How to avoid being fired

[nakeia]

I have been reading a lot of postings on firings of nurses and new graduate nurses. Some of these stories are shocking and frighten me just a little... okay... a lot. I want to know how often does this happen?? And as a soon to be new graduate nurse, HOW CAN I AVOID BEING FIRED??

[VikaRN_2008]

That's what I wanted to know too.

[HouTx, BSN, MSN, EdD]

It is scary out there, isn't it? I can't speak for all organizations - only the ones I have worked for -but there are commonalities.

First of all, make sure you are familiar with your HR policies - they will include a listing of the most serious offenses that would automatically cause you to be fired. These are usually things like falsification of time cards, coming to work intoxicated, assault, etc... In clinical areas, it will include offenses like falsification of records, HIPAA violations, diversion of medications - and so on. These are the biggies. . no second chances.

As far as lesser events are concerned, there usually needs to be a pattern of multiple offenses within a certain period of time. There is also a process called 'progressive discipline'. The first offense results in a verbal counseling/warning; second will be trigger a written warning, and third may cause termination. Most of the time, offenses 'drop off' your record after a specific period of time - this should be specified in the HR policy; if not, ask your supervisor.

Best way to avoid problems - Stop and take a deep breath. When you are feeling rushed and out of control, stop and give yourself a 'time out'. Don't take shortcuts on important processes like medication admin. Follow the rules, even if everyone else is not. Make sure you completely understand your states nurse practice act. Don't accept responsibility for things you are not competent to do. Don't ever do anything outside your scope of practice.

Don't worry so much - we've all been there. Try to RELAX and be kind to yourself.

[llg, PhD, RN]

Communicate regularly with your preceptor and with the person on your unit responsible for overseeing your orientation. That might be a "unit educator" or "manager" or someone like that. It varies from place to place. Ask them what their expectations are early in your relationship and then be sure to meet those expectations. If they tell you that you are not meeting their expectations, then ask for advice on how to improve -- and then quickly change your behavior so that they can see your improvement!

As a new grad, you have to walk a fine line between 2 extremes by:

1. Ask for help when you need it.

2. Don't appear "too needy" and incompetent.

It's fine to ask for help and you should always be ready to admit you have a lot to learn. But don't appear so helpless that you seem hopeless. You need to present yourself as a competent professional who can perform "just fine" if you can just get a little help to get you started in the right direction. Most experienced nurses, educators, and managers expect a new grad to have lots of learning needs -- but no one wants to work with someone who can't seem to improve in spite of efforts to teach them.

[ghillbert, MSN, NP]

Be able to solicit and accept constructive feedback. Really be honest with yourself about your skills and your deficits that you need to work on, especially as a new nurse. Ask for help when you need it - I know as a new nurse, I often didn't ask for help because I felt like I was meant to know how to do everything myself. It turned out that asking for help and delegating is a skill that comes with experience.

Try not to stress too much - I've been a nurse 12 years and don't know anyone personally who got fired without REALLY deserving it.

[Guest343211]

Be careful what you say and how you say it. Again, At-Will employers do not need a reason to fire you. It's nice to have something down on the file--just in case, so to speak. But really AWE can fire you for reason or no reason at all. You can be highly competent, moral, compassionate, etc--if someone decides there is something they don't like in your personality or communication--and they get the right others to listen and support them, well, you can very easily be weeded.

Also find out about who will be precepting you, if they've had a course in relating-teaching adults in clinical nursing--at least some kind of preceptor course--how many nurses they have successfull precepted, is there a nurse educator--meet her or him--are they truly supportive--are there measureable stages of progress and evalution through orientation--none of this last minute, "We feel you don't fit" nonsense upon the probationary period. Be quiet.

If the preceptor tells you to do something a particular way (hopefully according to policy), do it, and don't comment about how you did it in clinical or some other hospital, etc. No one cares. . . seriously. . .even if it is a good idea. It takes a while to build respect, so no one will care about what worked elsewhere, even if it is a good idea, until they have tested you in the fire. And you will be in the fire at times.

Read up as much as you can on pertinent things to your unit and patient population. Observe. Observe. Observe--not just things you haven't seen before--but people. You must get a feel for the people and the culture.

