse, that 'takes care of you', and manages to avoid all the triggers and scary things that set you off. You have that job :) and regardless of what you believe about yourself, you can and will rise above them with some good old fashioned self development work.

^This.

Keep pounding the pavement, and in the meantime, if you need to increase your therapy sessions in order to help with confidence building; if your lack of confidence is showing, that is something you have to work on; it will be an uphill battle to get a job if you don't get a hold on your lack of self-confidence-I have been there myself.

Best wishes.

[JustBeachyNurse, LPN]

Look into the ARC (formerly known as Association for Retarded Citizens) they often hire LPN/LVN into the group homes for developmental disabilities. And are quite often contracted by the state to do pediatric case management and respite care for those under 16 with developmental disabilities that aren't so medically complex they require private duty nursing. Many times children on the autism spectrum qualify for nurse respite care but aren't so fragile they need full home care (parents competent but too complex for a regular baby sitter).

ARC is supposed to be nationwide or have an equivalent. You can look into special needs camps in your area they may need an extra hand over the summer

[Crystal-Wings, LVN]

I need to start cognitive therapy! I've been avoiding it for years because I didn't think it would help me, but I'm willing to try!

[Crystal-Wings, LVN]

I don't think I could do case management, but definitely respite care! :)

[JustBeachyNurse, LPN]

I don't think I could do case management, but definitely respite care! :)

This case management is not the typical it's more care coordination. Look and see what the ARC or equivalent is in your area. They have a preference for LPN/LVN

[OrganizedChaos, LVN]

PDN & new grads never mix. I would look in the newspaper & online to see what jobs are available in your area. Good luck!

[Medic/Nurse, BSN, RN]

I too think you were set up for failure, through no fault of your own. Caring for peds in home care may sound low key but kids don't mess around when they go 'bad' between one moment and the next!

I've been a nurse (in a variety of settings) for 24 years and after blowing my right knee out (and wanting a change) I went from the hospital to home care with kids and adults. So far, I've just worked with kids. I had ZERO peds experience except with my own adult children and grandchildren lol. Kids aren't miniature adults, and my experience may have kept me somewhat calm, it also served the opposite because my imagination for what could go wrong is quite strong.

I agree that nurses working outside a hospital or LTC environment need at least a year of experience, primarily to GET that sense of self-confidence. Even if it is fake . Parents/family really depend on their perception of YOUR confidence, which goes without saying.

With your anxiety/depression/ADHD, your have some additional obstacles to overcome to get to that confidence, but you CAN and once you do, you'll find that your symptoms are diminished overall, in other areas of your life.

I suggest you get direct, specific help for your symptoms as they relate to work. You may have to do this yourself, by learning and applying cognitive/behavioral techniques to your thought processes, become aware of them and work with them (or around them!) until it becomes a HABIT to not just go off at the first feeling of anxiety.

Just to make it as a nurse with these conditions, you'll need to work hard on yourself with your symptoms. It will be totally worth it in the long run. One of the things that comes up with depression and anxiety is 'helplessness', where it doesn't occur to you to grab yourself by your bootstraps and get into 'conquer the anxiety' mode. It's hard to see that things are NOT as terrifying as your anxiety/depression make them appear. In fact, nursing itself is actually a good 'treatment' for these conditions. As you learn to manage your symptoms, and get nursing experience under your belt, you will begin to have 'success experiences' where you 'did it right' and then your confidence will improve. It's a bit like being thrown in the water to learn to swim, but that's where YOUR personal efforts to manage your symptoms comes in. Depression and anxiety are one of the rare mental illnesses that can be 'cured' or at least diminished greatly, with or without medication.

There are a lot of people 'just like you' and you are far from alone. Nursing tends to draw anxious, sensitive types of persons anyway, so some of your symptoms may actually become strengths once you get a grip on them.

You will never find a job, as a nurse, that 'takes care of you', and manages to avoid all the triggers and scary things that set you off. You have that job :) and regardless of what you believe about yourself, you can and will rise above them with some good old fashioned self development work.

This ^^^ is a wonderful post and should be made into a "sticky". Awesome.

[NurseFrustrated]

Personally, I probably wouldn't do home care nursing as a new grad. You would probably be better off working in a hospital or long term care facility for a while so you could have back-up from other nurses/a supervisor if something goes wrong with a patient. Then you can get some experience and build up your confidence. Just try applying to every LPN job posting you see in your area and go for it. Hopefully you will find something soon. If you have to work as an aide again in the meantime, there's nothing wrong with that. Good luck.

[nursel56]

At night you have plenty of time to go over emergency procedures, look up disease processes, procedures, etc. Mentally go over the steps to replace the GT, mentally go over the 911 procedure, etc. Think of every possible situation, and write out the steps on a paper, put those steps in a document protector and place these in a small binder to keep in your bag. At night, go over these. This will help with your confidence. Also suggest that you look into the immunization clinic jobs coming up to branch out a bit and add to your resume. Good luck.

Crystal-Wings I applaud your decision to take the steps you need to get a handle on your anxiety and depression, and even though you feel you've blown your only chance to work in peds, I wouldn't shut the door on anything so early on in your career.

I do want to say that your nervousness with new clients never goes away entirely no matter how many years you have on the job. Having said that I re-posted Caliotter's advice because I think it is so important.

Being prepared ahead of time will cut your anxiety level down tremendously. Parents pick up your fear first and foremost, so learning to create a calm demeanor even if you are freaking out inside is really important.

