Terminated from 1st job :(

pedicurn, LPN, RN · Aug 11, 2010

You were not supported by your charge nurse. She/he should have made sure this risky situation was managed better.

And BTW ....Was the p't receiving any tx for her low Na? Did she have any further electrolytes?

Was there another explanation for her disorientation?

A doctor should have seen the p't at least once that shift. The p't needed a medical review

Best wishes to you

scoochy · Aug 11, 2010

CaLLaCoDe has a point re: attempting to get your job back. You need to ask yourself if you want to return to work in a facility that had no problem "throwing you to the wolves." It is difficult at best to go up against a corporation. Should you decide to speak with an attorney, I strongly urge you to bring someone with you to the appointment; you will, no doubt, be very emotional, and may not "hear" everything the attorney discusses.

silentRN · Aug 11, 2010

hopefully it's in your documentation that the pt was confused, pulled out IV so on so on, then you can possibly refute the termination. I've seen people get their jobs back before.

Gentleman_nurse, MSN · Aug 11, 2010

I used to be a shop steward. Feel bad for you. Sounds like they threw you to the wolves not because you made an errror but because your expendable as a probationary nurse. Right now I'm more concerned about your license. The problem is what do the hospital and state regulations say? If the written policy is different than the verbal instruction, they got you. Trust me I know sometimes written policies are different than what is practised. Until you are off probation, CYA. In this climate, it's easier to replace you than to work with you.

mediatix8 · Aug 11, 2010

Sorry to hear about what happened. The policy at my hospital is that we may apply it without the order if we feel it is an emergency and that it's urgent and then we have 12 hours to get the order. In these cases I always notify the night supervisor and they have always given me the ok and just to get the order in the morning. I wonder if you also have some policy like this? Your manager should have done more investigating of the situation. Did you document her being confused? She should have also spoken with other staff. I don't know... at this point is there any one you could discuss this with like a director of nursing or anyone else to inquire if there's a policy regarding applying restraints without an order in an emerency? Can you e-mail someone from that organization? Can you find out from someone there if there is a policy that lets you restrain first in an emergency? She sounded pretty darn wild and was a risk to herself by constatly removing her tele (what if something happened and her tele was off?). I mean, if she coded and no one knew right away because her rhythm was never clear or was off due to her constantly removing it then you'd have been fired then too right? What if the doc doesn't call back for 4 hours while you wait for the restraint order and meanwhile the patient has no tele and codes? There has to be some policy in place that allows initial restraints for emergencies. You were there loger than 90 days... I'd get a lawyer.

nurse_mo1986 · Aug 11, 2010

hmmmm, well call me hateful but I always try to stay short and to the point. From the managers (and daughters) point of view...YOU UNLAWFULLY RESTRAINED THE PT. Now, having said that, I've worked in ICU for several years, and I know that there's times i've had to apply restraints and then call for an order afterwards, but I'VE ALWAYS CALLED. This is a prime example of how you should protect your butt by always calling the dr.

I do feel bad that you lost your job, but geez, you cant just go around tying ppl down to the bed, this isn't nursing in the 70's, and it just isn't done.

I do hope that you find another job, and hopefully will utilize better discretion next time in your nursing practice.

CrazierThanYou · Aug 11, 2010

hmmmm, well call me hateful but I always try to stay short and to the point. From the managers (and daughters) point of view...YOU UNLAWFULLY RESTRAINED THE PT. Now, having said that, I've worked in ICU for several years, and I know that there's times i've had to apply restraints and then call for an order afterwards, but I'VE ALWAYS CALLED. This is a prime example of how you should protect your butt by always calling the dr.
I do feel bad that you lost your job, but geez, you cant just go around tying ppl down to the bed, this isn't nursing in the 70's, and it just isn't done.
I do hope that you find another job, and hopefully will utilize better discretion next time in your nursing practice.

Well, I'm just starting nursing school next week but I know that in CNA class, it was drilled into us OVER AND OVER AND OVER that we cannot use restraints EVER without a doctor's order.

But, I can totally understand why you resorted to restraining your pt.

catlvr · Aug 11, 2010

Ugh, it sounds like a nightmare shift, and we've all had them. I'm a bit disgusted that your charge nurse didn't take any of the flack for this. I agree - get an attorney review. Do you have Liability Insurance? They may be able to refer you to someone reputable. It may work out that you get your job back - and once your name is cleared, you can find a new job where there is better support.

