Animorpha

Hi! I was written up recently at work for workplace negativity and unprofessional. I've been an RN at my job for almost 2 years and in that time I've actually become one of the more senior nurses on my shift because there is so much staff turnover. I really don't feel I'm negative at all, I vent of course like most nurses do and maybe people misinterpret that. Here's my write up but for my privacy I'm calling myself Gale and I've changed the date. On 9/7/15 the DON met with Gale to address complaints that she was extremely negative and unprofessional on the unit. Despite this meeting there continue to be complaints that Gale is "Rude, unprofessional and has an "overall bad attitude." Reports include concerns that Gale "lacks compassion" towards her patients. These complains have been reported by multiple peers. Gale must demonstrate immediate and sustained improvement. All interactions must be professional and the negativity must stop. Failure to make these improvements will result in termination. This is a last and final warning. I was shocked when I got this. The following paragraphs have more details for context, but I honestly just feel like I'm being picked on. Does anyone have any advice on how to deal with this or what to do to protect myself? I was talked to a few months back for being negative while training someone who ended up quitting before they even completed their training. They were essentially blaming me for someone quitting when I'm pretty sure he made that decision all by himself. On the day I trained him I was pretty negative for multiple reasons. My assignment was unclear until about 30 minutes into my shift and I had to call my supervisor and DON to sort it out. I had over 20 patients with no secondary support nurse, and I had to train this new nurse. To top it off, a few days ago I had requested to not be put on the unit I was on that day anymore because I did not like that unit, it was too stressful for me and the DON at the beginning of that day's shift told me she couldn't promise me anything. I guess I was too overwhelmed that day to even remember to ask for help, but both the supervisor and DON were probably pretty aware of how crappy my day had started and they didn't offer any help either. As for the real reason I feel I got the write up the head case manager at my job wrote my DON a letter instead of going through the chain of command and talking to me or even my immediate supervisor. The head CM was working later one day and I had just gotten some phone orders from a doctor. My new patient rolled in and the CM introduced herself to the patient and let me know the patient was there. I acknowledged what the CM said, but continued to write the doctor's order because I didn't want to screw up the order. I'll admit I wasn't all warm and bubbly with the patient, but part of that was my irritation with the CM and the fact that she went to me instead of any of the other nursing staff to welcome this no patient to the unit. I should have been nicer to the patient, but I don't feel my behavior warranted an e-mail to the DON. The DON said that multiple people say I'm rude and negative and aside from the two above example I really feel like people are either being oversensitive or the DON is making stuff up because she wouldn't give any details on what exactly I'm doing wrong, just that I'm "negative." I have no idea what to do at this point other than keep my head down and carry on.

I don't have a lot of experience with Hospice as an RN, but I recently had a pt with lung cancer that metastasized to his jaw and femur. By the time he was my patient he was actively dying. The nurse on the shift before me had been giving him prn ativan Q2hr and prn morphine Q1hr. I ended up giving him prn morphine again an hour later, but after that his breathing showed much more apnea and the pt overall just looked more relaxed. I gave the pt his scheduled ER morphine, but that was the last time during the shift I gave him morphine of any kind because physically the pt did not look like he was in any pain or distress whatsoever. His breathing because more chenye-stokes as the shift went on. My other problem was his temperature being so high. During the previous shift despite giving PR Tylenol q4hr and cooling measures the pt's temperature remained above 103 F. The daughter had told the previous nurse to not bother with the Tylenol anymore because it doesn't seem to be helping the pt so why bother the pt to give it PR and make the pt uncomfortable. So, when I got the pt I decided to follow what the daughter had said and not give the Tylenol since it was ineffective the shift prior anyway. I had cooling measures going the whole shift though. By the time the next shift came in the pt's temp had risen 105 and the nursing coming on looked at me like I was the most horrible person ever for not giving the Tylenol. I've been thinking about it ever since. What is protocol with at pt with this diagnosis regarding managing pain, breathing, and temp? Thanks!

Thanks for all the input guys. I realize it doesn't look good, but to add more to my story. I requested a two week vacation starting Feb 1st and I just found out today that it was denied. My former job doesn't know this though I did offer an explanation to my quitting, but I already have a new job lined up and I wanted to vacation for training time and the new job in the case that I got the job, which I did. I don't know if that makes it better, but that's my story.

I quit my CNA job in california with only a few days notice. When I quit, my now former boss started claiming this was patient abandonment because I was not giving enough notice. I was under the impression that patient abandonment was when you leave mid shift because you felt like it with no regard for the patients. My former boss is responsible for staffing and she is not very good at it. I feel like she was using this patient abandonment thing as a scare tactic and it just doesn't feel right. Does anyone else have experience with this "patient abandonment" thing as a CNA leaving a job?

There are no in house MDs at my facility. I was told to text the MD by a senior nurse and when I was hired the administrator told me that the MDs prefer texts over phone calls. I did not violate HIPAA in any way because I used no identifying information for the patient, only the room number and that it was a new patient. The new patient came in an hour before the end of my shift and expecting the MD to text me back within less than an hour on a Friday night seems unreasonable. The patient needs to be seen by the MD this coming Monday by the early evening so there is still time for the MD to see the pt. Unfortunately no one really has answered my initial question. So, can someone give me an example of how they would text the MD and politely indicate that they would also like the MD to text back so the RN knows the MD got the text properly? Thanks again.

I'm a brand new nurse at a very small end of life care facility. I got a new admit when I worked last and I was told I needed to text the facility's MD to let him know the new pt must be seen by a certain time Monday. It's been over a day now and the MD has not responded to my text. I charted that I did contact the doctor and summarized what I said to him in the text. I've never really communicated with MDs much before, but is there a "best way" to text MDs to get them to at least respond with an "ok" to my text to cover my butt? Thanks!