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

Specialties Private Duty

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!

Specializes in Peds/outpatient FP,derm,allergy/private duty.

Yep, this sort of thing is quite common in PDN as you now know . . .now my thought is it's a shame someone blew me off for something without asking me about it before they had a chance to find out what a great nurse I am:-)

I had one case where it seemed like I oriented 5 nurses for every one that was acceptable. I kind of had a sixth sense about those I knew would be great but ...not my call. The reason might be as simple as a client or family that was just in a cranky mood that day.

Learn what you can from it (as it seems you have with the temp paraneters) and move on. Best wishes to you

Thank you. Lemme tell ya, from now on I will not be assuming things are peachy just because they appear to be. I am now a skeptic!

I just really do not understand how people operate.

If there is a problem (like they didn't get notified about a temp), why not just say "hey...next time we would like to be notified for such and such."

What's the big deal?

Why just dump someone out of the blue without so much as an explanation? It just seems cowardly and a little mean. And unnecessary.

I know in orientation at my agency, they said if we are removed from a case not to contact the family about it. I guess they had to say that because it sure would be tempting to...

I don't understand it either. They always seemed so communicative before this. But obviously they aren't worried about my feelings and ultimately that's not their problem.

I was totally tempted to text the dad, heh... even just to say "I'm sorry things didn't work out, I enjoyed caring for your daughter." I never would, though.

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

Not worth contacting them. If they are nutty enough to pull a stunt like that, they are nutty enough to use legal action or say you are harassing them. You'll forget about them quickly and move on faster than you think. Its obvious you care and that is awesome! But unfortunately very few families realize how much we do care.

You can't control this situation happening. You can't change what happened or fix it. So the only option is to move on and know that this will happen again. I've said here before that if you do PDN its a matter of when a parent will drop you, not if. I've seen nurses get let go after being with a family for years because the family felt they got too attached. The job is a game called "keep the parent happy without breaking laws or crossing boundaries for as long as you can so you can keep a roof over your head and food on the table while balancing being the middleman between the agency and family plus that extra little part called nursing". Its a game where the nurse is always the loser unless you look at it as doing the best you can in the time you have to make a difference.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I was let go from a case in September. I orientated at the home & would work PRN. I worked a few shifts & everything seemed fine. But this one day when I was packing up I could tell the foster mom was uneasy/upset. I told her when I worked next & said goodbye. The next thing I knew I got a call dropping me from the case. I knew she didn't like me, how I did things or trust me. The foster mom was always in the room, bugging me & telling me this. The kid wasn't on a vent or trach. He was on constant oxygen & needed a lot of suctioning. But I wasn't shocked. I love working with peds but PDN sucks sometimes.

Specializes in Home Health (PDN), Camp Nursing.

I have a saying. "Nurses have an expiration date, just like milk. It not the milks fault it's expired, it's just time for it to leave." Even on the best cases, when everything is going ok, sometimes your date is up.

I'm pretty sure your employer would have told you if dad gave a reason, much less one that was sensational! I wouldn't obsess over it. Tend your wounds and don't let it effect your next case. Good luck!

Thank you. Lemme tell ya, from now on I will not be assuming things are peachy just because they appear to be. I am now a skeptic!

Good to do, but not too much that you become jaded:)

Specializes in Pediatric Private Duty; Camp Nursing.

I was let go of a case a year ago after only three shifts w a client. It's a huge blow to the ego especially when you are quite sure you've done nothing clinically wrong. It's actually good if you don't get a "reason", because it means it had nothing to do w your clinical skills. When I was let go, the client services mgr for the case was like, "Eh, don't worry about if", and immediately gave me a new Tuesday case. I found out later this mom dismisses nurses left and right without a fair shot.

If you're doing something wrong, believe me, they'll let you know and/or not give you any more hours. Maybe the parents did have a problem with you not waking them for the elevated temp. But if they didn't give you parameters how would you know what they wanted? I've been in the same scenario several times and I had a parent be grateful, and a different parent get irritated. I'm hoping the office gives us all crystal balls for Christmas this year. (Last year we got logo'ed lunch bags. We always get practical gifts.)

And yeah, my ego is still a little bruised, despite my own advice to you.

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

I had oriented to a case as a fill-in for a last minute vacation (primary nurse mixed up dates) with a nonverbal complicated older teen. It went well. Mom was happy. Primary nurse was impressed I understood his way of communicating with his eyes. I was all set. Client approved me, happy to have another nurse that understood him. Then the scheduler pulled me & sent me to another one of my cases. She wouldn't tell me why, but I had my suspicions.

My clinical supervisor was truthful. The second nurse that oriented is a young, cute 20-something. I am not. She could also do the full 16 hrs where I could only do 8. Heck I don't blame him. If I was 19, total care and cognitively intact I would rather spend the day with someone pretty. & closer to my age....even if my mom had to come in and help translate my needs. We laughed that the scheduler was afraid to tell me the truth. I suspected that would happen once I found out who was orienting after me.

It happens. If you did something wrong you would likely be called in and not rescheduled right away.

+ Add a Comment