Granuaile

Thank you for clarifying.

True.

Thank you for saying this. Substance abuse and addiction are not only complex and controversial, but in my experience still poorly understood by many who work in healthcare.

The Nurse Educator of Vanderbilt did testify as to the competency of RaDonda's nursing practice, though in general terms and she was one person, so based on what I have read so far, other opinions/evidence as to her competency are not known. RV did skip over multiple precautionary steps that we are all taught to take when administering any medication, and she did not monitor the patient after giving her medication. We don't know if she had a pattern of unsafe practice or not. At least from what I have read, I don't yet know that. We do know that she immediately reported her error when she realized she had made it. This is an aside, and does not absolve her of her complacency, but it is a little disturbing that none of this even came to light until an anonymous person notified state and federal authorities of the med error, 9 months after it had occurred, because the hospital covered it up by falsifying documentation to the Medical Examiner and simply not reporting it to state and federal authorities. As stated in an article by the ISMP (Institute of Safe Medication Practices), "This fatal error involved accidental administration of a neuromuscular blocker to an unventilated patient by a practitioner who thought she was administering a different drug—an all-too-common scenario with errors involving neuromuscular blockers," https://www.ismp.org/resources/safety-enhancements-every-hospital-must-consider-wake-another-tragic-neuromuscular which leads me to believe that errors involving this potentially life-threatening medication are a known issue. Additionally, midazolam is no longer available under the brand name Versed. So even if RV were to never be allowed to touch a patient again, are hospitals (and other healthcare settings) actually safer without her?

I am surprised to hear she is appealing to get her nursing license back. Like others have said, first, she didn't use the 5 rights, which could have saved her at multiple points between accessing the med and administering it to the patient, and she didn't use the nursing process, which of course includes evaluating the outcome. Pretty egregious, no matter how you look at it. I think *were* she to have her license reinstated, she should not be allowed to be responsible for providing care to patients (ie as staff nurse, charge nurse, or supervisor of other nurses, etc).

I agree with this fully. I do feel that in addition to the factors discussed by the OP, that nursing burnout is ultimately a problem that originates at the top. Or at least, that this is where change needs to start. Even though there are lots of research papers, news articles, and blogs written on nurse burnout, it still feels like a topic that nurses are reluctant to talk about or take a stand on. And who can blame us? Nurses voices are not heard or valued when we do speak out, and in fact many nurses face a real fear of retaliation if they do, not only from management, but from their peers; it's as though nurses are set up to do what they need to do to survive, because that's all we have time for, and we are not supported to go beyond that. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775923 https://www.nbcnews.com/news/us-news/nurse-burnout-remains-serious-problem-putting-patients-danger-experts-say-n1266513 https://pubmed.ncbi.nlm.nih.gov/33764561/ https://www.nytimes.com/2021/08/12/opinion/nurses-understaffing-covid.html https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/nursing-in-2021-retaining-the-healthcare-workforce-when-we-need-it-most

