Nervous over possible termination

[funsizedliv]

So I haven't posted in a long time. Since my first thread, I have graduated, worked in a crappy job for 6 months, and since leaving there, I have been at a facility for one year this week. So this is what I am worried about:

I found out that I had made a med error five days in a row, ( I didnt check the dosage listed on the pill card). I was taken of the schedule for sat, and sun., and asked to meet with the DON on mon(holiday). She was not in on monday (my normal day off). I arrived to work on tuesday and was not on the schedule. I am terrified that I am going to get fired, is that likely?

backstory: I work on an acute rehab floor. We had been pretty empty for a few months, but there suddenly was a surge of admissions which really threw us off. Many having some pretty serious issues, one even being returned to the hospital for elevated potassium that the hospital missed (he seemed the most healthy out of all of my pts). Several of my patients require A LOT of nursing care, I have two MR patients, one is non-verbal and has bolus GT feeds, I have one psychotic patient on dialysis who is 90 years old and not doing well, yet refuses to sign a DNR, I have a woman with expressive aphasia who now has a GI bleed, A pt with hepatitis B+C with 4x daily blood sugars and behavioral issues, a 80yr old new gt patient with recurrant aspiration pneumonia running a temp of at least 100.0 for 3 days, and lastly, one with PTSD and severe anxiety who, despite 'wishing she were dead' for needing one, requests an enema every morning, and those are just the heavy ones.

For my end of the unit, I am one nurse to 18pts, I have two CNA's ( who arent allowed to do much more than AM care and toileting per the facility). I am responsible for all treatments, meds, and skilled notes on 17/18 of them. There is a charge nurse (who I consider my mentor) who has every intention of helping, but she is so bogged down with orders that she cant get away from the desk.

We also have a new MD and a team of NP's that work with him. One NP comes in daily to take off some workload from the MD. This new doctor has most of the patients on the unit, approx 30pts. For some reason, they stopped giving the other two MD's (one being the medical director for the floor, the other is the former director) admissions. Well once this NP came in, instead of checking patients and ordering things, she began overhauling how we do things. She even hijacked our part-time unit clerk, keeping her on the floor at all times (and now she has no time to do medical supplies, her primary job).

So this made a mess of everything and caused confusion for the staff. We finnally started getting the hang of it though after a few days. So she wants: VS and weights as soon as she arrives on the floor. (of course this is done before meds anyway, but my cna's havent done vitals at this facility, and its like pulling teeth to get weights done.) So When I arrive on the floor in the morning I (personally) have to: take VS on all 18 patients, make sure weights are done before breakfast (the 11-7 shift wont do them) get report, count, check the breakfast trays and help pass them out, check the bm book, check the apointment book, then I can start my med pass. Then, once the NP arrives, she tears through things, bombarding us with questions that I usually dont have the answer to, then gets really annoyed with us and 'throws us under the bus' to the DON. Then I can finish the rest of my work, but I havent been able to get done on time for a few weeks now.

I have so much to do and so little time (I have never taken a lunch break since I started BTW), that I have to rush through everything, and having ADD, I already dont have a good attention to detail all the time. (not to mention it is really hot on the floor, I sometimes think they are doing a study on our behaviors related to intense temps.)

On thursday we had staff meetings, the State had just done our survey, and then returned to investigate problems they found. After the meeting I attended, the DON asked me and the charge nurse to stay behind. She told us what needs to change on our floor and that we are not up to her standards of quality at that time. She even told us to change our handwriting becaus its 'too loopy'. She said she was trying to motivate and not push people out of the facility. (she told me that I was going to be the death of her).

So later that day It was discovered that I had been giving a patient too much digoxin for five days. He was supposed to get 0.125mg but was getting 0.25mg. I checked his AP before each dose and held it on the day that the error was discoverd since his AP was 55. The NP was looking at his labs and discovered he was in dig toxicity, she asked my nurse manager to investigate. When my manager asked about the med, it clicked. I knew that the dose ordered was 0.125mg, but the med I had was 0.25mg, I had been rushing through the meds and I never got to check the dosage on the pill card. (the pharmacy also never sent the correct card, and the old one was never removed from the cart). So I felt terrible, cried my eyes out once I was home, and was worried sick about the patient. (I found out this morning that everything is ok and he is out of toxicity). It was all my fault, I am the primary nurse and missed this error for days. (there was only one other nurse who gave him the med on the weekend, but I dont know if anything happened with her).