Good luck,

e

nyteshade, BSN · Aug 11, 2010

hi all,
i have a question- how do you go about finding a new job after being terminated when you only have 9 months of experience? i have searched other postings that say not to post that you were terminated on your applications, but on most of every one that i have applied for, they ask you straight out if you have ever been terminated. here is waht happened-
i had a patient come in due to a fall. the patient had a potassium level of 2.6 and a sodium level of 116, both of which, by our hospital, are critical levels. (was the patient getting any replacements?) i had the patient the night before and she didn't sleep, and during shift report, the day nurse reported the patient was confused and had been hallucinating. (did the day nurse do something about the change in patient status? if not, would've called doc at 1900 as this could be r/t her lytes) fast forward to 0000. patient had yet to go to sleep, had been wandering around in her room and trying to come out to the nurses station, and had taken off her tele monitor multiple times. i repeatedly went in to place her back in bed and to replace her monitor, as had the pca.(patient condition is getting worst, need to call doc) i informed her each time that the monitor was so we could watch her heart rhythm with her electrolytes so low. she started complaining about wanting to move her furniture around to better suit her and saying that her "box" (tele monitor) was tying her down. finally, around 0300, she takes her iv out and has blood everywhere. we get her cleaned back up, back into bed and i place soft limb restraints on her wrists (need md order, you will have a hard time standing up without one). the freaks out when she wakes up, and once her daughter comes up there, the both holler elder abuse and i was terminated. they claimed the patient was not confused, and without talking to the other nurse or pca's they said that they had to let me go due to elder abuse and the fact that i didn't follow policy in applying restraints (yes, they are right, you didn't mean harm, but it can be looked at like abuse). of course, with that in mind, i can't appeal the termination because i didn't follow policy (restraints are a big deal, need proper orders, proper documentation, etc). but, as i explained to the manager when she fired me, i was told in orientation that the nurses never call the doctor at night unless it is critical, and only the charge nurse is suppose to call, which she didn't. (heresay never flies) also, i was told that we don't call for restraint orders because the doctors don't want to be disturbed for that, we just print out the orders and they will sign them when they come by. (you as the nurse can call the md) they told me that they would have to better instruct the nurses doing orientation, but that didn't help me. needless to say, i learned my lesson on the order policy!! (always read the actual policy, not what they tell you to do)but, it has been 2 months now, and no one will look at me i had an interview at the hospital i used to work at as an extern, but they said they were leery hiring me as a termination, and i would have to go through some different steps because of it. that was last week, and i haven't heard back. anyway, sorry for the long posting, but i am devastated that my dream to become a nurse has ended this quickly, and was wondering how to apply for jobs that ask if you have been terminated. i tried leaving it blank, but the application wouldn't send until i checked the box answering yes or no.

unfortunately this is a harsh lesson in cya. it boils down to being able to identify that the patient has a problem, and what are you legally going to do for this patient to help solve this problem.

your hospital did set you up for failure, like telling you things that contradicted standard nursing practice. however, if you ever had to face a jury, think about how silly it would sound to say, "i know, but my hospital told me to do this instead." the hospital will always be protected, because they will pull out their shiny policy paper, and prove you wrong.

be safe,

m

Flying ICU RN · Aug 11, 2010

Why this happened to you and a lesson for all.

Restraining someone is by its very nature and definition, a denial of the Constitutional civil right of freedom. There are two circumstances where this is legally provided for, one is in law enforcement, and the other is medical necessity, hence the requirement of a physician’s order.

Where Nurses get into trouble here is in the “interpretation” of medical necessity. Hospital policies often take into account the fact that a physician may not be immediately available, and allow for nurses to implement restraints in those circumstances where “immediate and grave harm” may come to the patient and or others. This is usually in either an ICU or interventional crisis setting.

Often time’s difficult patients (such as this one), interfere with the efficacy of their own treatment plan by simply being stubborn, non-compliant, ignorant, or any combination thereof. However, that in and of itself, does not constitute the standard of “self harm”, despite the pulling out of an IV, and removal of cardiac leads. Always ask yourself this question, would the layman (man on the street or juror) be able to clearly see and concur with the decision to restrain. This is the “Prudent Nurse Standard.”

Faced with situations such as this one, you implement interventions to the maximum ability of your clinical privileges, with supporting documentation of patient education, and involvement of superiors, (CN, Supervisor, and MD et al).

Finally, faced with a situation where termination is a certainty, ask for the consideration of a resignation effective immediately, as Nurses have a hard time justifying unemployment compensation, and you can still use the employer in your history.

Esme12, ASN, BSN, RN · Aug 11, 2010

I am so sorry this happened to you............first lesson. Even though they "don't bother the docs at night for restraints" if it isn't written not to call at night you have to follow policy or calling the MD. The hospital will never stand behind you and you have fallen in to the abyss of using the nurse and a scape goat. I do not know if talking to a lawyer will do because you did not technically follow policy. That vague "dicsinplinary actio up to and including termination" is code for......I get to make the rules. Just curious......did anyone replace her Na? That is in the seizure,coma,death zone. Confusion is highly likely with a Na that low. On an application I would check both of them and explain in the interview that you did not leave on good terms. I am so sorry.....I always have told nurses.......you can get fired and sued for not calling the doctor.......so call them! So what they yell...big deal.....get fired for calling the doctor and being fired because you woke him up is grounds for wrongful termination. I have also in the past notified familes even in the middle of the night and asked them if they wanted to come in and sit with their loved one because they were going to get hurt and that we may need to place a gentle reminder on the patients wrist to keep them safe......good luck! I think you made a good decision to make her safe. Be careful of hospital policies they will in you in the butt quickly.

Esme12, ASN, BSN, RN · Aug 11, 2010

Why this happened to you and a lesson for all.
Restraining someone is by its very nature and definition, a denial of the Constitutional civil right of freedom. There are two circumstances where this is legally provided for, one is in law enforcement, and the other is medical necessity, hence the requirement of a physician's order.
Where Nurses get into trouble here is in the "interpretation" of medical necessity. Hospital policies often take into account the fact that a physician may not be immediately available, and allow for nurses to implement restraints in those circumstances where "immediate and grave harm" may come to the patient and or others. This is usually in either an ICU or interventional crisis setting.
Often time's difficult patients (such as this one), interfere with the efficacy of their own treatment plan by simply being stubborn, non-compliant, ignorant, or any combination thereof. However, that in and of itself, does not constitute the standard of "self harm", despite the pulling out of an IV, and removal of cardiac leads. Always ask yourself this question, would the layman (man on the street or juror) be able to clearly see and concur with the decision to restrain. This is the "Prudent Nurse Standard."
Faced with situations such as this one, you implement interventions to the maximum ability of your clinical privileges, with supporting documentation of patient education, and involvement of superiors, (CN, Supervisor, and MD et al).
Finally, faced with a situation where termination is a certainty, ask for the consideration of a resignation effective immediately, as Nurses have a hard time justifying unemployment compensation, and you can still use the employer in your history.

WELL SAID!