we often see threads with the title "fired for no reason," or "new grad harassed and fired" or something to that effect. and i always feel at least a little sympathy for the individual involved, if only because i can clearly see by reading between the lines of their self-justifying post that there was a reason for their termination, even if they just don't get it. (there are always a few posts every year from a new grad who is convinced that the reason she's not getting along with her co-workers is that she's just so beautiful they're all jealous, that crowds of mean people are following her around, that she's so wonderful she's going to rock the er or icu or nicu or or and no one sees her wonderfulness clearly, or that some mean, tired, old nurse who ought to retire and get out of the way is targeting her for no good reason.)
i worked with a new grad who was recently terminated for, as she puts it, totally bogus reasons. evidently seeing mine as a sympathetic ear, she went on and on and on about how unfair it was that management expected her to get her act together and actually understand what was going on with her patients. "i've got the time management thing down pat," she said. "i don't know what else they want. they're just picking on me for no good reason." i liked sal, i really did. she was interesting and entertaining and really, really nice. she was also smart, hard-working (when she was at work) and well-educated. but she didn't study outside of work, and really didn't understand what was going on with her patients. i participated in several meetings with her in which it was pointed out that it's not enough to do the tasks, you have to understand why you're doing them. it's not enough to draw the labs. you have to understand what the results mean and then address them. for instance, if the inr is 9, it might explain the nosebleed, the cherry red urine and the fact that the hemoglobin is now 6. giving the coumadin at 6pm as scheduled is not a good thing, even if you gave it right on time and were able to explain to the patient that "it's a blood thinner." i could go on and on.
i got a call from sal today, complaining that she knows she's blackballed for no good reason because she just can't get another job. she wanted me to give her a reference. did she just not get it?
all you new grads out there who are convinced that you're being picked on for no reason, that your more experienced colleagues are just out to get you, and that you're being unfairly targeting, harassed, or picked on, hear this: it may be something you're doing (or not doing) and all those "mean people" are trying to explain it to you so you catch on, learn your job and succeed. we all tried over and over with sal, and she still doesn't get it. are you guilty of the same thing? if your preceptor says you lack critical thinking skills, do you take it to heart, think about it and learn from it? or are you convinced that the entire issue is that she's jealous of your extreme good looks? if your charge nurse charges you with a deficit in your time management skills do you spend time figuring out where you could speed things up a bit? or do you dismiss her as a tired old dog who can't learn a new trick and ought to retire anyway? are you taking to heart and benefitting from any negative feedback you're getting, however poorly given it is? or are you obsessing about how "mean" that nurse was to you and totally overlooking the message?
i wish sal would have "gotten it." she would have been delightful to work with if she had. but right now she's focused on badmouthing her preceptors and the charge nurse, and she still doesn't understand what she did wrong. don't make the same mistakes.
I understand what it's like being nervous going through orientation. But that does not excuse a nurse from making medication errors. Why didn't she make check the patient's wristband to the MAR before giving meds? I find it inexcusable. I've given meds to the wrong patient once and I was scared silly when I realized what I had done. I was busy and didn't check the MAR to the patient's wristband. I owned up to my mistake, called the doc, and filled out an incident report. But giving meds to the wrong patient three times?? Three times?
Emphasis: many nurses new to an institution or new grads are not anymore sow's ears than anyone else. People quickly forget. You did not become the nurse you are today in a vacuum. I say the pool of nurse "idiots" and "incompetents" is a lot smaller than some want to admit. Look at the the processes--do cause analyses. If these are honest and objective, you will find that the pool of "total nurse incompetents" is more miniscule than is stated here.
Teaching in any form is always a give and take process. And it has to be one of openness and individual acceptance not undue intimidation. The very process of starting new somewhere is quite intimidating.
I understand what it's like being nervous going through orientation. But that does not excuse a nurse from making medication errors. Why didn't she make check the patient's wristband to the MAR before giving meds? I find it inexcusable. I've given meds to the wrong patient once and I was scared silly when I realized what I had done. I was busy and didn't check the MAR to the patient's wristband. I owned up to my mistake, called the doc, and filled out an incident report. But giving meds to the wrong patient three times?? Three times?
Right, and that has to be evaluated on an individual basis. We were not there with this person and his/her experiences. We don't know all sides of it.
Most nurses actually want to be careful practitioners--at least those I've worked with over the last 20 years. And most have what it takes to be just that.
Again, we have to move away from evaluations that are based on "he said, she said." We have to look objectively at cause on ALL SIDES. Let's forget getting mired in battles of who are the idiot nurses and who are not; that's simply a waste of time, not effective, and it's not realistic.
Subjective responses aside, we must look as objectively as possible at all the dynamics.
Again I say most people aren't village idiots. But being new requires a lot of guidance, support, balanced direction, etc. On every step of the orientation, what was documented and what plan of actions was put in place to help remediate, correct, or further evaluate the problem???? See, we don't know all the details, and we will never know all the details.
