Reasons nurses get fired

Silver_Rik, ASN, RN · May 8, 2019

Radical thought, and something I don’t think I could support myself. Doctors almost never lose their jobs, and especially not for silly bs. Why? A strong lobby (AMA) plus supply and demand. The control point for how many new MD/DO enter practice each year is the number of residency slots. Last I looked that was 28,000 per year, and it rarely increases (I think 5000 slots were added recently, but it was the first increase in decades). This is to provide new doctors in a pool of 900,000 practicing physicians.

By the way those 28,000 slots are filled by 18,000 US allopathic grads, 2,000 US osteopathic grads, and 8,000 foreign med school grads.

We have 2.7 million active RNs working in healthcare. So a ratio of 3 RN to 1 MD/DO but we have 230,000 (and that’s an old number, I bet it’s more now) pass the NCLEX-RN each year.

So it takes 32 years to train enough doctors to replace all current docs (and that’s just to the point of starting residency), but the entire pool of RNs can be replaced in 11 years. Of course the fact that New RN can be turned out in 2-4 years vs 8 before starting residency for most docs is relevant, too.

Counterintuitively, perhaps the answer to the (alleged) nurse shortage is to produce fewer nurses. If nurses were like doctors we’d only have about 85,000 new RN’s each year and employers would have to do more in salary and working conditions to keep them happy and employed long term. (Though to be fair there are plenty of miserable physicians).

The more replaceable you are the worse you’re going to be treated in the workforce relative to other professions. Nurses have a leg up over many jobs. Do I expect anything to be done to limit the supply of new nurses? No, and I’d be a hypocrite to support that; though I think maybe the push for BSNs is motivated in part by it. Would closing low performing nursing schools and putting a cap on the number of new nurses entering the field help improve working conditions in the long run, I think so.

Oldmahubbard · May 8, 2019

Let's not forget, when a new MD shows up for the first day on a job, he is she is presumed to be basically competent. Other MD's automatically respect him or her. Staff follow suit.

It isn't like that in nursing. In fact, you are presumed to be a royal fool until you prove otherwise.

MD's have post-education very extensive paid training programs, and RNs do not.

ruthogden, ASN, BSN, MSN, PhD · May 8, 2019

Silver Rik

I agree with you.. When I first became a nurse in the late 70s, and throughout most of the 80s, there really was a nursing shortage.. Jobs were always available, and advancement easy. Benefits were good. We were treated with respect and the only reason I ever saw a nurse fired was for drug abuse (switching out patient's meds for plain Tylenol and pocketing the narcotics). And I saw a lot of activity that I would have considered actionable toward dismissal. But toward the mid 90s, all that changed and nurses became more plentiful. Benefits started being stripped, and job security went along with that. We became dispensable like a product that is used and replaced by a less expensive model. That is when experienced nurses started being targeted and new grads were hired to replace them in large quantities. They didn't have to offer the new grads the same quality of pay and benefits that they were locked into with the longer term employees. I was a victim of this targeted strategy. I lost my job because I was trying to advocate for a close friend back in 2001 just before HIPPA was widely implemented. Our hospital had recently implemented it. I was sitting with a close friend on my off duty time. She was dying from pelvic cancer and having severe cramps. Though she was on Dilaudid drip, the new grad nurses did not recognize the signs of muscle cramping. So I wanted them to call the doctor and get a muscle relaxant. The new grad showed me on the chart that she was allergic to Flexeril. I explained that there were other muscle relaxants and said that I would call her daughter in if they would not call the doctor. I said that if I called the daughter in, I was sure she would then call the doctor. It was 2AM. Finally they decided to put a catheter in her. Of course that wasn't the problem and they finally did call the doctor at 4AM. HE complained about being called at 4AM but they did start her on valium the next morning relieving her symptoms. In the meantime... I ended up being fired for 1. violating HIPPA (even though the young nurse that showed me, WHILE I WAS A VISITOR, the chart received no reprimand. 2. For creating a HOSTILE work environment because I THREATENED to call the daughter in! I live in a right to work state with at will employment, so after 17 years with the hospital and 27 years as a nurse, as well as having recently being named EMPLOYEE OF THE MONTH, I was the first to go. My pay was above their current top pay scale and I am pretty sure that is why I was targeted. I had never been written up for anything related to my job and had only stellar annual reviews. I was able to talk them into letting me resign to preserve my retirement since they were letting me go for something that had nothing to do with my personal employment.

I was more fortunate than those that followed after. After my departure and over the next 2-3 years, many of my co-workers, nursing and otherwise were dismissed as they approached retirement, therefore losing their retirement. Because part of the retirement plan was that if you were fired, you lost it. If you quit, you could keep it.

I continued working as a nurse for another 10 years, but never regained my love of nursing. I was jaded. I went on disability at age 54, and though I miss the income, I am so thankful NOT to be a part of that culture anymore.

So to the young nurses, I say don't count on being where you are long term unless you are fortunate enough to live in a state with a union. And to the seasoned nurses out there, watch your back and if you see trouble in your path, resign before they can get you. NURSES BEWARE.