Hello fellow nurses! Beware - this post is long! I've been a nurse for 12 years. Prior to being a nurse I was a chemical dependency counselor, and prior to that I was a food server for many years. I always wanted to be a nurse, but it took me awhile to believe in myself enough to even pursue it. So now I am mid career and mid life. Often people think I am younger than I am because of my voice and I can pass as younger appearance wise. Why I mention that is because sometimes it seems like my peers assume that I am young (ish) and have just started out, and I have a very mild speech impediment so it also seems they think that that means I am not competent and intelligent. This all mostly applies to when people first meet me. In my 35 years of working (at 12 I marketed myself via flyers in mailboxes to babysit for several neighbor families), I have never been fired, until this year. It is not to say I haven't had jobs where I was bullied into resigning, but that has only happened twice. I work hard, have a super strong work ethic and sense of integrity, have a safe nursing practice, know when I don't know something and am not afraid to ask questions, ask for help, etc. Like many if not most people, I come from a background of childhood trauma and as most of you will know, folks like us tend to re-create past traumas in our present lives, unconciously, and working on resolving that trauma becomes a non-negotiable task should we want to break those patterns. It is fair to say that I have experienced a hefty amount of bullying at different times throughout my life but I have also been working on healing myself for a long time, so when I start to see red flags I am better at first of all seeing the red flags and second, responding in a healthy way. In no way whatsoever do I see myself as a victim or disadvantaged or anything - these are just realities in my life and undoubtedly there are countless other nurses who deal with similar challenges. So, back to be being fired. I left a nice job at a good hospital so that I could start my journey in critical care. I had been working in medsurg/tele for a year and a half and the hospital I was working at, while I had applied to work in their ED, did not pursue transferring me to that unit. I had not yet applied to their ICU as I felt like I wouldn't fit in socially. It's a small hospital, about 50 beds, and so the opportunities for growing into other specialties is limited. I was offered a position in an ICU in a different hospital within the same hospital system. I was stoked because this hospital is a large level 1 trauma center and there are seemingly endless opportunities to learn new things. Also, it was much closer to home. I accepted the ICU position at the larger hospital and left my medsurg/tele job in good standing and with the full support of my supervisor; as well I gave them plenty of notice; I even let my supervisor know 3 months in advance of my last day that I was looking and why. I started my new job in April and absolutely loved it. I felt stimulated mentally, I looked forward to going to work every day (or night), and I felt like I finally was in a position that was right for me. I was receiving positive feedback from my preceptors, and the only constructive feedback was, for example, my preceptor would say "okay, tonight remember to draw your labs by 2 am," or "remember to stay caught up on charting your vital signs and I&O's hourly, even if you can't get to the rest of your charting until later in the shift;" as well, I was given feedback to try to get better at asking for help, mostly in regards to turning heavy patients that were on a vent and multiple lines, etc. I responded with a positive attitude to all feedback and made the requested changes. There was never any warnings given or signs that they were not happy with my progress. The biggest thing that stood out was a few times, my preceptor would stop me and say "you seem nervous, are you okay?" I tend to be an anxious person, especially when adjusting to a new social group, so for me I did not feel anything out of what was typical for me. Then I noticed on a few counts that there seemed to be some cliquishness that didn't feel right. As in members of that clique did not seem to be above dishonesty where I was concerned. Still, I just didn't worry too much about it because I don't internalize kindof being treated as the odd man out like I have at times in the past. I remain focused on my patients, my job, and keeping lines of communication open and positive; usually after a time that dynamic seems to fall away, and at the very least a mutual respect remains. July 26th comes around and before my shift (I was on nights), the director calls me and asks me to meet with her at 5pm. I ask what it is regarding and she laughs and says she is in the middle of payroll and will tell me when I get there. So I go in, with a very bad feeling, and with a couple charge nurses present, she hands me a termination letter. No reason whatsoever for the termination is stated in the letter. But because I was still in the probationary period, she did not need a reason, and the union could do nothing to support me. She and one of the charge nurses present said some demeaning things to me and I was kind of in shock. Mind you she was an interim director; the director who had hired me had been terminated for reasons nobody knew, a couple weeks or so after I started. I had only ever met with her once and it was not for a performance or conduct issue; aside from that when I would see her I would just say hello or good morning, etc. In addition to firing me she made me a Do Not Rehire (!) It was, not to be over-dramatic, emotionally a kick in the gut. Okay, so after she fires me I am a little tearful but I say thank you and leave. When I get home I immediately start applying to new jobs and land 2 interviews in the first week. It is now November and I have had about 8 interviews and have applied for I'm not sure how many jobs - probably more than 30? I have bombed a couple interviews but many of them have gone very well. I have been candid about the termination and if asked what happened I answer. It's hard to answer because nothing "happened." I sometimes joke and say "I thought I was doing great but they apparently didn't." I have a PRN job that I have held for the past 4 years 4 months, and I have interviewed for several positions within that company. It is acute care but not considered complex - it's inpatient hospice, which is not well understood by folks who have no experience with it - so that experience seems to be undervalued by hiring managers. I have been told a couple of times when I have received feedback after the interview that I do not seem to have enough experience for critical care. Most of the time, as is the norm, I do not hear anything or eventually get an email thnaking me for my interest. I should mention that I have been applying for ICU and ED positions mostly, but also, step-down, progressive care, and peds, as I am most interested in ICU or ED. I have also looked into travel nursing but I have a lot of obligations where I live and I really have been hoping to not have to go back to medsurg/tele. If I were in my 20's, even 30's, I would be more open to that. And of course I am being forced to realize that I need to be open to going back to medsurg/tele. I have done ED in the past and really enjoyed that and while it was more than 3 years ago, I know I can work in an ED; it is probably a better fit for me that the ICU as I thrive in dynamic environments. So I have been facing rejection after rejection, not only by an employer I already work for, and for positions I am qualified for, but during a time when employers can't find nurses to fill their positions - I was told by one hiring manager of an ICU for a large local hopital that they aren't even getting applicants! This ICU was their dedicated COVID ICU, and I worked the whole first and second wave of the pandemic on the medsurg/tele unit, taking care of patients on optiflow, bipap, etc, so it seemed like I would be a good fit as I had plenty of experience with COVID patients and had even helped on the ICU during the pandemic (at the small hospital where I worked medsurg). But, I "didn't have enough experience." Anyways, if anyone read to the end of this, thank you. I know it's super long but I have really been struggling to keep my morale up. Thankfully I do have a PRN job and I do volunteer in the community so my sense of purpose has been buoyed a little, and financially I am okay for now. I just feel I deserve a chance and I know that I would be an asset wherever I was hired. I am trying hard to not give up. PS I am open to advice but as this post is already super long, I am not including all of the steps I have been taking. I have tried to write this post conveying the story as accurately as possible but going into a lot of specifics would make it a mini novel!

