Termination, reflection, and moving forward

[TrixieRN1]

As a relatively new RN, I moved from Med-Surg (20 months exp) in one facility to an ED position in another for 5 months before being terminated from my position. Before obtaining my ADN, I worked as an LPN for five years in an outpatient clinical setting. Prior to my most recent job in the ED, I had never been reprimanded or written up. I've always received good job evaluations, including the ED job that I just left. In the short time that I worked in the ED, I received written accolades from patients' families and the hospital as to the exceptional care that I'd given patients. I love patient care and being terminated has been challenging in many respects. It has, however, provided me time for reflection on what occurred. Reflection is good. Rumination, on the other hand, is not. I have decided to move forward from reflection and would like to share some history of what occurred, as well as some of what I've learned.

I made two errors during my 10-week orientation in the ED: 1) a dosage med error that I realized immediately after the fact and self-reported (thankfully no harm occurred to the patient); and 2) I did not de-glove, perform hand hygiene, and re-glove when moving from one procedure to another on the same patient. To reduce the risk of repeating these errors, I did the following: 1) I always circled name, age, acct no., medication name and dosage on the printed order and took a copy of the order to bedside with me to compare with patient's armband and verbally confirm with patient or family member; and 2) I slowed down when performing procedures on patients to give me ample time to think things through because I was new to the ED setting. I did not repeat my mistakes during the remainder of my five month employment.

Shortly after completion of my 10-week orientation, I received a "Final Written Warning" because I used an otoscope to look in a patient's ear. The warning stated that I did not have the delegated authority to examine patients' ears unsupervised by an APRN or MD. I did not use an otoscope again.

A couple of months after the written warning I was terminated for ambulating a patient wearing a "high fall risk" armband rather than transporting the patient in a wheelchair. My patient did not suffer any harm as a result of me ambulating him to a nearby department. There was no written hospital policy stating that a high fall risk patient could only be transported by wheelchair. When I pointed this out during my exit interview I was told that I had not utilized critical thinking skills in ambulating my patient, even though I performed a neuro assessment and said patient was AAO and steady on his feet. I was one of four nurses to leave the ED in approximately six weeks - three terminations and one resignation. The other nurses who left employment had from two to several years of experience.

Allow me to share some of the things that I've learned as a result of this painful journey. One, in spite of preceptors telling you to go faster, remember that speed will come with time. Be in the moment with your patient. Two, pay attention to the white flags. From the get-go of entering the department I overheard numerous co-workers complain about mismanagement of the department and employees were fired "at the drop of a hat." I remember asking one of my preceptors, "How do you learn who you can trust here?" To which she replied, "Trust no one." There were other white flags that I choose not to mention. I chose to push on because I wanted to remain positive and do well in my job. Three, speak up for yourself. I had seven preceptors during my 10-week orientation, sometimes switching from day to night shift during the same week and suffering from a disrupted sleep schedule. I also switched back and forth between the main and fast track sides of the department during the same week, each with its own set of protocols. I should have said something to my educator about this during orientation because it affected continuity of flow in my training. Fourth, start searching for another job if you receive a final written warning. I told myself that I could succeed in my job in spite of the fact that I received a final written warning. I have a Type A personality and strive to grow/excel in whatever I do. I didn't want to give up on myself or my job. In hindsight, I should have started the job search when I received the final written warning. Fifth, don't assume that what was accepted practice at your prior places of employment is acceptable in any way, shape or form at your new place of employment. When I worked Med-Surg at a Magnet hospital, it was acceptable for staff to ambulate a high fall risk patient after properly assessing the patient and determining it safe to do so. Learn your facility's written and unwritten policies. Anyone with advice on how to learn the unwritten policies?

After taking time to reflect on my recent termination of employment, I feel I'm ready to move forward with my job search. My resume will not mention job termination. However, many online job applications do ask if one has ever been terminated from a job. I will answer affirmatively to said question. I would value input from anyone who has dealt with the termination issue, particularly in online job applications and interviews.

Though a lengthy post, I hope that what I've shared will be helpful to others. I haven't posted here in quite some time, but have enjoyed reading and learning from other's posts.

[OCNRN63, RN]

The first two errors were things you needed to correct; the second two? Bogus.

I've looked in ears and down throats for years without harming anyone. As for ambulating a high fall risk patient, I'm a high fall risk and when I had surgery several months ago I was allowed to walk with supervision.

Yes, you made mistakes, but I think your termination had more to do about them than you.I am glad you feel ready to move on and hope you find a job that works out better for you.

[canoehead, BSN, RN]

I would have been fired a lot faster than you were. Chin up. In some hospitals, being fired is a sign of competency, and not thinking like a herd of sheep.

[Ruas61, BSN, RN]

It sounds like it may ultimately be for the best for you to move on, the place sounds screwy. Good luck!

