New Grad, disciplinary woes

[furelite]

I am a new grad on a busy M/S floor on day 16 of my floor orientation. I have two more weeks under a preceptor, though I have been caring for my patients independently for the past several shifts with supervision over my charting. I work in a hospital that has no formal residency or training program, you essentially get paired with a preceptor and are expected to take on 4-5 patients independently by the end of 6 weeks on the floor if not sooner. People are very helpful, but of course it is very scary as a new nurse on this type of floor especially, as every patient is a different set of problems never encountered before as an inexperienced nurse. I worked last night, and everything seemed to go just great with my patients overall. I did my hourly rounding and made frequent checks. I got called in this afternoon to meet with my manager. I was terrified I had made a medical error...but instead, I received a verbal warning based on a complaint regarding my interpersonal interaction with a parent and the care of their child last night. I am not going to go into specifics, but there was no indication through the night of dissatisfaction, and the patient was sleeping most of the time except during an episode of acute pain, which I attended to promptly. However, the parent's perception of my service was very negative (no med errors or unsafe practices...essentially a negative interpersonal impression). Of course, with all the emphasis on the patient experience and ratings, they take this complaint very seriously. My preceptor was never notified of any issues through the night. Now I have a verbal warning that I have to sign, and am feeling like a failure. How do I regroup? Maybe this sounds silly to everyone else, but I feel I have a target on my back, though my clinical skills are not in question and up until now, I have gotten really good feedback. The thing is, I get along with almost everyone really well, and my patients...up until this one, have always loved me. The patient's parent complained loudly, and took it up the administrative chain. Now I have to sign a verbal warning because this complaint will take our patient satisfaction ratings down significantly. Of course I can reflect back and understand misperceptions and miscommunications and will learn from it. I just feel like this will have a very negative impact on my success and am doubting myself and my career. I guess I am looking for support. Being disciplined is not something I am used to. I am a third career new nurse and now am questioning everything.

[l1234567]

As someone who worked in paeds before leaving for adults (I did about six months). It is a really really tough gig, I had a patient's mother write a two page complaint about me. It wasn't even, like with you, anything of clinical significance. Although I want to point out to you that six weeks! is a long time (maybe not in America it seems) to find your way to a 4-5 pt load. I had one at the end of week two, then with no real support on the ward. Then when I changed to Adult pool grad program myself and all the others had three shifts! However in my adult grad program I did have a resource person to keep in touch with for six months, to debrief. Also we have a clinical facilitator on the ward to come help with gaps of knowledge or to show you how to do things. Is it a sort of scenario 1) or 2) for you? Will you have an ongoing resource person>?

At the end of the day I changed from my paeds program because management was NOT supportive, did NOT give me a feeling of safety (like many other staff, inexperienced and experienced). So as long as you feel that your unit is a supportive of safe care and that your management is supportive of you, then I would sign your disciplinary note BUT I would include an email of rebuttal of your side of the story. Hopefully they reassured you a bit and will let you move on from it. If this is not the case, I would be aware of your job market just incase.

[Mavrick, BSN, RN]

Maverick, you're exactly the type of person who gives nurses a bad name. You have no idea what her situation was...I've seen new nurses treated in ways I wouldn't treat my dog. From what I can see nobody was calling anyone "meanies." That is your rude, immature response...the typical one from an older nurse who is happy to accuse rather than explain.

You realize I was responding to the poster I quoted right? And though she didn't actually use the word "meanies" she referred to her manager with calling her in with "no feedback, no warning and let me go. The manager half-heartedly threw out a few excuses" while showing absolutely no responsibility on her part for this situation. I doubted it was all as one-sided as she presented. She was mostly trying to "one-up" the OP by showing how much worse her situation was.

Speaking of one-upmanship. You sure showed me how quickly you can throw insults into a situation you know nothing about.

Do you have anything at all to offer the OP?

[NickiLaughs, ADN, BSN, RN]

I can't believe she would even create a verbal warning for that. That's a pure he said she said case with no factual information. You can't be written up for a family member's "perception." I would ask what exactly broke policy to require such a verbal warning and see if your preceptor would have your back during this case. First off the family member should have contacted your preceptor, and if no than the manager should have. Totally inappropriate to pass through the chain of command like that, and more inappropriate that you were written up for that.

