Fired partially due to ADHD

[FlyMurse, BSN, RN]

I'm a pre-nursing student (should get in Jan 2011!!) and was a nursing assistant in an ED/Trauma Center (Level I) in downtown Phoenix and was fired late in July. I was dx with ADHD in 2002 when I was in 7th grade and it has been pretty well controlled with meds until a few months ago. I noticed my Strattera wasn't really working very well- I was scattered, couldn't spit out what I wanted to say and just generally inattentive and even hyperactive at some times.

Well long story short, I had gotten in trouble before for "wandering around the department" (I'd offer to help in other areas besides my own if I wasn't busy) and some scope of practice stuff (I picked up shifts in the EKG department and did ER Tech "stuff" on codes, including putting a foley in, and offering to start an IV[i didn't know our IV skills were only good in the ED. I didn't even start the line since the MD dropped a Fem line]). One day I was working with this nurse that I didn't get along with (he didn't respect our advanced skills and never let techs start lines on his pt's or even do foleys for that matter). We were working in the procedure area where me and another RN were in charge of starting lines and doing urine and other Point of Care testing, while he was in charge of giving meds. He wouldn't allow me to start ANY lines that day because he refused to push meds through a tech's line. (I told the charge RN and he fixed that quickly which just made this nurse even more upset with me).

So the next day we had a pt come through with symptomatic bradycardia. Somehow he ended up in our "clinic/urgent care" section (the non-acute area). The PA ordered an EKG which I did. It showed a 2nd degree A/V block. The MD said "okay, lets start a line, an iStat 8, and get him to a monitored bed". I went to get stuff for the IV. Came back and another nurse said to take him to Rm 20. I set the stuff on the bed and pushed him back. Hooked him up to the monitor and was waiting for the nurse (of course, its the one who I didn't get along with) to come out of another room so I could tell him about his new patient. While I was waiting, I decided to get the IV stuff ready in case this guy went downhill for some reason. I had all that ready and he still wasn't there. So I put a tourniquet on to start looking for veins- there's nothing wrong with just looking, right?

Well he comes in and I asked if I could start it. Of course he says no, so I thought nothing of it and left. Later my manager and the charge nurse call me into the office. I thought "oh boy, here we go again...". Basically this nurse said I was in the process of starting the IV without his permission and I was fired over it. I guess I really didn't object or try to defend myself- I was in complete shock about how I was going to pay bills and thoughts were racing through my head.

Now the day I got fired was my first day of switching from Strattera 80mg to Adderall XR 30mg (my idiot doc decided to start me at the max dose, saying we could always go down from there. BIG MISTAKE). I can't blame my disorder nor medication change on losing my job. Heck, if the nurse didn't come in, maybe I would have started the line. I don't know. I just couldn't believe what happened. That night, I was up literally until 4am looking for jobs- I couldn't sleep. I was having mood swings so severe that I was apologizing to my dog for keeping him up all night. I went into these deep depressions, couldn't eat and barely slept. I thought it was normal side effects from switching from a non-stim to a stim. After about a week of this, I went and got my dose lowered which seemed to fix the problem.

Here's my issue (sorry this is so long): Ever since then, I've been questioning my future in healthcare. I guess I'm not sure that I'd be a good clinical nurse (Granted there are other areas to go into) with ADHD. I love healthcare but this whole being fired has really gotten to me and I'm just second guessing myself. I just needed to rant. Maybe some others have had similar experience with ADHD?

Thanks so much for listening. God Bless,

Jeremy

[noreenl]

Were you ever officially informed as to where your advanced skills were authorized to be used in your facility? Areyou a member of a union? it sounds like the facility may not have been very clear on the limitations of your job description. I have heard of skills be limited to a facility but never just to a particular unit. are you state certified in any of these skills. you should find out if the facility reported this incident to that agency then because it could affect your ability to sit for the nursing boards. Scope of practice violations are serious and you need to know what your status is. I wishyou well.

[HouTx, BSN, MSN, EdD]

I have a great deal of sympathy for your situation but am dismayed that you are not taking more responsiblity for your own situation. The 'mean nurse' was not at fault. If I understood your post, you were working as an unlicensed person. Unlicensed people are not authorized to 'start lines' or insert catheters. I am also concerned that you felt you were "in charge" of anything when actually you were assisting an RN to perform tasks. When the physician said "let's start a line" he/she intended for this to be carried out by the appropriate person - this would not be you.

The scope of practice for EMTs and other 'first responders' is strictly limited to the pre-hospital environment... you are not authorized to perform clinical interventions inside a hospital. The nurses in question could have faced severe professional discipline for allowing you to perform any skills other than those normally performed by a nurse assistant. It was their professional duty to stop you.

I think you are wise to question whether you should proceed any further until your ADHD is completely controlled. Loss of focus and 'wandering around' aren't compatible with patient safety and quality of care. The "scope of practice stuff" is extremely important in the delivery of health care. Failure to adhere to professional boundaries is an egregious violation of licensure - and will also cause expulsion from nursing school.