Work hard. Pray a lot. Do the best you can. Don't draw too much attention to yourself. Keep as quiet as you possibly can. Be cordial, but don't say too much about ANYTHING unless it is absolutely necessary. Be willing to help others, but at the same time, don't overlook things that people will be looking at--combing over your flowsheets, I's & O's, notes, important vitals and updates, meds, etc. If you don't know about administering a certain med, of if you question anything at all, look it up--call pharmacy. Be careful about hanging non-compatible things. Peds has meds that must be doubled checked w/ 2 RNs. Never, EVER bypass this. IN fact, if you are giving anything like IV electrolye boluses/replacements, anticoagulants, insulin, pressors, narcotics, etc, just double check with another RN. Working in peds teaches you to never take any medicine for granted. Always follow similar policy with blood products, etc. I don't work oncology, but shoot, if I were a oncology RN, I 'd double check the chemo too--honestly don't know if they always do that with adult oncology. I am sure with kids they do.

Believe in what you are doing. Some don't know how to effectively and wisely give feedback when a nurse, new to the institution, is doing something in way that is not what the new institution does. There is a way to correct people and guide people. And then some people can't stand any correction without often getting defensive. But I try to take into consideration that the new person is under a particular kind of stress that is often quite unnerving. Some preceptors are understanding and compassionate, and others, lol, well, they just plain aren't--unless they have some specific fancy for you. You would be surprised how down right harsh some "preceptors" can be. On the other hand, understand that the preceptor too has a lot of stress observing, guiding, instructing you as preceptee. He or she has got to concern themselves with how what you are doing will effect their patient/s. Nurses, particularly in critical care can be very protective and very territorial. Some of that some should ease up on--other times, there is a good reason for the protectiveness. You have to just accept it.

It's one of the toughest fields. You have to grow some thick skin without becoming hard. No easy task.

[Guest343211]

ghillbert,

With all do respect, I do. And not just me either. I know quite a number of nurses who were "let go" for seriously bogus reasons. The likeability factor is a big factor--as is the "Please the right people and don't tick off the same" factor. I've been a RN significantly longer, and I can honestly say it is true. Deserving it many times does not have anything to do with it.

In fact, people that creep into the narcotic drawers have gotten better deals than nurses that were just not liked, but were good, ethical, caring, non-drug-seeking nurses. No offense to those that have addiction issues. I am just making a point. That has more to do with being someone that is more towards some protected status. Those that cannot claim that, and that work as AWE--well it's often up to how much they are liked.

[rachel110]

I totally agree with samadams8. I've been a nurse for 20 years. I've won local and national awards and was consistently pointed towards by management as "the person you will learn the most from." We had a sudden change in management - it was not thought out well because the 5 members of senior management do not seem to realize that 2 of them have completely opposing philosophical beliefs. (Actually the new "philosophy" was not given to us. We were told the patients had too many rights and we were going back to the old ways of "taking care of crazy people.") So no one knows what to do or who to say "yes" to - what you did yesterday (and for which you were praised) might get you fired today. I know I'm too outspoken so every day I go in holding my breath.

[nakeia]

Thank you all for your responses. These are things that I will take into account on my first job. Greatly appreciated! :)

[mama_d, BSN, RN]

I may get in trouble for this one, but here goes...

Learning about your patients does not always stop when you clock out. If you come across an unfamiliar diagnosis, test, etc. and don't have time to look it up at work, look it up at home. Chances are, if you stay in the same area for a while, you'll come across it again. I've been on the same unit for five years now, and still come across stuff that makes me go "huh?". I keep a binder that I print out articles from places like WebMD or the CDC on strange stuff I come across, so if I encounter it again, I've got it handy.

Be involved with unit politics. By that, I mean attend staff meetings, go to inservices, join committees, etc. as much as you are able to. The more involved you are and the more your manager gets to see your smiling face, the more they are willing to put forth the effort to guide you (at least from what I've seen on my unit).

[Atheos]

ghillbert,

With all do respect, I do. And not just me either. I know quite a number of nurses who were "let go" for seriously bogus reasons. The likeability factor is a big factor--as is the "Please the right people and don't tick off the same" factor. I've been a RN significantly longer, and I can honestly say it is true. Deserving it many times does not have anything to do with it.

In fact, people that creep into the narcotic drawers have gotten better deals than nurses that were just not liked, but were good, ethical, caring, non-drug-seeking nurses. No offense to those that have addiction issues. I am just making a point. That has more to do with being someone that is more towards some protected status. Those that cannot claim that, and that work as AWE--well it's often up to how much they are liked.

