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Probably getting fired from ICU...how can I move into full-time LTAC from prn status?

LTAC   (6,832 Views | 12 Replies)

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Hi, there. I found out today that I may get "let go" from my ICU job, and I'm wondering how to best position myself to ask to go full-time at my prn LTAC job.

Background: After 4 years of med-surg nursing, I got into an ICU residency (for RN's with no ICU experience). During 12-week orientation, I didn't do too well on the unit with critical thinking, and administration was helpful enough to extend my time under my preceptor and give me feedback. Now, it's 5 months later, and, try as I might, I'm still not performing well. They say I don't quite "get it" and my critical thinking suffers. They're still giving me the stable patients (basically, LTAC patients, or patients about to transition to the floor). Today, I learned that if I don't improve within the next 6 weeks (by September), I'll be let go, with 2 to 4 weeks notice.

I'm going to keep trying to improve (particularly because I have to pay up about $8-10,000 for some form of breach of two-year contract if I'm fired), but I need a Plan B.

I have a prn job in the ICU floor of an LTAC (just got off orientation for this LTAC job - my first off-orientation night is in a couple of days). These patients are trachs, vents, wound care, sedative drips, some hemodynamic drips, central lines - and I've felt more comfortable working there than in ICU; this work seems more "do-able" to me. My question is, how do I best present myself to move from PRN to full-time, with my current situation? And when?

I just checked the LTAC website today, and they are hiring for full-time in the ICU portion of the facility, the same floor that I currently work at prn. When I go to the supervisor and mention that I want to move to full-time, is there a good way to avoid stating that it's because I'm being fired for ICU incompetence? Or, if it comes out that I've been fired, how do I best present that information?

**Important: I'm not trying to put any patients at risk, and I don't really think that I will, in the LTAC. I have felt more comfortable there than in my ICU job. I never really had any "red-flag" incidents in the ICU where I put a patient at risk (except for removing restraints too soon from a fall-risk patient when he appeared more oriented) - the thing is, I'm just not really functioning as a full-fledged ICU nurse (not seeing the big picture, lack of confidence, not focusing on "if this happens, what then / what does this mean / what should I be looking out for" - which wasn't really so much of an issue for me when I was working medical-surgical). Obviously, if I find that I'm still not cutting it in the LTAC ICU and that my judgment is putting patients at risk, I'll look for another type of nursing job.**

Fortunately, I live right within a couple of blocks from my LTAC job - literally walking distance -- so I'm thinking that I could present the ultra-short commute as a reason that I want to make the LTAC job full-time?

And WHEN should I approach my LTAC job manager? Maybe just make some casual comment about it now (about how friendly the people are - which they really are - and how convenient a commute it is), since I still have 6 weeks? I don't want to wait too long and, if I wind up fired, maybe the full-time LTAC job is gone.

I feel a little weird about the whole thing, because I'm normally a very honest person, and I don't really like to feel sneaky...but the reasons that I'd like to work at the LTAC are genuine (I just want to leave out the whole getting-fired thing). And obviously I gotta pay my bills and avoid becoming homeless. :( If I get fired from ICU, I'm thinking that transitioning from PRN to full-time in my LTAC job will be a lot easier than starting from scratch, going into job interviews and having to explain why I "left" ICU less than a year after starting, or filling in "yes" to the "Have you ever been fired from a job?" question, or trying to figure out the "Can we contact your former employer?" question.

Appreciate your advice. Take care.

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lub dub has 27 years experience.

254 Posts; 5,970 Profile Views

I'm sorry to hear that things didn't work out in the ICU. However, how can you be on the hook for $8-10,000 when they are firing you? Can't you transfer to another unit in the same facility?

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2 Followers; 14,620 Posts; 104,755 Profile Views

You haven't been fired yet, and you don't need to volunteer any information about how you might be fired. You can apply for the position (and I would do so ASAP) and talk about what a good experience you're having there as a prn nurse, how much you like everyone there, the convenience to your home, etc. If they ask directly about your current ICU job, the standard cliche' in nursing to explain these situations is "it wasn't (isn't, in this case) a good fit." It sounds like the people at your current position are making an effort to give you every chance, and, if it really comes down to it, they may be willing to let you resign rather than letting you go, which would avoid your having to report, in the future, that you were fired from a position.