Thank you for sharing your experience. I had to do a double-take on the name because it sounded like something I would have written about myself, haha I just want to offer my support, and thank you for helping me feel less alone. I hope that you can be kind to and compassionate with yourself. Like if your child or best friend were going through the same thing, what would you say to them? I have no doubt your words would be loving and supportive. You deserve the same ❤️

I forgot to say the reason I asked to go PRN at the ED was so I could have the flexibility to work more hours at my other job (inpatient hospice)... it's hard to explain, but I was PRN at the hospice, but was offered a full-time position after being there 10 months. I knew there would always be a ton of hours avilable at the ED, while in contrast, even full-timers at the hospice rarely get all their hours because of low census. So, in my mind, the only thing really changing was which job would be providing me benefits, and the benefits at the hospice job were a lot better. So good intentions, yeah? If only people would see things my way, lololol!

I am a Gen-X'er and nursing is my 3rd career. I count food service as a career - I did it for 15 years and loved it. Maybe I am even on my 4th career, if you count babysitting, which, at age 12, I couldn't wait to enter the workforce, so I marketed myself (I put flyers in neighbors's mailboxes) and babysat for about 5 different families until I was old enough to get a "real job," haha! My second career was as a Chemical Dependency Professional, which I did for about 5 years. All along, though, I had wanted to be a nurse; I just didn't believe in myself. Being a Chemical Dependency Professional gave me confidence and taught me that I have a knack for connecting with people from alllll walks of life. So here I am, have been a nurse for 11+ years. Lessee... 1) Worked in correctional nursing for 3.5 years as an LPN; left as I wanted to do hospice and work a little closer to home; left on good terms 2) Worked in a unit that did both LTAC and hospice for 2 yrs, 9 months, first as LPN; earned my RN along the way; left as it was no longer a "good fit," and I wanted to try home hospice; this departure was very stressful and emotionally difficult for me 3) Worked in home hospice for 9 months and was so burned out I was becoming physically ill; no days off and not paid for OT! I left on neutral terms, ie "I'm out!" Haha 4) Started work in an inpatient hospice unit over 4 years ago, but have been PRN for most of that time (learned that I can no longer do hospice full-time and that I want to become as versatile a nurse as possible!); am still employed at this job 5) Worked in an ED for 6 months and actually loved it but made a stupid decision to try to go PRN too early - you'd think I'd know better! First they said yes to transitioning to PRN then no, but I did leave on good terms 6) Worked at an acute care hospital in tele (during the pandemic we were a COVID unit) for 1.5 years; left to work for another hospital in the same health system; left on good terms. This hospital was very small and the commute sucked, so I was thrilled to land a job at a sister hospital, that was closer and had tons of opportunities to learn. 7) Worked at that sister hospital I mentioned for 3 months, and was terminated! I loved that job so much and wanted to stay there the rest of my career. I didn't make any mistakes, I had perfect attendance, a great attitude....I'm not saying I was perfect, but literally they gave me no reason except for a very vague "you're not cutting it," which I have to say I disagree with them completely! Haha I say that as I sit here, unemployed ? Thankfully I still have my PRN job! So that's 7 jobs in 11 years (with some overlap) - I guess I'm a job-hopper to some, but it seems like after I got my RN (after being an LPN for 6 years), I have just been trying to figure out how to build a career that allows me to continually grow and that helps me be as versatile as possible. I am thinking that public health/humanitarian nursing might be the right fit for me, because I can travel, public health nurses serve many different roles, and I have always been drawn to helping marginalized people. ☺️

Indeed; at the end of the day, I only have control over myself and knowing that I consistently treated others with kindness, was professional, and provided excellent patient care are what is most important to me.

