Seeking advice and understanding. Started a new grad program/ in desired field cardiac, had 6 weeks orientation but felt nervous to be to be on my own so had my orientation extended another week. Once I was on my own I was perfectly fine there were moments I wasn't sure about a situation but I asked co workers and it was fine. I felt my time management and prioritization was good. I had one time I had a patient with uncontrolled hyperglycemia, it was night shift and his cbg was in the 300s, I scanned his insulin and no pop up came up signifying half dose; I questioned why no pop up but thought I remembered it was Q4 checks, which would explain no pop up, so I gave him his full dose. Once I did I went back to the computer and realized it was 4x a day. My blood ran cold I rechecked his cbg 20 min later and it was around 365, it was like the insulin had no effect. I still felt I made a mistake and filed it in the system for management. It was never brought up again and I figured it was because there was no adverse reaction. I go the rest of my 6 months feeling good and fairly confident. Then the last week before my 6 months is up I Change out an iv bag and tubing for the on coming RN and forget to put a date sticker and curos cap on the tubing, that morning management compiled a list, I didn't finish my admit intake(bcs Pt went to dialysis for most of the night), didn't change out an Iv, was due that morning, had to talk to my cna multiple times that night for not completing task, and he told the manger things I didn't say (no past issues w/ other CNAs), lastly I prepped a pt for surgery despite no orders; based on shift change report and pt statement and advice from charge nurse...this was the list presented to me upon being let go 1day after my 6 months...help! Is this justified and do I now forget ever working in cardiac or a hospital again? How do I move forward in interviews, I didn't feel over my head and I loved my job?! My union rep said I could file a grievance but it's yr long process so I agreed to resign. Ugh I'm moving back to California with family and it is difficult to findx work there! Thanx for any advice :/
It sounds like a few mistakes were made and not followed up on correctly, or at least not communicated correctly. For the Insulin, did you notify MD and (Charge RN) of the mistake, what did MD say, did you do, and document what MD stated ("MD notif of Insuin...states understanding and no intervention" (and also don't rely on just the computer MAR for accurate info); tubing not labeled correctly (should not necessarily be a big deal but maybe bc of other tasks neglected was metioned), next time just be more careful; prepping a patient for surgery without MD orders could potentially harm the patient (depending on what you actually did) and should have been clarified with MD ("patient states you said he would have surgery tomorrow, I don't see any orders...") and appropriate MD orders placed if the pt was having surgery (NPO, IVF, chlorhexidine, labs etc.) and again document what MD stated ("MD states not sure if pt will have surgery so no new orders, pt notif"); CNA (you don't say what happened) so I would think it was more of a communication issue, next time speak to your Charge RN if CNA is not listening to you, Charge RN can assess if you are being appropriate in your expectations or if the CNA needs further counseling; not completing admission paperwork, did you notif the Charge RN that you were getting behind (so he/she could possibly assist), notif the next RN that is was not completed, what still needed to be completed, and your reason for not completing. The paperwork can be very time consuming but still needs to be completed.
None of these mistakes by themselves should have been a deal breaker but together and/or without proper communication/documentation was (maybe) the problem. I just point it out so hopefully you can gain some insight and learn from the mistakes.
You say you are moving so I would just put that as the reason you are seeking a new job. You do need to put that job on your resume. You can also use one of these examples as a learning experience when questioned in your next interview.
Yes, was in the notes that he was to get the surgery at another facility but his emergent situation landed him at our facility. The notes mentioned it was best for him to have the surgery at our facility, but no order. He said he talked w/ the doc and agreed to have the procedure here, this was also comunicated at shift change... so he was npo and prepped in case the order was put in in the morning...all communicated with charge nurse
Yes, was in the notes that he was to get the surgery at another facility but his emergent situation landed him at our facility. The notes mentioned it was best for him to have the surgery at our facility, but no order. He said he talked w/ the doc and agreed to have the procedure here, this was also comunicated at shift change... so he was npo and prepped in case the order was put in in the morning...all communicated with charge nurse
Just because it is in "the notes" does not necessarily mean the surgery will happen at all, and/or when it will happen (it is just the plan). If he was transferred to your hospital because of an emergent situation (for a higher level of care) the pt may not be stable for surgery as planned. That is even more reason to clarify with the MD when surgery will take place and obtain actual MD orders. If the Charge RN knew this maybe he/she assumed you were going to contact MD. There was an MD on call for the patient (Hospitalist etc) and should have been notif of need for clarification/orders, that MD can then notif Surgeon if necessary (maybe the primary already talked to surgeon and just forgot to write orders). I have never worked anywhere that gave the RN latitude to just simply make a pt NPO because of real or possible surgery. What about other orders that were needed (labs, Xrays etc) or that needed to be changed (does the pt need IVF since NPO etc). You can (and should) always listen to the patient but it still needs to be clarified with the MD. (For instance you might withhold the dinner tray for a few minutes until you are able to reach the MD etc).
Again, I hope you can just take this as a learning experience (we all have to learn from our mistakes, myself included) and move forward to a new and better job.
