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 Pediatric.
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.

Oh wow, that is crazy and awkward. Crawkward! I've had moms lash out at me and it is soooooo not comfortable to deal with. Sigh.

Sent from my iPhone using allnurses.com

Wow, so dramatic! Sorry you had to deal with that.

My first assignment in PDN was horrible the Mom and the Dad kept the whole house in an up roar 24-7.... I was working at a local hospital and my sister asked me to work opposite of her on this case... The parents each had healthy teenagers by other people but when they got together and conceived a child turns out the parents were both carriers for a terminal illness...so boy how does one deal with that?? I'm sure they didn't mean it but they could be so hateful but my sister and I dealt with it as best we could...they eventually fired each of us from that case (and each nurse there after) which wasn't so bad....I learned to always always interview first with the family....I never go to a home without doing that first and I let them know that if they don't like me or something I do to let me know and I will correct it which helps keep the lines of communication open and always ask about what "their" preferences are in regards to care of their child... It's tricky working in someone's home so I do my best to blend in and do my work and never ever give your real opinion about anything that's outside of the work you do for your client ;)

Also fly solo...don't trust the nurses on the case your working at to keep your secrets ;)

What's up with cases and age?I've had a case where a guy(22 yrs old) only wanted young nurses...being 29 at the time,I was allowed to stay. He said he didn't think older nurses could handle hime physically. He was a big guy,but there was help around(his mom).Some of the reasons I was let go....I am reserved,but apparently that rubs people the wrong way. I'm also don't give out my phone number,my address,and other personal info.That burns people up,inclduing other nurses.By doing it that way,nurses don't have any juicy gossip on me. Other silly reasons,which many won't believe include...not speaking enough Spanish,havng curly hair,being overweight,being an Lpn,being an RN,being of a religion that doesn't celebrate holidays,not living closer to the pts's home,and those are just the reasons I was told.On one case,I had a suspicion that mom didn't want me back because I had long hair.she alreasy told the agency that I should put my hair in a bun or up

Specializes in Pediatric Private Duty; Camp Nursing.

Re: hair, I would consider that reasonable for them to request that its neat and out of the way. If that's something you refused to do, it could be taken as a bit peculiar and possibly unsanitary.

And some religions make some people uncomfortable, especially when they're way different from their own. I personally would not bar a person from working in my home if I was the client's parent, but I'd always be on my guard to not say anything offensive, which is a chore for me, frankly. It's best to leave religion entirely out of it when one is in another's private home. I realize JW's have died for their convictions because they wouldn't hide their religion, so advising somebody of that persuasion to just take a present, smile and say "Happy Holidays to you too" is not practical advice.

Specializes in Complex pedi to LTC/SA & now a manager.
Re: hair I would consider that reasonable for them to request that its neat and out of the way. If that's something you refused to do, it could be taken as a bit peculiar and possibly unsanitary.[/quote']

I agree. This is not an odd or unreasonable request. There are many occupations where long hair kept down is considered unsanitary/unacceptable/unsafe. I could see this as an issue with a medically fragile child or even a lot of high tech medical equipment.

There can be a lot of insecurity in the parental relationship when you have a MF child. Throw nurses in to that mix and it can create jealousy. I know a mom that had a lot of relationship problems with her husband and she did not allow any "cute/hot/pretty" nurses because she was constantly worried that he'd cheat on her. We saw her at clinic once and I had a cute, young female nurse with my son and she pulled me aside and told me to get rid of her before she hit on my husband.

Specializes in Oncology; medical specialty website.
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.

I've noticed that several people here mentioned they gave the parents their personal contact information. IMO, that is setting yourself up for trouble. When you're not with the patient, they should be going through the agency if they need to relay information.

It's dangerous to get too attached to these patients. I learned the hard way in home care/hospice that you have to maintain some distance; otherwise, you're in for a world of hurt later.

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