So on friday (my day off) I was very nervous to return to work on the weekend, expecting the worst for the patient. But at 7:30pm on Friday, I get a call from a coworker (turns out to be the nurse who trained me a year ago), telling me that the DON called her from home, and decided to take me off of the schedule for the weekend, and wanted to meet with me on monday. (monday being a holiday and my normal day off). So before ending the conversation, the nurse passing on the message wished me a 'good little vacation'. I didnt know if she knew what had happened on thursday so I just shrugged it off. So now, again with the waterworks. Fearing that I will be fired

I prepared for my meeting with the DON. I listed what I need to improve on, where I need help, and problems on my work floor that directly affect my work. I also posted my resume online and applied for jobs just in case.

Monday comes, I call work and leave a message for the DON to call me when she wants to meet up. (it was a holiday so she didnt come into work that day, as I expected. ) So, no call back on monday.

Tuesday (today) arrives. I get ready for work and prepare myself again for my meeting with the DON. I get there, and my name is off the schedule. The DON is not in yet, but I happen to bump into my floor manager. I tell her about the weekend (she seemed blank expressioned so I couldnt read if she knew something or not). I asked about the patient, and she informed me that he was fine, back to baseline and the med was d/c'd. So I asked her to have the DON call me when she see's her so I can meet with her. That was at 7am (its now 8:42a).

I am hoping that I was given the weekend off because the DON recognized that I was overworked and that led to the med error, but I fear the worst, and that I will be out of a job. (they reciently have 'cleaned house' and escorted staff out of the building, the charge nurse I work with thinks she and I will be next)

Any thoughts are appreciated.

[leslie :-D]

I think some people on here are being too hard on you. Yes making a med error 5 days in a row isn't a good thing... But how on earth can anyone expect you to get vitals and wts on 18pts, do 18 assessment, pass morning meds, chart, check new orders ect ect.... This would probably take me all day!!!!!!!!

Tiger

i think overall, the responses have been very supportive.

and those that have focused on the med errors (such as myself), i think, are trying to emphasize that no matter what is happening on the floor, it can be a matter of life and death by not administering meds safely.

proper med passing will always be priority.

and if the op can learn anything from this, it must be the significance of keeping our pts safe.

vs, wts, assessments, task in gen'l, are all secondary in the grand scheme of things.

and, making excuses negates the severity of one's actions.

yes, she should likely seek other employment.

but no matter where she goes, we cannot allow anyone or anything to interfere w/our ability to do our jobs safely.

at least, i'm hoping this is what she takes from this thread.

leslie

[Janet Leonard]

I know getting fired is not what you want but you can't continue to do the work of 3 people. You should keep looking for another job even if they don't fire you because that is the worst situation I have ever heard of and you worked too hard for your license to lose it because they want to save money. Save yourself and get out fast. Good luck and keep posting.

[gentlegiver, ASN, LPN, RN]

Sorry to inform all you Nurses who work in Hospitals, there are no patient limits in LTC. The first place I worked at I did all the op stated .... for 41 patients! The average patients for a LTC Nurse varies with the size of the unit, accuity doesn't come into the picture. Around here the average unit is 42 to 48 pts, and is split between 2 nurses. Since my first job, I've averaged 24 pt's each shift. If I'm lucky I'll have 4 CNA's and the other Nurse on the Unit will be staff who knows the pts in case of an emergency. If I'm not, 2 to 3 CNA's and a Travel or Agency nurse (nothing against either but having staff who know pt's and where to find supplies is a lifesaver).

Most new Nurses are not given enough orientation or support in LTC. I was told by my instructors that it would take 5 years for new Nurses to feel compatant (spelling??). In LTC they expect you to run your unit within 2 months. And you had better NOT make mistakes and complete everything within your 8 hour shift. Unrealistic??? You Bet!

