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.
