"Fired for NO Reason"

[Ruby Vee]

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.

[llg, PhD, RN]

Exactly, and God knows there are plenty of posts about how awful us old battleaxe jealous nurses who eat their young are. We should be able have a thread of the opposite nature from time to time:bugeyes:. :)

Definitely. Some people are WAY too quick to jump to the "nurses eat their young" assumption every time a new nurse receives some critique. Yes, sometimes preceptors and educators need to be more compassionate. But it's also true that the newer members of our profession have a lot to learn and need to recognize that they are going to make mistakes. They need to acknowledge their mistakes and weaknesses to learn from them. Not everyone who gives them negative feedback is wrong or being mean: many are simply trying to help them learn.

[netglow, ASN, RN]

"This very same thing happened to me when I was a new ICU nurse. Guy was really a PIA all night, I got this in report. THen 30 minutes later the guy died of a massive heart attack. That same night when that SAME nurse came back in for night shift, we told her what happened and she felt bad for not seeing it as a symptom. Yeah, the guy felt really bad ALLL NIGHT because he was dying and the nurse didn't even pick up on it." -Easttexas

Thanks for the support. Sometimes students run into a clinical semester where there are too many bad RNs all on your floor... you start to try to talk to ones you see that you might learn from... or try to talk to docs, etc. just to try to make up for lost clinical time. Its hard!!! My earlier reference to my last clinical where I reported S/S was on a pt. that was not my focus, but since she was such a "PIA" I ran to help often that day. The pt. did have a situation I later overheard. This is the first clinical floor I've had that really worries me... I need to be learning the heavy stuff, and I hope things improve.

[Freedom42]

New grad here. Thank you, Ruby, for your post. I'll keep it in mind as I start my first job.

Everyone has a unique interpretation of Ruby's post. Here's mine: I don't think it's about new grad versus veteran, young versus old, or even about nursing. It's about Sal's lack of insight.

Sal will have the same problem wherever she goes, whether she's an accountant or a nurse or a teacher. She'll always have this problem in her relationships, too. It will always be someone else's fault. Until she takes responsibility for her behavior and her actions, until she sees that she is not the center of the universe, until she sees that she is a bit player on the world stage, she'll always believe that everyone else is the problem. Haven't we all worked with Sal somewhere? As one poster noted, you've got to open your mind to learn.

Now, if you don't mind, I've had my license for seven hours. I've got to go celebrate.

[traumaRUs, MSN, APRN]

Great thread! As a veteran nurse and advanced practice nurse, I now have a unique outlook: I am a nurse but I'm not a staff nurse so I can literally see much of what goes on: most new nurses do want to succeed and they work hard at doing so. Some have an easier time than others. Some would be successful in any field while others bring issues (irresponsibility, inability to prioritize, etc)., that would hurt them in any career field.

[tencat]

I have seen a lot of relatively new nurses who cannot critically think their way out of a paper sack. It is scary. In an area such as ICU a nurse HAS to be able to think critically, not just follow orders. It sounds like Sal truly doesn't get it and needs to be on a less critical unit where she can follow orders and doesn't have to do as much critical thinking quickly.

[talaxandra]

As someone who's worked with a few nurses like Sal, your post really resonates, Ruby. Sometimes there are surmountable problems, like a poor fit between preceptor and preceptee. And sometimes it doesn't matter how many (or how good) the preceptors, how supportive the environment, how thorough the educating, the nurse just doesn't get it.

For example - a stable patient is elective admitted to begin a new drug with a known propensity to cause hypotension. She's closely monitored after the drug is commenced, and has a systolic drop of 15mmHg, to 85 at 12:25. The afternoon nurse, with eight months of experience, and who believes she's ready for ICU and is insufficiently challenged on our (six specialty) ward, doesn't check her BP for the entire PM shift and gives an antihypertensive at 20:00. When the night RN checks her BP it's 65/40. That's the difference between critical thinking and task-oriented nursing, and not a particularly subtle case, either.

[eriksoln, BSN, RN]

As someone who's worked with a few nurses like Sal, your post really resonates, Ruby. Sometimes there are surmountable problems, like a poor fit between preceptor and preceptee. And sometimes it doesn't matter how many (or how good) the preceptors, how supportive the environment, how thorough the educating, the nurse just doesn't get it.

