Terminated After Two Months!!

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Hello! I agree that you will absolutely find your niche. Don't give up! However, I do have to disagree with the comments that home health might be a good starting point for you. True home health is definitely a slower pace than acute hospital work, however, it truly tests your clinical, prioritzation, and nursing knowledge abilities. I say this from experience, as I worked in home care prior to my current hospice CM role. After your initial orientation (which is probably only a couple of weeks) you are given a case load and that's it you're off... alone. You are solely responsible for trying to keep these patients out of the hospital. You are the liaison between pharmacies, therapy, doctors (who rarely call you back), special diagnostics and medicare/insurance companies.

Personally, I always knew I didn't want to work in the hospital. I just don't like it. But I had to begin somewhere. I worked in LTC for a year after graduation. It was fast, it was stressful but this is nursing. Lol that's just how we roll. But I digress... LTC gave me a chance to be in an environment where I was supported by my coworkers and was able to hone my skills in prioritization, medications, disease process and teaching.

It might not be the right answer but its just my 2 cents. Keep your chin up! You will make it. :up:

Specializes in School Nursing.

Having worked in the medical unit at a correctional facility, I would have to say that this would NOT be a good fit for a new grad. You are usually working with one other person, but the workload is so large, that you may not have time to confer with each other. I remember when I had an inmate try to jump over the desk at me (off of his Lithium for 2 years), and two ODs were brought in and were unresponsive when the COs found them. We also had a potential heart attack that was not transferred out to a hospital. Inmates would be brought into medical every few days for us to see for various conditions. I could go on and on.

I would definitely suggest starting elsewhere.

Specializes in Med-Surge; Forensic Nurse.

Wow! I'm so saddened, angry, and well, angry, at your experiences. Here's my two-cents and I hope it will offer you some perspective, support and encouragement:

First, as important as it is for you to be employed, take this time to process, reflect, and think some more about your role in all that's happened. By that, I mean, take some time to think about every situation, everyday at those jobs, and mentally process the events, incidents, and outcomes. Ask yourself, ,"What could I/should have done differently at this point?"

I'm not saying this as a way to blame you or have you beat-up on yourself, but, I believe that in these situations, we have to be able to step back and see ourselves as part of the whole system; and, more importantly, see where we could have done things differently to effect different outcomes. If we don't process these events, we will continue onto other positions doing the same thing. We have to face ourselves, as it were.

Next, I would apply to Long term facilities/Skilled Nursing Units. As my former nursing instructor told us, "As a nurse, you may not get that 'dream job' the first time you apply or it may not be for some years. But, as a nurse, you should be able to work anywhere for at least 1 year, offering your skills, learning, growing, and being an asset to the company, your colleagues, and your patients." Keep applying, keep seeking, and do it all over again.

I would also encourage you to review some of your basic nursing protocols, skills, etc. Yes, we nurses do make mistakes. I wrote about a medication error I committed once, too (You can find the article on allnurses.com). There is always some learning to be done as a nurse and the moment we think we don't have anything to learn, we (and our patients) are in trouble.

What makes me angry about your experiences is that as stressful as nursing is and with all the nursing/professional organizations, conferences, seminars, and evidence based research, we, as nurses collectively, don't seem to present an assertive resistance to the systemic ills that 'set-up' nursing professionals for failure. I don't understand this seemingly willing acceptance of a work/professional culture that just keeps pushing more and more, yet with the expectation that nothing or no one will ever break!

Lastly, take responsibility for your weaknesses. We all have them, as much as we don't like to admit it to ourselves, much less others. But, having them is not the problem-not knowing what our weaknesses are is much more problematic (and worse) than simply being weak in an area. Taking responsibility means knowing when we are not equipped to do something; knowing when we need to ask for more help, more time, and/or ask for clarifications; and, taking responsibility means knowing when to say, "No, I can't do that," Or, "I need more training before I will feel competent to carry out those tasks." I think knowing when to ask for help is one of the most effective and safe ways we can perform our duties as a nurse towards our patients and our colleagues.

So, in all this, I hope you are giving yourself time to grieve your losses-they are real losses-and process what all this has meant to you. I hope you continue to seek employment and professional support; and I hope you grow tremendously as a nurse and as a woman. Take care and good luck!

Specializes in Cardiovascular recovery unit/ICU.
BabyFood26 said:
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 ... 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!

I looked for a grad "internship " program and went into critical care right out of school. We were in the classroom for 4 months and had to pass all of our exams. Then we were in an empty unit with "hands on" from r another months. When we finally got to the unit (mine was CVR) we had a preceptor for three months. After that we were assigned a "mentor" from r the first year.

I know this may seem like the perfect scenario, but they are out there if you do your research. It worked for me. I studied on my days off like mad and learned everything and anything I could about my new specialty. That was back in 1991 and I'm still in CVR/ICU today and love it.

My best to you. You can do it!

