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Topics About 'Job Termination'.

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  1. Meet Theresa Puckett If you do a Google search for "nurse fired for being sick" you will be inundated with articles about Theresa Puckett, PhD, RN, CRCP, CNE, a nurse from Northeast Ohio who found herself terminated after a legitimate bout of the Flu during one of the worst Flu seasons our country has seen. According to an article in Becker's Hospital Review, Theresa worked as a PRN Nurse at University Hospitals, based in Cleveland. She called in sick one day at the end of December 2017 with flu symptoms. Theresa visited a physician and tested positive for the flu virus. She was treated with Tamiflu and ended up missing two days of work. Her physician provided a note excusing her from work for these days. She returned to work a few days later and was instructed by a supervisor to leave early due to continued illness. The next day, she saw a Nurse Practitioner who diagnosed her with a sinus infection and provided her with another note stating she should not return to work for a few more days. However, returning to work was never an option for Nurse Puckett because she was terminated. You may be thinking - How does that happen? According to the University Hospitals statement to Becker's Hospital Review, they allow six unscheduled absences for full and part-time staff within a 12 month period, and nine absences may result in termination. For "as needed" or PRN staff, two occurrences of unscheduled absences within a 60-day period may result in termination. Because Theresa returned to work for one shift in between her two absences, this counted as two occurrences and qualified her for termination. Presentism versus Absenteeism If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it. To really understand both sides of the issue, you need to understand the difference between absenteeism and presenteeism. Absenteeism is the practice of staying home from work or school when you are ill. Of course, there are other reasons people call off, but for this article, we are only exploring this issue concerning illness. So, what's the opposite of absenteeism? Presenteeism - the act of going to work when you are ill. Nurses have high standards for themselves and the care they provide to patients, even when they are ill. A 2000 study by Aronsson, et al. reported that rates of presenteeism were highest among nurses and teachers. But, we know that presenteeism may result in adverse patient outcomes, poor nurse health, and cost consequences. So, why is it so difficult to take a sick day? Let's consider a few of the most important factors when deciding which side of the issue you support. The Team Needs You Your throat is on fire, your head feels like a giant elephant is jumping on it and crawling back into bed sounds like the best possible plan - but, you know your teammates need you. You don't want to let others down. Staffing on many units is kept to a minimum so even one call off could cause your co-workers to take on larger assignments, be in unsafe situations, or be upset with you for calling off. A February 2018 article by News 5 Cleveland quoted one nurse as saying "Nurses are often commended for coming into work sick, so they don't put their comrades at a disservice for being understaffed." It seems the issues of teamwork, loyalty, and service is a double-edged sword on nursing units. Patients Need You Nurses spend more time with patients than any other healthcare professional. You recognize minor changes in assessments and notify physicians. Yes, the doctors diagnose and order new treatments, but it's the nurses who carry out these orders that are often life-saving treatments. A 2015 study published in JAMA Pediatrics explored the reasons physicians and advanced practice nurses work while ill. While 95% of the respondents believed working while sick put patients at risk, 83% reported working at least one time in the prior year while sick, and 9% reported working while ill at least 5 times. Symptoms reported in this study included fever, diarrhea and acute onset of respiratory symptoms. 92.5% of these clinicians cited not wanting to let patients down as one of the reasons they headed to work with these signs of illness. So, as you lie in bed contemplating calling in - that's what runs through your mind, right? Without you - who will care for your patients? And, what if you are not the only one with this dreaded illness? So, off to work you go. Sick Time Policies Are sick time policies created to protect or punish you? This is a hard question to answer. And, it often leaves nurses faced with difficult decisions that end in absenteeism or presenteeism. Let's explore a few sick time policy practices. Forfeiting Pay Some call-off policies will withhold pay from nurses if you call off at specific times. This might mean that calling off the day before a holiday will result in forfeiture of holiday pay. Or, if you call off on your last scheduled day before a planned vacation or on your first scheduled day after a planned vacation - you forfeit vacation pay. In a world where many people live paycheck to paycheck, this policy might result in nurses putting themselves and their patients at risk to keep pay that many would argue is rightfully yours. You can't plan illness, so if you are sick around these specific time points, what are you to do? Unexcused Absences Most policies give a number of 'unexcused" absences allowed over a period of time, such as 12 months. Typically after missing this number of days, you will be reprimanded. You may also be given a specific amount of time, such as the remainder of the year or 90 days, in which you must not miss any more work. Of course, if you end up legitimately ill during this time, you are probably going to go to work or risk disciplinary action. No Sick Pay Nurses who work a limited number of hours per week or prn often have no sick time. This leaves you making financial decisions in the face of illness. Or, your policy may require you to use vacation time before using sick pay. This may seem counterintuitive given the fact that nurse burnout and fatigue runs rampant on many nursing units and days off are necessary. Physician Notes Some sick policies require a physician's note for any unplanned absences. Others might state that no MD note is necessary because all unscheduled absences are unapproved. Or, you may also find policies that require a doctor's note after a certain number of days, which may be due to the Family Medical Leave Act. No matter what your policy reads in regards to doctors notes, you need to understand it before you need to use it. Be sure to get notes when they are required to remain compliant with your facilities policies. Termination Almost all sick policies will lead to termination as an end result. And, when such procedures are executed the same across the board, most nurses find these policies to be acceptable. However, when these policies are not carried out consistently, you may feel that they are being used against you or other staff on your unit to force your hand at finding a new job. Some of the allnurses team met Theresa at the NursesTakeDC rally earlier this year. Nurse Beth was able to interview Theresa and learn more about her ordeal. Thank you for sharing with us, Theresa. What are Your Thoughts? So, where does all of this leave you? Do you stay home when ill or head to work in an attempt to avoid discipline, even when you know it is not best for you or your patients? Now it's time for you to decide. Tell us your thoughts and experiences with nurse absenteeism, presenteeism, and termination.
  2. "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?
  3. Nurse Beth