[lmccrn62, MSN, RN]

I am sorry, we all make mistakes. I am not sure anything you did required written warning or termination other than the medication error. All I can say is move on its not worth your time or energy. It seems this place would have been miserable to work for.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Who gets written up during an orientation period! Seems to me that whoever was assigned to train you was really doing a bang-up job. Your performance during that time is supposed to be overseen by your preceptors. That's why they are chosen as preceptors...to show you the ropes until you are deemed competent to go at it alone, in need of more orientation, or determined to not be a good fit because you are just not getting the hang of things. If you are deemed competent to go at it alone and screw up afterwards, then I could see the progressive disciplinary measures. That's how it's been in my many years of nursing.

At my job, barring an utter lack of responsibility and a total disregard of policies and procedures, mistakes are viewed as learning and investigative issues in order to determine how the error happened so that measures can be implemented to ensure that the risk of a repeat incident is minimized or alleviated. It is not to point the finger.

Also, the purpose of identifying persons as a high fall risk is so that there is a staff member accompanying them during ambulation to ensure their safety. The only way that you should have been cautioned against ambulating the patient is if the physician wanted that patient on bedrest.

By the way, unwritten policies are not policies.....they are hearsay that guarantees a one-way ticket to the front door. All the above being said, I think this place actually did you a favor by terminating you. I could actually see them going after your license one day, should you have remained.

[gigglestarsRN]

As a relatively new RN, I moved from Med-Surg (20 months exp) in one facility to an ED position in another for 5 months before being terminated from my position. Before obtaining my ADN, I worked as an LPN for five years in an outpatient clinical setting. Prior to my most recent job in the ED, I had never been reprimanded or written up. I've always received good job evaluations, including the ED job that I just left. In the short time that I worked in the ED, I received written accolades from patients' families and the hospital as to the exceptional care that I'd given patients. I love patient care and being terminated has been challenging in many respects. It has, however, provided me time for reflection on what occurred. Reflection is good. Rumination, on the other hand, is not. I have decided to move forward from reflection and would like to share some history of what occurred, as well as some of what I've learned.

I made two errors during my 10-week orientation in the ED: 1) a dosage med error that I realized immediately after the fact and self-reported (thankfully no harm occurred to the patient); and 2) I did not de-glove, perform hand hygiene, and re-glove when moving from one procedure to another on the same patient. To reduce the risk of repeating these errors, I did the following: 1) I always circled name, age, acct no., medication name and dosage on the printed order and took a copy of the order to bedside with me to compare with patient's armband and verbally confirm with patient or family member; and 2) I slowed down when performing procedures on patients to give me ample time to think things through because I was new to the ED setting. I did not repeat my mistakes during the remainder of my five month employment.

Shortly after completion of my 10-week orientation, I received a "Final Written Warning" because I used an otoscope to look in a patient's ear. The warning stated that I did not have the delegated authority to examine patients' ears unsupervised by an APRN or MD. I did not use an otoscope again.

A couple of months after the written warning I was terminated for ambulating a patient wearing a "high fall risk" armband rather than transporting the patient in a wheelchair. My patient did not suffer any harm as a result of me ambulating him to a nearby department. There was no written hospital policy stating that a high fall risk patient could only be transported by wheelchair. When I pointed this out during my exit interview I was told that I had not utilized critical thinking skills in ambulating my patient, even though I performed a neuro assessment and said patient was AAO and steady on his feet. I was one of four nurses to leave the ED in approximately six weeks - three terminations and one resignation. The other nurses who left employment had from two to several years of experience.

Allow me to share some of the things that I've learned as a result of this painful journey. One, in spite of preceptors telling you to go faster, remember that speed will come with time. Be in the moment with your patient. Two, pay attention to the white flags. From the get-go of entering the department I overheard numerous co-workers complain about mismanagement of the department and employees were fired "at the drop of a hat." I remember asking one of my preceptors, "How do you learn who you can trust here?" To which she replied, "Trust no one." There were other white flags that I choose not to mention. I chose to push on because I wanted to remain positive and do well in my job. Three, speak up for yourself. I had seven preceptors during my 10-week orientation, sometimes switching from day to night shift during the same week and suffering from a disrupted sleep schedule. I also switched back and forth between the main and fast track sides of the department during the same week, each with its own set of protocols. I should have said something to my educator about this during orientation because it affected continuity of flow in my training. Fourth, start searching for another job if you receive a final written warning. I told myself that I could succeed in my job in spite of the fact that I received a final written warning. I have a Type A personality and strive to grow/excel in whatever I do. I didn't want to give up on myself or my job. In hindsight, I should have started the job search when I received the final written warning. Fifth, don't assume that what was accepted practice at your prior places of employment is acceptable in any way, shape or form at your new place of employment. When I worked Med-Surg at a Magnet hospital, it was acceptable for staff to ambulate a high fall risk patient after properly assessing the patient and determining it safe to do so. Learn your facility's written and unwritten policies. Anyone with advice on how to learn the unwritten policies?