Honestly, sounds like your doing awesome, put in your time and transfer to another hospital/unit or something eventually, this manager has no back bone.

[Been there,done that, ASN, RN]

You think you have problems? I was a new nurse 3 weeks on the floor working with a preceptor. This is a second career for me. I was a teacher & had a few other very professional positions in my life. Nursing is my calling and I was never happier than to be putting all my hard work to practice....when they called me in with no feedback, no warning and let me go. The manager half-heartedly threw out a few excuses that really meant nothing, but in the end said it wasn't a good fit. They barely gave me a shot. I'm not just some young kid. I worked my butt off and took pride in my patient care. How's that for showing how completely unfair nursing can be. Now I'm scrambling! Terrible.

"You think you have problems?" is not the best way to support OP. Wondering if lack of sensitivity could be your issue.

[Been there,done that, ASN, RN]

Nobody really cares about these complaints. Patients complain constantly, there is nothing you can do about it. Just do your best; go to work, do your job correctly, and go home.

SOMEBODY cares, administration cares. She is being written up .

[Susie2310]

My guess is that the parent, trying to ensure that the care their child received was of high quality, did not wish for an inexperienced nurse to take care of their child, and perceived that you are an inexperienced nurse. The parent may have decided to make the best of the situation if they could not detect any obvious errors in your care and did not believe that their child's safety was at immediate risk, but found aspects of your care that they were unhappy with (you did not provide any details of the nature of the parent's complaint), and formed an intention during your shift with their child to inform a manager/administrator after your shift was over. That is my guess as to what may have happened.

I suggest reflecting on the parent's complaint: If you see things you could improve on when delivering care, then make an effort to do that. As a new nurse, there will be things you can improve on, which is true for all of us. If you believe that the parent's complaint is groundless, I would accept it knowing that patients/family members sometimes do not wish to receive care/feel uncomfortable receiving care from certain nurses for certain reasons. You understandably didn't provide any details of the verbal warning, or why the manager believed the warning was necessary, but we only have your side of the story, so it is not possible to really say that what happened to you was unjustified, or unfair.

[jadelpn, LPN, EMT-B]

You do NOT have to sign a verbal warning. What exactly is the administrative complaint against you? I would file a grievance first and foremost.

Pediatric nursing is a tough gig. There are hyper-vigilant parents that develop the wrong impression. My guess is you were so focused on administering the proper care , you did not pat little Johnny's butt / head enough.

You do not deserve a write up, do not need to take 20 lashes for the almighty satisfaction scores.

DO NOT sign a thing. See what your union rights are, if you are union. If you have malpractice insurance, get them in the loop--just so in case this goes any further, they know what's up.

Interpersonal skills when a child is sleeping?! SERIOUSLY?! And when the kid woke up in pain, what you were supposed to get the kid all riled up further, as opposed to treating the pain, then the kid drifts back off to sleep?

"I object to the idea that I was inappropriate in my behavioral interventions. Evidence based practice suggests that... "

There is an awesome algorithm that talks about evidence based decision making. And in my experience, to startle a kid fully awake, all worked up into a whoop-de-do in the middle of the night, just doesn't make sense.

Evidence-Based Decision Making | James M. Anderson Center for Health Systems Excellence

[caliotter3]

SOMEBODY cares, administration cares. She is being written up .

As long as there is a replacement employee or two walking into the HR department or hitting send on their online job application, administration has no incentive to listen to their current employee's side of the story, or to care about the employee when they did nothing wrong. Write them up, appease the complainer, ship out the employee, and call down the hallway, "NEXT!" Then repeat per protocol.

[OldGrayNurse]

This is really sad. I work in a SNF, but I can sympathize. In my case, it's the kids instead of the parents. :) I live in an "at-will" state, so I definitely would not sign a verbal warning, as my employer can basically fire me any time he wants for any reason he wants. I certainly would not sign it if I felt my side of the issue had not been represented and placed in black and white as well. Still, I'm not sure what the laws governing your state are; if I were union or contracted I would be seeking out my rep, for sure.

