Let go from my first patient - Please help me understand!

Published

I got let go from my first patient as an RN (I'm in home care). I got absolutely zero explanation and the agency is telling me not to take it personally and has already assigned me another case... but I'm devastated! I don't know if I screwed something up or what. Please read and help me understand, if possible.

I got my RN in July and obtained a job as a home health nurse shortly after. My first case, a 3 year old with lissencephaly and microcephaly, was stable and a relatively simple case - Overnight shift, no meds, just maintaining her oxygen level and lots of suctioning. I was with her 2 days a week for the past 3 months and everything seemed to be going swimmingly. I got report from the dad and reported off to the mom every shift and we got along great. They even wanted to take me on for another night but I would have been over my hours.

Last night when I arrived my patient was sick, having caught the cold going around the house. The dad didn't make a big deal about it, simply telling me to be extra cautious about her oxygen level and to give Tylenol if she spikes a fever over 99.0. Okay, cool, that's easy.

So dad goes to bed, I do my initial assessment and her temp is 96.5 axillary which is normal for her. Next hour, same temp. 3rd hour - 103 degree fever. I immediately give her the Tylenol ordered, flush her G tube with cool water and break out the cold compresses, wrapping her head and abdomen. Slowly her fever comes down... about a degree an hour. By the end of my 8 hour shift she was maintaining a temp of 98.3-98.6 axillary. Tylenol was ordered Q6 so I didn't give it again.

She maintained her oxygen 95-100% all night, suctioned her and performed chest PT as normal, albuterol treatment as ordered, no big deal. Some seizure-y activity which was not out of the norm for her and typical of patients with her condition. Only difference was more suctioning than normal.

I report off to mom in the morning who did not appear phased and when I said, "See ya Saturday!" she smiled and said goodbye as usual.

Fast forward to tonight. I get a call from my agency telling me they got a call from the dad earlier today who asked I be removed from his daughter's case. When asked why he vaguely said, "It just isn't working out, I don't think she's comfortable with my daughter."

WHAT?!

My manager said it was extremely strange he wouldn't cite a reason even when pried, and that is sounded "shady" to her. She told me not to be upset and not to worry, she already had another assignment for me.

I'm glad I'm obviously not in trouble and my job isn't holding this against me... but what the heck???????

I had absolutely ZERO inclination anything was wrong. Like I said, I got along great with the parents, was in love with my patient, and thought I was doing everything right. Even last night before dad went to bed he was talking about how he'd like me to change the G tube this coming Saturday.

So obviously, at least to me, this has something to do with how I cared for my patient last night. Without a reason all I can do is speculate.

-Did I let her fever get too high? It spiked so suddenly.

-Should I have woken the parents up? I did all I could do for the fever, nothing more the parents could have done, really. And in home care the rule of thumb is to not wake the parents unless it's an emergency. Before he went to bed dad told me to wake them only if her pulse ox dropped, which it didn't.

-Does the fact her fever was that high constitute an emergency? Maybe I should have woken up the parents?

-Did I not bring her fever down fast enough?

-Was there something else I should have done?

These are questions I would like answered and if anyone has any input that would be great. Like I said, the fever was the only thing that was out of the ordinary so I'm really thinking I screwed up somehow. But I can't learn from this situation without knowing what I did wrong!

Aside from this, I'm devastated and I feel so betrayed :( Everything seemed to be going so well... I feel like I just got dumped. I guess I should have never gotten so attached, I know... sigh. I've been crying for the past hour. Sorry this was so long but thanks if you read. Please help me understand this!

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.

Sometimes it's as simple as a parent changed their mind or just felt like getting a new nurse. You can't take it personally in pedi home health/private duty.

You couldn't drop her temp faster especially with a seizure risk as it could have induced a seizure. There wasn't much more you could do with care based upon what you wrote here.

Up Vote Up Vote ×
Specializes in ICU, step down, dialysis.

Moved to Private Duty Nursing forum for best response.

Up Vote Up Vote ×

I will say that a temp of 103F axillary on a normal 96.5F is much too high of a fever to not tell the parent. That's like 105.1F on a patient that is normal at 98.6F!!

In my opinion as a parent, that high of a fever with such a rapid onset would have warranted waking the parents even if there was nothing else they could really do simply for the fact that it is their child and they should know so they can decide how they want to proceed.

Up Vote Up Vote ×
Specializes in Peds(PICU, NICU float), PDN, ICU.

Typical. Get used to it. Not meaning to be harsh, but its how it is in PDN.

I would say that its not a good thing to do PDN as a new grad. Also, cold washcloths on the abdomen and head is inappropriate. It should be lukewarm. I'll let you look up the info on that.

Parents will let you go for any reason or none at all. They might let you go because of the car you drive or because they don't like the color of your scrubs. People are strange creatures...parents with medically fragile kids can be even stranger!

Up Vote Up Vote ×
Typical. Get used to it. Not meaning to be harsh, but its how it is in PDN.

I would say that its not a good thing to do PDN as a new grad. Also, cold washcloths on the abdomen and head is inappropriate. It should be lukewarm. I'll let you look up the info on that.

Parents will let you go for any reason or none at all. They might let you go because of the car you drive or because they don't like the color of your scrubs. People are strange creatures...parents with medically fragile kids can be even stranger!

I don't mind the harshness. I totally realize this is going to happen and it's the nature of the beast... just going to be harder to take than I realized!

I'm starting to feel that way as well. It's difficult not having a floor of nurses/doctors/etc to consult with and being completely alone, even if the case is "easy." I did home care for 2 years as a CNA so it was just easy for me to get into and the only job offer I had at the time.

As far as the washcloths - when I said "cool" I meant lukewarm/not "cold"

Up Vote Up Vote ×
I will say that a temp of 103F axillary on a normal 96.5F is much too high of a fever to not tell the parent. That's like 105.1F on a patient that is normal at 98.6F!!

In my opinion as a parent, that high of a fever with such a rapid onset would have warranted waking the parents even if there was nothing else they could really do simply for the fact that it is their child and they should know so they can decide how they want to proceed.

Fair enough. I guess part of the problem is there were no parameters set - I was never told, "If her fever gets to such and such temp, wake us up." I suppose I could have asked...

Up Vote Up Vote ×
Specializes in Peds(PICU, NICU float), PDN, ICU.

Being psychic is in our unwritten job description. So is putting yourself in the parents shoes.

Up Vote Up Vote ×

We had parameters in large writing on the white board that said we were to be notified immediately for below/above certain numbers for temp, respiration, heartrate, O2 sats, b/p. Also in large letters it said "If B were your child and you think you'd want to be notified about a change, then notify us!"

I know there are parents that "just want the nurse to handle it" and there are overly protective parents like us that wanted to know immediately about changes/problems even if the nurse could handle so I don't know how to advise on that except to ask.

Up Vote Up Vote ×

You live and learn. I will definitely be asking from now on! Thank you.

Up Vote Up Vote ×
Specializes in NICU, ICU, PICU, Academia.

Ditto on 'Don't take it personally'.

It happens- and the fact that your agency immediately assigned you somewhere else should be reassuring. In my agency- that signifies 'you were right, but the customer is ALWAYS right' - so don't sweat it.

It's happened to me several times, and I imagine it will happen again.

Up Vote Up Vote ×
Specializes in Medical Surgical/Addiction/Mental Health.

I think it falls under, "and other duties as assigned" :-)

Being psychic is in our unwritten job description. So is putting yourself in the parents shoes.
Up Vote Up Vote ×
+ Join the Discussion