New Nurse, Med Error = Lost Job

Leader25, ASN, BSN, RN · Nov 7, 2019

I have always said the MAR is going to kill some body some day.We had constant problems with it ,ecause it was set to ER time adult med protocols and our unit was unique and did not not fit into that time frame,so you would get red box alerts for meds that were NOT due til the next day etc.

In your case your assignment was ridiculous .They handled you in a most despicable manner.

Constantly telling someone you are slow.,you are too slow, be faster, etc is so wrong ,the end result being what happened to you.

I have worked in places where nut job managers made issue over Aand D ointment on the butt.

You are getting so very good advice by smart experienced nurses on this site,take it to heart,you will be ok.

DeLana_RN, BSN, RN · Nov 7, 2019

Would you believe that I know a nurse with 20 years experience who was fired for a common, routine med error (wrong pt, but the dose was less than the PRN the pt could have received; no harm was done; pt was not allergic, everything was self-reported to the doctor, management, risk management, etc.). Like pp said, this was only the excuse the manager (who lied about it to HR) needed to get rid of someone who was "too slow" (i.e., too safe). Sloppy, careless nurses who committed serious med errors were not let go in the same facility.

Sadly, even today nurses eat their young and their own. No other profession I'm aware of does this to its members.

From what I have read, you will be fine. I advise you to look for a nurse residency program for new grads; they will typically accept someone with less than 6 months experience. It's shocking to me that even today some places still throw new grads to the wolves. You deserve better!

All the best, let us know how it goes!

ghia · Nov 7, 2019

I'm also a new nurse! I recently started working on a med/surg unit where I had 3 weeks of orientation. My first shift alone I had a full patient load, and much like you my time management skills are not on par with a more experienced nurse (as is expected). I was struggling to complete all my tasks and knew I would be staying late to complete my charting. In my frenzy I made a med error. In my case I gave a pt tylenol 3 instead of T2, I immediately informed the patient, his family, the team, and my manager. Although there was no harm to the patient (in fact even his family said "that'll make him happy", and the pt was used to taking T4), I was still mortified at my mistake, after all it's one of those things they DRILL into you in school. Thankfully my manager was very understanding and even took the time to provide me a little comfort after the fact...but honestly I beat myself up about that for a while. Now I look back on that experience and remember how important it is for us new nurses to really take the time we need to practise safely. In the end we are still learning and only have basic nursing knowledge, and time managemnt/organisation seems like a constant process.

Many have mentioned this already, but it does seem unreasonable to fire you over that kind of error, so much is invested in new hires that is seems incredibly counterproductive to not try to invest a little more time in developing your time management skills instead!

Even if you don't find out the full rationale for letting you go, I still think you should take this experience and use it to remind not only yourself of how important it is to be mindful of your practise, but also to help other new nurses/colleagues understand how terribly easy it is to make these mistakes. Also it may be a good opportunity to point out any flaws you found in the electronic MAR system, my hospital also uses an eMAR and because of the med error I found out it won't prompt you that it is not the correct med if you have taken the med out in a certain way - sharing any system flaws you find also helps the tech people fix these issues ultimately making med admin safer!

Ultimately my point is please don't give up just yet, from what I understand it is considered "normal" to feel overwhelmed in a new job as a new nurse for at least 6 months, I'm only two months in and trust me I feel like I'm in fight/flight mode ahahha. It also sounds like this could be a good time to reflect on the type of nursing you want to do (though it sounds like you are doing quite a bit of reflecting already).

KEEP GOING, one day, with a little time and a little practise you will find what works for you, and you will know that you worked hard to be someone to be proud of. - Something that has helped me get through tough days

Ella26, BSN, RN · Nov 7, 2019

OP, sorry that you had such a tough time...

Perhaps, you could try assisted living, LTC, home care, psych or clinic nursing?... The hospital has a steep learning curve (as it should, those patients are very sick).

To be honest....I have avoided the hospital at all costs! I absolutely HATED it during clinical. I was terrified I would kill someone. Or having a patient die on me and even if it wasn’t my fault, I wouldn’t be able to get over it. And god forbid if it was, I would have had a mental breakdown! So, I knew I wasn’t cut out for it as my JOB.

It was too fast paced for me and too much responsibility-IV meds, patients coding, high patient ratios... I’m a very cautious person and felt like I would have been too slow as well. I have anxiety and tend to overthink and ruminate on everything, so I know I wouldn’t have been able to hack it.

Maybe... “hospital/bedside nursing” isn’t for you... at this time... or at all...and OP, that’s OK!

I know we’re all told that you’re not a real nurse unless you work at the hospital. That is simply not true. Not every nurse is cut out or meant to be a hospital nurse. We all have different strengths/weaknesses.

Something for you to think about...

But, nursing has plenty of avenues to explore. Don’t throw in the towel just yet!

Good luck to you!

whisperingsage · Nov 7, 2019

Pushing nurses with understaffing and overburdening is so common, how do we explain? THIS is why the average nurse age is in their 40's, the young ones get disillusioned when they are forced to speed up beyond human safety. I only know it helped me immensely to start as a CNA (10 years) and then LVN (15 years). I've pretty much done everything I will be doing as an RN. Some things legal in some states, and not others as LVN/LPN. RN all is legal. That experience on the floor goes a long way. In the "olden days" in my lifetime, Nurses used to get on the job training, and could go from a CNA to an LVN/LPN at the facility. Training there, under supervision of LVN or RN. Testing there. I know I'm dating myself. Most have never heard of this. BUT on the job training is far better than regulating all jobs to the college and throwing new nurses out with a full load and expecting them to be organized. With on the job training, you develop your organization skills as a CNA (because THEY have a huge load!) and then transfer that ability to the higher levels.

