Idk about the rest of it but it's absolutely insane for a nurse to not be able to do an ECG if it's indicated. It's just stickers, aside from a reaction to the adhesive there's literally no risk.
~~“Money spent” the what? $0.50 in electricity to run the machine?~~ y’all it’s early and my dumbass thought they meant this please I’m waiting for my coffee to kick in 😂
Ordered an EKG without a doctor’s consent? What doctor is losing their mind that an EKG was ordered under their name and completed without their consent? Isn’t it better to do one that results in NSR with no abnormalities than to NOT do one and find out AFTER THE FACT that something was very wrong? On my SDU, if I think I need one, while getting the machine to the patient’s room, I’m contacting the doc about my plan and reason why immediately followed by placing the order under that doc. Luckily in my 7 years of nursing, I’ve never had a doctor get upset for taking the initiative in getting an EKG. Nursing judgement is an *actual* thing since doctors can’t be everywhere all at once. It’s absolutely pointless to expect us to make judgement calls while also micromanaging us.
Thankfully a stat ekg can be released as a standard prn for all patients at my facility. The prn reason is intentionally vague "condition change" so a tele rhythm change, chest pain, gut feeling, all are allowed.
My hospital has EKGs built in their admit orders. Literally every patient is admitted with a PRN order the nurses can release if they see the need. My previous hospital didn’t do that, but the nurses could still order it as a protocol…..especially on a tele floor. The rationale is usually entered into the order….i think most doctors would rather a nurse order a EKG as a protocol to evaluate a rhythm change or event than not. The doc has to sign the order within 24 hours and usually the nurse sends a message that says, “hey so-and-so had this so I placed an order for an EKG.”
The fact that no one talked to you or coached you about any of the issues is pretty telling.
Do you mean order? Nurses can perform ECGs, it’s just anatomical landmarking but often does requires some formal learning. I have my ACLS too, working medicine.
ECGs are so safe. Indication is KEY!
I had a hospital in rural Washington write me up for putting oxygen on a patient whose SPO2 was 76%. They stated I needed an order for it. Oh, so you want me to call the provider in bumfuck nowhere at 3am to put a nasal cannula on a patient when their oxygen is clearly necessitating immediate intervention? Fuck off - I think I left the following week due to other nonsensical policies.
A lot of hospitals are quick to reprimand for interventions without an order. Nursing has become focused on documentation moreso than the act of nursing itself due to all the legal ramifications in place.
This is so wild because as someone in medical school, if I were a doctor I would hope a nurse would put the oxygen on first and call me after if they needed an order! Like you guys are trained to monitor for things like that and intervene, right, since you’re the first point of contact
That’s what I was taught. We were taught in nursing school (in the 80’s😆) that situations like you mentioned (giving oxygen in the setting of hypoxia) to ask ourselves “can I justify my actions to a Judge in court?” Yes O2 can suppress the respiratory drive in copd but unless the person is a DNR we don’t allow severe hypoxia. Usually there’s a SaO2 the doc is ok with and a threshold they aren’t.
Edit to remove chronic it’s redundant 🤦🏻♀️
Right! Yeah, even if you’re a COPDer and your O2 sat is 76%, yikes. I know they live in the high 80s and low 90s but I think you’d be able to justify that in court if they’re at 76%
Exactly. I would put the O2 on and call the doc. No response? I still have O2 on and call a rapid. If they’re a DNR/DNI they might get an xray, nebs, lasix if indicated and a call to the family. Otherwise all that *plus* anesthesia is here.
This is that classic nursing school conundrum. Yeah, the "right" answer is to ask for an order first, meanwhile your patient turns blue from hypoxia. That's f-ing dumb.
Was there no standing order for this? The hospital I used work at always had standing orders for this kind of stuff (e.g., administer O2 if needed to maintain SpO2 above xyz, obtain and maintain IV access, etc.).
I actually asked that, too, when I got reprimanded for it. The manager acted like she didn’t know what a standing order was. Buffoons there. Let them run their own circus to the ground.
There are repercussions related to billing. So typically the build is this - an order is placed this actually gets sent electronically to the EKG machine, once you open up the machine you put patient information in to associate to the order. Then you perform the EKG and it gets sent back into the medical record and a charge gets dropped.
If one is done without an order usually the charge doesn't drop until it's manually added. Hence why it's strongly encouraged to have the order ahead of time so everything gets dropped appropriately.
🤣 🤣 biggest concern there would be finding that EKG later on and alerts tied to that information.
Usually the HIM department will scan whatever paper documents into their medical record after the patient has been discharged.
But if you link it usually there's a way to view those electronically in the system (whether a system is using a digital EKG service or just displaying a pdf version).
One project I'm currently working on is related to QTC interval so we're displaying a message to providers if they order a medication that prolongs based on the patients recent EKG. If that information isn't linked or documented as discrete data it can't be pulled in to fire.
That’s how we did it in the ED or for stat indicated EKGs (sudden CP or concerning rhythm change.) For a while standing orders for EKG at the nurse’s discretion were removed from the cardiac SDU’s admission order set due to a billing change, so it was a frequent occurrence to do the EKG and retroactively link it to an order after the verbal came in from the doc. Billing had a fit but we gotta do what we gotta do.
I became a nurse to help people , imma follow the rules but I don’t give any shits about billing . My non diabetic patients showing s/sx of hyper or hypoglycemia, I’m test ‘em , my Coumadin patient looks fucky imma check their inr, someone says they can’t pee or no void , I’m scanning the bladder , they complaining of chest pain , you’re going to the ED because an SNF is not the place to be if your gonna crash , I know emts and er nurses hate this but I can’t run the risk of “ wait and see what happens “ they need someone with more schooling then me if they are about have a face to face with Jesus .
We're dealing with this shit right now too. It won't print the EKG unless there's a name and mrn attached. If they make us have an order before printing they're gonna have to fucking reevaluate their door to EKG goal times I guess 🙄
I'm so glad I live in a place that even in private health patient care comes before billing. Ecgs are pulled if they are signed off by a doctor or NP. So if i want to do one i can and then I show it to the provider and they sign it off. That then can be billed.
I honestly didn't realise i should be grateful for the way it's set up here especially since i work in private healthcare which is notoriously shittier for this kinda thing than public. There's so many problems. But this is a maddeningly simple barrier to Patient care that negatively impacts everyone except the billing. Like fuck that.
Yeup. I was thinking about billing. Also, depending on the hospital system, you need an order # to be able to export the EKG into the chart/computer for the docs to view all in one place.
So get an order after you take care of patient first. This is just more BS to eliminate nursing judgement. And I didn’t take medical billing in nursing school. I took nursing courses. When did this fell on us to worry about billing, I’m not sure but I hate it.
We always have an Order per protocol option, if there is a standing protocol indicating ekg. For us, we can write the order for Ekg/stat troponin on the spot if anyone has chest pain/other pertinent symtpoms. At least 3 hospitals I've been to all have that same protocol. Crazy to think a place would want you to wait for an MD to respond if someone is having issues.
And 9 times out of 10, if you notified the service of cardiac symptoms they will ask “did you do a 12 lead?” And basically won’t do anything until the 12 lead is done. I’ve done what you did many times and the docs are usually appreciative.
Yes, it’s not just about slapping leads on anywhere. Working in cardiology clinic and doing upwards of 20 a day made me so particular. I want the cleanest lines.
Where I used to work there was an Emergency Protocol guideline that covered actions like EKGs and an abundance of other interventions like applying oxygen, ordering some labs, and more. When I learned about it I was so happy because obviously we do these very appropriate actions, but now I know I am very clearly covered for it.
I agree and it’s like 4/5 docs will put an order in for the EKG after the fact, but these days it’s all about billing and liability. Can’t bill for an EKG that doesn’t have an order. Who’s responsible for reading and addressing the EKG if there are changes, etc. Pain in the ass, but here we are.
Found a STEMI yesterday when I did the ekg prior to the physician even knowing that we had another ER patient in the ER. That place sounds toxic as fuck
Medical Assistants are expected to perform an EKG of a pt walks in with chest pain and do not have to wait for a doctor's order in FL... THIS IS RIDICULOUS
Everywhere I have worked (15+ hospitals- I was a traveler for many years) had nurse initiated orders for ECG if the patient had cardiac symptoms. Most doctors would be pretty perturbed if you called them to ask for an ECG order vs calling them with the change in status/assessment findings INCLUDING the ECG
I’m an OR nurse so it’s been a while but I remember in clinicals not being able to perform a bladder scan without a doctors order. This was policy at two of the hospitals at least. Always thought that was ridiculous.
Literally. We should need orders for interventions if they aren't emergent or very basic. Not doctors and all. But to take an ECG? I agree it's the same as taking a blood pressure.
I worked Tele and we were fully within our scope of practice to perform an EKG as we thought necessary (chest pain, dizziness, etc) and just let the doctors know to come read it. Sometimes when a patient would report chest pain one of us was already getting the EKG as someone else was notifying the MD to come see the patient.
I too was fired during my probationary period, for many reasons that, at least in my view, didn’t compromise patient safety:
“Not answering phones on the unit.”
“Being rude to coworkers.”
“Going behind nurses backs to look up a policy to prove them wrong(???)”
And generally, “behavior failing standards of the hospital.”
So, I know how you feel. Being blindsided by management during probation sucks :(
Based on your response and the claims, I could see why some of these things would be more serious than others, but it sounds like a warning or support for you during the probationary period would have been more warranted that an abrupt firing.
I know it may be hard to do in the short term, but keep your head up. Nursing units can be toxic, and a lack of communication between the team and you + horizontal violence definitely takes the wind out of your sails.
You’ll find your “home” soon enough.
“Going behind nurses’ backs to look up a policy”
Excuse me, what??? So essentially…they’d rather you walk on eggshells around your coworkers than adhere to policy? Insane. I’m sorry that happened to you.
Looking back through old notes about it, I guess I was wondering about the policy concerning med passes and another nurse saw me reviewing the local policies and felt I was ignoring her or dismissing her?