'Playing the game' is a well known part of adult life.

Choose not to play the game at your own peril. It's part of being an adult and is present in EVERY industry.

People seem to think that when someone that gets fired because the larger group didn't like them that it is wrong.

Really, it isn't, one of the parts of working somewhere new is being able to get along. If you can't fit in, it CAN cause a lack of team cohesiveness. Really, one shouldn't even want to work somewhere that they aren't integrating properly...

[Guest343211]

i know stanley, yet in actuality team cohesiveness is strongest when people openly accept each other and give them space to respectfully disagree. also, conflict is a part of it as well. those that never have conflict, whether in personal relationships or work relationships, reflect a lack of being genuine. why? well b/c it is not reality. conflict is a natural part of all aspects of life. it is not conflict that is wrong necessarily--nor should it necessarily be viewed as wrong. (yes the wrong kind can be problematic.) it depends on the conflict and how conflict is handled. that is to say, is there genuine commitment within the group to understand that conflicts may come, but "we are determined to find respect and resolution?" the attitude that looks toward resolution is the key--not develop a team that seeks to stop all and any conflict. such groups in reality are not real--it is surface peace and "effectiveness." that is not realistic or necessarily healthy in any relationship. did you know couples that are found to never argue in general are not as secure and close as those that do? it's not an issue of never having conflict. it's about how the leaders and group as a whole handle conflict--is it geared toward true resolution or just shutting folks up? see, people misunderstand that conflict often indicates an powerful sense of passion about something. you don't want dispassionate people in a couple or a team. it is about how one looks at conflict and how it is handled. one can tell so much from a couple or a group by looking at the issue of handling conflict. again, it is not about necessarily avoiding it--though sometimes that may be the right path. it is the attitude toward it. dont' be so quick to write people off b/c you think they love conflict. no. they just may be passionate, intelligent, and may see things from a well-needed different perspective. you don't want kill that, and sadly so many units do this. they think they are doing the right thing, b/c at previous times they had to deal with people that seemed to love destructive conflict, so now, in their minds, all conflict is bad and must be staunched. they then develop "thow the baby out with the bath water" mentalities. but that is not the path to ultimate success either.

also as my professor (she's great.) has shared, the most functional groups are not those that tend toward or favor cliques (a very low functioning "team") or those that tend toward factions (a little higher functioning, but still severely missing the functional mark of being a true team). it is in those that respect others, that respect openness, and that work to form coalitions that make up the highest functioning team.

cohesiveness comes when folks in a group rise above cliques and factions and are openly respectful of diverse perspectives, but have the clear goals of the team in mind, and thus they grow toward building coalitions. this means they don't meet for committee meetings and "carefully suggest" who should or should not be ousted or weeded out. it means that they are clear on their goals and realize at work not everyone is going to be casual or good friends, but that doesn't mean that they are not loyal, not supportive, not problem-solvers, or team-builders etc. individual closeness may happen or not, but that isn't what it's about.

you are right that one should not necessarily want to work where they are not "integrating" properly. but what does that mean in the particular situation?

integration is a process and it is a multidirectional process. the bigger issue with the group may be that they limit integration b/c they don't understand what the clear goals of the team are, and they do not understand such things as openness to others and/or they don't understand that forming a coalition is most essential to "team cohesiveness," not forming any form of cliques or factions.

usually you see this more in smaller units or groups of people. they think forming a tight band is the key. they don't see that is not what is essential to true success. indeed with the group to which i relate, i did not see clarity throughout as to what the goals of the "team" are. and that's when individual and side group agendas take over. some "key" players may have more of a sense of what the goals are--but it was not translated well beyond the key players--others seemed sectioned off from it, and they seemed to me to be a general misunderstanding as to how to apply that as a truly, whole, integrated group.

thankfully this experience has helped me to more clearly visualize the kind team i want to be on--that is one of open, respectful acceptance of others, their perspectives and styles, and one that is clear in its goals as a whole through most of the group's populace--and one that aims toward real collaboration--forming coalitions.

interestingly enough these work-related events helped me to relate to a lot out of my transformational leadership courses this term. i literally saw things play out in real work life; thus, it moved beyond theory for me.