[LilyBlue]

I justed wanted to give you another hug...I know this has been rough, it's made my own heart sink and I don't even know you! But remember that you've passed an important milestone today, too - several actually - first disciplinary action, first serious med error - and I think you have handled it really well. You didn't run away, crying... you are listening to advice and thinking of the future. Good for you, and be well

[gentlegiver, ASN, LPN, RN]

Let me add that I agree with above posts. Follow the 5 R's diligently! Let everything else go hang (except true emergencies) during med pass. Look very closely at the MAR and the Med Card. If it still seems funny to you, look into the Dr's orders. Doing this saved my tiny hiney many times.

Also start looking for alternate employment. This place will cost you your sanity if not your Licence.

[patwil73]

One thing I feel a lot of us fail to do in responding to these situations is considering the working area of the OP. We concentrate on what we should do - versus what we can do. In a perfect world this would be the same, but our world is far from perfect.

The OP missed a med change due to not following the 5 rights. Was that wrong? Yes. Should she know better? Yes. But the process of having so many patients makes it very difficult to impossible to follow.

Now many posters have said to slow down (very good advice) and concentrate on always making sure med passes are safe. However, what would happen if she did slow down to a safe level? How long would it take to finish everything? How upset would the NP and the DON be when things aren't done the way they want? Would she get fired for inability to perform her job?

Now many might say this would be a blessing (I might have mentioned something along those lines myself ) however in these economic times finding another job might not be easy. Also fired for any reason doesn't look the best on your resume. What happens if she can't get any other job except in the same area (LTC or rehab) and the same thing happens - remembering she is trying to go at a safe level. And she gets fired again.

Soon that license she worked so hard to protect is now worthless because she can't get a job anywhere except the desperate areas - where again she is forced to work in a process that is unsafe.

There has been a lot of attention given to safe staffing in hospitals recently - we really need to establish some maximum levels in LTC and rehab. Say 10-15 and less if more acute.

Sometimes regardless of what we know as wrong or right we must live within the confines of possible and impossible. Everyone will have to find their own balance where that is and hopefully strive to move what is right closer to what is possible.

Pat

[leslie :-D]

one thing i feel a lot of us fail to do in responding to these situations is considering the working area of the op. we concentrate on what we should do - versus what we can do. in a perfect world this would be the same, but our world is far from perfect.

the op missed a med change due to not following the 5 rights. was that wrong? yes. should she know better? yes. but the process of having so many patients makes it very difficult to impossible to follow.

now many posters have said to slow down (very good advice) and concentrate on always making sure med passes are safe. however, what would happen if she did slow down to a safe level? how long would it take to finish everything? how upset would the np and the don be when things aren't done the way they want? would she get fired for inability to perform her job?

is it preferable to accommodate the np/don and save our jobs, or to accommodate the pts and save their lives?

now many might say this would be a blessing (i might have mentioned something along those lines myself ) however in these economic times finding another job might not be easy. also fired for any reason doesn't look the best on your resume. what happens if she can't get any other job except in the same area (ltc or rehab) and the same thing happens - remembering she is trying to go at a safe level. and she gets fired again.

soon that license she worked so hard to protect is now worthless because she can't get a job anywhere except the desperate areas - where again she is forced to work in a process that is unsafe.

at least she'll have a license to protect.

if a med error is such that it causes serious harm/death to the pt, she could easily lose her license.

there has been a lot of attention given to safe staffing in hospitals recently - we really need to establish some maximum levels in ltc and rehab. say 10-15 and less if more acute.

no argument there, for sure.

sometimes regardless of what we know as wrong or right we must live within the confines of possible and impossible. everyone will have to find their own balance where that is and hopefully strive to move what is right closer to what is possible.

pat

i still would rather live within the confines of safe vs unsafe.

and yes, while termination is definitely a consideration, we just cannot allow ourselves to be bullied any longer.

i need to sleep at noc, which will only happen knowing i gave my personal best to my pts.

very few of us can afford to lose our jobs, but to me, one is totally worthless once you lose your self-respect.

there are just certain things we cannot afford to do.

everything has its price.

yet trying to retain a job at the cost of integrity and a pt's well being...

both are priceless.

and i agree, that it's unconscionable we are forced to deal to make these choices.

leslie

[Magsulfate, BSN, RN]

*phew*

And find another job.

