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.

[leadesign]

:twocents:I'm very glad to hear you didn't lose your job. I think this experience is definitely a wake-up call. I hope I might be able to offer some suggestions.

I think we have all found ourselves in some pretty bad work situations at one time or another. I have found that documenting everything will really make all the difference. Keep notes on everything that has transpired; about your working conditions, about the effect on patients, and things you would like to see changed. Save a copy for your personal files. With sentinel events such as this, there should have been a meeting of all involved(including the pharmacist and the MD). Everyone should be given the floor to offer their perspective. Only when the problem is identified can there be a solution presented. People are human and no one is perfect. But to perform efficiently, there needs to be less chaos! These conditions seem to be spreading innocuously throughout the healthcare system. Most facilities are seeing less $$ in reimbursements and therefore are making cuts in all the wrong places! As nurses, as long as we continue to deliver without complaint nothing will ever change.

I also recommend the need to call your supervisor in charge to let them know you need more help! If this doesn't produce the desired results, write up an incident report - and not just the one time but every time this occurs! You may also want to contact the California Nurses Association to see how to organize some kind of nurse advocacy group(do this from home). Another source for you as well as other nurses would be the National Labor Relations Board. I could be mistaken but I think your employer is required to give you 15 min of breaktime for every 4 hours of work.

I think the only way to stop the madness is to expose these conditions, get support with other nurses, and force these kinds of workplaces to change the current working conditions. This will help the patients as well as the workers.

You are not alone.

[dede1956]

First off, God Bless You for putting up with such a horrendous work load for as long as you have. I don't know what state you work in, but I would check the state regs as to what staffing should be at a facility such as yours. I know long term care staffing is different than acute care, but come on!!!! All that work for 18 pt with little to no help and it sounds like no cooperation from other shifts/staff. I agree with you though, put your resume out there, there has to be something better and less risky to your license.

[rnheart]

hey Fun do you really want to work at that facility. cuz I wouldnt

[dorimar, BSN, RN]

My goodness!!!!! Better to lose your job, than your license!!! That place sounds like a threat to your license on a daily basis. Sounds like no one there is held accountable to do their job correctly except for you (nights won't do the weights, CNAs won't do the vitals, etc.). Geez Louise! You can't do everyone else's job, when you can barely do your own with that patient load! Better to go.

I think they set you up on the Monday thing on purpose by the way. Surly everyone (including the DON) knew it was a three day weekend when they took you off and then said to meet with her Monday. She probably expected to you to get up early and come in to find her not there. Great that you called first! I don't think you can hope for anything but termination. But, that is ok. I think it will be a Godsend. I promise you that someday soon you will look back at this job and this experience and realize termination from this job may be the best thing that ever happened to you! You will find something better--then you will realize how bad this place is and you won't believe you were expected to and did endure such a work environment.

[dorimar, BSN, RN]

No doubt. There are things that should be done that are missed every day due to time constraints. However, I do NOT feel that medication administration is the place to skimp on time or safety. There is NO instance in which it is okay not to follow correct drug administration guidelines. None, no matter the circumstances. Not ever. That is not being an idealist. That is just non-negotiable.

That was not what this post was about. The OP did not shirk her accountability here. The OP took responsibility for the error. She state she feels terrible. She was just asking for support,advice, and what to expect. I think it is rather cruel to respond to such a post and to such vulnerability with comments such as this. I suspect that everything you just stated was heartbreakingly reinforced to the OP from this experience, and she did not need to hear you reprimand her for what she has already learned the hard way.

It does sound to me like there are some serious system problems that precipitate errors there (aside from the horrible accuities and the horrendous ratios and people not being expected to do their duties). Pharmacy didn't send a new pill card..... I'm not sure what that is, but it sounds like there is potential for errors communication, handoffs and transcription. Doing a root cause analysis of such an error would be so much more valuable to the organization than doing a punitive witch hunt.

[joaniej231]

dorimar

Amen to what you said. My sentiments exactly. OP received a gentle reprimand when she was asking for support and advice. That reply from ghillbert is from an overbearing new grad eater, which I have seen many many times over the years, and what typifies what has been wrong and what continues to be woefully wrong with this very noble profession. Give the poor girl a break. You don't think she knows how to give meds properly? Of course she does, that is basic bare bones nursing. That wasn't her problem, it was all the other stuff that interfered with being able to properly administer the medication.

There is not enough mentoring of new nurses. That DON of that facility typifies the mentality of many nurses. Let them fly by the seat of their pants and then be right there to chop off their heads when they screw up.

Like I said earlier,she should get out of there as quickly as possible and don't look back, keep running until you are somewhere where you are valued and respected. Those places do exist.

[rnheart]

No doubt. There are things that should be done that are missed every day due to time constraints. However, I do NOT feel that medication administration is the place to skimp on time or safety. There is NO instance in which it is okay not to follow correct drug administration guidelines. None, no matter the circumstances. Not ever. That is not being an idealist. That is just non-negotiable.

I wonder if ghilbert or anyone that has agreed with her has ever made a med error?

[rnheart]

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).

darlin you cant save the world, and remember that you are only one person and you are human.

[joaniej231]

funsizeliv, Remember one very important thing- noone is indispensable- noone. If you go, there will be someone else to take your place faster than you can bat an eye. Noone is irreplacable and if you think that is not true, you are sadly mistaken.

[gradRN2007, BSN, RN]

so what happened............

wow, i could never handle what you handled.........med error for 5 days and dig no less, pretty bad,,,night shift should weigh patients before they go to bed and you should never have to handle that workload...maybe getting fired will be good if not start looking for a new job and hope that your current one starts getting better.

[diane227, LPN, RN]

Don't let them terminate you. You do not want a termination on your record. Resign.

[lpn2icu]

It is time to move on...

It is not worth it!