5 Reasons Nurses Get Fired and How to Avoid Them

You're Fired! These are words that you probably hope you never hear. Learn a few of the top reasons nurses get fired and how to protect yourself. Nurses General Nursing Article

5 Reasons Nurses Get Fired and How to Avoid Them

"You're Fired!" Those words might make you queasy at the thought of hearing them directed at you. Many nurses get fired every day for reasons that range from legitimate to downright ridiculous. And sometimes, you don't have to do anything wrong to be fired. Your actions might be a simple misunderstanding that places your employer at a risk you didn't even consider.

Here are a few reasons nurses get fired and how to keep yourself off the chopping block.

Breach of Ethics

Nursing is a serious profession. Besides making life or death decisions daily, you are held to moral and ethical standards that are much higher than those held by other occupations. Unfortunately, some nurses engage in some of these behaviors anyway, such as lying, not working to the expected level of professionalism, HIPAA violations, or even patient abandonment.

How to protect yourself: You may think that following morals or ethics is common sense. But, we all can think of a time or two where the "right" thing might not have made as much sense as other possible actions. Make sure you are familiar with the American Nurses Association Code of Ethics, which consists of nine provisions and interpretative standards. It's a good idea to familiarize yourself with your state's nurse practice act too.

On a local level, understand all human resources and ethics policies for your facility. These policies will guide you to your employer's expectations while on the job.

Misrepresentation of Your Work

You know that if you didn't chart it, it didn't happen. But, what if you chart something that didn't happen? Falsifying documentation is a serious offense. There are many cases of nurses documenting care they didn't provide and most of the time, these cases end with the nurse being caught, disciplined, fired, or even charged with criminal offenses. Take a look at one such story here.

How to protect yourself: It's relatively easy to protect yourself from this offense. Do your work. Document accurately, honestly, and thoroughly.

Causing Harm to Patients

Mistakes happen, but acting recklessly is not accepted in most professions, and nursing is no exception. According to American Nurse Today, malpractice is negligence, misconduct, or breach of duty by a professional that results in damage or injury to the patient. In many cases, the care provided didn't meet the standard of care expected to be delivered by a "reasonably prudent" nurse.

How to protect yourself: Communicate appropriately with colleagues, physicians, and other members of the healthcare team. Follow all standards of care. Assess and monitor your patients according to standard practice protocols. Delegate properly and document according to your facility's policy.

Diversion

Unfortunately, you've seen stories of nurses diverting medications in the news. Controlled substance abuse and addiction affect nurses like anyone else. Many nurses get caught each year for diverting drugs away from their patients and into their own pockets.

Diversion can ruin your reputation and put your employer at significant risk. If caught, you can be criminally prosecuted and might suffer civil consequences as well. You might lose your job, your license, and be subjected to monitoring, detox, rehab, and other programs.

How to protect yourself: Never start this behavior. You should know the signs of drug diversion, just in case you would notice them in a colleague. Common symptoms of diversion include:

  • Change in behaviors or job performance
  • Multiple absences
  • Long and excessive breaks
  • Withdrawing from colleagues, friends, and family
  • Excessive medication errors
  • Change in mental alertness or confusion
  • Mood changes
  • Incorrect narcotic counts
  • Large amount of narcotic waste
  • Reports of ineffective pain relief from patients
  • Offering to medicate co-workers patients
  • Changing verbal orders

False Credentials or Work History

No matter how badly you might want a job, never falsify your work history or credentials. You might think that telling someone you have a Master's degree will get you the interview or even the job, but if you don't have these credentials, don't pretend you do.

Another licensing issue that can get nurses into a bind with their employment is forgetting to renew on time. You probably don't enjoy completing the required continuing education courses or paying your state to renew your license, but it is a professional expectation and requirement to keep your job.

How to protect yourself: Never lie on job applications, resumes, social media profiles such as LinkedIn, or verbally about your credentials or degrees. Be sure to renew your licenses and other certifications on time. Set reminders on your calendar or on your phone to make sure you never miss a deadline.

Have you been fired? What lessons did you learn?

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Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. You can see more of her work at melissamills.net.

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Specializes in LTC & Teaching.

Unfortunately I was fired a few years ago after working in Long Term Care for over 15 years. However, it was not for any of the reasons mentioned.

I badly injured my back in a freak accident at work. I was caught in the proverbial damn if I do damn if I don't scenario. I was pulled off work by both my family doctor and the employer due to the physical state that I was in, as well as the mental state from being impaired by the various medications I was on to treat the injury. Yet the Worker's Compensation Board (WCB) was ordering me to be at work and instructing me to give out medications (this is all documented). To be at work in the state I was in would have violated numerous nursing guidelines such as jeopardizing patient safety. I sided with the family doctor, the employer and the nursing standards that I required to adhere to.