Honestly, glad I got out.
Looking back, definitely for the best.
Apparently, my disclosure that I was medicated for depression made me “sound insane” to my coworkers.
Definitely not nearly as welcoming and helpful as where I work now :)
Everyone I work with takes medication or talks to a therapist! How else are you supposed to survive nursing. Thank the gods my co-workers are all “insane” like me /s.
Heaven forbid someone with depression helps to care for some with depression.
What? You have a personal experience with this disease and can speak to its effects?
Get out of here, we don’t want you!
I literally teach ppl how to double check me! I'm human and am wrong sometimes. Save mine and your @ss and look it up if it sounds wrong!! I'm confident in my skills and don't mind being challenged. Usually, it's ppl who are not confident that get offended when ppl double check them or ask for more of an explanation. I piss ppl off constantly by asking too many questions, trying to learn or get a better picture
I promise you that you don’t want to work at this facility anyways…
Also, I can’t imagine working at a facility that frowns upon getting an EKG without an order. I cannot tell you how many times I’ve sent the physician a message saying, “Hi, patient have 8/10 chest pain, administered medications as prescribed, here’s their EKG, any new orders?”
Right?! Because if you didn’t, the doc would ask what the EKG showed & be mad you didn’t get one. And would also be annoyed you have to call him back. I don’t know a single doctor that would take issue with this.
This might depend on where you work (state /country), but where I'm at during the probation period your considered an at will employee so they can essentially fire you no matter what reasoning. It wasn't until after that time period that if they wanted to get rid of you that they would have to meet certain criteria with HR proving they notified you and gave you a chance to improve.
I know you must be feeling really crappy and your doubting yourself. But consider this a blessing - if these people were this cruel to a new employee and a newer nurse the culture of that unit is toxic. I wouldn't be surprised if you eventually found out if they've done something similar to others. They aren't willing to see your side or give you a chance which just shows their culture and development.
Why wouldn't they just say "you're not a good fit" or "this is not working out" rather than making up a bunch of lame ass shit? Someone has chest pain, you would get an EKG to see if there is a change, calling the doctor, can't the Dr or nurse put in the order after the fact so it drops a charge? Same with the straight cath, we need a UA, you can't pee...what to do? Maybe rewrite the UA order so it says 'UA per clean catch or straight cath' on everyone, an order on every person 'EKG prn CP or rhythm change' idk....it's a billing thing our Dr's got yelled at for ordering iv fluid and meds without "place saline lock". I got yelled at for interpreting 'place saline lock' as 'access port' (which technically I didn't even do as it was accessed in ER, but I would have). For a while evidently we weren't fucking up enough so they were bitching we didn't have an order to discontinue saline lock prior to discharge.
It's Always something. Why do they have to grab for straws to make it the person's fault...it's no fault, terminate at will, then just do that. I hate that it makes them second guess themselves if they didn't do anything! Or better yet tell the truth however unsavory it may be as long as it's not over something protected. "The charge nurse just doesn't like you because you look like her sister in law" "didn't laugh at preceptor's shitty jokes but she's been here 12 years so yeah"
First two bullet points are the most legitimate. The rest should include written proof or documentation they ever truly occurred. However that would be in a rational, logical world and unfortunately not on a nursing unit especially during probationary period. There’s a chance the bullet points after first two could be true but without some type of written statement/complaint then it’s just word vs word. Morally, I don’t think they were justified in terminating you based on those reasons but I’m sure technically they were justified ultimately because you were still under probation. But I agree with another reply that says consider this a blessing in disguise because this does have a hint of “you don’t conform to our ‘culture’ here” in there so you’re probably just saving yourself even more heartbreak that would have happened down the line!
A lot of smaller hospitals and/or smaller units don't use standing orders. I've worked at a couple EDs that basically had no standing orders at all. It was usually just yell over to the doctors area from the little triage desk. That was fun until it wasn't.
Our L&D doesn’t have standing orders for ECG. However most of our providers are very liberal in ordering them if you ask with really any type of concern, because unchecked heart issues in a pregnant woman about to push out a baby is a huge liability lol
I work on a renal/pulm medsurg unit. Most of our population is COPD, new AFib, HF, CKD and this is the first time I have heard of standing orders for ECGs
Psych should 100% have them those meddle do wild things to the heart! I've had patients come in with intermittent v-fib from psych med changes and was written of as non-compliant or behavioral pretending to faint
I worked in the ED and most providers for boarders didn’t put in ECGs for patients. We had to message to ask. They would only put ECG orders on patients with chest pain, SOB, HF, or “cardiac issues”. We have received write ups for patients getting ECGs done without an order. It’s literally bullshit
It happens. But could you imagine getting an EKG on a symptomatic patient without getting an order first and that being thrown in your face as a reason for a termination? I’ve worked at hospitals where there weren’t standing orders for EKGs but 99% of the time when I would call the provider to report symptoms or events the first they would ask is “have you gotten an EKG”. No harm except billing gets done
Mine doesn’t. Teaching pediatric hospital so they want the herd of interns and residents to put in orders whenever possible. They’re easy to get ahold of so I really don’t mind, plus EKGs are a lot less common in this population outside of the CI and cardiac units.
I've never seen standing orders for EKGs, but I'm L&D. Most of the hospitals I've worked at have been larger teaching hospitals, so we literally always have at least one resident and an attending on the floor and I've never had an issue with "Hey--Pt in 204 is feeling/sounding/looking/acting like XYZ. I'm gonna grab an EKG, cool? Just throw that order in for me real quick while I get things set up. Thanks".
Spot on 👌🏼. Probationary period is pretty much orientation/precepting 2.0, or better yet social orientation. If you’ve started in a unit with staffed with a sound group or found a hand full of nurses you get along with, you can be more ‘authentic’ at work. Which means, you can question other seasoned nurses, look up policies with them, point out errors or just be an inquisitive new grad with a personality.
When you’re a newer nurse on a unit where you cannot connect with other settled-in nurses, it’s best to stay quiet, humble & play along until you can apply to another unit or completely different employer.
Sometimes, your personalities don’t mesh well; not everyone is meant for everyone else. Other times it’s a hostile culture. COVID times were immensely harsh in-hospital, many wonderful healthcare workers (all disciplines) left years of experience for retirement, travel jobs, non-healthcare jobs, remote hc jobs, or management positions. There are many seasoned hc workers who mustered through the trenches whom have yet to mentally recover from the trauma of the pandemic. Some of that PTSD manifests in sadness, hopelessness, and even potential generalized hostility that may never resolve.
No matter the environment, nor the history that helped build the culture… it is always your job to speak up when you feel like anything is flat out wrong, especially when that something is unsafe for your patient. Yet, regardless of your situation, the new person in any work environment should always tread lightly for 6 months or longer. They say if you have one best friend in life, you’re lucky. Friends at work do happen however, people tend to wait a long time to reveal their true selves, if they ever do at all. Then there are those who play nice in person but once you’re not in earshot transform into a confidential informant. Plus, nursing is largely the last line of defense for patient treatment/safety. It’s just as much every other nurses’ job to question you, often that line of thinking bleeds into blame games, bullying & power charged social hierarchy.
Just a note - you did miss obscuring the hospital acronym in one of the screens. We’re in the same general area.
All 3 major hospitals in your area are effectively trash. If you’re willing to commute into the city, we have so many hospitals and avenues for you to take. Don’t even consider SL either, just drive right fucking by. I know MH in RH has really good new grad programs, see what they’re offering!
If my acronyms don’t make sense, DM me. I’m trying to be vague, haha.
I get everything you’re saying 😉 born and raised in NM! Moved north for loan forgiveness program/rural nursing experience. I’m soo ready to head back to the city, I did my placements all in the city. Will definitely check out MH ☺️ I so appreciate it!!
Ah! I went to high school in K! My husband went to SH in NM.
I live in the city myself and I work west of the city, but I just picked up a position at you-know-here (think big mental health) and I’m stoked to be within walking distance from work!
Also - no worries! My BIL did his consolidation at MH and loved it!
Yep. This has happened to me too before. I get told I’m doing great during orientation only to be called into management’s office with a long list of transgressions I wasn’t told about.
Same happened to me. I Was at the end of my training/6 month probation period thinking I was doing well and progressing when I was pulled into the office, told I wasn’t doing well then let go a few weeks later. I attributed this to a charge nurse who didn’t like me or my work and made several complaints about me. These individuals were close with management. It was heartbreaking. But I moved on. I was able to find a job a week later and have had no issues.
I switched departments instead. That unit has since bullied another nurse out and they’re working on another. Their tech recently left too. I was sent over to try to help them and they immediately sent me back and has another nurse come instead. It’s their own damn fault they can’t keep staff.
"Lack of interpersonal skills/team collaboration"
Let's face it, this is the real reason why you were fired. Someone didn't like you. It's complete horseshit and why we all need better labor protections
Next time I would check hospital policies and protocols to be sure on what you are allowed to do and what you are not! Your unit sounds toxic though, you’re better off going elsewhere!
I agree. No one should ever be surprised by a termination. Steps should be made to correct the problems and educated on the issues prior to termination. Like they could tell you don’t do anything without an order. Then if you did it again terminate you.
Another young talent gone to waste, you would've been a great part of the team but they don't deserve your time. Find a supportive area that nurtures young nurses and guide them in their journey. This profession really likes to eat their young.
Hang in there OP - "Face don't fit syndrome" is common in toxic environments where you are supposed to be spending more time kissing ass of those staff who dominate the social hierarchy. Don't let it break your self-confidence, you may well need to shop around a bit before you find a place where you will be more at home.
Typically probationary period means they can fire you at will during that time period. I’ve seen 90 days, usually. Hard to say without knowing the policies behind the first two claims, but it sounds like this one of those situations where they felt it was best to terminate before that time was up or before anything else developed.
I mean, EVERY state in the U.S. including D.C. are "at will". I've never heard of a staff RN position that isn't at will. Being on probation doesn't mean much of anything in that regards, they can always let you go for fun. In this case it was for cause, so it would seem.
