Let go

caliotter3 · Mar 5, 2012

I think the punishment may have been harsh for what could have been a simple misunderstanding. If you were expected to know that, then maybe a stern reprimand. As a licensed nurse, this is the first time I have encountered this information. I believe you will be able to explain what happened without a new employer holding it against you. Be ready to explain the circumstances and what you learned from it. Good luck.

Wonderlost · Mar 5, 2012

Yeah... I mean I am upset that it happened, but I did learn from it at least

I also now know that ammonia inhalants are apparantly archaic, but I guess working in a jail with limited resources its to be expected lol.

Truthfully, I didn't know you had to get an order to use an ammonia inhalant, or that they were considered a medication, but like I said, at least I know it now lol

colleennurse, ASN, RN · Mar 5, 2012

All you can do is be honest and explain what you learned from it and how you might handle future situations. Honesty and being able to admit when you made a mistake are good qualities. Everybody has made some mistake at one time or another. Good luck with your job hunt!

OCNRN63, RN · Mar 5, 2012

I was recently let go from my job as a med tech inside of a county jail.
A woman came in & took a lot of klonopin before hand, & effectively knocked herself out. We could not send her to the hospital because she turned herself in
The nurse on duty had her placed by herself in a cell, on 15 minute checks.
She told me whenever I go down there, to check her vital signs. I got down there later in the night, & whenever the officer took me to her cell, we could not wake her up, so I used an ammonia inhalant on her, that the nurse had left with the officers earlier in the day.
I know now that I should have used the sternum rub on her before anything, but I can't go back in time & fix that unfortunately.
After I used that inhalant, I went into the nurses station & gave the officers a few inhalants to replace the one that I had used to wake her up, that the charge nurse had given them earlier.
A few days later, I was fired for practicing outside of my job description, & my scope of practice, by using an inhalant without an order, & for distributing them to the guards.
My question is, when I go in for interviews to find a new job, how bad is this going to look to employers?
I mean I know now that I should have used the sternum rub, & that the inhalants are considered a medication that I can't distrubute, but at least now I know for future reference I guess.
I don't have a problem telling employers what happened, but is the situation really so horrible that it would keep me from finding a new job once I tell them?

I don't understand why 911 wasn't utilized. The woman had taken drugs, then she became unresponsive. If there were ever a condition that warranted EMS, it would be this one. Really, she should have been shipped out as soon as it was known that she had taken an OD. The sternal rub wouldn't have been helpful. Ammonia inhalants are not going to help in this situation; even if she had awakened, she still would have needed treatment.

You don't have a scope of practice because you don't have a license. You did have a job description, but I'm willing to bet ammonia inhalants and their use and distribution isn't included in it. If you have a job interview, tell them that you learned from this experience to know your job description thoroughly. You may want to review the sorts of situations that would require activating EMS.

Before someone jumps all over me for sounding harsh, I am not being harsh, I am being matter-of-fact. The first thought should be for the care and safety of the patient (and future patients). How to handle interview situations is further down the list of priorities.

Wonderlost · Mar 5, 2012

Unfortunately, I was not able to make decisions like that , calling EMS would be on the charge nurse & she would have to talk to the doctor before that

I think the issue was that I used the inhalant before I checked to see if she was responsive or not, which she didn't really rouse when I used the inhalant, but she was up long enough for me to take her blood pressure & get O2% & pulse etc, & then fell right back asleep

I agree that EMS should have been called or at the very least she could have been moved to the infirmary, but all that is on the nurse.

I was always told in my CNA class to stay within your scope of practice so I just assumed I had one, but I should know by now that whenever I make assumptions, like if the nurse can give the officers an inhalant I can too, I always end up in trouble haha

Thanks for the help, I appreciate it, and I will. Next time I get a job I am just going to memorize the description & never assume anything...

