Shocked...Confused...& Terminated=SAD "(

Nurses General Nursing

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i would like to start off by stating that i have never been terminated from any job position i have ever held...until today. i have always had a great reputation at work and never had any issues at any of my jobs...including this specific job. i am going to be very brief and vague in my description in order to avoid possibly giving to much information. with that said...i am just going to briefly give a description of my actions which apparently led to this termination in order to hopefully recieve feedback and some direction. here goes...

today only 30 minutes into my shift at the immediate/urgent care facility i work at part time i was interrupted in the middle of carrying out an order by the physician which was to apply a wet to dry dressing on a patient. i didn't even start applying the dressing yet when the medical assistant barged into the room screaming for me to hurry up and follow her. i asked my patient if she would be okay in waiting here and had her sit completely back on the exam table before leaving. as i followed the ma out of the room i ushered for another ma who was standing in the hallway looking at me to stay with the patient and make sure she was okay until i returned. as i followed the ma down the hall i began asking her to tell me what was wrong. all she kept repeating though was "i have no idea what happened i left her alone for only 5 minutes." when i entered the room the patient was slumped in her chair with one other ma and a receptionist propping her up. she obviously had a vasovagal response to something. i immediately had the ma's assist me in laying her down flat on the floor as i elevated her feet and pulled an ice pack from the drawer to place behind her neck/head. i told the receptionist to go and get the np or md and she stated the np was at lunch and the dr. was doing an exam. i reassured her that it would be okay to politely nock on the door and let him know what was happening. she hesitated before departing. i than grabbed an ammonia tab and had an ma begin waving it under the patients nose in order to try and awake her. i than did a rapid assessment. the patients airway was patent with no signs of obstruction. breathing was normal and even with no shallow or labored breaths. patient was perl. her bp and pulse were low. there were no physical signs of trauma or of a potential allergic reaction. the dr. entered the room, assessed the patient, asked me what happened, and than had me start an iv. he had an ma retrieve the atropine and than gave me the order to administer the medication. i asked if he meant im but he was clear that it was through the iv. i politely refused as this was not in my scope of practice. he looked at me as if i had spit in his face. i tried to explain myself but he rebuked me and asked me to leave the room. i went back to my patient completed my order and continued with my work. i was called into his office 45 minutes later and was informed that i was being terminated for insubordination with a possibility of neglect. there was a huge debate that followed but i will not get into that. it ended with the office manager and the np stating to me once the dr. left the room that they were sorry and that i did nothing wrong. they even said that i can use them as a reference and they would both call around to other urgent care's who had an opening.

i have been there 1 1/2 years. never have i been written up or anything. i am so sad. i have no idea what i did wrong. on a good note; i already was offered a job at a small private urgent care by a pa who partially owns the clinic. in addition i also currently work for my local hospital part time. he was contacted by the np at this job.

i want to know if i should have done something different in these circumstances in order to have avoided this outcome. i admit i am not the most experienced in dealing with situations like this so i know my former coworker who is an rn probably would have been more helpful...but i did what i could... any feedback would be appreciate.

respectfully,

nrselucky

Why didn't Dr. ******** push the atropine?

Specializes in Clinical Research, Outpt Women's Health.

Out of curiosity may I ask how low the heart rate was and what the outcome was. I mean there is a BIG difference between a pulse over 45 and under........

Nevertheless he should have given the med that was out of your scope or had the NP do it (if it was even needed). My experience has been most people with syncopal episodes do not need Atropine esp. young and healthy ones.

Sounds like you were set up for failure. I can't understand why an LPN with a limited scope is practicing in an urgent care setting. Everyone should be ACLS prepared.. you never know what is going to come through that door.

Specializes in Critical Care, Education.

It is very uplifting to see such a quick outpouring of support from colleagues for the OP.

However, referring back to the original scenario - in TX, a physician can direct ANYONE to do just about anything in an emergency situation if she is directly supervising their performance of the task. Our LVNs are permitted to administer IV meds if they have been trained and had competency validated. So, maybe the 'rules' vary by state?