Now, in CA, they only require LVN's to go through CNA classes first and not work on the job in that capacity. The result of that is nurses that don't remember the basics of rolling patients over linens and other basic care tricks and tips. I worked with an LPN and we were going to get a straight cath urine sample, and instead of helping me change her wet pad, by rolling her onto a new clean one, she ripped the old one out, luckily not causing a shear injury, but I don't know how long she will be doing that without causing shear. This was a confused little lady pt too. I just scares me what the schools are tolerating sometimes. My class was scary.

NefforamaRN, BSN · Nov 8, 2019

I'm really sorry to hear that you lost your job and made a mistake that I'm sure you feel horrible about. There are definitely some areas for growth that I can see from this experience, but I'm also thinking you may have dodged a bullet by being let go from an organization that only gave you 10 weeks of orientation on a neuro unit, fired you for one mistake without giving you feedback on 2 others, and for rushing you when you are learning to care for very sick patients.

As you prep for interviews for your next position, ask to shadow and ask questions about the orientation process. How long is it? Do you get regular check ins with the nurse manager or educator? Can it be extended? How are preceptors trained? If they are uncomfortable by these questions or they brush you off, then don't give them a second thought.

A good, solid, safe organization worth YOUR time will invest in you and ensure that you grow, with timely, insightful, and meaningful feedback. Remember, you also get to choose THEM. YOU are also interviewing them. The organization and the unit will need to meet your standards as well.

I think it's a great that you are seeking to learn from this experience. "Critical Thinking" happens when you allow yourself to think. I would suggest meditation or some increased self care so that you get to know yourself when you're feeling stressed or rushed.

Don't worry, you'll get to where you need to be. I have faith in you!

P.S

Most nurses have made mistakes, even really big ones, and are still nurses..... you are growing.... and you WILL get there.

headofcurls, BSN, RN · Nov 8, 2019

?it’s okay. You’re not a bad nurse. I know you’re disappointed but this will mold you into a better nurse.

jag nurse, RN · Nov 11, 2019

On 11/6/2019 at 1:26 PM, NewRN9423 said:
To everyone, thank you for your advice. I am taking everything into consideration as I plan my next steps. One thing I forgot to mention is that we had no PCA on the unit, which did not help my situation.
I have been looking at the jobs out there, and there is not much. I am afraid to take another med/surg job, as I might again end up overwhelmed with too many patients. I see a lot of LTC/rehab openings, but I have heard horror stories about the nursing environment in these type of facilities. Any insight out there regarding jobs for a new grad RN with 3 months of experience?

I believe that SNF, LTAC and Rehab nursing takes a special person. You could job shadow and see if it fits you. Where I am from, their patient load is quite high, but you can check out your area.

If you think you may prefer to stay in hospital nursing, someone here mentioned a residency program. That is an excellent idea. The nurses I see come out of these programs are very well prepared and confident. You won’t just be thrown to the wolves; someone will be there to guide and teach you. If there is a hospital near you who offers one, I would highly recommend applying. They only start one to two times a year, but if you’re interested, even if they aren’t currently hiring, I would set up an appointment with the program directors through HR and see what they offer. Again, best of luck! Let us know how it goes.

TooManyCats, ASN, BSN · Nov 11, 2019

So we’re you looking to the MAR or your brain page for med due times? Or relying solely on your paper and the Pyxis? When you scanned it did it not give you a warning that medications were given too close together? You have them three hours apart, when we’re the actual due times?

whisperingsage · Nov 12, 2019

I had been a CNA for 10 years, and an LVN for 15 years, I have worked in rehab and SNF and both are some of the highest patient loads you will have with very needy patients. I have worked a lot of Per Diem due to my needing Sundays off to attend my Husband in his church, I am church staff. I have worked in at least 10 SNF's and 2 rehabs and they are connected, and the load is similar in both. Yes they are usually in the same building and DON's, and scheduling staff (which is often an otherwise competent or at least assertive CNA) can abuse nurses and CNA's. I have not been in one facility that was completely above board and ethical in most ways. It's how they run off nurses and CNA's and why we have a nursing shortage. It's why they have such a high turnover rate. They burn people out. They use and abuse the good nature of the nursing staff and their dedication to their patients. They depend on our good will to get the job done while lacking equipment/safety/laundry/staff/etc. I DO NOT understand why they are all universally horrible. But if you think Med/surg is stressful, you haven't seen nothing till you have worked a SNF/Rehab.

allnurses Guide · Nov 12, 2019

I like the suggestion above about shadowing on a unit. It will help with your confidence a LOT if you are able to see the work environment prior to starting. I would encourage you to not shy away from another med-surg or other acute care unit. You learned more than you realized and not all work environments are that kind of horrible. There ARE good jobs out there on good units. Hang in there.

I hope you will let us know where you land. There are a lot of us here rooting for you.

Older Guy Nurse · Jan 15, 2020

In recognition of the fact that nurses are indeed human, and in the interest of patient safety, there is a concept of Just Culture. In a Just Culture, the honest report of an honest mistake DOES NOT lead to punishment, but to protection of the patient and, if needed, remediation for the nurse. You made an honest error, and you promptly reported it, because you ARE a good nurse. The very vindictive actions of your management can encourage nurses to be silent about errors, to the detriment of the patient. Perhaps the manager who NEVER made an error should be the one to cast the first stone.

This being said, if there is actually a problem of multiple errors in a short period of time, or if errors can be considered of to be caused by a failure to learn from the past errors, then there may be a skill/ attention problem at hand, that the institution does not feel obliged to deal with.

But, to discharge a nurse for one, self-reported error is egregious on the part of hospital management.