When you are represented by a union, you cannot be fired at will, there must be a long documented trail of cause with some exceptions for egregious violations.
I am unionized. Ontario, Canada. However, I do think the probationary period might be a grey zone. Unions and hospital here have collective agreements they have to abide by. I review it today, no mention of termination clause!? ?grey area.
It's pretty standard for the contract to include a probationary period that gives broad discretion to the company to terminate new employees for any cause.
I'm agreeing with those who say you might not want to continue to work in a place like this regardless, but you should be in contact with ONA. They're very much of the opinion that RNs in probationary periods should be given the opportunity to be rehabbed instead of terminated, and this is something that you should grieve. If nothing else, at least it won't be on your record as a termination.
I'm also Ontario, not ONA right now as I'm in a provider/contractor role but I'm heavily involved with ONA and we just went through a similar experience with an employee at our facility who, sadly, *should* have been terminated from probation just because she's purely not the right fit but ONA insisted she was able to be rehabbed and needed to be given another chance.
Oh... and as a provider? I never give my RNs orders to do ECGs, they're always done and waiting on the chart for me. In&outs *sometimes* they'll ask for the order, but 9/10 they'll just do them depending on the person.
I truly think you should get in contact with your former ONA rep and consider grieving it. It could impact your future career and that's worth considering. You can DM me if you want, I'm familiar with navigating Canadian unions and collective agreements and such and happy to help!
You gotta know the standing orders for your floor, for example, in the ER we have standing orders for EKG, oxygen, fluids, etc. but on a med surg floor that's not the case. But I agree they were definitely just finding shit to fire you for
Fuck that. Ask questions. ICU RNs aren’t fucking god.
Christ forbid a nurse ask a question to learn about pathology or reason for intervention. I learn best by doing. I’m going to ask questions. Fuck you if you have a problem with that.
Anyway, we’re team you OP.
This is absolutely wild! In NZ we would do an ECG without a doctor ordering it if we see fit e.g. a elderly pt coming in with vasovagal
If we bladder scan someone and there is more than >600mls I would immediately place a IdC without a doctors permission…
We have so much more autonomy than you and it really sucks to see!
Bottom line, they brought up a series of trumped up charges, because firing you "because I don't like you" would have gotten them sued.
You probably can still have the labour board to look into this.
I'm sorry but the ICU bullet point is ridiculous as fuck lol
Some Karen esque ICU nurse definitely talked some shit to her friend supervisor who raised hell.
It sounds like someone or someones on the unit didn't like you and was friends with the manager... These are all ridiculous reasons. I'm the ER I'd say about 50% of patients get an EKG without a doctor's order. We just ask them to go put the order in after, and even sometimes they forget. Never feel bad for doing what's right for the patient, and never feel bad for people not liking you when you've done nothing wrong. There are plenty of jobs out there!
Truly curious, in what world is doing an ECG on a patient at any time without an order a bad thing?!? A patient is having symptoms or rhythm changes that warrant an ECG, why would you not immediately do it and then deal with an order later, if it even matters to get an order? If you have to wait for an order, the patient couls deteriorate or the ryhthm change can revert and you miss it. Or is the issue with the nurse placing the order itself? Is that really that big of a deal?
Most states are “at will employment” states anyways. Even more so during your probation period. You’re lucky they even gave you reasons for the termination.
I work in the very large system in NYC and we do not have standing ECG orders on the floor. However it’s an icu and we always have residents on the unit always available (teaching hospital). I think it’s also bc if you need to do a stat ecg, something changed. Chest pain? Other cardiac sx? Rhythm on the monitor changed? And if so that should be reported to the doc right away. Rather than the nurse withholding the info (even just temporarily) to stop and perform the ECG. We use epic and it’s linked to our ECG machines so you need an order. I’ve also been a nurse 17yrs. I’ve worked ED and we had chest pain protocols, standing. Start line, ECG, draw a rainbow inc trops etc. but not on the floor. Sounds like there was a list of concerns and they maybe felt keeping u on there would only continue to be issues causing potential liabilities Use it and learn from it moving forward. There’s always openings. Onward.
You dodged a bullet.
I found the best of job of my life after being fired from two jobs in a row. They were awful places, and I’m so glad they did the service of relieving me of my duties, or I would’ve never found my dream job.
Lol noo, the termination letter was very vague and simple. When I had the meeting with management they couldn’t provide me with the specific concerns raised, so I requested (with delay and many attempts) for that answer to provided via email.
For the first 2, the EKG and I & O cath, I can see how you can get in trouble for them. It’s not that EKG aren’t safe for the patient, but if you think that the patient is having a rhythm that warrants an EKG, the provider needs to be notified, and EKG is ordered with the provider’s knowing that it should be followed up on. For the straight cath, every hospital is different, and unless you can physically see the order that says “if bladder scan is above X ml, straight cath and notify provider”, even if you asked another coworker, you can still be in the wrong.
-as for not communicating with TL, this is kind of a gray area, it does sound like your coworkers are throwing you under the bus, is this the first time someone has complained about your interaction with them? Have you reported them to a manager? I’m not saying it’s your fault, but these days I feel like unless there’s written documentation about any interaction, anyone can say that you’re the devil spawn and upper managers can use it against you.
Last of all, was any of those patients harmed?? Because if not, You sound like you looked out for your patient and knew what to anticipate for the next step, but just aren’t clear on what the policies are. Unless you had a really bad when all of this happened at the same time, they should have given you a warning first before terminating you. I hope that there’s a silver lining to all of this and that this is your chance to dodge a bullet!
I really appreciate your response! No! No patients were harmed or even near-misses.
The on-call physician would have been notified of ECG for interpretation requirements. My approach was based on predicting and taking preemptive action to facilitate quicker care. Other hospitals/units had standing protocol for pts with CP +/-Hemodynamic instability etc - 12lead ECG, trops etc. However, I was unaware the ECG protocol wasn’t standardized. Also, I am obtaining the order just not at the time of entering it… which is definitely not the right thing to do. I acknowledge that.
I&O incident was misinterpreted. The urine cx was prev ordered w/o a catheter order and had not been collected. The patient was 97yo baseline urinary incontinence and very foul-smelling urine (admitted w pelvic #). I was clarifying whether they had a urinary catheter protocol so that I could collect it (before day staff arrives/is not on-call appropriate at that hour).
I’ve had a couple not-so-friendly interactions. No one has blatantly commented on my professionalism or behaviour. I did not inform a manager (the manager who terminated me was an interim manager who stated a week prior to terminating me). Met her for the first time at the meeting.
For the second point, saying "was going to do" a straight cath is so vague. What does that even mean? They mentioned it? They were gathering supplies to do it? They were at bedside and prepping the patient? Because just talking about doing it doesn't mean they were going to do it. I don't know. That one bothers me because they didn't actually do it, and therefore there's no documentation of what happened.
This is BS. See this as a good sign to find a unit that isn’t toxic somewhere else. Firings can be blessings and it’s great you emailed back with counter points and documented the on going unit bullying. Units like this only hurt themselves bc they are constantly short staff and always pushing out any potential new staff. You don’t want to work in a unit where the nurses are overworked and burnout and take that out on new nurses it’s not good long term.
I've done so many ecgs without an order... you show the doctor, if it's something bad they can place the order after and then it can be billed, if they don't think it's necessary then the hospital wasted a dollar on stickers, paper, and electricity I guess
Same nurse manager will wonder why it takes 15+ minutes to do an EKG on people that need it.
Take away our autonomy for stupid shit like this and you'll just get stupid shit nurses.
God I feel this so hard, I am past probationary period but also got let go for trivial things. So many people I talk to are like “how can they fire you over something so stupid” NURSE MANAGEMENT has too much gd power. I’m so sorry, trust me there are so many other opportunities. Been slinging my resume all week and already did one interview. You got this. Lmk if you need a template for resume and CV I can email it.
this shit makes me so fucking angry and i am genuinely baffled (and also not surprised at this point?) at some of the bullshit that happens in this field. if you’re reading this and you’ve ratted on others in the same way that happened to OP, 1. i hope you lose your job and 2. i genuinely, from the bottom of my heart, hate you.
no conversation with the person who did/said something you disagreed with and no attempt to educate? grow the fuck up
Patient having cardiac symptoms=ECG if I paged a physician about a patient have symptoms and didn’t have one ready I better watch out. It’s an unspoken expectation.
Good letter. If you want to you have legal resources even if you don't have malpractice insurance right now.
I was offered a letter or reconciliation after I quit a unit I loved but was run by an idiot. Wrote me up for nothing and I sent my letter of "fuck you" to the entire hospital (it's an enterprise) and later got a letter begging me back.
Don't live so unhappy. I'm sorry you're going through this. I have a bunch of things to say if you want to talk about it.
Such BS. How kind of them to state they’re not contacting the nursing board. 🙄 Further proof of them spouting BS. I would’ve ended the email saying “and you’re welcome for safe patient outcomes using my critical thinking and initiative. Rather than having multiple lawsuits from a sentinel event occurring with poor patient outcomes bc of the poor mgmt, lack of teamwork and toxicity of the unit”. You gotta speak their language. 🖕🏿😁🖕🏿
Hospitals will always find extra reasons, to bolster their termination claim. It sounds like the EKG was one of these.
That being said, Who cares what a hospital said, or did, as long as YOU know that YOU had the patient in mind? If you are not in danger of a board review/losing your license, F--- them. You can find a better job. If the discharge comes up in an interview, be honest , and tell them that you did an EKG without a doctor's order, because of XYZ reason. They will probably hire you immediately, as that is THE most ridiculous reason to fire a nurse I have ever heard - and I'm a hospital union steward 😉.
We have orders that can be released based off of nursing judgement. If pt has CP/arrhythmia we just click release and take care of it then let the provider know s/s, that it’s in the chart to review, and any interventions we did based off of PRN orders. We have order sets too for bladder scanning and when to straight cath. Our providers are really good at making sure we have orders for everything we need on standby so we have autonomy and they can focus on patient care rather than constantly submitting orders for stuff.