I agree. Not all nurses come from the same background. Many do come from backgrounds of abuse/trauma, and some nurses are aware of their own issues that they have as a result, and they deal with these issues head-on, while some nurses are not self-aware and so these issues fester and they can interact with co-workers in a problematic way. Some nurses here have talked about their strong family units, and that is awesome, but not everyone has had that privilege. It seems like no matter where we come from, making the choice to either lift each other up or stand by as others are torn down or worse yet be the one tearing others down is just that, a choice. When I see a nurse who is questioning herself, who seems to have low self-esteem, my first instinct is to be supportive. I don't coddle them but I express my support. So, I don't totally buy it that such nurses invite mistreatment. To me is echoes the argument that says a woman who wears a short skirt and revealing top is asking to be sexually assaulted. We need to stop blaming the victim. Yes, predators prey on the vulnerable, but does this mean it is the vulnerable person's fault? If we want our nurses with lower self-esteem, etc, to be stronger and more confident, is telling them they just need to "rise above it" going to help? Maybe, but it goes deeper than that; as well, if bullies are not held accountable, does it not undermine such efforts? I had two careers (over a period of 23+ years) prior to becoming a nurse, and I always worked in crazy busy environments with people from all walks of life. I worked with people that perhaps didn't all like each other but we got the work done. I have to say that in nursing it has been a new experience for me to have bullying and cliques be the norm, and for bullies and cliques to have so much power. Someone either on this thread or another was talking about lateral oppression, and I do think this is a huge factor that contributes to bullying in nursing. I have stood up for others who have been bullied; I have been bullied then ended up becoming friends with the bully, actually more than once; I have maintained equinimity like a pro in the face of some pretty crummy behavior; I have hid in the bathroom crying; I have been reactive and led by the nose by my emotions. I have worked hard, for a long time, on my own personal development ie examining myself, my part in things, and changing what I can ie my own behavior and responses, and I have become better and better at letting the poor behavior of others roll off my shoulders. I am probably very fortunate that this is the first time that the bullying of others has resulted in me losing my job. The way the communication worked on this unit was, preceptors would talk to the Unit Director, without you knowing that they did, yet no one would come to you and get your side of the story. I remember one day my preceptor was standing behind me as I was working on my charting, and she seemed exasperated because she thought I was charting a certain way that she did not think was the best way. The only thing, is she misinterpreted what she saw me doing, but instead of asking me about it, she just started telling me where to move the mouse and it kind of threw me off of my train of thought. Also, I just felt super uncomfortable with her standing over me and literally telling me how to move the mouse. I was having trouble following her directions in that moment, and I said to her "It's hard for me to do this with you standing over me" or something like that. I think that moment was a nail in my coffin, as she came to me a few minutes later, and in front of everyone said in a very strong tone, "that was really weird," referring to what I had said to her. In my 13 weeks at this job, I remained consistently equinamous, except perhaps in the example I gave above. Equinamity is something that I feel is an inherent part of my personality, *except* when being bullied, and I am aware of this and have worked hard on this, to where I am often the one trying to calm others who are in an emotionally charged/reactive place. Nurses are human, and to me it seems much more mature and better for the overall morale of the unit for nurses to try to work through uncomfortable interactions. In my case, the Unit Director did not come to me once to ask me what my side of things was. I think this is a disservice to the unit, as, it just reinforces a culture of disjointed communication and mistrust. I remember a few times where I knew that a preceptor had thought I did or did not do something or catch something, and they were, in fact, mistaken, but there was not an opportunity to talk about it; instead, I presume, they just talked to other members of their clique and/or the Director. So even if I were equinaminous 100% of the time I think I was pretty much screwed.

While I am not all about that mind-shredding, what I glean from what you have said on this thread is that, as nurses, many of us (myself included) have not learned to have self-worth, have not learned how to establish and reinforce our boundaries, and may not know they have been crossed until it is too late. I hear a desire to protect others, even if I disagree with the methodology. What I am learning from my experience of being fired last Monday is to hold my head high, because I know how I performed, and I know that they just threw away a damn fine nurse, and unfortunately they will probably do the same to other damn fine nurses.

Joansmith, My heart goes out to you! I literally just went through the same thing 2 days ago. It was the first nursing job I have ever been fired from. The director, who is an interim director that replaced the director that was fired a few weeks after I was hired, literally gave me no reason, and 2 things she said were not true. I did not try to defend myself because I was stunned. She said "we've already extended your orientation, and I've talked to the higher ups and we can't extend it anymore." They had extended my 3 month orientation in the ICU by one week, and upon hire had said the orientation length was flexible. Anyways, yes, I felt and feel devastated. I finally felt like I found my niche in nursing! I loved everything about the job. I am so sorry that you just went through the same type of thing. I found your post as I am definitely still reeling from the experience; it helps to know I'm not alone! Reading people's responses is helping me, as well.

Hello, I just wanted to provide a quick update. The advice received here was very helpful for me ☺️, and I am very grateful for it! I have been offered 2 different positions, both are similar, but at different hospitals (one is step-down, and the other is a combination of medsurg & step-down, as that hospital doesn't have a stand-alone step-down unit). One position is at a smaller hospital that is a little far away, but not as far as most of the small hospitals here. The other is in a huge, busy hospital in the downtown area. Both I'm sure would be very good opportunities. I think I might choose the job at the smaller hospital, though, as it doesn't seem like there is as much pressure to work overtime (I have another job - I don't mind working a lot, I just like variety), and more importantly, as some commenters have advised, a smaller hospital may be better for me at this point. ?