I really need some advice here as I'm in new territory! I was just fired from the ICU after 5 months and it has really devastated me! I went from a tele/observation unit to a cardiac ICU at a different hospital. I fully admit that it was a big jump from what I was used to but I realty felt that I could do it. I had a pretty rough orientation in that I had very high acuity patients right off the bat. My 2nd or 3rd week in I was dealing with a very sick patient that needed CRRT. Before transferring to the unit, I didn't even know what that was. My preceptor said I wasn't ready for it yet but she then changed her mind and had me run it. It was awful and I had tears in my eyes all night plus a headache. I then realized that maybe I had gotten in over my head but then I thought no, I can do this. As I was meeting with my manager and clinician for the first time they expressed concern to me that I was missing alarms and I had missed titrating an insulin drip and got a written warning for it, not even a verbal at first. That was the first I heard of any of this as my preceptor never came to me and talked to me about it and said hey you really need to work on this or that and see if I improved she just went straight to our manager. And after that meeting I was hyperaware of alarms and was telling the other nurses on the unit about their patients! I also didn't miss a beat with titrating insulin but noticed that a seasoned nurse was only getting 2 hr blood sugars after I got report from her and it was suppressed to be every hour....I should have told my manager but didn't. I know better now, record everything and report everything! I also had an incident after orientation on a post-op patient that was to be receiving fluids but I didn't see the order as the computer system was still new to me. Another where pts sats I was told were low and that I needed prompted to check the patient which was not true. The sats for the pt were 88 and above which was acceptable for her and I noticed at the same time the other nurse noticed when she did actually drop and I went right over to the pt. The pts PaO2 in the morning was 50, I know not good! I was told the pt had altered mental status but she was not like that for me, she answered all questions and was sleeping for at least 4 hours thru the night. I'm really not sure how that happened?
These were the main reasons I was let go. They didn't feel it was a good fit yet also said I was good with the patients and their families and that I was a good nurse and person but I wasn't offered to transfer to a med/surg floor? I took a bonus so this really screws me over not to mention now I have to put on my applications that I was fired and give reasons why to who I interview with! This is awful and I'm completely embarassed and devastated. I keep running everything through my head over and over!
Actually, an employer can, and will say anything that they wish, as long as it's true and provable. Example-you've interviewed for a new job and they are calling for a reference. They can say, HansRN had an attendance issue. There were 10 days missed in a 180 day period. As long as they can prove that you missed, no issue. They cannot say that you have a drinking problem or suspect drug issue or threatened violence against coworkers if there is no documentation to support the comments. I do some calls in my area, as I've developed many relationships over the years, and can get the "unofficial skinny" on prospective employees. In truth, many do this, whether they admit it or not. Also, nursing is a small world, so make sure that you keep a positive attitude and build the absolute best reputation you can.
I was in precisely the same situation as the OP twice. Both times, they spent significant amount of time and effort to build paper trails and documented things according to which I should not be let around other people in McDonald's. There were multiple citations for "concern for patient's wellbeing", "lack of safety", "weak communication skills", threats to report to Boards, of course, etc., etc. - except for one thing: all of it was sucked out of the thin air. There was no documentation of more or less serious mistakes, no attendance issues, no physicians complains - both places were just dirty rasist, cliquish units with atmosphere and moral of a cross between ghetto middle school and gestapo.
I was working in one of those units few months after termination as agency RN PRN for a while (and then was fully accredited in the system as NP) and in another as an NP provider despite of existence of negative personal records and known "do not hire" status, in addition to my, well, kind of unusual way to do things.
HR people can tell only what is supported by evidence. Even for threatening behavior or drug use right at the workplace there must be massive supporting documentation from more than one source. A piece of paper on which it is written "HansRN misses calls, teaches other nurses how to do their jobs and doesn't care about his patients" is evidencing only one fact: that someone has negative personal opinion about HansRN. This piece of paper cannot be used as evidence against HansRN but it can be turned against whoever wrote it, should HansRN pursue legal action. There were multiple precedents of people doing just that and winning in pretty much every professional area including nursing. So, if it is just about classic "poor fit for the unit", deserved or not, HR will keep silent except for, maybe, very personal communications between people who know each other for years - but such connections are not that common even in nursing.
In fact, constant mentioning that "everything that you do as a nurse is legal", can be used against you and kill your license and so forth has little to do with reality. HR people stand whole way closer to the "legal" part of healthcare and for this reason they are trained to be extra cautious.
BTW, nursing is a truly small world and bad reputations of managers, units and hospitals are well known too. It doesn't pay well at all on the long run to have someone who will tell other nurses to avoid your job openings - and giving bad recommendations will achieve just that.