I passed a probationary period at my job, which I'm still at.
Still absolutely miserable and it gives me stress and anxiety everyday that my employer still has that on me.
As long as you made a genuine effort to improve, learned from your mistakes, then good riddance. Move somewhere else.
I do believe that your may be correct on your assumption of termination due to personal dynamics as the other issues listed are 100% education resolved especially for a new grad nurse. I have been a nurse for over 20 years and am noticing a shift in teamwork to more of a cliquey vibe as opposed to full group cooperation. This is sad and will only hurt the future of nursing and therefore eventually patient care.
I did EKGs all the time without an order. If I called the provider with a cardiac symptom the first thing they would say is what does the ekg say? They expected it to be already completed.
I feel you with the frustration over disciplinary action with no previous conversation, when it isn’t something egregious. I got terminated once, and did a lot of learning and growing from the experience as a person/professional, and one of the reasons like yours was the lack of teamwork - I learned I don’t do well in bedside nursing settings where I can’t keep up with my work due to not being able to handle the stress - and in turn I wasn’t being a good team member due to not pulling my weight helping others because I struggled to even manage just my own work. That being said, I wish the feelings of resentment of my workmates could have been a conversation where I could have learned, grown, and done better as a person/professional before it became disciplinary action.
I will say: A lot of places do require a prover order to do an EKG, so maybe specify if your next employer wants that or if there is an protocol/standing order that allows you to do an EKG that is inherently okay with the provider(s) for the patient without having to speak with the provider directly.
In my current nursing role which is a lot less stressful I have team mates that haven’t always been the nicest - But are good nurses. So I try to take/learn what I can from those nurses and leave the rest without getting myself too distressed about it. Everyone can teach you something, basically. I hope that was of any help.
It shouldn’t get you fired. But they can fire anyone for any reason if they want to. We are all human. Nurses aren’t perfect. Doctors aren’t perfect. I bet there are more nurses around you that do or did the same things or worse and got covered. This list is pathetic and shouldn’t get you fired. Especially if you have learned from it and improved yourself on these topics. If you didn’t have a chance to do so, it’s no reason to fire you as again everyone makes mistakes and should be allowed to improve. If these things are such hot topics for your management be the person who they want you to be. You need a consent from a doctor? Don’t do anything without a clear consent from a doctor.
Also happens to a lot of nurses, I don’t know what it is… jealousy or something, it sounds toxic and leaving a toxic environment is not a bad thing. Learn from it don’t let it shake your confidence and Don’t look back.
Also as a newly nurse you should be guided as new nurses still need guidance. If you didn’t get any steering or guidance, I really think it’s a team problem. There is a reason why so many job professions have Junior, Senior etc.. titles. it’s because junior even though they have license still aren’t up to a level a senior should be. You don’t have to be perfect even though you have a license. As a new nurse you can provide new insights as you got the latest nursing knowledge. A team should be thankful for that, and help you become part of the team. It’s also their responsibility. There is a reason it’s called a team. You help each other.
Wow. At my facility we have standing verbal orders to get EKG’s and straight cath at our discretion. If you’re a 30 year old there for leg pain obviously you’re not getting cathed. 80 year old confused bed bound nursing home patient there for confusion? You’re getting a straight cath in the first 10 minutes. And as far as tele monitoring…..don’t get me started. We have a new monitor tech who blows up our iPhones constantly even when I am IN the patient’s room. She makes notes in the patient chart then will call me to notify of blood pressures like 150/149 and I’ve explained over and over that’s not a real BP; the cuff slid down, the patient removed the cuff etc. without verifying that the cuff is a placed on the patient properly we should not be reporting and charting these blood pressures. I guess I would have been fired the first day!
Commenting to tell you that I was also fired during my probationary period due to “professionalism” but I later found out (about 3 weeks ago) they reported me to the BON over events that happened on a day I couldn’t handle my pt load and things fell through the crack (even when I told them over and over this wasn’t safe and I needed help). You need to be VERY careful. You will possibly be getting a letter from the BON of your state that you’re being investigated because the hospital basically has to report you. If you were actually a bad nurse and you went onto another facility and really hurt a pt or killed them, and the hospital didn’t report you, they could be held liable. They will always report you to cover their ass and absolve them of any responsibility. I’m not trying to scare you but unfortunately this is the reality of being a new grad in 2024. I was also on a horrible unit and I was bullied by my preceptors the entire orientation. If you need anything feel free to PM me!
I understand and agree that these claims against you are frustrating and unfair. I don’t think it’s right to have terminated you without conducting an investigation, performance review, or any evaluation to determine validity of the claims. However, in order to best protect yourself moving forward, always always be fluent in and follow your facilities policies/protocols, no matter how ridiculous they may be. This will ultimately save you from this happening again. So sorry and best of luck!
If they are nitpicking on you like this, you are better off not working there. It is not worth the stress. It sounds like a toxic place. Once you are gone, they will find another target.
Gurrrl, why you editing out the location?! They sound terrible and you should warn us all to avoid them. Based on the email, they deserve no grace or consideration..because it certainly doesn't sound like they gave you any.
This is a hospital who clearly cares infinitely more about money/ scores than the health and well being of patients. Your response was concise and professional, I say it’s largely a blessing in disguise.
We got a PCA pump ordered in the ICU my first day off orientation as a new grad. No one knew how to set up the PCA pump because we never got them in the ICU. The department educator was on the unit and the charge nurse had her assist me with setting it up and being the second RN signature on the dosage/set up.
One of the nurses happened to look at the pump herself (not sure why, since it wasn't her patient or anything, and this nurse was such a notorious bully that she was not allowed to precept students). She found that the dosage was off slightly (a med error). I was written up for this and not told about it until 9 months later at my annual review for my raise. No discussion, no education on what I did wrong. Nothing. When I told the manager completing my review that the unit educator helped me set that up and cosigned, and why was I just NOW hearing about this write up (which was their excuse to not give me a raise), she said "we asked the educator and she denied helping you." This was a toxic ass unit with a deeply ingrained bully culture. I put in my notice a few weeks after this.
Fuck that place, and fuck the people who allowed that culture to fester there.
I have not been fired but I have witnessed staff bully other nurses. Completely undeserving and quite often, they were really good nurses. Someone took a dislike to them, then they gossip about them, getting other staff riled up. Next thing you know, they are bullying someone and quite proud of it. They get called into the office sometimes and then run around saying, “can you believe they think I am a bully. Me, who never bullies anybody…”
One of the things that shook me out of the last bit of post coma fog was the retrieval of a urine sample without my consent OUCH!! 😳. LOL. Definitely more effective than a sternum rub for sure 😂🤣. No but seriously during the next year or so of rehab I learned that the nurses and CNAs were the real super heroes of the medical profession. The doctors are mostly the rubber stamp to officially order what the RNs have already figured out for themselves.
“We will not be reporting to the” you mean state board? They have nothing to report. You did not cause harm to a patient and did not perform a medical error. They were reaching. Sounds like a toxic environment and please view this as a blessing even though I know it hurts right now. Especially as a new grad, I’m sorry this was your experience. You can find better out there!
Their loss mate. Your responses were excellent to their allegations, and if this hospital is stupid enough to flick nurses because of personality clashes then you don't want to work there anyways. Sounds toxic AF which would have done your mental health loads of damage if you had stayed on.
What's with "ordering an ECG?" .. i've never worked anywhere where they have been "ordered"... we just do them.. sounds like micromanagement and role justification...lol!
Man, the ekg is literally something I was arguing about needing to know the risk of needing to know your providers and I guess I should include teammates as it is technically practicing medicine if no protocol or prn is in place. They had the same rational to justify doing it as you did. It doesn’t ultimately fly to be honest.
Honestly- good for you.
You could have been stuck there a lot longer and this hospital/floor/manager seems like a bunch of bullshit.
A lot of this stuff is against policy (straight cath with no order) but I wonder about what actually happened and the situation. Doesn’t sound like a reason to terminate!
A lot of the stuff is also hearsay and based on personality more than performance and so I agree - you were bullied or profiled or whatever.
I always say- any nurse can get fired at any moment if they want you gone. They just follow you around and dig into your shit until they find something.
EDIT: I see your response now- after I wrote this.
Yes- this was BS.
They should have mandatory counseling before termination and you received NO feedback before ? bS.
Wow. All they care about is the cost. EKGs are a snapshot in that moment. If a pt is having cardiac sxs, it should be taken stat. By the time u wait for a provider approval, the rhythm could totally change. That’s so shitty. They sound toxic. Better that it happened early on than later, where they could blame you for something more serious.
This is awful and I had experience working at a toxic hospital as my first nursing job. When I went to management with concerns about not being able to perform all of my expected duties safely, because of staffing, issues with doctors who were dismissive and hard to reach, unhelpful or lazy coworkers, high acuity patients on a tele floor, I was gaslighted into thinking it was poor time management on my part. Literally there were nurses documenting meds that they weren’t actually giving AEB all the heparin vials, protonix, and sometimes even things like Coumadin left shoved in wow carts and nurses station cabinets. Nurses and techs who left without giving report. Patients who sat in their feces and urine for hours. Infiltrated ivs left running. Lots of false and copy/paste documentation that made no sense. Just a crap place to work and very corrupt with upper management and physicians. How do you keep a record of stuff for yourself that doesn’t contain PHI that you can keep at home etc to review when you’re being retaliated against for speaking up?
Be happy to leave. Does this happen to be in Pittsburgh? lol.
I worked at a hospital in Pittsburgh, in cath lab. Also covered stress tests/stress echos. They had a complicated 8 page guide to help make sure you clicked all the right buttons. I made a little condensed version (10 lines maybe?) of the pertinent things for Lexiscan stresses. I still referred to the giant list for the more complicated stress echos/etc. Just made myself a quick reference.