OCNRN63, RN · Mar 5, 2012

Unfortunately, I was not able to make decisions like that , calling EMS would be on the charge nurse & she would have to talk to the doctor before that
I think the issue was that I used the inhalant before I checked to see if she was responsive or not, which she didn't really rouse when I used the inhalant, but she was up long enough for me to take her blood pressure & get O2% & pulse etc, & then fell right back asleep
I agree that EMS should have been called or at the very least she could have been moved to the infirmary, but all that is on the nurse.
I was always told in my CNA class to stay within your scope of practice so I just assumed I had one, but I should know by now that whenever I make assumptions, like if the nurse can give the officers an inhalant I can too, I always end up in trouble haha
Thanks for the help, I appreciate it, and I will. Next time I get a job I am just going to memorize the description & never assume anything...

If someone is in distress, you can call 911. You don't need a license to activate EMS. Anyone, even a layperson, can do it. Better to err on the side of caution than not call and have someone have a bad outcome.

I didn't see that you were a CNA. Depending on your state, it's possible you have a defined scope of practice. If you have one, make sure you know it. I'm a little troubled by your frequent statements of "that's all on the nurse." If you want the responsibility of caring for people, you have to be willing to go over someone's head if a patient needs care and isn't getting it. If you think something is out of line, it's wrong to just stand back and say "It's not my responsibility."

sapphire18 · Mar 5, 2012

I also agree that the woman should have been sent to the ER to begin with. That being said, I have never heard of the ammonia (like smelling salts?) being classified as a medication. My instructor used that on me when I passed out in my labor and delivery clinical! Lol. And since the nurse had given them to the guards in the first place...did she not expect it to be used?? What am I missing here!?

Wonderlost · Mar 5, 2012

I don't think you are trying to be harsh or anything, I know you are just being honest about everything & I appreciate it

But as far as calling EMS goes, in the jail, before EMS can be contacted you have to make the jail staff aware that EMS will be arriving to pick up an inmate, and also the medical staff, & it MUST be the nurse on duty to make that decision

I am not always going to say something like that & not take responsibility for something that I know is wrong & try to make it right for the patient, but as far as this goes, I just don't think it would be appropriate for me, with 1 year of experience & 1 certification, to go over the head of a well experienced licensed professional who made the assessment that was acceptable for the inmate to stay, as well as the doctor who agreed with her decision.

I would probably be fired either way, but honestly, I would rather explain to my boss why I used an ammonia inhalant & gave one to the guard, than explain to my boss, the doctor, the nurse, as well as the jail staff why I made the decision to call EMS to pick someone up

Wonderlost · Mar 5, 2012

I also agree that the woman should have been sent to the ER to begin with. That being said, I have never heard of the ammonia (like smelling salts?) being classified as a medication. My instructor used that on me when I passed out in my labor and delivery clinical! Lol. And since the nurse had given them to the guards in the first place...did she not expect it to be used?? What am I missing here!?

I am pretty certain they basically are smelling salts... Hell I have used them to wake myself up in the mornings on groggy days, you can buy them at Walgreens...

I don't know either, honestly.

Someone told me later that she probably gave it to the guard to have for herself in case the inmate does become unresponsive when one of the guards were checking on her, but that doesn't make sense to me either because whenever a situation arises that a nurse has to go into the jail population, we have a bag that we take with us that is full of medical supplies, including a box of inhalants

Wonderlost · Mar 5, 2012

I didn't try to fight for the job and ask why they were considered medication or anything, because at that time, we had become very over staffed and I was not getting any hours anymore really, & when I was there it was more frustrating than anything. I had just been there a year, so I at least got a year of experience from it

jt43 · Mar 5, 2012

I think it sounds suspicious. I mean phlebotomists can use smelling salts. I doubt it was outside the scope of practice for a CNA, but you should check on that with the licensing board to be sure. It might have been beyond the scope of your job description though. Prisons have "odd" rules. Even so, if a guard could administer it, then you should have been able to as well. I think they were overstaffed and just looking for an excuse to fire someone.