BTW, nursing is a truly small world and bad reputations of managers, units and hospitals are well known too. It doesn't pay well at all on the long run to have someone who will tell other nurses to avoid your job openings - and giving bad recommendations will achieve just that.
I did say that everything that is told by HR must be factual with evidence. Most good managers and HR depts are smart enough to winnow out the information. And many only offer hire dates to avoid having to deal with what could become an issue with legal ramifications
Also, who said that every "behind the scenes" reference is bad? 95% or more that I've given, and gotten, are good.
The one that stands out is a nurse who was working in LTC and did well in the interview-I was the manager of a small rural hospital ICU. I didn't know the DoN where she currently was, but did know the DoN at facility prior. Prior facility DoN told me that narcotics frequently disappeared when she worked (she as a PRN). She was given the choice to test or quit, she quit. HR didn't mention this incident either on check. I decided to pass on hiring her. 1 week later, she was found deceased in a resident bathroom with the needle still in her arm in her current facility. Her coworkers at that place said that they thought something was up with her-this was quoted in the newspaper! Should employer #1 gotten her help? Yes, but that was in the past. Should employer #2 followed up if coworkers truly thought something was up? Yes, but that wasn't my place to call out either. Am I glad that I didn't inherit that problem? Another yes. This was in 2006, and still sticks with me. And why sometimes I reach out, even if someone seems perfect.
I did say that everything that is told by HR must be factual with evidence. Most good managers and HR depts are smart enough to winnow out the information. And many only offer hire dates to avoid having to deal with what could become an issue with legal ramifications
Also, who said that every "behind the scenes" reference is bad? 95% or more that I've given, and gotten, are good.
The one that stands out is a nurse who was working in LTC and did well in the interview-I was the manager of a small rural hospital ICU. I didn't know the DoN where she currently was, but did know the DoN at facility prior. Prior facility DoN told me that narcotics frequently disappeared when she worked (she as a PRN). She was given the choice to test or quit, she quit. HR didn't mention this incident either on check. I decided to pass on hiring her. 1 week later, she was found deceased in a resident bathroom with the needle still in her arm in her current facility. Her coworkers at that place said that they thought something was up with her-this was quoted in the newspaper! Should employer #1 gotten her help? Yes, but that was in the past. Should employer #2 followed up if coworkers truly thought something was up? Yes, but that wasn't my place to call out either. Am I glad that I didn't inherit that problem? Another yes. This was in 2006, and still sticks with me. And why sometimes I reach out, even if someone seems perfect.
And what could happen if that RN would not be an abuser? "Narcotics disappearing" is not an evidence by itself, and most people in sane mind would leave immediately after being presented with the choice to test or quit, guilty or not.
If your friend DON had something to eye out, it was her responsibility to obtain evidence and report the case as appropriate instead of "sharing" between her best friends only. The nurse in question could be hired by some other, more distant facility with whom your friend DON wouldn't "share" her suspicions and continue to endanger patients there if she wouldn't overdose. Or your friend DON could defame an innocent person and likely ruin her career for life just out of "concerns" and "suspicions". How either of both could come anywhere close to "professional behavior"? What happened with presumption of innocence?
You can never know for sure who is really calling you. There are companies which impersonate interested employers and make calls on behalf of some travel company or SNF with the purpose to know what DON or HR will say about a person. Should that happen, it would be defamation charge against company and the person who answered the call served on silver plate.
Nursing administration is just too lucky that nurses en masse are fantastically illiterate about their legal rights as employees and citizens.
I was terminated under pretty much the same circumstances because someone once said that my accent presents "important safety and security issue".
WOW!! I thought my situation was bad but that's some pretty blatant discrimination. Did you talk to HR about this?
I'm from the south and once they heard my accent, they told me I wouldn't be able to keep up with a "Boston pace" because us southerners are slow, apparently. Oh, and they'd turn me into a "Boston nurse" (read: a "superior" nurse). Don't even get me started on how my southern education was inferior too somehow.
OP, you have my sympathy. I saw you mentioned missing an order for fluids though. Out of curiosity, what charting system were you using?
So.....ED nurse here, not an ICU nurse (unless you count ICU nurse holds). First, I always thought that CRRT was a skill pretty far into your job - like a year or two. Either way, that is a very advanced skill and one that your preceptor should have been at your side for every step of the way. Second, it sounds like there are a lot of things odd about your unit and a generally unsupportive team. I have been there done that - also been with great teams as well!
Can you go back to your tele floor? Don’t give up on ICU if that is ultimately what you want to do. I would recommend shadowing next time or finding an ICU recommended by your peers where you know it will be a supportive environment.