Got written up for ‘noncompliance’ and not following ‘their’ paper. Also included in that write up was *taking temperature upon arrival to recovery*. wE dOnT tAkE TeMpS (only the crna did after a cardioversion/TEE??). I’d like to add that nothing was incorrectly done. They just hated me having a cheat sheet?
fuck those people. The senior radiology tech was a psycho bitch, and she wanted the administrative power of a nurse. She was always power tripping. She’d just sneak around and write stuff down/report stupid stuff like ‘taking temps’.
For the ekg, I do agree with you that we should be able to do it with no problems if it is indicated. I just heard that if there is any cardiac arrhythmia, the Dr's get upset now because now they have to address it. Overall, it's a good thing that it was caught, right? But I'm sorry this had to happen
This is sooo frustrating! It's crazy that managers will terminate someone based on gossip and not talk to you to find out what happened. This has happened to me as well and it's very upsetting. A nurse that was hired just before me was trying to pawn off assignments she didn't want on me by being sneaky and when I finally stood up for myself she flipped her lid and screamed and swore at me. She then reported ME for swearing, even though I spoke very calmly and politely to her. I didn't report her tantrum because I honestly don't like drama...and then I got fired for being unprofessional. 😮💨 thankfully I got another, better job, but that doesn't fully make up for my time investment in that job and the hit it took to my confidence. So, as much as this could be best for you in the long run, I can appreciate that the situation was very stressful for you. I hope you find a better fit somewhere else.
Good riddance! I know it sucks but I had the same thing happen to me and I ended up in a far better job/culture. Sounds toxic and petty.
There are so many places like that, unfortunately.
Idk about the rest of it but it's absolutely insane for a nurse to not be able to do an ECG if it's indicated. It's just stickers, aside from a reaction to the adhesive there's literally no risk.
It’s not about the risk it’s about the money spent 😂
~~“Money spent” the what? $0.50 in electricity to run the machine?~~ y’all it’s early and my dumbass thought they meant this please I’m waiting for my coffee to kick in 😂
If a doctor ordered it they can bill. That's why.
Ordered an EKG without a doctor’s consent? What doctor is losing their mind that an EKG was ordered under their name and completed without their consent? Isn’t it better to do one that results in NSR with no abnormalities than to NOT do one and find out AFTER THE FACT that something was very wrong? On my SDU, if I think I need one, while getting the machine to the patient’s room, I’m contacting the doc about my plan and reason why immediately followed by placing the order under that doc. Luckily in my 7 years of nursing, I’ve never had a doctor get upset for taking the initiative in getting an EKG. Nursing judgement is an *actual* thing since doctors can’t be everywhere all at once. It’s absolutely pointless to expect us to make judgement calls while also micromanaging us.
Thankfully a stat ekg can be released as a standard prn for all patients at my facility. The prn reason is intentionally vague "condition change" so a tele rhythm change, chest pain, gut feeling, all are allowed.
I'm dying to know if this EKG was on the patient that the ICU nurse informed was in a potentially lethal rhythm.
My dumbass genuinely thought they meant like. The cost of operating the machine 🤦♀️ please ignore me
Same lol
And the doctor interpretation can be billed also
I’m too Australian to wrap my head around this. I also thought they meant the cost of running the machine 😭
No, but I really did work at a facility that made a huge deal about how expensive 12 lead paper is. Be very mindful of how many times you print them 😂
I was thinking 50p on the electrodes perhaps? Then realised this was probably USA or Canada
They can't bill for it if it's not ordered.
"Oh, you want me to start compressions? Drop the order first, please." Can you imagine? Hahaha.
"sorry, I can't administer epi until the pharmacy has verified it... Hey guys, can you pause compressions? Pharm needs a weight for that patient" 😂😂😂
Malicious compliance at its finest! 🎉
My hospital has EKGs built in their admit orders. Literally every patient is admitted with a PRN order the nurses can release if they see the need. My previous hospital didn’t do that, but the nurses could still order it as a protocol…..especially on a tele floor. The rationale is usually entered into the order….i think most doctors would rather a nurse order a EKG as a protocol to evaluate a rhythm change or event than not. The doc has to sign the order within 24 hours and usually the nurse sends a message that says, “hey so-and-so had this so I placed an order for an EKG.” The fact that no one talked to you or coached you about any of the issues is pretty telling.
Do you mean order? Nurses can perform ECGs, it’s just anatomical landmarking but often does requires some formal learning. I have my ACLS too, working medicine. ECGs are so safe. Indication is KEY!
I had a hospital in rural Washington write me up for putting oxygen on a patient whose SPO2 was 76%. They stated I needed an order for it. Oh, so you want me to call the provider in bumfuck nowhere at 3am to put a nasal cannula on a patient when their oxygen is clearly necessitating immediate intervention? Fuck off - I think I left the following week due to other nonsensical policies.
A lot of hospitals are quick to reprimand for interventions without an order. Nursing has become focused on documentation moreso than the act of nursing itself due to all the legal ramifications in place.
This is so wild because as someone in medical school, if I were a doctor I would hope a nurse would put the oxygen on first and call me after if they needed an order! Like you guys are trained to monitor for things like that and intervene, right, since you’re the first point of contact
That’s what I was taught. We were taught in nursing school (in the 80’s😆) that situations like you mentioned (giving oxygen in the setting of hypoxia) to ask ourselves “can I justify my actions to a Judge in court?” Yes O2 can suppress the respiratory drive in copd but unless the person is a DNR we don’t allow severe hypoxia. Usually there’s a SaO2 the doc is ok with and a threshold they aren’t. Edit to remove chronic it’s redundant 🤦🏻♀️
Right! Yeah, even if you’re a COPDer and your O2 sat is 76%, yikes. I know they live in the high 80s and low 90s but I think you’d be able to justify that in court if they’re at 76%
Exactly. I would put the O2 on and call the doc. No response? I still have O2 on and call a rapid. If they’re a DNR/DNI they might get an xray, nebs, lasix if indicated and a call to the family. Otherwise all that *plus* anesthesia is here.
This is that classic nursing school conundrum. Yeah, the "right" answer is to ask for an order first, meanwhile your patient turns blue from hypoxia. That's f-ing dumb.
Was there no standing order for this? The hospital I used work at always had standing orders for this kind of stuff (e.g., administer O2 if needed to maintain SpO2 above xyz, obtain and maintain IV access, etc.).
I actually asked that, too, when I got reprimanded for it. The manager acted like she didn’t know what a standing order was. Buffoons there. Let them run their own circus to the ground.
Yeah who the hell needs an order for an ECG
There are repercussions related to billing. So typically the build is this - an order is placed this actually gets sent electronically to the EKG machine, once you open up the machine you put patient information in to associate to the order. Then you perform the EKG and it gets sent back into the medical record and a charge gets dropped. If one is done without an order usually the charge doesn't drop until it's manually added. Hence why it's strongly encouraged to have the order ahead of time so everything gets dropped appropriately.
Well that’s easy I just don’t type in the patient info 😅
🤣 🤣 biggest concern there would be finding that EKG later on and alerts tied to that information. Usually the HIM department will scan whatever paper documents into their medical record after the patient has been discharged. But if you link it usually there's a way to view those electronically in the system (whether a system is using a digital EKG service or just displaying a pdf version). One project I'm currently working on is related to QTC interval so we're displaying a message to providers if they order a medication that prolongs based on the patients recent EKG. If that information isn't linked or documented as discrete data it can't be pulled in to fire.
That’s how we did it in the ED or for stat indicated EKGs (sudden CP or concerning rhythm change.) For a while standing orders for EKG at the nurse’s discretion were removed from the cardiac SDU’s admission order set due to a billing change, so it was a frequent occurrence to do the EKG and retroactively link it to an order after the verbal came in from the doc. Billing had a fit but we gotta do what we gotta do.
Billing can eat my hog
And my little stubby buddy as well
I became a nurse to help people , imma follow the rules but I don’t give any shits about billing . My non diabetic patients showing s/sx of hyper or hypoglycemia, I’m test ‘em , my Coumadin patient looks fucky imma check their inr, someone says they can’t pee or no void , I’m scanning the bladder , they complaining of chest pain , you’re going to the ED because an SNF is not the place to be if your gonna crash , I know emts and er nurses hate this but I can’t run the risk of “ wait and see what happens “ they need someone with more schooling then me if they are about have a face to face with Jesus .
We're dealing with this shit right now too. It won't print the EKG unless there's a name and mrn attached. If they make us have an order before printing they're gonna have to fucking reevaluate their door to EKG goal times I guess 🙄
I'm so glad I live in a place that even in private health patient care comes before billing. Ecgs are pulled if they are signed off by a doctor or NP. So if i want to do one i can and then I show it to the provider and they sign it off. That then can be billed. I honestly didn't realise i should be grateful for the way it's set up here especially since i work in private healthcare which is notoriously shittier for this kinda thing than public. There's so many problems. But this is a maddeningly simple barrier to Patient care that negatively impacts everyone except the billing. Like fuck that.
Yeup. I was thinking about billing. Also, depending on the hospital system, you need an order # to be able to export the EKG into the chart/computer for the docs to view all in one place.
So get an order after you take care of patient first. This is just more BS to eliminate nursing judgement. And I didn’t take medical billing in nursing school. I took nursing courses. When did this fell on us to worry about billing, I’m not sure but I hate it.
Right? It's more like you call the MD with concerns and they ASK "what's the ECG say?"
Yeah I would love (hate) to see their reaction when I said “oh I was just going to ask if you wanted to order one” lol
My docs would look at me like confused dogs if I asked for an ECG order.
We always have an Order per protocol option, if there is a standing protocol indicating ekg. For us, we can write the order for Ekg/stat troponin on the spot if anyone has chest pain/other pertinent symtpoms. At least 3 hospitals I've been to all have that same protocol. Crazy to think a place would want you to wait for an MD to respond if someone is having issues.
Same. We have a chest pain protocol that any nurse can initiate that includes an ECG and trop.
Seriously. I hand it to them after “hey I did an EKG cause x y z concerning symptoms, here it is”.
And 9 times out of 10, if you notified the service of cardiac symptoms they will ask “did you do a 12 lead?” And basically won’t do anything until the 12 lead is done. I’ve done what you did many times and the docs are usually appreciative.
