Medication issue

At will employers can fire you for no reason at all, get a lawyer to handle your unemployment. You probably will not get unemployment. Do not be surprised.

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I should probably also ask: How do I bounce back from this? My reputation is on the line. I've only been a nurse for a year. I have frequently felt that I did not get the support I needed at this facility and had to learn how to do my job many times on my own. When I asked questions, I was told "what do you think" and not in a nice way. I only had a total of 7 days of orientation. This latest episode is the culmination of a very difficult year. It is discouraging. I am determined though to continue. I worked too hard to let this slow me down. I just don't know where to go from here. Will the lawyer challenge the termination? I'm not even sure I can afford a lawyer.

Folks, there seems to be a major misunderstanding of what an "at-will" state is.

At will...means they can fire you for any reason. However, the problem always starts WHEN THEY GIVE YOU A REASON..if you get unjustly accused of something and they TELL YOU what the reason is and it is not true, then the employer has opened up an opportunity for a legal mess.

Yes, the OP has a case...I find it odd that the documentation that supported her claim "suddently disappeared". They are required to keep up with the materials that are included in the patient's chart. If you gave it to them and they lost it, then that is their fault....not yours. I have a feeling it didn't disappear at all.

No way would I let that drop.

Sounds to me OP like the orders were not clear. And you did the right thing calling for a clarification. Does someone witness your narc removals? Is there a Pyxis type machine? What was the narc count? I also would not let this drop.

Thank you everyone! These posts have been very encouraging. I've been reading other posts too where members have told others in similar situations to not be afraid to question something. The day you stop asking questions is the day you become a dangerous nurse. I know I did the right thing. Now, I need to fight for unemployment.

The count is always double checked at the end of the shift and there is no Pyxis unfortunately. Anyone looking at the sheet would be able to tell if I gave it or not though. The time ALWAYS has to be written down. Two things that were noted against me - someone complained that I did not give it until 2000 and they thought that I should not have questioned the prn order at all - as a result, the "patient waited too long". In other words, I should not have assessed the patient and I should have given the medication regardless of what the adverse side effects may have been!!!! Apparently, this is standard with hospice patients?????!!!

This is why I refuse to work in a non union facility. I doubt your getting fired has anything at all to do with this PRN med issue. Someone, for whatever reason, decided they just didn't like you so they just pulled this out of their hat. I have friends who worked at non union facilities who got fired for missing a couple initials in the treatment book. Of course it had nothing to do with that. They were good nurses. Many managers in LTC just have trigger fingers when it comes to firing. If they feel you don't "click" they can and will trump up any BS charge they want. Try to find a union position somewhere. The union would have protected you on this one...

Well, in the end, I was told that they had done a thorough investigation and that they could not find that I had given the pain medication at the time I said I gave it. The prn medication sheet has somehow disappeared (the one I documented my administration on).

Seems to me, if the med sheet is missing, they cannot conclude that the med was given in a timely manner or not. They know that it was given or else the family would be complaining that you withheld pain meds rather than just being slower than they liked.

This just sounds awful. I hope you figure it out. I'm sure you will find another facility that will support you rather than blame you.

I have had a couple of experiences with hospice patients. One experience was with my mother in law. I had to manage the whole end of life episode with her. Bottom line is that THE MOST IMPORTANT aspect is COMFORT. A nurse needs to know that the management of pain and anxiety are very closely related. The patient knows they are going to die, the family know it also. It is a very frightening awareness for both. Not to be rude or condescending, but that is why the patient is on hospice care, end of life care. Depending on how close they are to dying is how close the meds are going to be given. Family members are more acute at knowing the the more familiar grimacing a patient may do and subsequently may push for more meds, even if the patient does not or is not able to respond. There should be a hospice nurse supervisor that you can bounce questions off of. They were very helpful with my situation and knew that I was a nurse.

It depends on how aggressive the family/patient desires are for the situation. In my mother in law's case it was very clear in her written wishes what she wanted. She wanted to go quickly and pain free. So we monitored the morphine (respirations) and her anxiety. If she became conscious of what was going on she became fearful, verbal and restless, so up went the morphine and up went the Ativan until you could see on her face that she was peaceful and in comfort, not thrashing around. The hospice super and the nurses there were very helpful. We ended up transferring her home from the hospital and that is where she "blasted off".

In retrospect, you may want to get a hold of a morphine and Ativan protocol and review it or have someone else review it with you. Also the chart should explain the patient's wishes. Hospice care involves a different use of medication as opposed to what we are taught in school.

Good luck I hope this was helpful.