And what could happen if that RN would not be an abuser? "Narcotics disappearing" is not an evidence by itself, and most people in sane mind would leave immediately after being presented with the choice to test or quit, guilty or not.
If your friend DON had something to eye out, it was her responsibility to obtain evidence and report the case as appropriate instead of "sharing" between her best friends only. The nurse in question could be hired by some other, more distant facility with whom your friend DON wouldn't "share" her suspicions and continue to endanger patients there if she wouldn't overdose. Or your friend DON could defame an innocent person and likely ruin her career for life just out of "concerns" and "suspicions". How either of both could come anywhere close to "professional behavior"? What happened with presumption of innocence?
You can never know for sure who is really calling you. There are companies which impersonate interested employers and make calls on behalf of some travel company or SNF with the purpose to know what DON or HR will say about a person. Should that happen, it would be defamation charge against company and the person who answered the call served on silver plate.
Nursing administration is just too lucky that nurses en masse are fantastically illiterate about their legal rights as employees and citizens.
I agree that she should have turned her in to state, as any abuser should be. But I wasn't the supervisor for that facility. She quit after refusing testing, no one fired her. So while I had no proof that she was a substance abuser, she refused testing, so something was fishy. And the DoN, who isn't a friend or best friend, as you put it, but a colleague, only told me the facts.
OP,you have my sympathy. I saw you mentionedmissing an order for fluids though. Out of curiosity, what charting system were you using?
They used Cerner and I came from a hospital that used Epic. So that was a big change too.
So.....ED nurse here, not an ICU nurse (unless you count ICU nurse holds). First, I always thought that CRRT was a skill pretty far into your job - like a year or two. Either way, that is a very advanced skill and one that your preceptor should have been at your side for every step of the way. Second, it sounds like there are a lot of things odd about your unit and a generally unsupportive team. I have been there done that - also been with great teams as well!
Can you go back to your tele floor? Don’t give up on ICU if that is ultimately what you want to do. I would recommend shadowing next time or finding an ICU recommended by your peers where you know it will be a supportive environment.
My preceptor was watching me do everything for CRRT, then if I'd do something wrong she'd tell me and show me the right way. It wasn't really guidance, it was more like, "here figure this out and if you can't do it I'll step in." Not the best way for someone to learn, especially with someone so critically ill. Thinking back I probably should have asked for a different preceptor.
I possibly can go back to my old job. My old boss did say that she would be glad to have me back if things didn't work out. But with COVID I don't believe they're hiring right now. I will be calling her though. And I think I'll take some time before I decide to go into an ICU again. It's made me question wether it's really what I want.
I agree that she should have turned her in to state, as any abuser should be. But I wasn't the supervisor for that facility. She quit after refusing testing, no one fired her. So while I had no proof that she was a substance abuser, she refused testing, so something was fishy. And the DoN, who isn't a friend or best friend, as you put it, but a colleague, only told me the facts.
Hoosier_RN,
if an employee is given a choice to test for narks or resign immediately, it clearly means that he got a target on the back. If only one person and not a whole shift asked to test, some other explanation can hardly be expected. Even if result is negative, he will be under microscope. A reasonable person very much might want to just resign, guilty or not.
And if he is not guilty and after this he somehow finds out that he was denied jobs because his former boss telling about "suspicions", it is named "slander" with all four elements. Whoever does it can, and very likely be, sued in person for all incurred damages and then quite a bit. This is after the fact that doing it behind someone's back is not quite professional, even if it is done "just out of concerns for my patients".
This is why so many industries moved to "no references" policies a decade ago. Medicine and nursing in particular are way behind of everybody else in this sense, as usual.
You may count yourself lucky that the story ended the way it did. For one of my former NMs the very similar story (except she was "just sharing" her "concerns" about my legal status) ended up as being grilled alive in Boards.
All the things you mention are concerning. And the fact that after you were told about not answering alarms and beeps you started reminding other nurses, did not bode well for you. As a newbie, you focus on yourself.
I must not understand how your insulin gtts work. Do you not set your VTBI for the amount the computer tells you to? Like if the rate was 7.3 for one hours would you not set your VTBI for 7.3 so you would know when the next check was due? How does one check every 2 hours?
And what do you mean the sats for this woman we’re normal in the 80s? Did you have an order stating to keep O2>88%? What did your orders say?
When something is brought up to you that you are doing wrong, it is not your job to keep tabs on others. Fix what you are missing. My concern here is that you really aren’t taking responsibility because others are doing it.
ICU needs new people who are open and willing to learn and to accept their mistakes and work to fix it.
I was very willing to learn and fix my mistakes in fact at the end of orientation they said, thank you for "brining it" meaning, thank you for giving us your best.