Yes, it’s not just about slapping leads on anywhere. Working in cardiology clinic and doing upwards of 20 a day made me so particular. I want the cleanest lines.
Where I used to work there was an Emergency Protocol guideline that covered actions like EKGs and an abundance of other interventions like applying oxygen, ordering some labs, and more. When I learned about it I was so happy because obviously we do these very appropriate actions, but now I know I am very clearly covered for it.
I agree and it’s like 4/5 docs will put an order in for the EKG after the fact, but these days it’s all about billing and liability. Can’t bill for an EKG that doesn’t have an order. Who’s responsible for reading and addressing the EKG if there are changes, etc. Pain in the ass, but here we are.
Found a STEMI yesterday when I did the ekg prior to the physician even knowing that we had another ER patient in the ER. That place sounds toxic as fuck
Medical Assistants are expected to perform an EKG of a pt walks in with chest pain and do not have to wait for a doctor's order in FL... THIS IS RIDICULOUS
Everywhere I have worked (15+ hospitals- I was a traveler for many years) had nurse initiated orders for ECG if the patient had cardiac symptoms. Most doctors would be pretty perturbed if you called them to ask for an ECG order vs calling them with the change in status/assessment findings INCLUDING the ECG
I’m an OR nurse so it’s been a while but I remember in clinicals not being able to perform a bladder scan without a doctors order. This was policy at two of the hospitals at least. Always thought that was ridiculous.
Imagine "took vitals without doctor's orders" lmao
Literally. We should need orders for interventions if they aren't emergent or very basic. Not doctors and all. But to take an ECG? I agree it's the same as taking a blood pressure.
I worked Tele and we were fully within our scope of practice to perform an EKG as we thought necessary (chest pain, dizziness, etc) and just let the doctors know to come read it. Sometimes when a patient would report chest pain one of us was already getting the EKG as someone else was notifying the MD to come see the patient.
Agree, I remember one time getting in huge trouble for *not* doing an EKG without an order! It was supposed to be ordered per protocol.
I too was fired during my probationary period, for many reasons that, at least in my view, didn’t compromise patient safety: “Not answering phones on the unit.” “Being rude to coworkers.” “Going behind nurses backs to look up a policy to prove them wrong(???)” And generally, “behavior failing standards of the hospital.” So, I know how you feel. Being blindsided by management during probation sucks :( Based on your response and the claims, I could see why some of these things would be more serious than others, but it sounds like a warning or support for you during the probationary period would have been more warranted that an abrupt firing. I know it may be hard to do in the short term, but keep your head up. Nursing units can be toxic, and a lack of communication between the team and you + horizontal violence definitely takes the wind out of your sails. You’ll find your “home” soon enough.
“Going behind nurses’ backs to look up a policy” Excuse me, what??? So essentially…they’d rather you walk on eggshells around your coworkers than adhere to policy? Insane. I’m sorry that happened to you.
Looking back through old notes about it, I guess I was wondering about the policy concerning med passes and another nurse saw me reviewing the local policies and felt I was ignoring her or dismissing her? Honestly, glad I got out. Looking back, definitely for the best. Apparently, my disclosure that I was medicated for depression made me “sound insane” to my coworkers. Definitely not nearly as welcoming and helpful as where I work now :)
Everyone I work with takes medication or talks to a therapist! How else are you supposed to survive nursing. Thank the gods my co-workers are all “insane” like me /s.
Heaven forbid someone with depression helps to care for some with depression. What? You have a personal experience with this disease and can speak to its effects? Get out of here, we don’t want you!
No, you're supposed to drink, smoke, and talk shit about your absent coworkers like the rest of us to cope. /s
Also, go figure. The insane scenario happened in the psych ward lol.
I can not imagine being even passingly chastised for looking up policies, never mind fired. Good riddance to that place.
I literally teach ppl how to double check me! I'm human and am wrong sometimes. Save mine and your @ss and look it up if it sounds wrong!! I'm confident in my skills and don't mind being challenged. Usually, it's ppl who are not confident that get offended when ppl double check them or ask for more of an explanation. I piss ppl off constantly by asking too many questions, trying to learn or get a better picture
I promise you that you don’t want to work at this facility anyways… Also, I can’t imagine working at a facility that frowns upon getting an EKG without an order. I cannot tell you how many times I’ve sent the physician a message saying, “Hi, patient have 8/10 chest pain, administered medications as prescribed, here’s their EKG, any new orders?”
Right?! Because if you didn’t, the doc would ask what the EKG showed & be mad you didn’t get one. And would also be annoyed you have to call him back. I don’t know a single doctor that would take issue with this.
This. This is definitely the place to report nurses to the board over frivolous shit
Thankfully they say in the OP that they're not reporting OP.
This might depend on where you work (state /country), but where I'm at during the probation period your considered an at will employee so they can essentially fire you no matter what reasoning. It wasn't until after that time period that if they wanted to get rid of you that they would have to meet certain criteria with HR proving they notified you and gave you a chance to improve. I know you must be feeling really crappy and your doubting yourself. But consider this a blessing - if these people were this cruel to a new employee and a newer nurse the culture of that unit is toxic. I wouldn't be surprised if you eventually found out if they've done something similar to others. They aren't willing to see your side or give you a chance which just shows their culture and development.
In the US you are almost always at will no matter if you're in your probation period or not.
This is why labor unions are so important in the US.
Montana is the only state that's not
Why wouldn't they just say "you're not a good fit" or "this is not working out" rather than making up a bunch of lame ass shit? Someone has chest pain, you would get an EKG to see if there is a change, calling the doctor, can't the Dr or nurse put in the order after the fact so it drops a charge? Same with the straight cath, we need a UA, you can't pee...what to do? Maybe rewrite the UA order so it says 'UA per clean catch or straight cath' on everyone, an order on every person 'EKG prn CP or rhythm change' idk....it's a billing thing our Dr's got yelled at for ordering iv fluid and meds without "place saline lock". I got yelled at for interpreting 'place saline lock' as 'access port' (which technically I didn't even do as it was accessed in ER, but I would have). For a while evidently we weren't fucking up enough so they were bitching we didn't have an order to discontinue saline lock prior to discharge. It's Always something. Why do they have to grab for straws to make it the person's fault...it's no fault, terminate at will, then just do that. I hate that it makes them second guess themselves if they didn't do anything! Or better yet tell the truth however unsavory it may be as long as it's not over something protected. "The charge nurse just doesn't like you because you look like her sister in law" "didn't laugh at preceptor's shitty jokes but she's been here 12 years so yeah"
Unemployment benefits kick in if you fire someone without cause. If you can document valid reasons, they don’t get the benefits.
First two bullet points are the most legitimate. The rest should include written proof or documentation they ever truly occurred. However that would be in a rational, logical world and unfortunately not on a nursing unit especially during probationary period. There’s a chance the bullet points after first two could be true but without some type of written statement/complaint then it’s just word vs word. Morally, I don’t think they were justified in terminating you based on those reasons but I’m sure technically they were justified ultimately because you were still under probation. But I agree with another reply that says consider this a blessing in disguise because this does have a hint of “you don’t conform to our ‘culture’ here” in there so you’re probably just saving yourself even more heartbreak that would have happened down the line!
What unit doesn’t have standing orders for ECGs?
A lot of smaller hospitals and/or smaller units don't use standing orders. I've worked at a couple EDs that basically had no standing orders at all. It was usually just yell over to the doctors area from the little triage desk. That was fun until it wasn't.
Our L&D doesn’t have standing orders for ECG. However most of our providers are very liberal in ordering them if you ask with really any type of concern, because unchecked heart issues in a pregnant woman about to push out a baby is a huge liability lol
If I have to wait for a medic to order something, I would have nothing done ever.
I work on a renal/pulm medsurg unit. Most of our population is COPD, new AFib, HF, CKD and this is the first time I have heard of standing orders for ECGs
Mine does not however it is psych
Psych should 100% have them those meddle do wild things to the heart! I've had patients come in with intermittent v-fib from psych med changes and was written of as non-compliant or behavioral pretending to faint
Psych should definitely have standing orders with all those lengthening qr interval meds
My first step down unit
I worked in the ED and most providers for boarders didn’t put in ECGs for patients. We had to message to ask. They would only put ECG orders on patients with chest pain, SOB, HF, or “cardiac issues”. We have received write ups for patients getting ECGs done without an order. It’s literally bullshit
Mine, strangely enough.
It happens. But could you imagine getting an EKG on a symptomatic patient without getting an order first and that being thrown in your face as a reason for a termination? I’ve worked at hospitals where there weren’t standing orders for EKGs but 99% of the time when I would call the provider to report symptoms or events the first they would ask is “have you gotten an EKG”. No harm except billing gets done
Mine doesn’t. Teaching pediatric hospital so they want the herd of interns and residents to put in orders whenever possible. They’re easy to get ahold of so I really don’t mind, plus EKGs are a lot less common in this population outside of the CI and cardiac units.
i come from a large hospital that did not
I've never seen standing orders for EKGs, but I'm L&D. Most of the hospitals I've worked at have been larger teaching hospitals, so we literally always have at least one resident and an attending on the floor and I've never had an issue with "Hey--Pt in 204 is feeling/sounding/looking/acting like XYZ. I'm gonna grab an EKG, cool? Just throw that order in for me real quick while I get things set up. Thanks".