The WCB went nuts and deemed me as un-co-operative. I was severely punished by them. They not only denied me loss of earnings while off of work, they also denied me the medical treatments that their own medical team indicated that I needed to recover from the injury. The deliberately sabotaged my recovery.

Several years went by with battling not only the WCB, but also the employer, the employer's insurance provider, etc. There was even one lawsuit with the employer's insurance provider who followed in WCB foot steps by not paying me. After the lawsuit was settled in my favour, the employer's insurance provider finally decided that they were going to cover the treatments that I needed and that I was going to get paid Long Term Disability. With finally getting the treatments that I needed, I thought that my lengthy nightmare would finally come to an end.

A few months later the employer decided to terminate my employment because I was off work for too long. This was in spite of the fact that I was in active treatments at the time of termination. In addition they knew full well as to why I was off of work for a lengthy period.

Here in Ontario Canada a worker can not pursue legal action against a WCB. However, the appeals drag on. I have since launched a significant case against my former employer under Human Rights as they not only went against Employment Standards, they also Contracted Out my Human Rights which is illegal. They did a lot of other things as well. The size of the package that I submitted for the Human Rights case was 182 pages in length.

The reason for the size of my Human Rights package is due to the shear amount of documents that were attached which included letters, reports, e-mails, etc. This is the point that I want to stress here. Insure that everything that happens in your case, it's thoroughly documented. When ever possible, do your communicating via e-mail or letters to ensure documentation of the conversation. I absolutely hate communicating via telephone. My Human Rights package contains numerous e-mails so the person(s) that I'm referencing can not deny their comments like they can if the conversation was over the telephone.

Even though my nightmare has dragged on for over 7 years (and continues) and my back is in really rough shape, I've shifted my nursing role in that of an educator and an advocate.

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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

Good article. I most certainly agree that things like charting accurately get blurry when we're working with our noses to the grindstone. Sometimes it's just to easy to sign those rounding boards blindly when we know we didn't really lay eyes on that patient. This is a mistake I see a lot of new nurses making while they're learning time management and prioritization.

I will point out though, the article seems, to me, to be written from a viewpoint of the "ideal work place." In short, this means it assumes all firings are justified and done with the intention of protecting the patient.

This "ideal" workplace is not common though. I've said it for years that MOST disciplinary actions taken by medical facilities are motivated by personality, not policy.

We've all seen it. A certain nurse rubs the wrong people the wrong way. Suddenly they can't breathe without attracting a write up. Every other nurse working on the very same unit does the same things they're being written up for but...........it's always *this* nurse that they catch doing it. Tension builds, they do something out of anger (become confrontational with the manager, begin calling off etc etc) and they hang themselves.

This is the reality of most medical facilities. Personality trumps policy.

So, it seems to me, in order to keep from being terminated, we nurses must not only professionally adhere to ethical standards, but we must on a personal level be well equipped for dealing with "difficult personality' superiors.

The above most likely contributes greatly to burn out. Just say'in.

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Specializes in Workforce Development, Education, Advancement.

Dear Truth66 - I am so sorry you endured this horrific event. I used to case management worker's compensation claims here in the states, so I appreciate how difficult it is to maneuver through this system. I don't know the ins and out of the Canadian system, but I can tell you that it is a broken system in the U.S.

Stay strong, best of luck, and thanks for sharing your story.

Melissa

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Specializes in Workforce Development, Education, Advancement.

AutumnApple - You raise excellent points! And, yes - the article doesn't go into issues with employers since that would be difficult to include all and lack evidence. However, when we talk about employer issues (specifically bosses) - you are exactly right that it seems to be driven by personality, not policy. In my 20+ year career, I have seen this as well. When I worked as a manager, I challenged myself always to consider the process, not people because 99% the issue could be solved by changing a process (even if a personality issue existed as well).

Nursing is a stressful profession and often that stress gets the better of us no matter what title we hold. It's unfortunate that some managers will hold a personality trait against a nurse for the sole purpose of getting them out of the workplace.

Thanks for your insightful comments. ~Melissa

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Specializes in LTC & Teaching.
Dear Truth66 - I am so sorry you endured this horrific event. I used to case management worker's compensation claims here in the states, so I appreciate how difficult it is to maneuver through this system. I don't know the ins and out of the Canadian system, but I can tell you that it is a broken system in the U.S.

Stay strong, best of luck, and thanks for sharing your story.

Melissa

Thanks Melissa.

