New grad nurse (RPN) - fired from my first nursing job after 1 week...help?

[HopeToBeDivine]

Hello everyone,

So right now at this moment I am pretty devastated and upset, yet at the same time kind of relieved.. I recently graduated and became an RPN. I was super excited to get into Fertility/Gynecology, as this was my pre-grad placement in my college, so I was very aware of the work and expectations that come along in clinic.

Anyways, I was offered a job as an IVF procedures nurse/operating room nurse as a new grad. At my other clinic, a nurse would get a maximum of 2 IVF procedures in a day, and also received help from the phlebotomists for setting up the OR, and we would always have one RPN and one RN (so the RNs can push the drugs since pushing drugs is not in the RPN scope of practice). Any who, when I started at the new clinic, I was not expecting to be overwhelmed.. I only received 3 days of orientation” at the new place, not even proper training (which most clinics here provide 1 month at least) and we had 12-15 IVF procedures in 1 day, back to back with no breaks (included charting, starting IVs and I just became certified, preparing the OR, setting up, obtaining vitals, preparing perscriptions, making sure equipment was good, counting narcotics, drawing up narcotics, etc) all in 10 minutes before the 2^nd patient was to be brought into the recovery room for preparation. I received no help whatsoever, and was unbelievably overwhelmed. The doctor was extremely rude. He owns a few clinics of his own, and when I was opening up the sterile field preparing for IVF procedures, he criticized my every move; pretty much telling me how I should walk, where my eyes should be directed, how I should login to the computer to view patient charts and have everything set up before calling him down for the procedures. (However, I did not even have a computer Login at the time, since I am new and the nurse manager was trying to create an account for me).

I explained this to the doctor, and he very directly stated Do not waste my time, I am relying on you to do everything”. After the first procedure was done, I ran into the bathroom and cried my eyes out, wiped my tears and then prepared for the next patient. Pretty much in between patients I was getting yelled at, and had to cry each time. The RNs and doctor also expected me to push the IV narcotics, and were disappointed when I told them it was not in my scope of practice (Even though I mentioned it previously before getting hired, and they were fine with having the doctor, or RN come in to push meds).

This went on for the whole 12-15 procedures that I could literally not handle on my own, not without help of course and as a new grad nurse, I thought they would be more lenient. The final mess up that happened and I believe what costed me the job, is that the next day after having 15 very very successful patient procedures (and taking **** from the doctor), I had to quickly discharge 3 of my patients, while drawing up narcotics, re-doing the count, preparing the room, etc). I grabbed a sterile tray (or so I thought), and opened up a few sterile objects to drop onto the field to prepare for the next IVF procedure. I was feeling proud of myself, and called the doctor into the OR to start the procedure. Well, the doctor checked the tray, and unfortunetly it was contaminated, and used on the previous patient (my mistake, I know). However, I was in such a rush doing everything alone on my 3^rd day on the job, that I honest to god thought I had everything in line, that everything was perfect going according to plan. I would never EVER drop sterile contents onto a contaminated tray if I knew this. Well, the doctor flipped his ****, yelled at me in front of the patient and said that I'm relying on you to do this, nobody did anything for anybody and you gave me a dirty tray, what did we train you for?” (I wasn't even trained… just oriented to the computer system and pretty much left alone to the patients with no training whatsoever). After performing the IVF procedure, I cleaned up, brought the patient into the recovery room and cried for the next 15 minutes in a separate room where nobody can hear or see me. I came back to discharge the patient, and to my surprise the patient got up, gave me a hug and said you are doing an amazing job, do not worry”. I was so shocked and pleased when she said this, and it gave me some hope. I really tried to do a good job and told the nurse manager everything. She was understanding and told me my schedule for next week.

Well, I get a call on Monday, and the nurse manager tells me she spoke to the doctor, and doesn't think I'm a right fit for the job. He wants someone with 10+ years surgical OR experience and thinks im not strong enough yet” to handle such a busy O.R/PACU job. Pretty much, I got fired after my first 6 days on the job. I told her that I wanted to be placed in cycle monitoring from the beginning, and didn't expect to be put in this position – especially as a new grad nurse but the nurses were so understaffed they pretty much took what they can get. I have been upset, yet relieved at the same time, and wondering if I am indeed a terrible nurse. I received top marks in my nursing program, and I believe for not being trained, I still did an excellent job as a new grad in a completely overwhelming position. The doctor completely hurt my feelings and was beyond rude from my experience.

My question is, what do you guys think? Do you think I did a terrible job? Or was it the orientation/training insufficiency? I am feeling under the weather here and am a bit discouraged..

(I apologize for the weird layout and random indents in the above paragraphs).

[NOADLS]

The manager supposedly wants someone with 10+ years experience, but you are hired anyways?

My assumption here is that the training they provide is based on all new employees having 10+ years of experience.

When you're in such a rush like you described yourself to be in with the above scenario where you mistakenly used a contaminated tray, the correct action is to request help, even if you are likely to be seen as "slow." Better that than to allow an error to cost you much more. From what I read, it sounds like you were trying to keep pace at a job that clearly wasn't suitable for you. Much better to admit that the position is not the right fit and resign as opposed to being fired under the circumstances you were fired.

[Horseshoe, BSN, RN]

I can't really speak to the specifics, but clearly you were put in a situation in which you were over your head. It seems as though they expected you to practice like an experienced nurse right out of the gate. That's not okay, and even the best new grad would not be able to live up to that.