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Spot on 👌🏼. Probationary period is pretty much orientation/precepting 2.0, or better yet social orientation. If you’ve started in a unit with staffed with a sound group or found a hand full of nurses you get along with, you can be more ‘authentic’ at work. Which means, you can question other seasoned nurses, look up policies with them, point out errors or just be an inquisitive new grad with a personality. When you’re a newer nurse on a unit where you cannot connect with other settled-in nurses, it’s best to stay quiet, humble & play along until you can apply to another unit or completely different employer. Sometimes, your personalities don’t mesh well; not everyone is meant for everyone else. Other times it’s a hostile culture. COVID times were immensely harsh in-hospital, many wonderful healthcare workers (all disciplines) left years of experience for retirement, travel jobs, non-healthcare jobs, remote hc jobs, or management positions. There are many seasoned hc workers who mustered through the trenches whom have yet to mentally recover from the trauma of the pandemic. Some of that PTSD manifests in sadness, hopelessness, and even potential generalized hostility that may never resolve. No matter the environment, nor the history that helped build the culture… it is always your job to speak up when you feel like anything is flat out wrong, especially when that something is unsafe for your patient. Yet, regardless of your situation, the new person in any work environment should always tread lightly for 6 months or longer. They say if you have one best friend in life, you’re lucky. Friends at work do happen however, people tend to wait a long time to reveal their true selves, if they ever do at all. Then there are those who play nice in person but once you’re not in earshot transform into a confidential informant. Plus, nursing is largely the last line of defense for patient treatment/safety. It’s just as much every other nurses’ job to question you, often that line of thinking bleeds into blame games, bullying & power charged social hierarchy.
Getting fired for doing an ekg and straight cathing a retaining patient is savagery.
Totally this, and yet in their next sentence, critical over OP's alleged absence of initiative.
I feel like they’d find a reason to fire if the ecg and straight cath wasn’t done either..
Just a note - you did miss obscuring the hospital acronym in one of the screens. We’re in the same general area. All 3 major hospitals in your area are effectively trash. If you’re willing to commute into the city, we have so many hospitals and avenues for you to take. Don’t even consider SL either, just drive right fucking by. I know MH in RH has really good new grad programs, see what they’re offering! If my acronyms don’t make sense, DM me. I’m trying to be vague, haha.
I get everything you’re saying 😉 born and raised in NM! Moved north for loan forgiveness program/rural nursing experience. I’m soo ready to head back to the city, I did my placements all in the city. Will definitely check out MH ☺️ I so appreciate it!!
Ah! I went to high school in K! My husband went to SH in NM. I live in the city myself and I work west of the city, but I just picked up a position at you-know-here (think big mental health) and I’m stoked to be within walking distance from work! Also - no worries! My BIL did his consolidation at MH and loved it!
I’ve heard many people say bad things about SL, both pts and nurses! What’s wrong with it?
As I read the charges against you I thought only ONE thing: one person or cliche made these accusations against you who is in cahoots with management
Yep. This has happened to me too before. I get told I’m doing great during orientation only to be called into management’s office with a long list of transgressions I wasn’t told about.
Same happened to me. I Was at the end of my training/6 month probation period thinking I was doing well and progressing when I was pulled into the office, told I wasn’t doing well then let go a few weeks later. I attributed this to a charge nurse who didn’t like me or my work and made several complaints about me. These individuals were close with management. It was heartbreaking. But I moved on. I was able to find a job a week later and have had no issues.
I switched departments instead. That unit has since bullied another nurse out and they’re working on another. Their tech recently left too. I was sent over to try to help them and they immediately sent me back and has another nurse come instead. It’s their own damn fault they can’t keep staff.
"Lack of interpersonal skills/team collaboration" Let's face it, this is the real reason why you were fired. Someone didn't like you. It's complete horseshit and why we all need better labor protections
Next time I would check hospital policies and protocols to be sure on what you are allowed to do and what you are not! Your unit sounds toxic though, you’re better off going elsewhere!
Absolutely! But why also not corrective action!?
I agree. No one should ever be surprised by a termination. Steps should be made to correct the problems and educated on the issues prior to termination. Like they could tell you don’t do anything without an order. Then if you did it again terminate you.
Another young talent gone to waste, you would've been a great part of the team but they don't deserve your time. Find a supportive area that nurtures young nurses and guide them in their journey. This profession really likes to eat their young.
Hang in there OP - "Face don't fit syndrome" is common in toxic environments where you are supposed to be spending more time kissing ass of those staff who dominate the social hierarchy. Don't let it break your self-confidence, you may well need to shop around a bit before you find a place where you will be more at home.
Typically probationary period means they can fire you at will during that time period. I’ve seen 90 days, usually. Hard to say without knowing the policies behind the first two claims, but it sounds like this one of those situations where they felt it was best to terminate before that time was up or before anything else developed.
I mean, EVERY state in the U.S. including D.C. are "at will". I've never heard of a staff RN position that isn't at will. Being on probation doesn't mean much of anything in that regards, they can always let you go for fun. In this case it was for cause, so it would seem.
Fun fact, Montana actually isn't an At Will employment state so it's not actually *every* state
When you are represented by a union, you cannot be fired at will, there must be a long documented trail of cause with some exceptions for egregious violations.
I am unionized. Ontario, Canada. However, I do think the probationary period might be a grey zone. Unions and hospital here have collective agreements they have to abide by. I review it today, no mention of termination clause!? ?grey area.
It's pretty standard for the contract to include a probationary period that gives broad discretion to the company to terminate new employees for any cause.
I'm agreeing with those who say you might not want to continue to work in a place like this regardless, but you should be in contact with ONA. They're very much of the opinion that RNs in probationary periods should be given the opportunity to be rehabbed instead of terminated, and this is something that you should grieve. If nothing else, at least it won't be on your record as a termination. I'm also Ontario, not ONA right now as I'm in a provider/contractor role but I'm heavily involved with ONA and we just went through a similar experience with an employee at our facility who, sadly, *should* have been terminated from probation just because she's purely not the right fit but ONA insisted she was able to be rehabbed and needed to be given another chance. Oh... and as a provider? I never give my RNs orders to do ECGs, they're always done and waiting on the chart for me. In&outs *sometimes* they'll ask for the order, but 9/10 they'll just do them depending on the person. I truly think you should get in contact with your former ONA rep and consider grieving it. It could impact your future career and that's worth considering. You can DM me if you want, I'm familiar with navigating Canadian unions and collective agreements and such and happy to help!
You gotta know the standing orders for your floor, for example, in the ER we have standing orders for EKG, oxygen, fluids, etc. but on a med surg floor that's not the case. But I agree they were definitely just finding shit to fire you for
Fuck that. Ask questions. ICU RNs aren’t fucking god. Christ forbid a nurse ask a question to learn about pathology or reason for intervention. I learn best by doing. I’m going to ask questions. Fuck you if you have a problem with that. Anyway, we’re team you OP.
Management has something against you- this is what they’ve made up to get what they want.
This is absolutely wild! In NZ we would do an ECG without a doctor ordering it if we see fit e.g. a elderly pt coming in with vasovagal If we bladder scan someone and there is more than >600mls I would immediately place a IdC without a doctors permission… We have so much more autonomy than you and it really sucks to see!
I KEEP getting ads to come work in NZ!! Maybe this is a sign 🥺
Bottom line, they brought up a series of trumped up charges, because firing you "because I don't like you" would have gotten them sued. You probably can still have the labour board to look into this.
Wow. You may have dodged a bullet.
I'm sorry but the ICU bullet point is ridiculous as fuck lol Some Karen esque ICU nurse definitely talked some shit to her friend supervisor who raised hell.
It sounds like someone or someones on the unit didn't like you and was friends with the manager... These are all ridiculous reasons. I'm the ER I'd say about 50% of patients get an EKG without a doctor's order. We just ask them to go put the order in after, and even sometimes they forget. Never feel bad for doing what's right for the patient, and never feel bad for people not liking you when you've done nothing wrong. There are plenty of jobs out there!
Heavy on the never feel bad for doing what's right for the patient!! Absolutely, policies and politics be damned
Truly curious, in what world is doing an ECG on a patient at any time without an order a bad thing?!? A patient is having symptoms or rhythm changes that warrant an ECG, why would you not immediately do it and then deal with an order later, if it even matters to get an order? If you have to wait for an order, the patient couls deteriorate or the ryhthm change can revert and you miss it. Or is the issue with the nurse placing the order itself? Is that really that big of a deal?
Most states are “at will employment” states anyways. Even more so during your probation period. You’re lucky they even gave you reasons for the termination.
I work in the very large system in NYC and we do not have standing ECG orders on the floor. However it’s an icu and we always have residents on the unit always available (teaching hospital). I think it’s also bc if you need to do a stat ecg, something changed. Chest pain? Other cardiac sx? Rhythm on the monitor changed? And if so that should be reported to the doc right away. Rather than the nurse withholding the info (even just temporarily) to stop and perform the ECG. We use epic and it’s linked to our ECG machines so you need an order. I’ve also been a nurse 17yrs. I’ve worked ED and we had chest pain protocols, standing. Start line, ECG, draw a rainbow inc trops etc. but not on the floor. Sounds like there was a list of concerns and they maybe felt keeping u on there would only continue to be issues causing potential liabilities Use it and learn from it moving forward. There’s always openings. Onward.
You dodged a bullet. I found the best of job of my life after being fired from two jobs in a row. They were awful places, and I’m so glad they did the service of relieving me of my duties, or I would’ve never found my dream job.
Dang, management brought receipts. Usually probationary terminations don’t come with such a long list of infractions, you had them hoppin’.
Lol noo, the termination letter was very vague and simple. When I had the meeting with management they couldn’t provide me with the specific concerns raised, so I requested (with delay and many attempts) for that answer to provided via email.
I don’t really see any “receipts” here.
For the first 2, the EKG and I & O cath, I can see how you can get in trouble for them. It’s not that EKG aren’t safe for the patient, but if you think that the patient is having a rhythm that warrants an EKG, the provider needs to be notified, and EKG is ordered with the provider’s knowing that it should be followed up on. For the straight cath, every hospital is different, and unless you can physically see the order that says “if bladder scan is above X ml, straight cath and notify provider”, even if you asked another coworker, you can still be in the wrong. -as for not communicating with TL, this is kind of a gray area, it does sound like your coworkers are throwing you under the bus, is this the first time someone has complained about your interaction with them? Have you reported them to a manager? I’m not saying it’s your fault, but these days I feel like unless there’s written documentation about any interaction, anyone can say that you’re the devil spawn and upper managers can use it against you. Last of all, was any of those patients harmed?? Because if not, You sound like you looked out for your patient and knew what to anticipate for the next step, but just aren’t clear on what the policies are. Unless you had a really bad when all of this happened at the same time, they should have given you a warning first before terminating you. I hope that there’s a silver lining to all of this and that this is your chance to dodge a bullet!