Good luck.

What she said.

Since you are new, is it possible that you thought this patient load was okay?

Also, the fact that your manager suspended you on friday and you didn't even know until TUESDAY is a bigggg problem. That is very unprofessional. There ARE other jobs out there, and you have been taken advantage of. Get the hell out of there before that place sucks the life out of you.

[patwil73]

i still would rather live within the confines of safe vs unsafe.

and yes, while termination is definitely a consideration, we just cannot allow ourselves to be bullied any longer.

i need to sleep at noc, which will only happen knowing i gave my personal best to my pts.

very few of us can afford to lose our jobs, but to me, one is totally worthless once you lose your self-respect.

there are just certain things we cannot afford to do.

everything has its price.

yet trying to retain a job at the cost of integrity and a pt's well being...

both are priceless.

and i agree, that it's unconscionable we are forced to deal to make these choices.

leslie

i appreciate your reply leslie and hope you did not take my post as an endorsement of unsafe behavior. often times due to the constraints we must exist under we operate on a continuum from safe to unsafe. we do so because the we have no choice - to complete our jobs often require that we take shortcuts where we can - especially when dealing with a large number of patients at once (it is much easier i believe to keep closer to the safe end when working critical care and having only 2 patients than it is in ltc and having 30+)

so we choose the shortcuts that allow to do our jobs. hopefully the ones we pick will balance the needs of seeing all patients cared for and the safety of each one. but when we are forced to make those decisions - sometimes they won't.

you are quite correct that we should not allow ourselves to be bullied, but often it is a choice between being bullied and having no job (hence no food, shelter, etc). if everyone got together in a facility and said "no!" we will operate only in a safe manner they might get better results. but as long as the facility can fire anyone for any reason and hire someone else the very next day - there is no incentive to change. there is a large enough supply of unprepared nurses and out of work nurses and nurses just looking to try something different that they can keep rotating through without repercussion. and since we are usually the type of people who struggle to stay on thinking we "owe it" to our colleagues and patients - often times the facility will have us for longer than they should.

so we make decisions on how we care for our patients - and like maslow's hiercharchy we do so from the bottom up. ethical decisions will unfortunately take a backseat to basic needs - like do i have a job to pay me to eat and have a home. some people have the resources to weather those decisions and the confidence to know that they can find another way to meet the basic needs so the ethical decision comes into play - unfortunately others do not have those resources.

it is one of the great tragedies of the nursing profession that those who goal is to help people are often placed in such a position that actively hinders achieving that goal.

here's hoping for change

pat

[funsizedliv]

The funny thing is, I keep thinking to myself, "who is really going to put up with my patients besides me?" That is why I always had the same side of the unit, because I could remain calm despite insanity. Plus, I consider myself tech support on the floor, fixing the gadgets and helping the unit manager find things on her computer. She did say once "what would we do without you?" and I said (joking) "you would all be screwed!" lol. I have re-orientation this morning, then I am going to the third floor where I will have my med pass observed for two weeks (I wonder how long that will last), then once weekly for a month, then once a month for a while. I am still looking for something different, and have applied other places, but I am going to try to make the best of it.

I am just a little bit bummed out because I consider the staff on the second floor my friends, I have worked with essentially the same team for a year, and I don't adjust to change easily (meaning I dont enjoy it, I can figure things out quickly though).

[flygirl43]

Sounds like you have the worst job ever! I would never accept that kind of work load. If you get fired, don't care. I would put in my walking papers first though, if possible. There is always something better out there (trust me, Ive been thru it!!!!!!) It may seem like the end of the world now, but after you find another job.....you will be so relieved and wonder why you didn't do it earlier. Wipe away those tears and good luck!

[RN1982]

The longer we constantly stab each other in the back, pick on each other, accept heavy and unsafe workloads and patient assignments, the longer we are going to hinder our profession. We need to be united and there are too many nurses out there who are TOO passive and will do whatever their manager wants instead of standing up for what is right.