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Probably gonna get fired my first week...

Nurses   (7,305 Views | 41 Replies)

AngelfireRN has 15 years experience as a MSN, RN, APRN and specializes in med-surg, psych, ER, school nurse-CRNP.

1 Follower; 2 Articles; 23,452 Profile Views; 1,286 Posts

And all because I'm too darn careful.

No, I haven't been scolded, counseled, or even looked at cross-eyed, but after the day I've had, it would not surprise me. Tell me, y'all, if this was you, what would you have done differently?

Case 1) Grandma brings in kiddo, around age 5, multiple c/o: cough, runny nose, sore throat, thinks she has a UTI, vomiting, etc. Typical viral picture. Drainage is clear, vomiting not excessive, 2-3 times over the last few days. Kiddo looked a tad puny, but was responsive and giggling when I examined her. All tests negative. Explained to GM about viral syndromes, symptomatic tx, etc. Did not want to jump straight to an antibiotic, as no real s/s to warrant such. Told GM that I typicall do not do Phenergan for a kiddo that young (and skinny as a rail), and that Emetrol was what we had had success with with this bug. She agreed to the treatment, and left.

Fast forward a few hours, GM is steaming mad, wanting to knwo why all I did was send a med that she already had at home to the pharmacy that she had to drive 30 miles to get. I was stunned. Explained again about viral syndrome, the treatment she agreed to, etc. She was having none of it, said that WHEN she brought the girl back, she'd make sure I didn't see her. Fine and dandy by me. Thank God I always do a note on my charts.

Case 2) Woman seen for an URI 3 days ago, represents and requests cough meds with narcotic, specifically. Was told by the other provider that saw her 3 days ago that she would not be prescribed this, as she was on a narcotic regimen already. I told her that I would not deviate form the treatment already prescribed (no cough heard the whole time she was here, chest clear, already on an antibiotic, etc.) She became irate and tried to say that she was no longer on her narcotic regimen, but as we had no way of knowing this for certain, I declined. She called the lot of us "worthless" and stomped out.

This is an urgent care setting. Both of these patients have PMDs, and no, they had not contacted them prior to coming in. The GM even said she brought the kiddo because the mom did not think she needed to be taken to the doc. Just wondering if I should throw in the towel. Yes, I'm thin-skinned today.

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Double-Helix has 9 years experience as a BSN, RN and specializes in PICU, Sedation/Radiology, PACU.

1 Article; 3,377 Posts; 41,877 Profile Views

Why would either of those situations get you fired? It sounds like you did everything you should have. I think your just over- anxious because you're new. :-)

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3 Articles; 2,815 Posts; 30,550 Profile Views

Your decisions sound perfectly reasonable to me. Not sure why you'd get fired.

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AngelfireRN has 15 years experience as a MSN, RN, APRN and specializes in med-surg, psych, ER, school nurse-CRNP.

1 Follower; 2 Articles; 1,286 Posts; 23,452 Profile Views

Cause I'm paranoid and I HATE getting yelled at, lol! Thanks for the backup...makes me feel better.

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9 Posts; 983 Profile Views

Hi there,

Sick and tired of feeling like this... I :crying2: I LOVE being a nurse but my paranoid feelings will not let me relax while at home on my off days when I should be recharging my batteries...

I work in LTC.... Naturally. I have been there for two months and have been working my tail off to deliver exceptional care however...

I have administered Tylenol for a 99.1 T and documented it (UA C/S pending) on the 24 hr report only to have a fellow new nurse announce it's not a fever...:confused: I knew it wasn't but the days previous she was spiking 102 temps so I was just trying to avoid an issue.

Sent out a COPD patient to the hospital vitals stable but sats where dropping to 84 %. Contacted nursing supervisor.. Gave her more 02 (without and order with COPD) and We sent her back to hospital via ambulette, she was def heading into distress.... Took **** for not calling 911 from another nurse....

Cried about issues like these for days... I can't get a handle on my life. I feel scared and insecure and feel like I'm going to get fired 24-7.....

Document like a novice..... I spend hours after my shift... still look and sound like an idiot

Can't give report bc I'm hypoglycemic at the end of my shift bc I don't eat....

when I'm home I'm obsessively googling or on AN boards reading bc I'm obsessed and panicked about mistakes that may be found on my off days.....

I have a family to raise and other things to do but I have not stopped crying and stressing since I started this job....

Any adivce? Is this normal?

If I made a massive error over the weekend with that COPD patient would I have gotten a call about it today??

I'm sorry for the debby downer attitude but I totally understand your feelings..

you on the other hand sound like an amazing nurse and did all the right things,....

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DixieRedHead has 20 years experience as a ASN, RN and specializes in ED/ICU/TELEMETRY/LTC.

638 Posts; 9,696 Profile Views

I am confused. Are you a nurse? If so why would the course of treatment be up to you?

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linnaete has 9 years experience as a ASN, BSN, MSN and specializes in Psych, Maternity, ER, Ortho.

91 Posts; 2,804 Profile Views

Looks like they're a nurse practitioner...

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4,412 Posts; 33,933 Profile Views

I am confused. Are you a nurse? If so why would the course of treatment be up to you?

Angel is an NP (not a newbie one either).

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4,412 Posts; 33,933 Profile Views

Angel, I believe that some people give urgent a try on things they know they cannot get from their PCP. They don't think of you (urgent care) as having REAL Docs and nurses -- so, you are supposed to be easy to put one over on.

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JeneraterRN has 3 years experience and specializes in OB, Med/Surg, Ortho, ICU.

256 Posts; 6,022 Profile Views

Angelfire, you are doing just fine. There are those who are impossible to please, and there's no fixing it. Worry about your charting and not their attitudes, and you'll do fine.

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37 Posts; 3,126 Profile Views

I don't mean to sound unsympathetic but you're just going to have to get thicker skin. I work in a pediatric ER (not much different than urgent care or primary to be perfectly honest) and parents leave irate almost daily. The thing is, it's your job to do what's best for the child/patient even if they (parents!) don't agree. You don't have to be rude or unkind but you can't win them all! (and you won't!!)

Unnecessarily prescribing an antibiotic (or 'insert your patient's requested intervention here) is not only senseless, it's dangerous! A popular speech my attending uses frequently for viral pharyngitis R/T adverse effects of Amoxicillin: 1/10 kids will develop a rash, 1/25 kids will develop diarrhea, and 1/1000 kids will develop a severe, life-threatening reaction to the abx. Now compare that to the risk of rheumatic fever: 1/1,000,000!!! There is less chance of developing this life-threatening illness than of the patient developing a reaction to Amoxicillin!! (you'd have to double check my stats but I believe they are pretty accurate)

Now enough of my rant--the moral of the story is to stick to your guns. The best thing you can do is keep up with your reading so you can present the most up-to-date evidenced-based reasoning for your plan of care. But please, please, please don't practice defensive medicine--it can be just plain dangerous.

That said--hope things get better. I'm sure you're doing great ;)

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