It's very difficult to practice nursing care in this day and age already, with shrinking wages, non-existent benefits, outrageous caseloads, and a falling away of bedside nursing.

Years ago, when I was working on an oncology floor of a local hospital, I had a patient develop leakage all around her newly placed central line, that had been put in on the floor the shift previous to mine. She wasn't receiving chemo yet (these were the days when nearly everyone on chemo was inpatient) but had been hooked up to fluids and they were all coming back out. I did all I could, changed the dressing, dried her site up, replaced an op-site dressing (does that phrase date me?) and made sure her connections were secure. Within minutes, it began to ooze all around the site. My nurse manager tried to flush the ports and got very sluggish returns and so was reluctant to go any further, as most likely there were clots formed somewhere. I had no choice but to call the on-call general surgeon to come take a look because it appeared it would have to be pulled and a new one placed. She was a newly diagnosed lung cancer patient, and had her husband and daughter staying with her through her first few days of chemo/rad. therapies. It was late, they had all had a long day, and were exhausted. To have to tell them she was probably going to need a new subclavian line was just the icing on the cake. She was tearful, frightened, angry...you name it, and she expressed it all over her face. I called the on-call doc, who was just sitting down to dinner in the cafeteria and was not happy I had interrupted his pizza feast. He was terse but stated he would be up shortly. When he arrived to the floor, he strode into my pod, walked right past me, flung open her door to her room, and saw her daughter leaning over her mother's bed, adjusting her hospital gown around the central line to keep her mom from exposing some delicate parts. I knew what she was doing, she knew what she was doing, but apparently my snippy little surgeon didn't. He YELLED at her and pointed his finger at her, turning to snarl at me, "THIS IS WHAT'S WRONG WITH THIS PATIENT'S CENTRAL LINE, DAMN FAMILIES ALWAYS THINKING THEY CAN DO WHAT THEY WANT, AND TO HELL WITH THE CONSEQUENCES! GO GET ME A CENTRAL LINE INSERTION KIT...." I informed him I already had one ready for him, in a soft tone of voice, in order to try and calm his arrogant behind down. He looked at this woman's family, pointed at them, and said, "And you can ALL take your asses to the waiting area at the end of the hall until we are finished here. And when I'm done, DON'T touch it, DON'T look at it, DON'T even breathe around it, understand?"

Good Lord, was I mortified. I wasn't even the one he was dressing down, and I wanted to slink away with my head down. Her family filed out, wordlessly, meekly, without even looking at me or the surgeon. Looking back, I think the family reacted the way they did because they took their cue from me-and mistook my initial reaction of trying to stay calm-and thought they should show the same deference I had.

Satisfied he had taken care of the "problem", he proceeded to pull the line and place another in, oblivious to this poor woman's tears streaming down her face. When we had finished, I asked if I could speak to him privately outside. Certain that I wanted to commiserate with his terrible situation of always having to clean up behind others, he agreed. When I had him out of earshot, I calmly suggested he make his way down to the waiting area and speak to the family, reassuring them that he had taken care of the problem, and maybe, just maybe, he might want to apologize for the way he had spoken to them because they had done nothing wrong; the central line had just not been locked with Heparin well enough when it was inserted, or something. I really didn't think the family had anything to do with it. I never saw them go near it except the unfortunate time the daughter was simply adjusting her mother gown to keep her from flashing everyone in the hallway. He sneered at me, "Hell will freeze over before I apologize to THAT family".

Long story, I know, but I said all that to say this: he reported ME to my floor manager the next day for insubordination, and wanted me to receive a "verbal warning" with a "written apology" to him. I explained my side of the story to the manager, but it made no difference. He wanted me to sign a verbal warning and write an apology. So, I didn't sign the verbal warning, but I did write an apology. I wrote on the bottom of the verbal warning, "I'm sorry you're such an ass, and hell will freeze over before you get an actual apology from me". Well, my manager called his manager, who called her manager, who called the V. P. of Nursing Operations. She told them all to tear it up, that he was an ass, and that she would speak to him directly. He never bothered me again, and I heard he had to write a letter of apology to that family, though he denied it vehemently.

If you feel you're right, you have nothing to lose by refusing to sign that verbal warning and asking to explain your side of the story.