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

[NrsLucky]

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

[BuckyBadgerRN, ASN, RN]

Nope, assault is verbal or swinging and missing. Battery is the act of physically touching someone.

[Merlyn]

I feel the same way. The only thing that has me confused is that I told the Dr. that I was not allowed to administer IV meds and he stated coldly "I know what you can and cannot do. But I am right here in front of you observing. So give the medication." I told him I could not and he literally pushed me backwards onto my butt and said "get out of this room and out of my sight." I am still at a loss for words.

If Doctor god pushed you and someone witnessed it, then you have leverage to make God sweat. It's a small thing called assault. Write the Board of Medicine in your state. Don't inform Nut ball that you are going to do this, that would be a threat, just do it. Also If you are as vindictive as I am, notify your BON that this waste of human life tried to force you to do something that you were not qualified to do, and when you refused you were fired. Don't let this idiot get away with this, Fight. Take a few days to recover then fight. If he calls you just tell him to talk to your lawyer( Even you don't have one)

[herring_RN, ASN, BSN]

i'm not an attorney but do think this is a clear case of wrongful termination.

if you can prove you were fired because you refused to administer atropine intraveneusly i think it will help others if you sue the employer and/or md.

i don't have any experience with this organization but they offer to review your case at no cost or obligation - http://www.lawyersandsettlements.com/case/california_labor_law.html

below are links to information an attorney could use.

but if you can't prove that is why you were fired it would be a difficult case to win and may not be worth it.

you did the right thing.you only have one license. as you know it is possible to get another job.

[color=#3754d4]

licensed vocational nurses (lvns) provide basic bedside nursing care to clients under the direction of a physician or registered nurse. the lvn utilizes scientific and technical expertise and manual skills. duties within the scope of practice of an lvn typically include, but are not limited to, provision of basic hygienic and nursing care; measurement of vital signs; basic client assessment; documentation; performance of prescribed medical treatments; administration of prescribed medications; and, performance of non-medicated intraveneous therapy and blood withdrawal (requires separate board certification.) - bvnpt - history

copy of lvn practice act - www.bvnpt.ca.gov/pdf/vnregs.pdf

the business and profession code, section 2860.5 and california code of regulations, article 8, section 2542, are sections of the law that define lvn scope of practice in relationship to ivs. these sections state that an lvn who is iv certified, may start peripheral ivs and superimpose intravenous solutions of electrolytes, nutrients, vitamins, blood and blood products.

lvns do not have statutory authority to administer iv medications. in addition, an lvn does not have statutory authority to administer any intravenous agent via a central line. this applies to all practice settings. - np alert: assessment

[Artynursing]

i am sorry for what happened to you. i hope you are comforted by the support you received at work and here on these boards. most importantly, i am glad you've already got new work prospects lined up.

anyone who has spent time in this profession has dealt with bad behavior, be it from patients, families, physicians or other healthcare providers. i normally tell people who are subjected to this to 'just move on.' also, i can understand the physician’s frustration with the situation. if he had just ranted a bit, embarrassed you, or made you feel bad then my advice would be: shame on him but don't waste your time thinking about it ('just move on'). however, everything changed the minute he laid hands on you and became physically violent. perhaps he did not hurt you, but, he crossed a line that should not be crossed and he needs to know it. he really needs a reality check about the inappropriateness of his actions.

again, i am sorry this happened to you, but it did. and it might happen to someone again in the future unless this guy gets a strong wake-up call. i suggest you file a grievance against the physician with the organization, the state medical board, and perhaps even (as others have suggested) the police. organizations are notorious for protecting physicians who go on tirades but no way will they defend someone who has become physically violent in the workplace; it is (or should be) a zero tolerance behavior.

after the incident, no one would blame you for just washing your hands of the situation but i hope you do not.

best of luck to you.

[FlyingScot, RN]

He put his hands on you...he should pay. Notify the state medical board ASAP and file a police report! Even if you take it no further he will be on notice. Next thing he'll be slapping someone.

[fltnrse2, ASN, RN]

Dear Lucky,

I would be at a loss myself for the cause of this patients rapid change. Please don't let this get you down, what else could you have done diffenrently? Maybe nothing it was just going to happen no matter what. If you hadn't been called away by you boss this would be a different story, so I feel you could use that event to your advantage. It soounds to me that your are a very capable nurse.

Just think how bad we were treated when there was a nursing shortage???

Hang in there, don't let this get you down, try to let it go and move forward in your career.

I might even ask admin to but into writing for the termination.