May be try to stay further away from bedside nursing. You can also enroll in a critical thinking class which may benefit you. I myself have taken one. Don't feel bad that this jobs let you go. Worse scenario would be either or both forward you to your state board of nursing. That would be the beginning of your nightmare. You have a chance to become a better nurse.

Specializes in Emergency Room.

I have to agree with others who recommend Long Term Care. It's a slower pace (usually) than acute care and you'll learn valuable skills that you can put into place if you actually decide to try acute care again. I was an LPN in LTC for about 2 years before I got my RN and went straight to the ER. I didn't realize it at the time but that experience was very helpful in terms of being comfortable with patients and learning new things, asking questions of staff and doctors, not making too many mistakes, and not becoming too overwhelmed.

Also once you get more experience under your belt, you'll have more options as to where you want to work. I won't work at a facility that is chronically short staffed and if I am at a facility where it's becoming more of a problem, I put in my two weeks and move on. Don't do this TOO much or frequently as it will look bad to potential employers but at the end of the day you have to protect your license. Try to give a job AT LEAST 6 months, but better to resign than risk getting fired or losing your license if things start going south fast.

To be honest reading this it really sounds like you should have quit that second job a lot sooner. A nurse with a few months experience should not be in case management. Especially when there are staffing issues and you're not getting adequate training. I think whoever hired you was more at fault which wasn't fair to you. They shouldn't have hired you to begin with.

One of the great things about being a nurse, especially if you have an in demand specialty, you won't have much of a problem finding a job once you have enough experience. And once you do get enough you can always do agency or travel nursing which is basically all I do for now. If I don't like a place I either don't have to go back, don't have to deal with it on a regular basis, or am only there for 13 weeks and am not obligated to stay.

But keep your head up. You had some setbacks and we all make mistakes, but try to learn from them. Don't let them hold you back.

Wow, what a story. Sounds like you got tossed to the wolves. I have seen this many times. RN's come out of school with knowledge and basic skills of nursing. You really don't learn anything until you are on the floor with a solid teacher. Tele is no joke and moves fast, been there. It's a high-stress job. I was concerned about the Lasix drip not being turned off. The Charge RN should have know that when passing report. The next RN should have checked the orders. Running all night was a huge blunder on several people.

Then to step into CM with little experience was not a wise move. The best CM's have experience and know how things flow.

Hang in there, it's a tough job.

I advise you to try and accept the mistakes made in the past and try to build yourself uo again from the begining,you can start in a clinic,skilled nursing home,or even med-psyche floors so as to gradually re-build yourself

I think nursing homes are a good way to start out. You get experience without the urgency of other units.

I don't believe correctional nursing would be good. I've worked in a jail and a prison and only had 3 weeks of training at one and 2 at the other. They can be very fast paced depending on how many inmates. I could have 3 chest pains, 2 cutters and someone try to hang themselves all in one night. You need to be able to weed out fakers and malingerers. In prisons they often have infirmarys that will either have long term care patients or those with complex medical needs straight from the hospital. You never know what you're gonna get in a correctional facility.

Specializes in ED, OR, SAF, Corrections.

I hope you hang in there and find your niche! Just a caveat though, I really wouldn't recommend jail or prison nursing for someone without at least a year or two of hands-on nursing care.

Often you are alone (MD usually only comes at certain times on certain days). The system usually works like this - prisoners fill out 'kites' which are short forms requesting care for symptoms they list on the form and these go into a box that the nurse on duty will retrieve and review.

You need to be able to have solid clinical experience because you will be triaging these kites and determining who needs to see the doc and who you can treat on your own using set protocols (minor lacerations that don't require suturing, minor burns, sprains, etc...), you'll respond to emergency situations frequently on your own (medically speaking, there will always be C.O.'s but you're the one making the medical judgement calls) and so you need at least baseline experience so you know what you're looking at and what the appropriate response is.

Taking this kind of job would be setting you up for more failure and I'd hate to see you get walked again. You need to find someplace where you can learn the ropes and how apply both your skills and clinical judgement so you can learn to feel confident in yourself and your practice. ALL nurses have made mistakes, but nursing ethics demand that you own your accountability - and you have (and that's so much more important than you may realize), you just need to find a place where you can grow.

Good luck!

Specializes in Trauma Med Surg, Telemetry, Education.

If you want to get nursing skills I would go to a medical/surgical unit, or even a rehab. Those types of units would help with basic nursing skills, intuition, and confidence building. I would suggest maybe a facility with a residency program that has you do classes and continually builds upon your knowledge and skills. I would also recommend pairing up with a mentor/preceptor that you feel comfortable talking to and asking questions.

It can be challenging in the beginning but once you do find your niche it gets better.

Specializes in ICU, ED, OR, PACU, CCH.

I'm so very sorry to hear that we as nurses have not helped you, we do tend to "eat our young", which is no excuse. I would recommend that you look at a low stress, high supervision job. I work in correctional health and you need lots of nursing experience to be an effective nurse here, also home health is very independent, and you are a new nurse needing lots of training!! Hope this helps!!

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