Specializes in Hospice, ER.

Be glad you got out of there with your license intact and no lawsuit on your tail. Because if that had gone badly wrong and you had given the atropine you would be under the bus right now. Any doctor who treats you like that certainly isn't going to have your back. I work with a nurse who is also a Legal Nurse Consultant and the stories about lawsuits she tells me makes the blood run cold. You did the right thing. I actually think this makes you a better candidate for jobs because it shows that you think for yourself and know your scope of practice and have the patient's best interest at heart. This doctor scares me.

Specializes in Nurse Leader specializing in Labor & Delivery.
Be glad you got out of there with your license intact and no lawsuit on your tail. Because if that had gone badly wrong and you had given the atropine you would be under the bus right now. Any doctor who treats you like that certainly isn't going to have your back. I work with a nurse who is also a Legal Nurse Consultant and the stories about lawsuits she tells me makes the blood run cold. You did the right thing. I actually think this makes you a better candidate for jobs because it shows that you think for yourself and know your scope of practice and have the patient's best interest at heart. This doctor scares me.

I 100% could not agree more.

Specializes in Psych ICU, addictions.
However, referring back to the original scenario - in TX, a physician can direct ANYONE to do just about anything in an emergency situation if she is directly supervising their performance of the task. Our LVNs are permitted to administer IV meds if they have been trained and had competency validated. So, maybe the 'rules' vary by state?

Perhaps...but if the OP didn't know what the rules were for his state, he was wise to error on the side of caution and not push the medication. IMO, better he didn't give it and find out later that he could have given the med IV in emergent situations, than to push the med and if (God forbid) something went wrong, find himself in front of his BON explaining why he went outside of his scope of practice.

Again.. I do tend to repeat myself... If the doctor wanted the medication to be given.. so effin' badly..

WHY didn't he just push it himself???

Lawyer up ... stat.

She is an LPN.

Sounds like you have legitimate grounds for legal action if you so choose.

Some lawyers will evaluate your case and if they think you have a case they will take it with no money up front...

Why do this? I mean you are obviously going to be fine...And lawsuits are not good for anyone really...

I suggest it because it is not right that our employers push us to do things that are not in our scope or are unsafe..and if we say no...all to often we face the real threat of retribution!

Its good for us all as nurses when someone fights back against these practices...to set the standard that We will NOT be treated this way!

I hope you do look into it..and thank you if you do!

Specializes in Peds/outpatient FP,derm,allergy/private duty.
It is very uplifting to see such a quick outpouring of support from colleagues for the OP.

However, referring back to the original scenario - in TX, a physician can direct ANYONE to do just about anything in an emergency situation if she is directly supervising their performance of the task. Our LVNs are permitted to administer IV meds if they have been trained and had competency validated. So, maybe the 'rules' vary by state?

In California an LVN can do all of that stopping at the IVP medications, but ironically is more constrained than an MA as the MA falls in the jurisdiction of the Medical Board. So I guess theoretically he/she could do anything if the doctor trained them (like cauterizing polyps) but if something happens it's the doctor's that will hit the roof. Very murky.

Specializes in ED/ICU/TELEMETRY/LTC.
It is very uplifting to see such a quick outpouring of support from colleagues for the OP.

However, referring back to the original scenario - in TX, a physician can direct ANYONE to do just about anything in an emergency situation if she is directly supervising their performance of the task. Our LVNs are permitted to administer IV meds if they have been trained and had competency validated. So, maybe the 'rules' vary by state?

The rules indeed vary state by state. In NC an LPN can administer and drug IV that she is "trained" to push (within scope) with an order. Cross the border to SC and an LPN pushes nothing, ever.

Unfortunately I am not an RN yet. Only an LVN. This is one of those times I really 100% wish I was an RN. But until I can get accepted into a bridge program theres nothing I can do.

You are not *only* an LVN. You are a skilled professional nurse who may not push meds.

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