Very concerned

[ButterflyRN90]

I'm going to make this as clear as possible . I work nights at a hospital on a tele floor. I'm currently on orientation and am towards the end of it. So, one night I had a pt who was in ARF, dialysis, and a Type 2 DM. So the pt BG drops to 44mg/dL and when asked states "I don't feel so well". I run in there to give OJ to which pt states "I don't want anymore ". Protocol is 50u of D50 if unable to give PO. So I gave 50u D50W. Pt shot up to above 200. I offered milk and pt refused (was also ineffectively coughing/ had fluid in lungs). Offered graham crackers (refused). After the elevated BG I administered the Levemir that was scheduled. 10 units of levemir which has no peak. Anywho out of my 4 pts I rounded on this pt the most because they had fluids and labs that I did. Pt had no BG checks during night (we don't do them). Every time I rounded I asked how pt was feeling (pt is aaox3). My last round was during lab draw around 0545. Pt actually told me "thank you for your help" and when asked if she was in pain (pain assessment) or if she felt weak/off (BG) pt stated "no I'm good, just want to get some sleep."

Gave report to day nurse who sees pt asleep and goes and continues getting report from other nurses. I was now giving report to other nurse and to finish charting.

1.5 hours after handing report to day nurse, preceptor runs to me stating "pt has a BG of 14! I run in and pt is non-responsive. Day charge nurse was pushing 2 amps D50 when I wheeled computer. When I mentioned pt only had LEVEMIR given preceptor yelled "WHY WOULD YOU GIVE THAT WITH A 200mg/dL BG!?" I'm a T1DM so it wasn't that I have a med I knew nothing about. So I told preceptor "but why wouldn't I?" She gave me a look of hatred as Rapid Response was called. Pt taken to ICU.

I sat at the nurse's station in tears. I'm being looked at as the one who did this even though my pt was aaox3 BEFORE report and pt wasn't checked after I gave report. I'm freaking out. They're investigating and pt is ok. What would normally happen? Would I lose my license or job? I'm really freaking out to where I have chest pain.

[Crush]

Really sorry to hear you were fired. Hope your appeal works for you. I am glad the patient was ok. I agree with Ddestiny, in be very careful in your wording. Best wishes.

[beekee]

And, how do you know about the patient's outcome? Is there a HIPAA violation in there? If so, don't make it easy for them to find an alternative reason to fire you.

[Triddin]

I really dislike the punitive you made a mistake and now are fired culture. How are you supposed to grow and learn from your mistakes? And usually a mistake is a result of several failures before it actually occurs.

However, from your posts, i feel I'm not seeing any reflection on your part or accepting that the mistake is ultimately yours. That is always a red flag; for your appeal, be humble. Recognize what YOU did wrong and how YOU will change in the future to prevent another occurrence.

Best of luck

[Lisacar130]

Man, forget this place. You did make a new grad error but it should have been caught by your preceptor. Maybe it wasn't because the staffing is unsafe and she couldn't handle it. I bet she wasn't very approachable either. Just a guess.

Next time, you call the endocrinologist and expect orders to either hold the lantus or give a lower dose. If no endocrinologist, you call the primary MD. Also, most hospitals have a hypoglycemic policy to check the blood sugars again (15 min, 1 hour, another 1 hour) after a low reading. See, all the things your preceptor should have talked to you about.

You just had a bad experience with a bad preceptor and/or bad hospital. Don't worry about your name there. Let them forget your name and move on to somewhere else. For the record I don't think this appeal is going to go anywhere as I haven't seen this work before. I wish you luck in it but you need to come to a place where you don't need an external entity deciding how you feel about yourself. It'll be easier to move on in a healthy way somewhere else.

[ButterflyRN90, ASN, RN]

I'm doing the appeal because I also need my name cleared. When a facility calls a previous employer one question they may ask is: Would you hire them again? Until my name is cleared it will be "no". My mother had to file an appeal years ago when she also worked at this facility and had it approved, however she chose to stick with her new job at that point. To the others telling me to word my appeal differently: Until you are in my position where you are the orientee being thrown under the bus, bullied, and ultimately have your job taken away, I'd back off. This is an extremely difficult and emotionally charged situation. No, HIPAA wasn't violated by telling me she went home. If that was the case then everyone would be violating HIPAA daily. To the other posters stating they don't see where i "owned up to it", I already did, I already punished myself, I already had the consequence handed to me so I'm fighting back. I notice quite a few of you (definitely not all of you) are quite pleased with having your thoughts heard about the update.