Yes the WCB system is severely broken. Here in Ontario there's currently an Inquiry going on into Long Term Care. I got permission to submit a 67 page submission. My submission was based on my experience as well as mounds of research. The corner stone of my submission was that WCB's and Insurance companies policies should never over ride a nurse's legislated responsibility. I emphasized that Nurses can not pick and choose which policy/standard that they can follow. I also emphasized that in my case, both the WCB and the Insurance company where deliberately jeopardizing public safety by pushing me to work while both physically and mentally impaired.

In my above post I mentioned about the importance of documentation. I just want to add quickly a comment that the lawyer who represented me in my lawsuit indicated to me. First of all he indicated that I make up approximately 1% of the population who actually fight back. For me that was scary to hear.

More importantly, he indicated that the biggest reason why my case settled so quickly was the sheer scope of the amount of documentation that I had. Nurses fully know the importance of documention with their careers. They need to exercise the same due diligence in personal documentation with what ever might happen to them.

Another piece of free advice I'll pass on is every nurse needs to be vigilant in having a huge emergency fund. Financial experts often indicate that a person should have 3-4 months of living expences in reserve, which I had. If a nurse gets badly injured and off for a long period and eventually loses their job, 3 months reserve will not cut it. I endured 18 months with no regular income coming in.

Insurance companies, lawyers, etc. usually drag out for quite awhile. Nurses need to protect themselves.

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If your lucky, they will just fire you and not make up a story and report it to the BON like was done to me. Now $$K later, I am still dealing with it and will in every state that I am licensed in. This is all thanks to the BON will not investigate unless you go to court over it and the BON TELLS you that the outcome will be worse, with stiffer penalties and higher costs. So they bully you into not taking it to court. It is a messed up system, for sure!!! I am meeting with a college advisor this week, I am getting out of nursing!

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Specializes in Workforce Development, Education, Advancement.

Oneof5 - I am so sorry you have had to go through this! Yes, unfortunately, employers and bosses can make this way worse. Thanks for sharing and best of luck!

Melissa

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Specializes in ED, ICU, Prehospital.

Three true stories.

1. KPH Sacramento has a CHARGE RN who falsified documentation on a patient that had an elevated troponin level. Pt was in a unit that he should not have been transferred to in the first place, having arrhythmias and then an elevated trop--she put him in an observation unit with med surg nurses and no tele. Policy stated that abnormal results must be reported to the provider WITH READBACK.

She documented that she did this. The nurse who was in obs had a confrontation with a VERY angry provider who, 45 min later, screamed at her that he was never told, and that this pt may very well be having an MI. The RN defended herself by showing the MD that the DOCUMENTED report TO HIM was in EPIC. He took a picture of the documentation on EPIC and then confronted the Charge RN.

The episode was reported to KPH management. The RN "disappeared" for a month or so. The RN who reported her was retaliated against by delaying lunches/breaks, denying relief coverage at end of shift, dumping highly acute patients on her while others sat around, help was denied routinely, and a transfer to another unit was denied.

The Charge RN? She was returned to duty. None the worse for wear. The RN who reported her to management is now going to the California Board of Nursing to report the incident with her documentation of the incident.

Facilities protect their favorites, but also, they will protect THEMSELVES. This RN was known for this falsification in other aspects, as the facility has a "59 minute" policy of transporting patients off of any unit. Once admission orders are written, the RN has 59 minutes to transport the patient off of that unit to the new bed. It doesn't matter what's happening, if there are no transporters, no relief to cover the RN if they transport the pt alone, or if the RN has 3 other critical pts. This Charge RN and others at that facility routinely "pull the pt off the board" in order to falsify that the pt is on another unit "under 59 minutes".

Patients can code or have other problems in the unit--before transport. What then? It's documented that the pt is GONE and on another unit! This is ROUTINELY done at KPH, and it is a all a numbers game.

Don't even ask about how pts are routinely discharged because of "wink and a nudge" between RN and MD when the pt isn't a "kaiser member" and the MD doesn't want to admit a pt.

2. A friend was accused of diversion three months after leaving a job. The RN Manager disliked her because she criticized the haphazard and Wild West attitude that the Mgr fostered in the step down unit. The Board of Nursing doesn't NEED or REQUIRE any proof upfront of accusations. People should understand this.

They are like the police in a very real way. They act first and ask for documentation later. In the process, innocent people are branded. I have seen SANE cases where a miffed girlfriend accuses a boyfriend of sexual assault---only to have that same boyfriend in the room later, when she calls him for a ride...and she admits that she was "just mad" at him. The police arrest these people and make accusations until proof is either shown or the accusation is rescinded. But the arrest remains on that person's record!

The BONs are EXACTLY like this. This RN was accused, a letter sent...and she remained on suspension for 4 MONTHS while the BON slow walked this issue. They are "understaffed". But they sure as hell suspended her toot sweet when the accusation was made! The facility had ZERO documentation that this RN did anything wrong...in fact, they never showed up---after she hired a very expensive attorney and was out of work for 4 months---on top of the stigma of having to tell her new employer that she had been accused of diversion.