As to contaminating the sterile field with used instruments...well, that's a pretty big mistake, and not surprising that you got canned since it came after a lot of other stuff. But that's not the real issue, so don't stress about that. If it hadn't been that, I suspect it would have been something else.

I think you have the makings of a very good nurse, but you need a proper orientation. You will get past this. You will learn from your mistakes, and you will also be able to recognize an environment that doesn't seem appropriate to a new grad.

Keep at it. This isn't the end of the world. I will try to encourage you to save the crying for after work. I think crying is a very healthy coping mechanism at the right time. But if you cry a lot at work, people are going to eat you alive. Even if you think you are doing it in private, it's pretty hard to hide. People see excess crying as weakness and poor coping skills. Don't give away your power like that. Save the tears for once you get home. I am an advocate of vigorous exercise, too. That helps to get out a lot of those strong emotions.

Good luck. Someday you will look back on this time and shake your head. But you will probably say that it helped to make you stronger.

And that doc sounds like a class A jerk. Yes, he expects the best for his patients, but you were not provided with the proper support and supervision. When he was coming up the pike, he didn't do surgeries without mentoring/supervision either.

[TheCommuter, BSN, RN]

Welcome! Your thread has been moved to the Nursing in Canada forum (since you are using the 'RPN' title, we assume you are in Ontario). Good luck to you.

[HopeToBeDivine]

Thanks for your advice. I spoke to the nurse manager ahead of time and told them I needed help, they said they would have help for me that same day i messed up with the sterile tray, but never provided me any. They were aware of my skills, but the nurses claimed they were "too overwhelmed themselves to help out the new nurse" I will learn from my experience, however they should have really did a proper interview, they knew I was a new grad, yet they gave me this job. I am so discouraged right now.

[HopeToBeDivine]

Hey HorseShoe, thanks a lot. The doctor really is a jerk. I tried my best, and requested help the previous day, but the nurses said they were too understaffed and overwhelmed to send help over to me. It was harsh, but I really did try my best. I will keep my tears hidden until I go home, and also go to the gym to relieve stress. I am sure in time it will get better. Right now finding work is hard, but I have a few interviews and I am hoping for the best. Any tips?

[joanna73, BSN, RN]

Unfortunately, for many new grads, the OR is not a good fit, especially if the staff are not willing to provide adequate training.

Hopefully, you will find another position soon.

[NurseStorm, BSN, RN]

Sounds like they put you in an unsafe situation by giving you minimal training and minimal support. It's basically like they set you up to fail. Yes the mistake was a big one, but I think it was definitely contributed by the circumstances they forced you under.

For your interviews be prepared for whatever the position is, review relevant information prior to going in. (eg. if a maternity floor review maternal assessments, newborn assessments, the most common problems that arise and their treatments, etc) Be personable and friendly, and dress professionally. Answer the questions the best you can using detail as much as you are able to give. I am an RN in Canada so I'm not sure how the LPN (here)/RPN interview questions go, but I'm thinking it would be somewhat similar?

Ours are a mix of:

-scenario questions (You have a newly diagnosed diabetic. What are some of the key teaching items you will educate the patient on), -interpersonal questions (You have a concern about a patient and the doctor is rude and dismissive on the phone. You feel the patient really needs to be seen, what would you do) or (Your coworker is constantly making rude remarks to you and insulting you frequently. How would you handle this)

and then some general questions (why do you feel you would be a good match for this job, etc).

Also have prepared a list of all your education if you have further courses/certifications/conferences/seminars/webinars ETC. Have these all written out with dates so when they ask re: your education you are prepared.

Eg. CPR certification last updated Nov 2015, NRP January 2016, attended breastfeeding seminar on latch and positioning March 2015, etc etc etc.

Good luck! Try not to beat yourself up about losing this position, it sounds like no new grad could live up to the expectations they placed on you with that minimal training and minimal to no support.

[HopeToBeDivine]

Hi Nurse Storm. Thank you so much for your kind words. The mistake was a big one, but it was an honest human error, I even double checked the tray before calling in the doctor, however I feel it slipped my mind or i didnt process it due to the rush. I will definitely be prepared for the next job I get. To be honest I was thinking of quitting this one anyways so its not that serious to me, but I just want advice on what is a better position for a new grad nurse

[HopeToBeDivine]

Thank you. I will definitely try my best to look for something better!

[NurseStorm, BSN, RN]

Hi Nurse Storm. Thank you so much for your kind words. The mistake was a big one, but it was an honest human error, I even double checked the tray before calling in the doctor, however I feel it slipped my mind or i didnt process it due to the rush. I will definitely be prepared for the next job I get. To be honest I was thinking of quitting this one anyways so its not that serious to me, but I just want advice on what is a better position for a new grad nurse

You're welcome :) Yes I didn't mean it to make you feel bad, I think in the situation you were put under, that time pressure, the pressure from the doctor, no support or help plus minimal training was just an accident waiting to happen, and sooner or later something would go wrong in that scenario I think.

A better position for a new grad nurse depends on your areas of interest :) I would recommend not as intense areas initially such as ICU or ER (if your area uses RPN's in icu) and to maybe try medical, surgical, palliative, maternity, pediatrics, endo... I think any of those areas depending on your interest would give you hopefully better training and more support than a smaller office scenario perhaps. Each area will have it's challenges and I'm not saying any are "easy" but I think those may be better options. Ask about the orientation plan in the interview, if you are assigned one person (this is better), how long, etc.