I updated because one poster thanked me for the last update and I felt that updates allow future readers to see how a similar situation could be handled. However, I am not a digital (because this is online) punching bag for anyone to continue stating: "you didn't do x,y,z" or "I'm not surprised that a,b,c happened". Some of you wonderful people supported me through this and I am truly grateful, the others? Please treat new nurses with kindness. You were once in our shoes.

[Ddestiny, BSN, RN]

To the others telling me to word my appeal differently: Until you are in my position where you are the orientee being thrown under the bus, bullied, and ultimately have your job taken away, I'd back off. This is an extremely difficult and emotionally charged situation.

It is emotionally charged....and letting your emotions get the best of you is NOT going to be in your best interest.

How can you expect the review committee to think better of you if you suggest that you made no error? That is what you do when you eschew accountability and put it all off on your preceptor -- you're saying you didn't make an error. But you did.

She may screw you over in her statement, but that has no barring on what you need to say. Let her hang herself. You can do better.

Make a bland, neutral, fact-base statement, just like any other nursing note, so they the committee can view it objectively.

My expression of this is not to "use you as a punching bag". Do you not see the concern? It's up to you to do what you want with this, but if I just wanted to throw you around I wouldn't have spoken of my own similar experience and indicated that all details are available on this very forum. I have nothing to gain but to know that I attempted to help someone that's been in a similar situation. Consider that.

[Horseshoe, BSN, RN]

I think firing you was overly punitive. Nowadays, it seems as if it's either "X happened, so quit!" or "X happened, so fire him!" No willingness to work towards solutions.

I find that very unfortunate.

I agree that in your appeal, do not go in overly emotional and do not present the appearance of taking no responsibility. However, it should be made clear that you were in orientation and depended upon the supervision and teaching of your preceptors.

SMH about the whole damn thing...

[kalycat, BSN, RN]

I'm sorry to hear this. I've worked at facilities that had fatigue guidelines before - but they seem to be few and far between. Unless her work hours were in direct violation of policy, I personally would avoid that topic in your appeal. Management may have even asked this preceptor to work different/extra days/shifts so that you would have consistency in orientation with a primary preceptor and to expedite the process of getting you on your own; you may not have the whole story. I know it seems cruel to say this, but to clear your name it is going to be critically important that you focus on *your* actions and your subsequent reflection. You could possibly work in contributing "system" factors that you thought about as contributors during your reflection on the incident, but even that is risky. Anything that will be perceived as you being on the defensive or not owning up to your role will cause them to rule against you. They don't have a lot of motivation to rule in your favor, from a purely strategic business standpoint.

For what it's worth, it seems your preceptor was ill suited to her role at best, and possibly completely out of touch with modern nursing practice at worst. But you have to focus on you - be humble, contrite and reiterate how seriously you took this and how it has changed your practice.

Punitive culture like this should be a thing of the past. This is the ethical equivalent of putting sugar in OJ for hypoglycemia, so maybe this facility's culture is just *that* out of whack. No matter the outcome I do wish you well. Not trying to add insult to injury in any way, but trying to give you some tools to change the overarching outcome. I wish you well.

[Lisacar130]

OK you weren't there very long, I assume, if you were still on orientation. I would leave it off my resume if it were me (name cleared or not). Leaving a job while on orientation is also a red flag to a new employer (as is getting a nonrehireable).

I know that's another thread all together and there are people who always list every job no matter what. Maybe you will still choose to include it and that is totally up to you. But I think you would have an easier time getting a new job as a clean slate (a new grad with no experience). I'm sure you could still find something either way, it just might be harder and might take more time. I also hope you can find something that has more reasonable staffing and these might be the more choosier employers.

More than likely no matter what you do...you will sooner or later find a new place to work that you love and will be glad this worked out the way it did, believe it or not! I know you're bummed out right now but it will eventually work out for the best. This experience will help you in your career, too. One day you will be someone's preceptor and you'll be awesome at it because of this.

[NormaSaline]

the others? Please treat new nurses with kindness. You were once in our shoes.

It's not just new nurses who make mistakes!

[NormaSaline]

Someone at my facility added some sugar packets to oj today to bring up BG. Why is this not indicated?

Second, I wish someone could answer my earlier question about getting to the root cause of the lability. Why was her sugar uncontrollable?

[ButterflyRN90, ASN, RN]

We wouldn't know that because she was transferred to ICU. They don't share that info to nurses not involved in her care. They basically gave me a paper that describes the incident which not everything was true, sign the form and walk away. That's why I'm appealing. This "just culture" movement is a farce tbh. Only thing I knew was that the patient had gone home weeks ago while I was becoming the second victim. That doesn't mean I don't feel culpable, however I'm going up the chain of command because this is fishy.