The BON isn't there for the protection of RNs. They are there to "police". And a little bit of power given them has gotten completely out of control.

3. An RN at a major trauma center on the east coast left her patients, 6 of them, on their own for 3 hours while she sat in the break room, unbeknownst to anyone other than the two other RNs who were also sitting there, talking and gossiping.

The patients were fast track, so not critical, but the MD stormed around searching for the RN responsible for the patients, to no avail. When an RN came to relieve this particular slacker RN--the MD attacked her, saying that she had "abandoned" the patients. She explained that another RN was the one responsible, but the MD was not interested.

The RN wrote a detailed letter, with documentation, to the RN Manager. Nothing was done. The RN in question, a "favorite" of the staffers and Manager, went on to retaliate by starting rumors that she knew of "legal troubles" and "drug issues" with the RN that reported her. This RN was taken off of rotations and placed as a "sitter for psych", routinely denied lunches or breaks "we forgot you were there!", and denied relief at the end of her shifts.

This is COMMON. I hear stories like this EVERY. SINGLE. DAY.

A former instructor of mine became a good friend. She was accused 20 YEARS AGO of something she didn't do--and the BON, because they are sociopathic...and cannot EVER be wrong...wrote a letter of reprimand and attached it to her file. The letter reads like an admission that they agree she was in the right, but they just had to smack her down. It tainted EVERYTHING she did after that. Every job interview, it was brought up. She had to explain herself and defend something that should never even have been an issue.

This is what the BONs are mandated to do. They have a misguided and malicious core--maybe it was started as something noble, but it's not anymore. Yes, there are bad actors in nursing. And they most definitely shoot themselves in the foot by their stupidity. But the slippery slope of what I call "Nursing McCarthyism" is rampant.

We have these crap RNs who should have been run out of nursing a long time ago, because they aren't worth a tinker's damn---no skill or unethical or diverters themselves---who point the fingers at others who "rub up the wrong way" or report their sorry butts as in the case of the KPH nurse....and the ethical nurse ends up on the wrong side of the BON.

I am in school for Nurse Practitioner. I work on an ICU unit until I graduated. My goal is to provide direct care to patients when this is over. Three of my most trusted RN pals are doing the same.

The facilities and the BONs encourage this behavior and it goes unpunished. The idea that "if we antagonize" these long standing lifers--the true troublemakers---there will be no one to work. A sociopathic attitude if I've ever encountered one.

This isn't about patient safety, or the public safety---this is about the bottom line of corporations. As long as the RNs who are a true danger and cancer on this profession will stay on shift---they are elevated to positions of power and the result is the mass exodus of ANY and ALL decent RNs from this profession.

It's not going to change, people. Get out of floor nursing while you can. Work your way into a position of administration or research or NP---and get the hell away from hospitals, clinics or LTCFs. As long as you have "Charge Nurses" and "Nursing Directors"...and them incentivizing cliques, gossip mills and coverups for their bad behavior, you will have wonderful, decent and hard working nurses being victimized by them.

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I had a patient who was a pre-med student with cystic fibrosis. He was very lonely and deeply depressed. He thought his hospitalization would distract him from his classes and that he'd never get into med school.

I gave a patient a $3 caduceus necklace from Amazon and told him to 'Never give up hope'.

His mother was in the room and was in tears. She thanked me for "taking the time to really know and care about [her] son".

She asked me if there was anything she could do to repay my kindness. I told her no, that it was just part of my job. She insisted and I directed her towards a stack of DAISY award pamphlets and said if she truly felt that way she could fill one out.

Rumors swelled on my unit. A few days later I was called into my manager's office and a woman from HR was there. They questioned my motive and my integrity, saying what I did was "a bribe". I said it was all just rumors and a complete misunderstanding.

I also have Asperger's Syndrome and see the world differently than others, which my manager knew.

Nonetheless I was let go on the spot, with no chance to defend myself.

That was my very first nursing job; I was fired and without a reference. I am still looking for work 18 months later

Moral of the story: always care at an arm's length.

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Specializes in LTC & Teaching.

It's sad to read stories of Nurses who were wrongfully terminated from their positions. Yet, I'm sure that we all know of nurses who we routinely ask ourselves, "how is it that person still has a job?"

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Specializes in Home Health/Wound care.

I have some very well substantiated research articles by psychologists that helped set up the workers comp system. It was specifically designed to re-injure workers, making it nearly impossible for them to recover, be compensated, or return to normal function. Those research articles are hard to find these days, trust me. Never work and be injured. Walk away, work elsewhere. You are protected by no one, and buy nothing.

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