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

Specialties Private Duty

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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!

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!

Well said.

It could very well be that you were punished for the child getting sick, nothing more. Or, they could have had your departure in mind for some time and this presented the opportunity. Don't discount the possibility that the agency was actively looking for a replacement for some time at the parent's request, but told you otherwise. You can not always count on the agency being on your side. And contrary to what they tell you, at some point, they will hold things against you, your fault or not. Just par for the course in home health. What you can't do, is to beat yourself up and lose vital energy obsessing over this. If there is something to learn from a bad experience, figure that out and move on. Most of the time it won't be you. You need your self confidence. Best wishes.

This type of BS is why I won't bother with anyone under the age of 18.

Thanks everyone for sharing your experiences and advice. I'm so glad I posted here - I feel a lot better. I'm still yearning for some type of closure but I realize that's a pipe dream.

This has all inspired me to stop being lazy and start sending out another round of applications to hospitals (I really want to get into critical care - ADULT critical care - I didn't really mean to get into peds... it was just all that was available to me at the time). There are just too many disadvantages to me in PDN, including my apparent propensity to get so attached to clients since you are with them for so long. I wouldn't mind doing this PRN in addition, though.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Thanks everyone for sharing your experiences and advice. I'm so glad I posted here - I feel a lot better. I'm still yearning for some type of closure but I realize that's a pipe dream.

This has all inspired me to stop being lazy and start sending out another round of applications to hospitals (I really want to get into critical care - ADULT critical care - I didn't really mean to get into peds... it was just all that was available to me at the time). There are just too many disadvantages to me in PDN, including my apparent propensity to get so attached to clients since you are with them for so long. I wouldn't mind doing this PRN in addition, though.

All the best to you on your goal to land a job in critical care! You've shown you can take a setback, learn what you can and move on without letting negative "baggage" hinder you which is crucial in any nursing job.

I'm not always totally OK with inexplicable behavior or lack of closure either. But PDN has given me lots of chances to practice.

Specializes in Geriatrics, Home Health.

I was asked not to come back to one peds case for political reasons. The child was a baby, the youngest of 6 kids. The family was very religious and very conservative, with Bible verses posted around the house. The nurse who oriented me was also very religious, very conservative, lived off the grid in the middle of nowhere, and had raised 6 kids of her own. I'm a childless liberal borderline atheist from the big city. I generally get along with conservative religious types, as long as they don't try to preach to me. I never said a word about their politics or religious beliefs, but after 2 orientation shifts they decided they didn't want me back.

I'm currently on a peds case where the mother's girlfriend is actively trying to get rid of me. Mom and girlfriend are having relationship and financial problems, and I'm trying to stay out of the crossfire. Mom and I get along fine, but since girlfriend is currently jobless, I deal with her most of the time. The agency hasn't pulled me only because no one else is available to work the case.

Specializes in Geriatrics, Home Health.
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.

My agency had a case like this. Client was in his late 20s, very into pop culture, didn't like older nurses. He tried to dismiss a nurse in her 50s solely because of her age (and said so), and the agency refused. It's a nursing agency, not a dating agency. The client now has mostly young male caregivers his own age from a different agency that does non-medical care, but my agency still does things like G-tube changes.

Specializes in Peds, developmental disability.

I do hear about families that "love" their nurse, and the nurse in return loves the family and especially the child, almost by the nature of "a nurse", and "a child". But after learning that these relationships DO "expire" after a while, I no longer get personally involved, in my own heart. I care, but not TOO much.

If the people at the office reschedule you at another home, you are fine!! It was not you. And in every setting, you LEARN from the events that surround the ill person. And so, you learned....and we all do, every day.