I back you 100% FLTNRSE

[DebanamRN, MSN, RN]

I would report him to the medical board. If he will put his hands on you, what about others? How about patients that can't fight back? This worries me. When I was an LPN lots of docs told me to do things out of my scope of practice for NJ. Nope, sorry, no can do. Now that I'm an RN there are times that I am still not comfortable with things I haven't done before. Ultimately, it is not safe to preform anything you are not comfortable with. Just think how the jury will rule, most likely in the favor of the plaintiff (patient) and not you. I get the NSO newsletter and reading it gives me chills. Even when we do everything right things still go wrong and juries rule based on their emotions, not logic (it seems). PS get yourself malpractice insurance if you don't already have it. $100 = peace of mind. And pulls you out from under the bus.

[NurseLoveJoy88, ASN, RN]

while i in no way want to minimize what happened to you, i can almost understand the md's frustration. here was a patient in a code situation and the only nurse he had in the room was refusing to push the drug the patient needed. was there anyway you could have prepared the drug and handed it to the md to push? i've done that in similar situations without getting into trouble. i sympathize with your situation, and wish you the best of luck in finding another job.

i disagree. this was out of her scope. oan: op you are never an only anything. you are a lpn, and a prudent nurse. be proud you did the right thing.

[northbynorthwest]

First question: Are you an RN?

Second question: If you are, or are not, you certainly knew the scope of practice you were taught at this facility. Are you absolutely sure you were not to administer IV meds? Get this in writing.

If you are absolutely sure you could not administer the IV med, this is what you need to do, and don't be afraid. Take a stand. Call your manager and ask for a personal meeting. If you get this, review the policies and procedures for your job role, and confirm that you were not allowed to give an IV med. That is all you want to know. Nothing else. Don't get into any other conversations about that. Respectfully dismiss yourself from the meeting. You do not want this person involved past this point.

If you find out you did the right thing, under the policies you were to abide by, your next step is to call the CEO or head of the urgent care to meet with that person. Explain exactly what happened, and be very clear what the MD instructed you to do. And bring in writing the section that says you can't administer an IV med. At that point, that person is going to tell you he/she will look into it, and will get back to you. They need to decide if your termination was justified. If they find that it was not, they will notify you. If they find that is was not justified, chances are you may never hear from them again.

If everybody refuses to speak with you, or, people along the line agree with you but do nothing, my dear heart, you need to find a healthcare attorney. This could be a wrongful termination, and if the attorney feels it it is, you have a case, and you need to follow through.

Doctors can be terrible bullies. That's Ok if they are within the scope of the job. But if they verbalize something to you that you are certain you are not supposed to do, this is illegal.

Alot of healthcare workers just simply back down in situations like this. Take a stand, and be true to yourself. Won't you feel alot better in the end that you fought for your rights?

You don't ever have to list this job on a resume, or what happened afterwards. All of it will be confidential unless you committed a felony, or lost your license, and I don't think you did.

[PsychNurseWannaBe, BSN, RN]

If you have a witness the first thing you should do is file a police report. You may need it. JMHO. I am sorry this jerk did this to you, but I really think you should advocate for yourself and for your fellow nurses. A MD can not tell a nurse what their scope of practice is. The only nurse that can supervise another nurse is an RN. (at least in my state). You were technically battered and wouldn't take that lightly.

[felixfelix]

this is what happens when MD's get used to having MA's around. they can do anything he directs them to do, but you, as an LVN, have a scope of work to think about.

[Altra, BSN, RN]

I wish you well, OP.

I too am curious just how low the patient's heart rate and BP were. But you don't have to share that with us if you don't want to. For your future reference, in my experience in hospitals, Atropine is given for symptomatic bradycardia less than about 46bpm, give or take, depending on the patient's history. A syncopal episode is certainly symptomatic. Although the MD behaved badly in this situation I have given him the benefit of the doubt that the patient's heart rate warranted the administration of Atropine. I could certainly be wrong, though.

A bradycardic, hypotensive patient is an emergent situation, even if she is 21 years old and without significant history. In an emergent situation, you & the MD are going to be working together, instead of a more typical office practice flow of order, then task completion. In other words, if I am ever syncopal in your clinic, please get some IV access immediately - my life may depend on your quick action.

I realize you don't have the same equipment in an office that we do in the hospital, but I hope I've given you some suggestions to think about. In the absence of a cardiac monitor you could connect the patient to an EKG machine and just let it run. You can certainly apply some O2. Ammonia capsules? Well, policies, practices and physician preference vary from place to place, but think about this: if someone loses consciousness is the priority to find out why, or to attempt to make them conscious? How does the ammonia capsule benefit the patient?

Good luck to you, OP.