as i said, at least in my experience, it was not a total loss, b/c i take some great learning experiences away with me.

to me it isn't this "us vs. them or he, she it" sort of thing. individuals there can rationalize things as they may. sure, i have some soft skills i need to build on, but nothing so messed up that it required being cut from the group. on the other hand, the group is struggling, and in my view, it is not realistic as to what it is really struggling over. i am thinking that some key people within the group are feeling powerless over certain things that they may not be able to control--census--no surgeries--and all that goes with that.

but also it reflects negatively on the organization as a whole that they do not have well-constructed processes and systems for orientation--and consistent, objective, and regular reviewing and evaluating those they are orienting. they play a bit of a capricious, fast and loose game with the "process," if you want to call it that.

i've seen a few organizations excel at structuring, maintaining, and continually developing nurse's "precept/orientation" experiences. they have a consistent means by which they as objectively as possible measure where they are each step of the way. this unit absolutely did not demonstrate that at all. they and their partner unit seem to leave it to "hit or miss," subjective and covert evaluation processes. that's not a recipe for success. you can continue to blame the "hiring choices," but at some point you have to look at the structure and function of your individual precept-orientation program and processes. and you also need educators that understand how to intelligently and energetically form effective action plans. i feel badly too, b/c this unit did not have a nurse educator--and imho, the pt educator on the other side didn't seem to get this either. people develop and grow in all aspects in structure. it doesn't have to be rigid, but the outline should be clear and progress and feedback should be at regular intervals.

look, if i use a gps system, i may just end up taking each turn it tells me to when i am upon it at the moment. but a person that cares about real navigation looks at the big picture and also has a general idea about the direction and markers around the destination point. and he or she evaluates along the way if he or she is still on course. sometimes gps can send you through a very problematic route.

in order to have folks succeed, whether in teams or individual precepting experiences, a course must be charted--a flight plan designed, if you will. and at regular intervals the process and progress should be evaluated.

we are all nurses and supposedly know the nursing process. i don't understand why this is so hard for some to see. this doesn't take genius, or a lot of excess organizational redistribution of money. it takes some realistic insight and understanding of human processes and genuine commitment to the unit yes, but also to those who are hired. they made a commitment and are living it out. this is the problem with at-will-employment. the individual may make a commitment and be working on it, but the organization or some part of it does not really make the same commitment--they don't have a sense of due diligence when it comes to those they take on. yes, if things truly and objectively aren't working out on the whole, you can't bring the whole group or unit down b/c of the individual. but honestly, that wasn't the case here. and i saw the signs when i couldn't get anyone to sign off or show a commitment to working through the precepting, having regular feedback and constructive measures and meetings on progress. sadly i've seen this before. in the end it was all about understanding different styles and likeability. see if they do due diligence and work through an objective evaluation process, oops, if they decide they don't personally like the person, it may make it harder to get rid of them. with awe, sadly most of the benefits are not the employer's side--it's often very one-sided. this is why, for better or worse, nurses have sought union representation.

we could circle this to the cows come home, but there is definitely more than two sides to this. again, for me, it has helped me grow in learning about myself, and also helped me grow some skills, but it also helped me to see the kind of team i want to play on. now i am may not find it, at least any time soon. but i have worked on teams that are much closer to it. but the organization and leadership was structured in such a way that enabled the building of such teams.

and it goes to show that you can receive honors and accreditation for this and that, but that doesn't mean you don't have a lot of important "stuff" to work on.

i assure you; i am a good and committed team player. it's just that a person has to know that there is openness to independent thinking (not that that thinking should dictate to what the group's consensus is--don't misunderstand. that is not what i am saying.). they have to know the big picture and where they are in the process. then a measurable process has to be worked. many a good person is lost and a team loses out, b/c people don't accept other perspectives and they don't see what it means in building true coalitions. fractions and cliques do not work anyway as well--and eventually they too fragment. it is also completely unrealistic to believe that conflicts are not a part of human interactions. they are and they can be valuable tools for growing a more cohesive, collaborative team--if they are handled with the proper insight and understanding--and if individual agenda don't take center stage. that's often what happens when a team is built on cliques and factions--individual agendas take over--or it looks on the surface like all is cohesive, and to some degree it may be so--but in reality the group or "team" is not growing--it is stagnate and is not really getting anywhere.