Nickc58 · May 8, 2019

16 hours ago, Ruby Vee said:
Things I've seen people get fired for:
Kicking in the screen of the Pyxis because it was being recalcitrant about dispensing narcotics.
Bring a handgun to work and then leaving work early to stand on a the entrance ramp to the freeway, pretending to take pot shots and employees leaving work.
Not taking any vital signs all night long (ICU) and in the morning, just "clicking down" hourly vital signs from the charting system, signing them, and not mentioning (or, in all likelihood, noting) blood pressures in the 70s systolic.
Having sex with a married colleague on an exam table on the transplant floor. (The female half of this pair.)
Things I've seen that people DIDN't get fired for:
Having sex with a married colleague on an exam table on the transplant floor. (The male.)
Getting pulled over for a DUI on your way home from work and going to jail because it was your fifth. Charge nurse needed to call the jail an hour before each scheduled shift so employee could be processed out on work release, and call either employees wife or girlfriend to bring him to work.
Having sex with the wife of a patient prior to getting pulled over for that DUI on the way home from work.
Aborting yourself with a coat hanger in the employee bathroom during your lunch break, and then leaving work without saying anything to anyone because you were bleeding heavily. Charge nurse followed the blood trail to the ER. All documented sixty ways for Sunday. Manager wanted to give her "another chance."
Turning the morphine drip up on a comatose patient because "the family is tired and wants it over with."
Calling in sick from a bar thirty minutes after your shift started. Documented up the ying/yang. Employee got away with it 4 times in two weeks. Then the manager's boss happened to wander by and answer the phone . . . employee terminated the next day.
Getting arrested for shooting at your wife . . . even though the state revokes licenses for DV. Don't know if he's still employed there or not, but he's had a few more DV arrests.
Raping your wife and going to jail . . . manager wanted to give him another chance. Different manager.

If you weren’t such a reputable poster I would call BS on half of those reasons in the DIDNT column. That’s just so unreal ?

Silver_Rik, ASN, RN · May 8, 2019

I would just say that today federal law (ERISA) protects employees’ retirement program. They can’t take your contribution to a 401 or 403 and once you’re vested (max 7 years) employer contributions are yours by law and can’t be taken even if fired. You can lose invested employer contributions.

Related - I’ve heard of nurses losing their employer contribution because they moved from one hospital to another in the same system. It seems that shouldn’t be legal.

Ruby Vee, BSN · May 8, 2019

4 hours ago, Nickc58 said:
If you weren’t such a reputable poster I would call BS on half of those reasons in the DIDNT column. That’s just so unreal ?

All true. Employee in jail for rape got FMLA for "mental health issues." Or so I was told. (Don't want to believe it, but it's probably true.). Employee in jail for DUI worked 72 or more hours a week during his sentence.

3ringnursing, BSN · May 8, 2019

Excessive pranks. I knew a really nice, funny guy who was an RN on the cardiac floor of a small, sinking hospital I worked at about 20 years ago - he was always doing outrageous things just for a laugh. One day he came down stairs to the ICU and told a couple of us to pay attention in about a half hour.

We had a paging operator at this hospital that had honest to God voice training lessons for the time of old Hollywood movies and it sounded like you were transported back in time the 1940's Hollywood. Suddenly her voice came over the hospital wide paging system to page Dr. Jack Mehoff. Oh boy.

The investigation was quick and punishment swift. As if they couldn't tell which extension the call came from.

On a side note a neurosurgeon who was at the ICU writing orders turned around grinning, claiming it was an old airport prank.

Poor guy just didn't know when to stop.

Alex_RN, BSN · May 8, 2019

We lost a ton of nurses who had many years of experience but no BSNs because of a policy change as the result of a change of corporate ownership. They were not fired but over the course of several months they left for other jobs. Now the average number of years experience is significantly lower overall. I imagine this saved the company a lot of money in payroll.

Long Term Care Columnist / Guide · May 9, 2019

Whatever you do, don't have a mental breakdown and take three weeks medical LOA. The Americans with Disabilities Act doesn't protect you like you'd think it would. You can file a lawsuit through the Equal Employment Opportunity Commission within 180 days of termination if they'll take your case, but I was so beaten down by the time I was fired that I had no fight left in me. My doctor and I tried to get reasonable accommodations but my company refused outright. I didn't know that they could do that. I found out real quick that they could. The EEOC might have helped me, but I certainly didn't want the job back and any damages probably wouldn't have been worth the hassle. I just learned from it and moved on.

inthecosmos, BSN, MSN, RN, APRN · May 9, 2019

I've read through most of these posts, which have done an excellent job at detailing why folks are fired.

I just hate that you reported yourself for an error and suddenly you're fired for it. Taking accountability should be revered. Alas, it may be best for you to move forward.

Zippy83 · May 9, 2019

6 hours ago, 3ringnursing said:
Excessive pranks. I knew a really nice, funny guy who was an RN on the cardiac floor of a small, sinking hospital I worked at about 20 years ago - he was always doing outrageous things just for a laugh. One day he came down stairs to the ICU and told a couple of us to pay attention in about a half hour.
We had a paging operator at this hospital that had honest to God voice training lessons for the time of old Hollywood movies and it sounded like you were transported back in time the 1940's Hollywood. Suddenly her voice came over the hospital wide paging system to page Dr. Jack Mehoff. Oh boy.
The investigation was quick and punishment swift. As if they couldn't tell which extension the call came from.
On a side note a neurosurgeon who was at the ICU writing orders turned around grinning, claiming it was an old airport prank.
Poor guy just didn't know when to stop.

This sounds like one of my instructors from nursing school. He was funny and always telling stories of his hijinks as a floor nurse.

3ringnursing, BSN · May 9, 2019

8 minutes ago, Zippy83 said:
This sounds like one of my instructors from nursing school. He was funny and always telling stories of his hijinks as a floor nurse.

It WAS pretty funny. As I tend to be rather childish in my humor too I made a mental note of what constitutes a toe nearing the line, and actually running past the line. He was a really nice guy and a great nurse though.