Learn from this situation and move on. Time management is a problem for new nurses, its not something they can teach in school. Orders should be clarified from the physician. I work with surgical patients all the time, if the patient is having surgery , there needs to be clear written orders from the physician regarding prep work. I would never prep a patient for surgery without orders. Sometimes the patients surgeries are delayed because the physicians did not put in prep orders for the surgery, the night before.
Specializes in Neurosciences, stepdown, acute rehab, LTC.
Most of these seem like non existent issues to me... the only thing that is a bigger deal is if you didn't notify the doctor after the big dose of insulin. Definitely NOT a fireable offense though! I would think a chat/ reminder with Your supervisor or manager would be enough. I agree with the other posters, this post is hard to follow, maybe from mentally reeling from stress.
I still don't understand what happened with the insulin. But I gather it was a med error of some kind, you recognized it as a problem, took steps to protect your patient, you wrote yourself up on it, hopefully corrected the deficiency and heard nothing back about it again.
As far as the surgery prep without orders.... If I was told at report that surgery is in the AM, the patient tells me they are having surgery in the AM, and the note says there is going to be surgery in the AM, I would have gone ahead and done the prep too even if there weren't orders for surgery prep.
I think you made the right decision. It wouldn't have made sense not to do a surgery prep given the information you had. And it would have made you look like an idiot if you hadn't done the prep. Yeah, we need orders for stuff, but it's not like a night before prep is a big deal, unless we're talking about bowel prep or something. We do a CHG wipedown and NPO.
From all you're telling us it sounds like you got the shaft. It doesn't sound like you made any horrible do-not-pass-go mistakes. Better to move on to make some lemonade with these lemmons as others have suggested. Only thing is I would have probably gone the union route just on principle, but I would have declined to work under that manager again.
I'm not sure how to tactfully list this job experience on a resume, but I think you need to list it? Maybe others will chime in with suggestions? Good luck in your job search.
Thank you, Accolay, my coworkers and union rep also think this was messed up... union rep said I could grievance but it's a year long process with no guarantee I will win... in the mean time I'm a new grad with only 6months experience...I'm truly stumped about the job search and feel like resigning myself to a SNF. With the insulin error I talked with the charge nurse and was told there was no need to contact the doc. There was no adverse reaction. I do think the manager should have said something but she never did
the patient is prepped the night before surgery with chlorhexidine wipes, basically like a bed bath. There were no orders for surgery which happens, then the doc comes in the morning of and puts the orders in. I informed the pt there were no orders but he said he had talked to the dr....this was one of the reasons my manager gave for my termination, that I falsely told him he was going to surgery...I'm angry and am not sure what to say in my cover letters, interviews, or resume... i don't know how to move forward
What you should not do when applying for a new job is badmouth the people who fired you.
I think they are jerks, BTW, for not talking to you about problems when they arose, instead of slamming you out of the blue at the end. It makes me think that your main issue was with the aide and maybe with other staff members.
Or maybe the nurse who followed you didn't like having to change an IV that you should have changed. If that sort of thing comes up again, move Heaven and Earth to not leave any work undone, even if you had 12 admits and 87 people went home or died. Some nurses are just such evil people and no explanation will ever be enough for them to see the work as 24/7, not just my shift/your shift.
Count yourself lucky to be out of there, although I do understood you being upset.
Take a little time to grieve this loss. After a while, the hurt and frustration will lessen and you will be able to think more clearly.
If you are moving out of state, that is enough of an explanation for needing a new job.
I have actually seen a very similar thing happen to someone I once worked with. The hospital had a union and the first 6 months of employment were a trial period and you could be fired at will, after that we were a permanent member of staff and very hard to fire without a very good reason and a massive paper work trail (your list wouldn't come close). The reality of that was that mangers looked a staff very closely right before the 6 month mark. One of my co workers had a story very similar to yours, a list of small things that really should have been dealt with along the way by peer counseling or a verbal correction by a manager but were seemingly ignored. She even received a positive evaluation at her 3 month mark. She was completely stunned to be fired right before the trial period was up.
Bottom line in my opinion is that this unit fired you rather than taking the time to train you. It's honestly really unfair. Chalk this up as a learning experience. In future try to consult the more senior members on shift for how to deal with abnormal situations like the insulin and the surgery. In most places the best bet would have been to call the doctor and obtain an order, as you have mentioned this was't possible I would have sort help for how to best protect yourself while caring for the patient in accordance with your units expectations. Also when an incident does occur actively seek feed back on how to better/ correctly (in their opinion) deal with the issue in future, it shows that you recognize you made a mistake and are committed to following your unit policy in future. I'm not saying you weren't at your previous job but I am staying their perception of your willingness to learn "their way" is probably a big part of why they fired you for a series of small events that many of us would agree should have just been teaching moments.
mtmkjr, BSN
577 Posts
It is better to prep the patient for surgery unnecessarily then to not to prep the patient and have it end up being necessary.
I agree with the others, the list you gave does not seem termination worthy.