If I were in the situation you describe, I would already by looking for other opportunities, whether within the facility/organization you're working (full-time) for now, or other employers. You don't want to wait until the actual day that they let you go (if it comes to that) to start working on this ...

Best wishes!!

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Clovery has 1 years experience.

549 Posts; 13,961 Profile Views

I would put in an application for the full time position at the LTAC, then tell the nurse manager that you applied. Go on to say how you really like it there: the people are friendly, the job is very rewarding since you can develop a relationship with the patients/families and you feel like you really make a difference with your nursing care. Mention the commute.

Are you sure about the contract? Maybe talk to the ICU facility, explain the situation and go to HR and clarify the contract. They might be able to place you on another floor to avoid breaking the contract, or they could agree to dissolve it since you are not a good fit despite your best efforts.

I'm sorry this is happening to you, I know it is really hard to hear that you just aren't cut out for something you wanted to do. I experienced a similar situation recently going from LTAC to an LTAC ICU and was unfortunately terminated 5 weeks into orientation.

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

2 Followers; 6,073 Posts; 60,642 Profile Views

If you are fired, they are breaking the contract, not you. Something doesn't sound right about that

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151 Posts; 4,759 Profile Views

It's probably a good idea to talk with a lawyer and have him/her look over your contract to know exactly where you stand. Those penalty clauses are typically included to prevent someone they would like to retain from taking advantage of the investment in training and then just leaving for greener pastures. If you have another position lined up, and need to leave prior to actually being fired, you might be able to get off the hook for the money if you can negotiate a termination by "mutual agreement". If it truly just isn't working out for the hospital you leave on amicable terms, and they might just be relieved to have it all end quietly.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 66 Articles; 13,948 Posts; 172,421 Profile Views

If you are fired, they are breaking the contract, not you. Something doesn't sound right about that

If you are fired for cause, you are breaking the contract, not them. I'm not sure if that applies to incompetence, but I know it applies to attendance issues, insubordination, failure to adhere to dress code, etc. It sounds as if they're working with you, though, so you might discuss the contract with them if/when you are asked to resign or are fired.

Perhaps if you were at home studying the things you need to know for the ICU job instead of doing a prn job in LTAC, you wouldn't be having as many difficulties in ICU. Succeeding in ICU requires studying on your own in order to become competent.

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icuRNmaggie has 24 years experience as a BSN, RN and specializes in MICU, SICU, CICU.

1,970 Posts; 25,298 Profile Views

Just be vague "it wasn't for me." Experienced managers have all been in your shoes at one time or another. If pressed just be honest. Say I dont think I am ready to take on 2 or 3 critically ill and unstable patients at this point in my career.

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129 Posts; 5,953 Profile Views

Funny you should mention a lawyer, HarryTheCat! My roommate is a liberal New Jersey journalist, and he got pretty darn fired up (as he does about many workplace issues), and offered to have his father, a federal attorney, look over the contract. At first I laughed, thinking it was kind, but overkill; but now that you've suggested it, maybe it's a good idea. ;)

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151 Posts; 4,759 Profile Views

If I was in your position, I'd certainly take your roommate up on the offer. Most attorneys, even the ones who don't specialize in employment contracts, can give you a pretty good idea of where you stand. If things get really sticky, an attorney who specializes in employment law might be advisable. Sometimes all it takes is a letter from an attorney to put an end to the threats.

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edmia has 10 years experience as a BSN, RN and specializes in Emergency, ICU.

827 Posts; 14,113 Profile Views

If you are fired, they are breaking the contract, not you. Something doesn't sound right about that

My thoughts exactly! Contact a lawyer familiar with labor contracts. How the heck is it your fault that they don't like you as a nurse? That's the risk they take when hiring someone. That's why there's a probation period. Do not stand for that.

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327 Posts; 4,321 Profile Views

Why not just inquire about a. F t position at the LTACH? People leave jobs all the time. Its easy enough to say you aren't happy and considering leaving.

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