Just recently got terminated

[ricaryx]

I graduated last year and has only practiced nursing in a Private-pay Convalescent home for 4 months, on-call, landed a new job at another SNF that has Medicare patients. Boy, it was so different than the private pay LTC, and very strict. I'm not sure if you can call this orientation, but I had a month long orientation on the floor and I was by myself. Day shift. If I didn't have the experience from my previous job, I would've sunk. Hard. The only thing my supervisor did for me, was find my faults, give me advice, then report those faults to the DON. Again, I can honestly say I need more exposure, being on-call at a slow convalescent home isn't really enough to call myself "experienced."

I've been stung for doing a bg check on a resident everytime I give them insulin. Because there was no order to do a bg check, "i'm going against doctor's orders". They said I was doing it to make myself feel better in giving insulin, the residents don't need an unnecessary poke. As long as the resident doesn't look hypoglycemic, just stick him the insulin. Is this supposed to be common knowledge? I don't want subjective assessments, I want objective. I only wanted to be safe, I'm already pressed for time in my med pass why would I waste time doing bg check? They were SO disappointed when I held a resident's insulin for having a BG of 70 (resident was asymptomatic), and failing to notify the doctor. That time I felt stupid.

I've been stung for my very slow med pass. I only have 23 patients, but it takes me from 0800 to 1100 to finish all of them. They weren't happy about that. My supervisor pointed out my mistakes, and reported that to the DON. I go through my MAR more than once when I pull out meds. It was a habit, and I admit it's a time waster. However, the main thing about me being slow was that, I double/quadruple check. I'd rather be late than make a med error esp. with these residents that I don't know. They didn't like that too, they want me to finish within two hours because if I don't, the meds after all that becomes a MED ERROR. Especially those pills that need to be given in 1300. They want me to work accurately and efficiently in a timely manner. I get that, but with me in a new environment, I need more time. I have 26 patients in my previous job and I get the med pass done from 0800-1000. Here, I can't seem to get that done because of all the interruptions and the busy, and i mean, busy environment. Not to mention the residents' whims.

So I did just that, 2 weeks later, I've improved my time. I focused on those two things they mentioned. They moved me onto a NEW station and left me there alone to fend for myself. I got overwhelmed because of the time. I wanted to finish my med pass within two hours, and I'm absolutely sure I wouldn't meet that. I went to my supervisor and asked for help. What she just did was observe me as I do my med pass, of course, that made me even more tense. She went up to me and looked at my MAR, found out that I wasn't able to properly sign all of them so she wasn't sure if I skip a med or not. From that point, I know I didn't purposely skip a med but the possibility of overlooking one of them is there. Because I failed to sign.

She said I'm still back from my habit of going over the MAR several times, despite how she told me not to do that anymore. It's a time waster and what's worse, this time I'm "skipping" meds. She reported that to the DON again. I felt really frustrated from making basic errors, and I felt incompetent. I know that wasn't me at my best. From then on, I got chewed out, they told me that that wasn't the only time I skipped a med. There were times in the MAR that I haven't signed. One of them was a Digoxin. It was funny, that was the only thing that I remember clearly that I gave to that resident. Because it WAS Digoxin. It's not colace or whatever. But they wouldn't/couldn't believe me because I failed to sign. Cuz "if you didn't sign it, you didn't do it." Right? I realized that the quality of my med pass has went down the drain ever since they told me to work on my time more. I can only blame myself for being so inflexible and giving in to their pressure.

That was my last evaluation. They said I failed to meet their expectations and they need to let me go before anything happens to my license and to their residents. For one moment there, I wanted to say hold on a minute I can prove myself (because their demand didn't look impossible if they gave me enough time to improve) but with that kind of pressure on me and the lack of support I get? I think they're right. I'm going to make a mistake and with the state always eyeing them, I'd rather not risk it. So there, I was relieved of my post. They said "I'll thank them in the future." In fairness, they think I have potential and they're willing to put in a good word for me if I ever make them as my reference for my next job application. That's the only good part about all this, and the fact that my learning curve went up a notch.

I just wanted to vent all that out. From my understanding, I was terminated because I wasn't good enough. I just wished I have had a proper orientation from them, I want a preceptor, not a critic that only points out my fault and doesn't work WITH me to overcome it. To be honest, I don't want to work at a LTC anymore with my current level of experience. Right now, I feel incompetent and I'm not sure if I still love Nursing as much as I did after I passed NCLEX with flying colors. It's just....sigh.

[cokeforbreakfast]

I wish you a hug. I hope you'll find the support and guidance you need from the experienced nurses on the forum, and the courage you'll need to move forward from here!

[shoegalRN, RN]

I would have question the practice of giving insulin prior to checking a blood sugar. That's basic nursing 101. And if the doctor had an issue with it, I would have called and got the doctor to order accuchecks.

That place don't sound safe anyway. Be glad you are out of there.

[caliotter3]

That insulin/BG check situation sounds weird to me because we did BG checks on our patients receiving insulin. New one on me. Hang in there.

[Jules A, MSN]

If there are a few suggestions from their critique you can use, great, but don't rest the entire responsibility of this situation on your shoulders. I always double check my medications before I give them and FWIW I don't give insulin without a recent finger stick and although I usually will ask the Doc for the ok to do one that isn't scheduled if the pt is symptomatic imo it becomes a nursing judgement and I won't wait for an order. In the long run you will be glad you aren't working in that atmosphere. Hang in there.

[NurslingRN]

sorry you are going through this:(. i think that you are definitely right when you say that you would rather have a preceptor to orient and teach you. i think you should apply for a position that will provide you with a good preceptor and an orientation process that will actually prepare you to work by yourself. i wish you a big hug and hope that you give yourself some credit for being as brave as you seem!:hug:

[steelcityrn, RN]

Thats one stressful place to work! Im sure they probably wanted the am meds done by 10. Putting the extra pressure on you, well thats just too much for one person to take. Go get yourself a better job, move on. Good luck to them finding a fast pill popper.

[CrazierThanYou]

This is an interesting thread. There is hospital based nursing home in my area and from what I'm told, no one's sugar is ever checked. It seems like it would be mighty dangerous to give someone insulin when their glucose was already low.

[JenniferSews]

I would have question the practice of giving insulin prior to checking a blood sugar. That's basic nursing 101. And if the doctor had an issue with it, I would have called and got the doctor to order accuchecks.

That place don't sound safe anyway. Be glad you are out of there.

I agree. But if you're looking for "proper orientation" then LTC isn't the place. I got 2.5 days as a brand new grad with NO experience at all. The first day my preceptor left halfway through the shift because she was staying over from the night shift. LTC is sink or swim, unfortunately. Hopefully you can find a hospital job where they are willing to give you orientation, and don't count it as a sign of failure if you need more orientation. Good luck!