For example - a stable patient is elective admitted to begin a new drug with a known propensity to cause hypotension. She's closely monitored after the drug is commenced, and has a systolic drop of 15mmHg, to 85 at 12:25. The afternoon nurse, with eight months of experience, and who believes she's ready for ICU and is insufficiently challenged on our (six specialty) ward, doesn't check her BP for the entire PM shift and gives an antihypertensive at 20:00. When the night RN checks her BP it's 65/40. That's the difference between critical thinking and task-oriented nursing, and not a particularly subtle case, either.

You know, I have to admit something here. I never really understood what the heck people were talking about when they talk about "critical thinking".

Here is my problem. I read your story and think to myself, even a task oriented person wouldnt have done that. See, I think I am task oriented. And when I see the mistake the nurse you talked about made..........first thing that comes to my mind is........"Lazy nurse, didnt check the BP before giving an anti-HTN med", which, is a task, that she skipped. I'm task oriented, and I check BPs before giving anti-HTN meds and psych. meds. In my mind, a "task oriented" person would never make that mistake.

I just for the life of me cant wrap my mind around what the heck people are talking about with this "critical thinking" stuff. I told a close friend who was a nurse that started same time as me this once. She told me "nonsense, you do it, I dont think you have a major flaw there". Pointed out a couple things that we do that is considered "critical thinking" and my reaction truly was...............thats just doing your job. I didnt get it.

Only time I kind of started to get it was when I had a pt. on a heparin drip once. Her PTT came back low, I followed the protocol and gave the predetermined bolus, increased the rate and ordered the next PTT for 6 hours later like the policy said. Nothing fancy there. Well, the PTT came back LOWER. I sat at the computer amazed. I had checked the settings with another RN, it was right, I knew that. I gave the bolus, increased the rate. No way in heck the PTT goes down. Then it hit me. I called IV therapy before I even went to the room, told them I needed an IV restart. When I went in the room, my suspisions were verified...........IV was infiltrated. It was the only ratioal explination. Told the friend I mentioned before about this and she said it was critical thinking.

OK, but I dont call that critical thinking. Thats more............IDK, the process of elimination. Critical Thinking is such a buzz word to us nurses and I so dont get it.

[SuesquatchRN, BSN, RN]

Critical Thinking is such a buzz word to us nurses and I so dont get it.

Replace it with "common sense."

[truern]

I understand what you mean, but why the reference about new grads thinking they are singled out b/c they are so beautiful, or extremely good looking? Do you know for a fact that is what they thought? If not, then you dont get it either.

You should read here a bit more...that has been posted.

[talaxandra]

If you're task oriented you focus on the jobs that need to be done (do the obs, give the meds, wash the patient) but don't think about why these need to be done.

So, for example, I'll sometimes find stable stroke patients having neuro obs a week after admission (GCS unchanged since presentation), because nobody thought about why this patient needed neuro obs and if that's still necessary. Or a patient has been on BD obs so the non-critical thinking nurse doesn't (or doesn't consistently) put together a change in condition with increased monitoring.

Obviously this is a fairly basic example, and for the most part most of us employ at least some critical thinking in our day-to-day practice, and as our knowledge, expereince and awareness of all the factors that interact with our patient's condition increases, we think more intelligently about what needs to be checked, changed and followed up. As you say, erik, it doesn't seem extraordinatry. If you're doing it.

For those nurses who don't seem to be able to think critically, the concept is invisible. It's not a process of elimination, perhaps because the connections between BP and meds (or reasons why an APPT might have dropped) aren't there.

[llg, PhD, RN]

A lot of people use the expression "critical thinking" to mean any mental process. that makes it hard to pin down as a concept.

Nurses need to be able to assess a situation -- to put a bunch of observable facts together and understand how they all fit together -- identify problems -- and then go through a process of sound reasoning to develop a plan. Unfortunately, not everyone has those intellectual skills. Some people see a lab value and all they see is a number: they can't see a relationship between that number and the other facts of the situation. Some people may see a problem, but can't figure out what might be causing it ... or can't think through the possible interventions and choose a reasonable one. They only see the concrete thing in front of them and can only see it in isolation. Those people really don't have what it takes to be a nurse -- unless they can improve those skills.

[talaxandra]

wow - that was so much better expressed than my attempt at an explanation!