I did not notice anywhere in your post where you mention calling anyone for guidance during your shift. My understanding is that the RN Supervisor is an integral part of private duty nursing, and someone is generally on call 24/7 for that reason. This is something I keep to a minimum, but I have called them. if you're going down for the third time you need to involve another nurse, which is absolutely not a sign of failure.

Wishing you the best!

[LPN With An Attitude]

Unfortunately, the parents of the pediatric cases you speak of can be unreasonable. You have to find the right case, it is largely just a matter of luck and nothing to do with your skills or ability to learn. I am working FT, albeit $6.00/hour less than what I was making in LTC facilities (holding pens for discarded people), but you cannot put a price tag on your piece of mind. Some parents forget that you feel awkward at first walking into their castle, and that they are staring at you, which may very well make you feel uncomfortable and even distract you. If you are facing bankruptcy and the loss of everything you have worked for, that can compound the situation. You didn't do this or that exactly the way nurse so in so, who has been on the case over the last 5 years did? I never used an electronic hoyer lift, I don't care for them in general because when the battery dies, I am expected to manually lift this 300lb person suspended in mid air while they can't find a battery that works, into a chair or into bed. I did it for years, but now entering into my 50s and not enjoying the aging process, has resulted in two damaged disks and an umbilical hernia. I continue to work in pain that most others could not begin to bear. You learn to ignore it. They show their gratitude (owners, managers, and other parasites by terminating you....not a good fit, we are an "at will" state so we don't have to give you a reason....the fascist's dream come true, the 'at will' rape of your civil rights, especially if you are in a minority group where it's open season)

So because you need your job because the rest of the world doesn't give you rent, utilities, etc for free you may be apprehensive about making a good first impression, being in someone else's castle, your economic woes aside. You learn the world truly is a cruel place real fast.

So I would advise you, keep at it, you will find a family that is reasonable. Put on that poker face and put all the issues that go with homecare and economic hardship behind you. After a few days, if given the chance, you will develop a routine and get acclimated to that place and your patient. Just because you express doubts about something like a Hoyer lift (I am a huge, strong male LPN...well I used to be strong) that didn't have time for a Hoyer lift doesn't mean you cannot assess a patient, give them their meds, hang their IVs or run their tube feedings.

First and foremost, try to get out of peds, at least the real young, fragile ones. If you can get an older, teenage patient with a parent or parents that will not give you a chance to get acclimated to being around them and get the routine down, then you can shine and provide good, quality care and make new friends and pay your bills all at the same time. Do not give up hope, there are still some reasonable, decent people out there. They may be rare, but stay at it, you will find a match

[NurseSpeedy, ADN, LPN, RN]

I agree with other posters that you were set up for failure. Pediatrics in itself is a specialty and if your training was anything like mine, it was lacking in that field.

I work in HHC now because it works with my school schedule going back for my RN (associates and then immediately bachelors after completion). Most of the cases are pediatrics medicaid and these children are complex (which is why some of them are granted the number of hours of home health nursing as they are. My current case has 24/7 coverage, which is practically unheard of).

The problem is, sometimes these cases are hard to staff and the client doesn't get a nurse because there is no one available. They will switch agencies trying to find one that can staff them, and sometimes they will come across an agency that is willing to hire new grads and 'train' them. The only problem is, a new grad requires more than a few hours of observation and when they are observing another new grad, then what kind of training are they really getting. Then, it's home health, so you don't have another nurse to help you if you don't know what to do (and you need to know what to do quickly). A lot of times when agencies will hire anyone, and they aren't paying well and lacking benefits, then they can easily get new grads because they are desperate to get any job to gain experience. This puts both the client and the nurse in a potentially bad situation.

Parents will want what's best for their child. If you appear nervous and they know that you are inexperienced, they are likely to ask for someone else. I personally would have never taken on home health with a pediatric patient as a new grad. I don't know if I would of even taken an adult fresh out of school. I had years of experience and I still had to adjust to the difference with the adult population that I was used to and the many differences involved with peds.

I would suggest starting off in an area where you can work with other licensed nurses at least while you are gaining your confidence in your skills. In home health, you are on your own and need to be able to know what to do (and do it right) when a situation occurs. There are some agencies that take private pay from client's for LPNs who are not granted an LPN by health insurance. These patients are typically a lot less intense and from what I experienced in the past were usually adults. They usually have a nurse instead of an aide because they have a PEG tube, meds/feeding via PEG, accu-checks with insulin, etc, but aren't dealing with may of the issues that would be covered by insurance companies. Again though, if you don't feel comfortable alone its probably best to do something different for a while.

Good luck to you with whatever you decide. I'm sorry for what you went through. It's hard to deal with being let go from a job but I think you were put in a situation that was unfair/unsafe to begin with.

[Crystal-Wings, LVN]

I think I'm going to go back to home care for seniors. It didn't pay much, but I enjoyed it and I know how to do the job. If I have to live in poverty for a while, I can live with that. I've become accustomed to that job, and it's something I can handle. Sometimes I get frustrated by not being able to learn and understand things quickly and in social situations like other people. I'm not very religious, but I found the story of St.Joseph of Cupertino to be comforting and inspiring (even if you aren't religious, I suggest anyone struggling with a disability or mental health problem read it! Just Google his name).

Right now I'm feeling lost, anxious, and exhausted. It takes everything I have to get out of bed. My father has told me I'm not allowed to come home (he has a history of being verbally abusive so perhaps it's a good thing I'm not there), and that I have to find any job and even senior home care is ok. I am looking into it as we speak but the constant worry still haunts me. I'm also looking for a therapist.