New nurse fired

_firely · Feb 26, 2023

Successful people take responsibility for their mistakes and learn from them. They may internalize the pain that comes with them for a short while, but they fight on and vow to do better. This is what you must do.

Nurses are in huge demand. Yet, as a new grad it can be difficult to get that first year of experience. You got that first job and you can do it again, but you must learn from this experience and be prepared to explain how you learned from this experience if it comes up in a future interview. Or, given the short length of time, perhaps you won't mention you ever worked there. Despite the high demand you can still get fired if you put patients, other staff, yourself, or the facility at risk.

As for med passing specifically, the correct protocol is as follows:

1) Identify the source of truth for incoming patient orders and stay on top of any new orders coming in. This is typically a medication administration record or perhaps your workplace has binders with orders.

2) Work on time management and being organized so that orders are not too early, too late or forgotten. Right Time is the most frequently broken of the five rights of med passing.

3) When you go to pass medications, you are expected to check the source while obtaining/dispensing the medication and again when you administer the medication to the patient. You are checking that nothing has changed with the order and that you have the right patient, right med, right dose, right route. You are also checking any additional administration notes and asking any questions at this point. You may need a witness for controlled medications or insulin and you need to be documenting what happened with every medication.

4) Never leave a medication with a patient no matter what. Technically this applies to simple things like eye drops, inhalers, ointments, etc. Your job is to oversee all details of every medication that patient receives in any form and to document this. Think about it from a legal or investigative perspective. If something rare and unexpected happens, how do we know where to look if everything isn't precisely managed and documented.

Okay, that's a lot of information but understand that medication passing is both one of the most common activities nurses do but also the highest risk and most dangerous activity nurses do.

There was once a nurse who was giving a patient insulin, actually both long acting and short acting insulin and was preparing both. She was required to have another nurse witness the amount of each insulin that was being prepared for the patient. However, during this process, the nurse had switched the amounts of the two insulins and the witness also did not catch it. The patient received the medications, though I don't know the outcome. How did this happen? Neither nurse was checking the actual order relative to the blood sugar value and what was drawn up (the witness was not really witnessing). The syringes were likely not labeled or not labeled correctly. The patient wasn't included in explaining the meds at the bedside (also an expectation and best practice), and the order was again not checked at the bedside prior to administration. All of these checks are there for the safety of the patient and when they are skipped due to distraction, laziness, a sense of being rushed, or whatever, the patient's life is endangered.

You did not do these checks or you would have caught the timing mistake. As for second mistake, perhaps you were never taught that you cannot leave medications unsecured with or around the patient. Other nurses may do it. You have to be better. So learn from your mistakes and keep working on being a sponge, learning, and asking for help. It is a very tough environment out there, but you will find good people to work with and you will become confident. Good luck.