As for the alarms, I was only telling the other nurse if their alarm was going off not taking care of their patient.
For the insulin gtts there was protocol for however high or low the blood sugar was. For example if blood sugar was 350 increase gtt by 1cc and recheck in BS in 1 hour. If the BS was only 140, make no changes to gtt and recheck BS in 2 hours.
And yes the sats for that put were normal at 88 and above for her med history.
And I'm not sure what you mean that I'm not taking responsibility because others are doing it? What are you referring to others doing? If its about the alarms, They expressed to me concern for alarms and I then took responsibility to make sure I was catching the alarms and questioning them.
I was very willing to learn and fix my mistakes in fact at the end of orientation they said, thank you for "brining it" meaning, thank you for giving us your best.
As for the alarms, I was only telling the other nurse if their alarm was going off not taking care of their patient.
For the insulin gtts there was protocol for however high or low the blood sugar was. For example if blood sugar was 350 increase gtt by 1cc and recheck in BS in 1 hour. If the BS was only 140, make no changes to gtt and recheck BS in 2 hours.
And yes the sats for that put were normal at 88 and above for her med history.
And I'm not sure what you mean that I'm not taking responsibility because others are doing it? What are you referring to others doing? If its about the alarms, They expressed to me concern for alarms and I then took responsibility to make sure I was catching the alarms and questioning them.
That’s an odd way to do an insulin gtt. So, are you saying the night shift nurse had all her blood sugars greater than 350 and was still checking every two hours?
And my point about the sat was, what was your order? No what they had been in the past, what was your order for? Was the order to keep it greater than 90, 92%? Yesterday, one patient had an order to keep greater than 90, the other greater than 94. You have to know and understand your orders. Nursing is not about what the previous shift did, it’s about what the patient is doing now with what your orders are.
My preceptor was watching me do everything for CRRT, then if I'd do something wrong she'd tell me and show me the right way. It wasn't really guidance, it was more like, "here figure this out and if you can't do it I'll step in." Not the best way for someone to learn, especially with someone so critically ill. Thinking back I probably should have asked for a different preceptor.
I possibly can go back to my old job. My old boss did say that she would be glad to have me back if things didn't work out. But with COVID I don't believe they're hiring right now. I will be calling her though. And I think I'll take some time before I decide to go into an ICU again. It's made me question wether it's really what I want.
It is not defeat or going backwards to go back to your old unit. If you were comfortable there and supported, then go for it! I do know COVID is definitely tying up job transfers for now but it won’t last forever. Honestly, sometimes a new job just doesn’t work out and it makes you realize that the grass isn’t always greener. I wish you the best in whatever you choose to do.
KatieMI, BSN, MSN, RN
1 Article; 2,675 Posts
I was in precisely the same situation as the OP twice. Both times, they spent significant amount of time and effort to build paper trails and documented things according to which I should not be let around other people in McDonald's. There were multiple citations for "concern for patient's wellbeing", "lack of safety", "weak communication skills", threats to report to Boards, of course, etc., etc. - except for one thing: all of it was sucked out of the thin air. There was no documentation of more or less serious mistakes, no attendance issues, no physicians complains - both places were just dirty rasist, cliquish units with atmosphere and moral of a cross between ghetto middle school and gestapo.
I was working in one of those units few months after termination as agency RN PRN for a while (and then was fully accredited in the system as NP) and in another as an NP provider despite of existence of negative personal records and known "do not hire" status, in addition to my, well, kind of unusual way to do things.
HR people can tell only what is supported by evidence. Even for threatening behavior or drug use right at the workplace there must be massive supporting documentation from more than one source. A piece of paper on which it is written "HansRN misses calls, teaches other nurses how to do their jobs and doesn't care about his patients" is evidencing only one fact: that someone has negative personal opinion about HansRN. This piece of paper cannot be used as evidence against HansRN but it can be turned against whoever wrote it, should HansRN pursue legal action. There were multiple precedents of people doing just that and winning in pretty much every professional area including nursing. So, if it is just about classic "poor fit for the unit", deserved or not, HR will keep silent except for, maybe, very personal communications between people who know each other for years - but such connections are not that common even in nursing.
In fact, constant mentioning that "everything that you do as a nurse is legal", can be used against you and kill your license and so forth has little to do with reality. HR people stand whole way closer to the "legal" part of healthcare and for this reason they are trained to be extra cautious.
BTW, nursing is a truly small world and bad reputations of managers, units and hospitals are well known too. It doesn't pay well at all on the long run to have someone who will tell other nurses to avoid your job openings - and giving bad recommendations will achieve just that.