After taking time to reflect on my recent termination of employment, I feel I'm ready to move forward with my job search. My resume will not mention job termination. However, many online job applications do ask if one has ever been terminated from a job. I will answer affirmatively to said question. I would value input from anyone who has dealt with the termination issue, particularly in online job applications and interviews.

Though a lengthy post, I hope that what I've shared will be helpful to others. I haven't posted here in quite some time, but have enjoyed reading and learning from other's posts.

TrixieRN1, I could have written your post 6 months ago. I was a new grad in an ER That sounds hauntingly familiar to your description. I felt unfairly singled out and had many strange run ins with the management. I started to doubt my memory, my competency, my future as a nurse. There were sooo many flags, too many to count. Like you, I thought I would learn adaptive strategies and forge ahead and gain respect. I ended up resigning 6 months in. It was the best decision I made. I had a new job 3 weeks later and I couldn't be happier. I learned a lot in that first job, but know it would have ended badly were I to stay. Keep your chin up and know that even tho it's hard being terminated, no place is worth that kind of misery and poor treatment.

[PeepnBiscuitsRN]

The otoscope thing sounds just silly. When I was an LPN I looked in ears and in throats and noses with an otoscope! The NP I worked under expected me to take the initiative and do those things. As for ambulating high fall risk patients? Happens every time at work when we get those new moms out of bed after a section!

My orientation in cardiac a couple of years ago (I don't work there anymore) was a lot like yours. I had a different preceptor all the time, I was supposed to work nights, but they had me orient on days, and then KABOOM, night shift. First night shift, my preceptor was very nice. Very patient. Second night- my preceptor floated to a totally different unit- so I floated with her and then the whole "hey you're supposed to be sleeping right now, it's 1:30am thing kicked in". Later, out of the blue, I got chewed out by my educator- apparently my preceptors couldn't tell me I sucked, but they could tell her to tell me. And she sure did.

I hope things work out better for you!

[GaRN1952]

I am proud of your positive attitude about what must have been a terrible experience. Keeping your chin up and moving on is something that happens sometimes more than once in a nursing career. I have been a nurse for over thirty years and have seen some of the best and worst places of employment. You have to be brave enough to walk away from the bad, even if the job seemed ideal at first. In my area, there is a shortage of bedside nurses and I have taken advantage of that. I went from administrative work, which is grueling, to bedside, which is physically hard, but more rewarding and ultimately less stressful. If you find petty tyrants in leadership, run, do not walk, to the exit!

[kbrn2002, ADN, RN]

I am so sorry. It sounds like a place you are better off without. Mistakes during orientation are generally educated on and a correction plan put in place, not cause for a write up. Receiving a final written warning just off orientation is not only wrong but just seems really extreme. To play Devils Advocate, just wondering why ambulating a patient would be the reason for termination...all I could come up with is if it was decided you were ambulating that patient without proper safety measures. Was the distance to the other department too long for safe ambulation if the pt was deemed "high fall risk'? Did you use a gait belt? Did you bring a wheelchair along behind the patient in case he needed to stop [preferably with somebody else pushing it]? I hope I don't sound like I believe you did anything wrong, I am just genuinely curious how they could come up with using that as an excuse to fire you since you assessed the patient prior to ambulation.

[schnookimz]

Can a nurse really not look in a patient's ear???

[TrixieRN1]

kbrn2002, I have no problem with you playing Devil's Advocate. After assessing the pt, I walked him from his exam room next to the nurses' station, past four exam rooms, past one restroom, and to the dept right next door which was a short distance. A gait belt and wheelchair were not necessary for this pt. I walked him to the next dept because no tech was available at that time. I would not have ambulated the pt if I felt it was unsafe for either of us. After ambulating the pt to a nearby dept a co-worker in that dept informed me that high fall risk pts must be transported by wheelchair. I confirmed with an RN in my dept that this was true. Apparently it's an "unwritten policy" that I was not notified of until the time I ambulated this pt. Though no written policy states that a high fall risk pt must travel by wheelchair, which I pointed out in my exit interview the following day, I was told that I did not use good critical thinking skills by ambulating the pt and was therefore terminated from my position. As an aside, one of my co-workers was terminated shortly before me for entering a pt's weight incorrectly (after she had previously received a final written warning). On a more positive note, I did grow as a nurse while I worked at the aforementioned facility and look forward to finding a nursing job in which I will continue to grow. Most importantly, I want to get back to taking care of patients, for that is what I sorely miss right now.