I was dismissed from a case for the first time earlier this year - shocked me, I know I shouldn't take it personally but I did. I had worked this case on the weekends for 3 months - single mom, most of the time mom would leave for work and return right before my shift ended. Never had any idea that she was unhappy with me. Her mom came for an extended visit (from another country), patient mother had already warned me that grandmother likes to do all the personal care & attempts to do the medical care (medications, Gtube feedings) but I was only to let her do the personal care - ok, fine with me. Grandmother did not speak english but I felt we seemed to get along ok. After a few weeks of working with grandmother at home I get a call from the agency stating that mom did not want me back - her reason was that I "didn't clean the equipment". The agency was shocked and asked me about working there - if I had any issues - I didn't. Anyway - nothing was ever said to me at the agency about why I was let go. It really bothered me at first but I learned to let it go.

A couple of weeks ago - this patients regular nurse was sick and the agency asked me to go work one day on the weekend - I turned it down - no way was I going back to work for someone who I felt lied about the care I gave.

Yikes! I wouldn't go back to mine if they asked, either. Too awkward.

It is my impression that oten when you first start with an agency you get a case they can't keep nurses on. That was the situation with my first case. It was mutual decision between child's guardian and me for me to be off the case and I was relieved, but a little shellshocked too I was really putting up with a lot because I didn't know any better. The next case got was soooo much better! I always see the other case on a list available shifts. I bet you will like your next case better too! Don't waste another minute worrying about why. If your agency thought t here was something to worry about they would tell you about it.

Specializes in Pediatric.
It is my impression that oten when you first start with an agency you get a case they can't keep nurses on. That was the situation with my first case. It was mutual decision between child's guardian and me for me to be off the case and I was relieved but a little shellshocked too I was really putting up with a lot because I didn't know any better. The next case got was soooo much better! I always see the other case on a list available shifts. I bet you will like your next case better too! Don't waste another minute worrying about why. If your agency thought t here was something to worry about they would tell you about it.[/quote']

So true. I've worked with 2 home are agencies and with both, the first assignments they gave me were their absolute most difficult.

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Specializes in School LVN, Peds HH.

I was let go from my 1st PDN case in August. The whole week surrounding it was just plain crazy! I had what I thought was a fantastic working relationship with the mom, and it was a dual-peds case... I had the kids down pat. One of the little ones had been having a rough time with seizure activity, so we had all been under an enormous amount of stress for about 6 weeks leading up to this event. Basically what happened was I noticed the mom withdrawing & giving me the cold shoulder. She was cordial, but nothing more. Spoke only to me if absolutely necessary. Highly abnormal for her. This went on for 3 days. On the 3rd day, she approached me in the kitchen on her way out (with one of her foster kids in tow mind you), and things turned hostile. She started verbally lashing out at me. Told me that I couldn't handle both kids, that I had a problem with her other kids, that she didn't feel like she could call me in early, and it went on & on... it ended with me in tears, giving a half-hearted defense of myself and her suggesting 3 times that "maybe I should find a new case because I need to do whats best for me and she needs to do whats best for her". Then she left. It was nuts!!! The next day I spoke with my supervisor and let her know what happened and she was floored! I guess less than 3 hours before she went hostile on me, she had been on the phone with my supervisor telling her that she was worried I was unhappy and that I was going to leave the case, so she wanted a solution to make it so I stayed. I asked for the rest of the week off (which was 2 days) to think things over and make a decision.

The mom kept texting me. At first it was things like "I'm sorry if I was harsh but it needed to be said". Which progressed to "I heard you're not coming in tomorrow, I hope you're ok!". And then longer, more detailed messages. I didn't have a chance to make a decision on my own. I got a call from my supervisor the next day telling me that the mom had asked for me not to return because she felt that she only used a tone & it shouldn't have upset me. I think I actually laughed when she told me that. The agency has to respect the parents wishes, and by that time I was so over the whole situation. I've been reassigned, I was actually reassigned within a week. It was a brand new case that took a while to get open, but they had me on it quickly. The new case is great! I have less migraines, less stress, more sleep (even though its NOC shift) & no one yells at me!

The mom from the other case has contacted me a couple times since I left. We chat lightly about surface level stuff over text every month or so, & things are patching up between us. I personally don't think she ever really intended for things to end the way they did. The stress of the little ones seizures took its toll on everyone. I hate leaving things without closure as well. I never would've talked with her, but she initiated the contact. I just keep it light-hearted talk.

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