Same things with so many nurses pushed aside for non-objective reasons. Many don't realize that for a good number of nurses, it really isn't about issues of safety, etc. Today, it really is more about the softskills and knowing how to fit in. Right or wrong, that is the reality. Every nurse and every doc w/ enough experience makes mistakes. We could encourage openness to taking ownership of mistakes if the environment wasn't so cut throat. Sort of what is hoping to be done with reporting medical errors in general nowadays.
Very few nurses are grossly incompetent or are Charles Cullins. We have to look at the system, and stop denying that there is a problem. That's how growth occurs. Just as the newer nurse to the institution (as well as all nurses) should openly admit errors in order to mitigate losses, make corrections, and learn from them, so should hospitals and those involved in orientation and precepting look to correct system and process problems.
Nursing needs to stop playing blame games with individuals and look to overall causes and then treat the causes.
That's what truly successful leaders, organizations, and professions do.
Do you think it's time for a new thread, titled, "Fired for Good Reason"? The past few pages deal with a seemingly hopeless new nurse who needs to repeat her medications /pharmacology and IV courses (or whatever they're called today). Granted there could have been extenuating circumstances, and a heart-heart talk and observation with the clinical advanced practise nurse for the area where she/he worked/is working.
We do need to look at the paper trail, especially in "at will" states, that needs to be completed before it's "bye-bye".
As a reply to the OP, people do have a defensive tendency to externalize errors. It is part of the idea of cognitive dissonance and how people will create external justifications so they don't have to admit of an internal flaw. I don't know if it's maturity, critical thinking, or some other factor that allows some people to look internally and accept responsibility for their mistakes. Hopefully, a professional nurse is able to critically examine everything surrounding an error including the system, available resources, and themselves.
A rose is a rose. If it is not nurtured, and lacks sunlight and water, it will not bloom as splendidly as it could have in a better envirnoment, but it is still a rose.
A weed is a weed. No matter how well it is tended to and nurtured, it will still be a weed.
As a reply to the OP, people do have a defensive tendency to externalize errors. It is part of the idea of cognitive dissonance and how people will create external justifications so they don't have to admit of an internal flaw. I don't know if it's maturity, critical thinking, or some other factor that allows some people to look internally and accept responsibility for their mistakes. Hopefully, a professional nurse is able to critically examine everything surrounding an error including the system, available resources, and themselves.
I hate to tell you this, but by the time you have made to through the rigorous experience that we call nursing school, those at the lower end of the normal curve are already weeded out. The truth is that most errors are process errors, not deliberate human screw-ups. One of the biggest problems in health care is the lack of acknowledgement of this basic fact. It is far easier to place blame than to change a system that is paralyzed by its own inertia. Yes, the person made the mistake, but as another poster pointed out root cause analysis will often show that the cause was something else. True QI in its purest form can be used to fix many of these issues, but the cost of quality is high, and most health care facilities cannot or will not absorb the costs. Instead of looking at problems, they put their emphasis on how they can save money by minimizing staff, discharging patients sooner, etc. Reducing pressures on nurses is just not considered dollar-worthy.
I hate to tell you this, but by the time you have made to through the rigorous experience that we call nursing school, those at the lower end of the normal curve are already weeded out. The truth is that most errors are process errors, not deliberate human screw-ups.
I'll agree that nursing school does weed out many who could not or should not be in nursing. Sad experience has shown that it does not weed out ALL of them though. Read the dangerous nurses thread, it'll be an eye opener. You'll find many examples there. And, it's not that people deliberately screw up. I've only seen one poster even mention such a thing.
Sure, there could be better training systems in place and maybe better training in nursing school. Start a thread or find one that's already out there for that discussion. This thread is about the very small number of people who received a nursing education, passed the NCLEX, were precepted and sometimes repeatedly instructed on items they should have learned in school and they still don't "get it". Then they don't understand why they're let go. I'd be surprised if they did understand it.
People who live in glass houses should not throw stones.
Look, I am sure there are a few wackadoodles out there, like the nurse who left the sick child alone to go out drinking. All I am saying is they must be few and far between because in my 24 years as a nurse and 5 years as an aide before that I never saw any nurse that was that bad. Some were unable to think outside the box, some were uncaring and selfish, but none were incompetent or deserved to be fired.
IMO if you try your best attempting to learn and have a positive attitude it will go a long way. If still problems with a preceptor, ask for a different one if possible, yet if problems with more then one it could be YOUR problem and not anyone elses. With plenty of others waiting for that particular job the manager has to decide how long before this person can be relatively self-sufficient and contribute to the team. If they decide one with more experience/energy/healthier what-ever would help more then you.. that is why people can loose their jobs. Some things we can't help i.e. the health issue..however some we can do a lot about: study, listen, learn.
RN1982
3,362 Posts
I understand what it's like being nervous going through orientation. But that does not excuse a nurse from making medication errors. Why didn't she make check the patient's wristband to the MAR before giving meds? I find it inexcusable. I've given meds to the wrong patient once and I was scared silly when I realized what I had done. I was busy and didn't check the MAR to the patient's wristband. I owned up to my mistake, called the doc, and filled out an incident report. But giving meds to the wrong patient three times?? Three times?