    Terminated After Two Months!!

    Dear Nurse Beth, On my first month on my own, I was incredibly stressed and overwhelmed. Ultimately, I made a pretty big mistake (MD ordered to D/C Lasix drip. Acknowledged the order but didn't do it) It ran overnight and when the MD rounded the next morning, she was furious. Luckily the patient did not die. I damaged his kidney function, but he was already very sick to begin with. I also had a needlestick accident. My manager was questioning my ability to be a safe nurse, so she placed me back on orientation for about another month. But I did not improve enough, so they gave me the option to resign or to be terminated. I elected to resign. All of my coworkers thought that placing me as a new grad on my unit was a bad idea to begin with. I was able to find another job in about a month. This time it was in a clinic. This was more of a case management role, in which I manage client cases. They initially started off training me pretty well, but things went to hell when staff members went on medical/stress leave. 2 nurses went on stress leave and 1 quit. My manager and the remaining staff started handling the rest of the cases. I believe training us got put on the backburner, and damage control became the priority. I was still assigned to a nurse and tried to help her and learn along the way. But all the other nurses were on edge with the additional caseload, and I believe it compromised my training. My nurse tried to help me, but with her additional caseload, it was difficult for her. Everyone had been putting in extra hours to compensate for the increased workload, including me. For the past month, I had been averaging 100 hours per pay cycle. Because there was still a lot of things I didn't know, I ended up making quite a few mistakes (which my team leader told me was okay. She told me to not be afraid to make mistakes because that is how we learn, and be more confident and independent). The turning point is where I compromised a client's case because I did not know that after surgery, the patient had to start taking certain medications. The patient did not get her medications, and it messed up her case. She was trying to have a baby and was on a time crunch. My mistake delayed her potential to have a baby right away. I realized my mistake when my nurse was going over another similar case with me. As soon as I realized it, I reported it to my nurse. I took responsibility for it and owned up to it. Naturally, my nurse was very upset. She reported it to the manager, who reported it to the higher-ups. As soon as I saw an HR Rep, I knew that I was done. They terminated me. My manager and team lead told me that they fought to keep me as hard as she could, but they could not save me. They also told me that if I ever needed a reference, I could use them, because they believe I'm really smart and will be a wonderful nurse, once I find my niche. I know I did the right thing by reporting my error. I know that if I waited, the situation would be much worse. Is this job even worth including in my resume? I feel incredibly disheartened right now. I was only at the clinic for about 2 months and got terminated so fast. I was only at the hospital for about 6 months before that. I'm starting to question whether or not I can be a good nurse. I haven't been in a hospital setting for a while, and am worried that nobody will hire me because I don't have a year of experience, and am worried about repeating the same mistakes I made in my previous jobs. What do I do? Dear Disheartened, I am so sorry and I can't begin to imagine how devastating this has been for you. I think every nurse who reads this will be affected because "there, but for the grace of God, go I". We have all made mistakes we have had to process and live with. You were honest and took responsibility. People (the public) do not realize the enormous responsibility nurses have coupled with the fact that nursing school does not prepare you for that responsibility. Work conditions can be unimaginably stressful as you describe so well. In new jobs, and every day on every shift, it's often "sink or swim"- but that is no way for an organization to ensure patient safety. I believe new grads in acute care need one year of a residency, similar to a medical training model. Putting you in a case management position with six months of nursing experience is setting you up for failure. My hunch is that you are a diamond in the rough. You need support and the right setting. I like what your manager said, "they believe I'm really smart and will be a wonderful nurse, once I find my niche." You are no longer a new grad, you have had 2 jobs in one year, and you are unemployed. I would look for a job that is lower stress as you build your confidence. Your two immediate goals are to: Get a job Stay employed for one year Here are some ideas- is there a correctional facility in your area? It may be less stressful clinically. I haven't worked in one, and those that have may want to chime in- but I do know it's not acute care, which is a level down in intensity. Outpatient surgery clinic or pre-op... It can be very busy, but it's repetitive work which can mean less room for error. Behavioral Health unit. Fewer clinical procedures and builds a different set of skills. Are you a communicator? I'm calling on the allnurses collective wisdom and help here for ideas for you. Fellow nurses, what do you suggest? Thanks in advance, friends. Best wishes, Nurse Beth

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