Terminated After Two Months!!

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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?

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Career Columnist / Author

Nurse Beth, MSN

157 Articles; 3,217 Posts

Specializes in Tele, ICU, Staff Development.

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.

Buyer beware, BSN

1,137 Posts

Specializes in GENERAL.

Nurse Beth,

Reading this nurse's story again confirms my belief that new nurses should start out in an ICU.

Although this may sound counterintuitive, it is a good way to learn the ropes in this contained and controlled environment working with a veteran nurse who hopefully has the temperment, patience and gift for teaching.

I very much feel that this nurse, years from now, will look back at her recent false starts as difficult learning experiences that will forge her into an excellent practitioner in the future.

But those who are honest with themselves and others, know her rite of passge is far from unusual.

For now, as the musician's say "you've got to get your chops together," learn the disease processes and treatments. Learn the drips and titrations. Learn the blood drawing and IV starting ropes. And all the other things that once learned become no big deal.

I can guarantee you that there are not many nurses out there that haven't missed an order and had some nutty doctor go ballistic on them.

That behavior is virtually right out of central casting. Always will be.

Everyone wants to be perfect but few in healthcare are except, as we know, the physicians.

3 months orientation is pretty standard for an hospital acute care setting. I am a little concerned at the comment that "I damaged his kidneys, but they were already damaged." I am sorry they put you on a tough floor for a new grad. In the new environment, why didn't the patient get the meds they needed after the surgery? Was that part of discharge teaching? In any event, I am sorry it has been a bumpy road for you and I do wish you the best. I do applaud you for reporting as soon as you realized the issue - that is advocating for the patient. Good luck to you.


34 Posts

As a 'second career nurse' I spent about 1 1/2 years in LTC. You learn prioritizing, juggling, multi-tasking and consistency, all of which are attributes you'll need as a nurse wherever you go. You learn to manage your time and ways to NOT forget that such & such patient needs an IV infusion started at 1300, as do 4 of your 40+ patients need their breathing treatments at that same time.

I'm in Home Health now and the pace is sooooo completely different. Although, between family members and their questions, phone calls, changes of conditions, falls, new dx's, paperwork etc., there are days when it's nothing but chaotic.

Just as Nurse Beth quoted above, finding your niche is the true key to success. Keep chopping away at it, "Terminated"....you'll find it!!


38,333 Posts

Extended care home health, not intermittent visits, might be a good place to destress until you have racked up some experience time and feel ready for your next option. One, stable, patient, with routine care. Not normally overwhelming on a day to day basis, and you would be building your resume. Just an option to consider.


203 Posts

Specializes in Home Health, Mental/Behavioral Health.

I agree with Nurse Beth. Outpatient surgery and behavioral health are great options to get your initial experience in. I'm not an RN, but I do know RNs that went straight from school into outpatient surgery, mental health and also home health.

It'll provide you with that opportunity to take a "breather," and kind of reset your confidence. They are not as high paying or will get you the type of procedural experience a hospital setting will, but it'll be a nice lower stress opportunity to get that initial year in.

And Nurse Beth, you mention there, but for the grace of God, go I” ... Amen to that!

So you had a rough start. The Lasix mistake is a biggie, theres no sugar coating that, but you're here seeking advice and laying it all out on the table. That's brave. And it shows great care for your own personal growth. This is a very important characteristic for any professional, especially a nurse... and you display this. You obviously have no problem owning up to your mistakes which says A LOT about you. I believe you have the capacity to be an excellent nurse and the possibilities for you are endless.

Keep on growing and learning. Be safe and don't give up!

TheCommuter, BSN, RN

176 Articles; 27,610 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

This is my 11th year of being a nurse. Due to my low-key type B personality and dislike of fast-paced work environments, I will continue to avoid acute care hospital nursing unless I had to avoid becoming homeless.

There is something for virtually everyone in nursing. Keep your head up.


916 Posts

Specializes in Critical care.

What stands out to me is that not only did she/he miss that the lasix gtt had been d/c'ed, but so did the night nurse if it ran until the next morning (which it sounds like it did since she said it ran "overnight"). I hope there have been some changes as a result of that. We've had issues with continuous fluids and drips not being stopped accurately, so now at change of shift both RNs review the continuous meds orders, review the pumps, line trace, etc. I personally think the eMARs should have an "overdue" alert if a med is not stopped (like it does if a rate isn't changed or a med isn't started).

I also will stop the drips immediately before I forget or if it's set to be d/c'ed at a specific time (such as 8 hours after the IVF was started) I will set an alarm on my phone so I don't forget (I say the hospital is a black hole where I lose all perspective of time).


4 Posts

I had something similar happen to me. I went to work for a major hospital through their graduate nurse program, and chose to resign a week before I was scheduled to be released from orientation because I knew that if I was sent out on my own I would make a mistake. The floor was too busy, too high stakes for me. I wound up taking a position as a per diem home health nurse for pediatrics, and learned how to trust myself again. I only worked there for a few months, and then was given a full time position with an LTACH. I love my job so much now, and was released from orientation in 4 weeks. I am much more confident and am surrounded by a team of nurses that support me and are happy to answer all of my "stupid" questions. You will find your niche, and you will rebuild your confidence. Just give yourself time to heal, and question everything when you go for interviews.


2 Posts

New grads should NOT start their career on Behavioral Health. You need to hone your medical skills which BH will not give you. Also, BH on your resume rather than med/surg will severely limit your employment options and when floated to a medical unit for a shift may compromise care and your confidence. I worked in various specialities during the beginning of my career, mostly in BH. I kept my m/s skills by actively putting myself out there to float to various areas. The last 5 yrs was stritly BH, compromising my skills and confidence.


1 Post

As a DON for a correctional facility , I would be very cautious of suggesting new grads find a job in the correctional setting. I highly recommend that you have at least 2 years acute care experience before venturing into this field. Correctional centers are not teaching institutions and if you have never experienced responding to emergency situations or not keen on using critical thinking, then this is not the place to learn those skills. Training is 4 weeks max and that is just orientation to the specific post, not how to be a nurse. I would suggest in lieu of acute experience start at a skilled nursing facility. Good luck and try to keep your spirits up!!!


145 Posts

I'm sorry to hear of your rough beginning. Stories like this only reinforce that nursing has got to evolve to care for its own. It does say a lot about who you are that you own your mistakes. Be proud of that. I think you should list both positions on your resume. If you don't, how do you explain the good recommendation? As for where to go from here... Maybe you could request a meeting with your last manager and basically conduct a career interview. Ask her what she feels your strongest skills are and where your weakest are. Ask her if she can point you toward a field. Of course, before you do that, you need to assess yourself honestly and try to list your strengths, weaknesses and interests. Listing your dislikes is important as well. Since you have your BSN, there are tons of nonclinical options available to you, if that's the way you want to go. I'm sure your confidence is shaken right now, maybe you could ask a local community college if they have a skills refresher, if that's where you think you need to go. If it's just juggling everything, that will all come with time. Be honest with yourself, but be nice to yourself too. Good luck.

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