Terminated and need advice

[wecan11]

Hi Friends,

I need some advice. I am very frustrated, confused and feel like a scapegoat. I am a new nurse, graduated in last yr. w/ LPN cert. I was recently term'd from a LTC facility for not having a Dr's order for insulin transcribed/copied over from the previous months orders. Another nurse had anonymously DC'd the previous months routine insulin orders due to a change in the PM insulin amount (nothing to do with her HS insulin) and she failed to copy over the bedtime insulin order. There are several other places that the bedtime insulin is recorded in the treatment book and these were not DC'd. The res. did not have a DC order in the computer or in her file hardcopy. I continued to give res. the HS insulin without the order written. Other nurses also gave the HS insulin without having it handwritten in the TAR. I feel like the TAR pages had been tampered with. There were quite a few changes to it. Are you not suppose to have some level of trust with your fellow nurses. There's too little communication. Med. changes happen and you don't always hear about it. Stuff just gets "thrown over the fence" for you to pick up the pieces. I would appreciate any advice from veteran nurses. I worked my ass off to get thru school & NCLEX. I feel like I was scapegoated/setup.

Thanks.

[SuesquatchRN, BSN, RN]

I'm a little confused about what happened but I'm sorry you lost your job.

Hugs.

[Rodoon, BSN, MSN, RN]

I'm confused too. Perhaps you can review your post when you're not so upset? I'm also sorry you lost your job as well. and hope things look up for you.

[DixieRedHead, ASN, RN]

Yes, it gets confusing. I was with you up to the point where you started talking about the TAR and treatment book. In the nomenclature at my facility these are related to "treatments" not meds so I am confused.

At any rate, med changes DO happen and no you don't always hear about them, that's why they are written down. Do you have someone who checks the medication administration records against the written orders? Third shift does this at our facility.

The carbons of the MD orders are left for the nurses to review for 24 hrs. At the end of the day we are all responsible for the medications that we give.

Have you had other med errors? It's hard to tamper with a medication record. And as for the trust thing........................you should be able to, but it's rarely put into practice when the deal goes south.

[turnforthenurse, MSN, NP]

I'm confused too, and I wish I could help. I'm so sorry this happened to you.

[jhanes]

It is not unusual for a SNF to terminate a nurse for a single med error. Doing so makes their QA and Safety programs appear more robust for State SNF Surveyors, but at the price of increased recruitment and retention costs when the fired nurse has to be replaced, the new nurse opriented and so on, while at the same time, existing nurses are kept wondering if they might "be next."

None of that tension results in a very desirable employment situation.

My advice? Look for a job at a facility where the Nursing Staff is supported, rather than scapegoated, and where the QA Program is not centered on the blame-game, but rather on unsafe practices, proper documentation, coordination provision of quality care which benefits everyone, rather than the Administrative witch hunt and blame-the-nurses agenda at the facility you were at.

[mazy]

I'm confused also. Why are the insulin orders in the TAR?

[caliotter3]

It is not unusual for one nurse to get fired over off the wall procedures that have been going on for a long time. But they won't fire everyone involved at the same time, only the one nurse. Sorry this happened to you. Just be aware for your next job so that you can make appropriate plans should you find similar circumstances. Good luck getting a new job.

[CoffeeRTC, BSN, RN]

Since this was a med, why wasn't it on the MAR? Was it on the MAR and you gave it? Or was it given and not on the MAR? (how do they prove that aside from low blood sugars or resident report) Was there an order in the chart...what does that say?

Was this your only med error or discipline? In my area..you have to kill someone to get fired!

Sorry you are going thru this.

[makes needs known]

I know what you are talking about, tx written in the medex and meds written in the tx book. Too many people making too many changes and things not getting checked to make sure they are correct and match. The first of the month comes around and then the stuff hits the fan. And the charge nurse passing the meds based on all the changes that were made and not transcribed correctly. This is a crazy and dangerous system for patients and staff. I am sorry you lost your job, but I also think that it must have been a very fustrating place to work and now things will get better for you.

[wecan11]

Since this was a med, why wasn't it on the MAR? Was it on the MAR and you gave it? Or was it given and not on the MAR? (how do they prove that aside from low blood sugars or resident report) Was there an order in the chart...what does that say?

Was this your only med error or discipline? In my area..you have to kill someone to get fired!

Sorry you are going thru this.

They put Insulin orders on the tx. administration record. where you note the time given, BS value, O2 value. They also include Insulin orders on the MAR just noting when it was given. The bedtime insulin order was not copied over by 3rd shift nurse from Sept. to Oct. and I didn't catch it and subsequently gave the HS insulin. There was no DC order of HS insulin.

Thanks for your concern..

[mazy]

They put Insulin orders on the tx. administration record. where you note the time given, BS value, O2 value. They also include Insulin orders on the MAR just noting when it was given. The bedtime insulin order was not copied over by 3rd shift nurse from Sept. to Oct. and I didn't catch it and subsequently gave the HS insulin. There was no DC order of HS insulin.

Thanks for your concern..

Oh good grief. That sounds like an absolutely impossible situation to navigate. I think you are lucky to be out of there. Sorry it ended badly for you, but I think you actually got the good end of that bargain. Hope you have better luck with your next job! At least you know what to look for.