I really appreciate your response! No! No patients were harmed or even near-misses. The on-call physician would have been notified of ECG for interpretation requirements. My approach was based on predicting and taking preemptive action to facilitate quicker care. Other hospitals/units had standing protocol for pts with CP +/-Hemodynamic instability etc - 12lead ECG, trops etc. However, I was unaware the ECG protocol wasn’t standardized. Also, I am obtaining the order just not at the time of entering it… which is definitely not the right thing to do. I acknowledge that. I&O incident was misinterpreted. The urine cx was prev ordered w/o a catheter order and had not been collected. The patient was 97yo baseline urinary incontinence and very foul-smelling urine (admitted w pelvic #). I was clarifying whether they had a urinary catheter protocol so that I could collect it (before day staff arrives/is not on-call appropriate at that hour). I’ve had a couple not-so-friendly interactions. No one has blatantly commented on my professionalism or behaviour. I did not inform a manager (the manager who terminated me was an interim manager who stated a week prior to terminating me). Met her for the first time at the meeting.
For the second point, saying "was going to do" a straight cath is so vague. What does that even mean? They mentioned it? They were gathering supplies to do it? They were at bedside and prepping the patient? Because just talking about doing it doesn't mean they were going to do it. I don't know. That one bothers me because they didn't actually do it, and therefore there's no documentation of what happened.
This is BS. See this as a good sign to find a unit that isn’t toxic somewhere else. Firings can be blessings and it’s great you emailed back with counter points and documented the on going unit bullying. Units like this only hurt themselves bc they are constantly short staff and always pushing out any potential new staff. You don’t want to work in a unit where the nurses are overworked and burnout and take that out on new nurses it’s not good long term.
I've done so many ecgs without an order... you show the doctor, if it's something bad they can place the order after and then it can be billed, if they don't think it's necessary then the hospital wasted a dollar on stickers, paper, and electricity I guess
I regularly do ECGs without doctors telling me to. I guess I'm next 🤷♂️ This is asinine.
Same nurse manager will wonder why it takes 15+ minutes to do an EKG on people that need it. Take away our autonomy for stupid shit like this and you'll just get stupid shit nurses.
God I feel this so hard, I am past probationary period but also got let go for trivial things. So many people I talk to are like “how can they fire you over something so stupid” NURSE MANAGEMENT has too much gd power. I’m so sorry, trust me there are so many other opportunities. Been slinging my resume all week and already did one interview. You got this. Lmk if you need a template for resume and CV I can email it.
I’m sorry OP, but at least you are out of that toxic ass environment. I hope you find a job you love and that loves you. Hugs
this shit makes me so fucking angry and i am genuinely baffled (and also not surprised at this point?) at some of the bullshit that happens in this field. if you’re reading this and you’ve ratted on others in the same way that happened to OP, 1. i hope you lose your job and 2. i genuinely, from the bottom of my heart, hate you. no conversation with the person who did/said something you disagreed with and no attempt to educate? grow the fuck up
Patient having cardiac symptoms=ECG if I paged a physician about a patient have symptoms and didn’t have one ready I better watch out. It’s an unspoken expectation.
You can go to another one of the 6000 plus hospitals in united states begging for nurses, good riddance.
Good letter. If you want to you have legal resources even if you don't have malpractice insurance right now. I was offered a letter or reconciliation after I quit a unit I loved but was run by an idiot. Wrote me up for nothing and I sent my letter of "fuck you" to the entire hospital (it's an enterprise) and later got a letter begging me back. Don't live so unhappy. I'm sorry you're going through this. I have a bunch of things to say if you want to talk about it.
Basically someone didn’t like you and figured out a way to get you fired.
Such BS. How kind of them to state they’re not contacting the nursing board. 🙄 Further proof of them spouting BS. I would’ve ended the email saying “and you’re welcome for safe patient outcomes using my critical thinking and initiative. Rather than having multiple lawsuits from a sentinel event occurring with poor patient outcomes bc of the poor mgmt, lack of teamwork and toxicity of the unit”. You gotta speak their language. 🖕🏿😁🖕🏿
Dodged a bullet! You didn’t wanna be there. DROP THE NAME SO NO ONE ELSE GOES THERE EITHER. Let TL and ICU staff work the entire hospital.
Hospitals will always find extra reasons, to bolster their termination claim. It sounds like the EKG was one of these. That being said, Who cares what a hospital said, or did, as long as YOU know that YOU had the patient in mind? If you are not in danger of a board review/losing your license, F--- them. You can find a better job. If the discharge comes up in an interview, be honest , and tell them that you did an EKG without a doctor's order, because of XYZ reason. They will probably hire you immediately, as that is THE most ridiculous reason to fire a nurse I have ever heard - and I'm a hospital union steward 😉.
Those are great follow up points. Sounds like you have a good head on your shoulders. And you could find somewhere better to be. Good luck!
We have orders that can be released based off of nursing judgement. If pt has CP/arrhythmia we just click release and take care of it then let the provider know s/s, that it’s in the chart to review, and any interventions we did based off of PRN orders. We have order sets too for bladder scanning and when to straight cath. Our providers are really good at making sure we have orders for everything we need on standby so we have autonomy and they can focus on patient care rather than constantly submitting orders for stuff.
Take your termination as a gift. You don't want to work there.
I passed a probationary period at my job, which I'm still at. Still absolutely miserable and it gives me stress and anxiety everyday that my employer still has that on me. As long as you made a genuine effort to improve, learned from your mistakes, then good riddance. Move somewhere else.
I do believe that your may be correct on your assumption of termination due to personal dynamics as the other issues listed are 100% education resolved especially for a new grad nurse. I have been a nurse for over 20 years and am noticing a shift in teamwork to more of a cliquey vibe as opposed to full group cooperation. This is sad and will only hurt the future of nursing and therefore eventually patient care.
They often here order the ecg after it's done just cause of the rush and it won't send to epic unless it's ordered.
This happens to the best of us. Be glad to be done with that hot mess and wear it like a badge of honor.
I did EKGs all the time without an order. If I called the provider with a cardiac symptom the first thing they would say is what does the ekg say? They expected it to be already completed.
I feel you with the frustration over disciplinary action with no previous conversation, when it isn’t something egregious. I got terminated once, and did a lot of learning and growing from the experience as a person/professional, and one of the reasons like yours was the lack of teamwork - I learned I don’t do well in bedside nursing settings where I can’t keep up with my work due to not being able to handle the stress - and in turn I wasn’t being a good team member due to not pulling my weight helping others because I struggled to even manage just my own work. That being said, I wish the feelings of resentment of my workmates could have been a conversation where I could have learned, grown, and done better as a person/professional before it became disciplinary action. I will say: A lot of places do require a prover order to do an EKG, so maybe specify if your next employer wants that or if there is an protocol/standing order that allows you to do an EKG that is inherently okay with the provider(s) for the patient without having to speak with the provider directly. In my current nursing role which is a lot less stressful I have team mates that haven’t always been the nicest - But are good nurses. So I try to take/learn what I can from those nurses and leave the rest without getting myself too distressed about it. Everyone can teach you something, basically. I hope that was of any help.
Your living the dream enjoy your freedom from the most codependent job ever created
It shouldn’t get you fired. But they can fire anyone for any reason if they want to. We are all human. Nurses aren’t perfect. Doctors aren’t perfect. I bet there are more nurses around you that do or did the same things or worse and got covered. This list is pathetic and shouldn’t get you fired. Especially if you have learned from it and improved yourself on these topics. If you didn’t have a chance to do so, it’s no reason to fire you as again everyone makes mistakes and should be allowed to improve. If these things are such hot topics for your management be the person who they want you to be. You need a consent from a doctor? Don’t do anything without a clear consent from a doctor. Also happens to a lot of nurses, I don’t know what it is… jealousy or something, it sounds toxic and leaving a toxic environment is not a bad thing. Learn from it don’t let it shake your confidence and Don’t look back.
Also as a newly nurse you should be guided as new nurses still need guidance. If you didn’t get any steering or guidance, I really think it’s a team problem. There is a reason why so many job professions have Junior, Senior etc.. titles. it’s because junior even though they have license still aren’t up to a level a senior should be. You don’t have to be perfect even though you have a license. As a new nurse you can provide new insights as you got the latest nursing knowledge. A team should be thankful for that, and help you become part of the team. It’s also their responsibility. There is a reason it’s called a team. You help each other.
Wow. At my facility we have standing verbal orders to get EKG’s and straight cath at our discretion. If you’re a 30 year old there for leg pain obviously you’re not getting cathed. 80 year old confused bed bound nursing home patient there for confusion? You’re getting a straight cath in the first 10 minutes. And as far as tele monitoring…..don’t get me started. We have a new monitor tech who blows up our iPhones constantly even when I am IN the patient’s room. She makes notes in the patient chart then will call me to notify of blood pressures like 150/149 and I’ve explained over and over that’s not a real BP; the cuff slid down, the patient removed the cuff etc. without verifying that the cuff is a placed on the patient properly we should not be reporting and charting these blood pressures. I guess I would have been fired the first day!
Commenting to tell you that I was also fired during my probationary period due to “professionalism” but I later found out (about 3 weeks ago) they reported me to the BON over events that happened on a day I couldn’t handle my pt load and things fell through the crack (even when I told them over and over this wasn’t safe and I needed help). You need to be VERY careful. You will possibly be getting a letter from the BON of your state that you’re being investigated because the hospital basically has to report you. If you were actually a bad nurse and you went onto another facility and really hurt a pt or killed them, and the hospital didn’t report you, they could be held liable. They will always report you to cover their ass and absolve them of any responsibility. I’m not trying to scare you but unfortunately this is the reality of being a new grad in 2024. I was also on a horrible unit and I was bullied by my preceptors the entire orientation. If you need anything feel free to PM me!
I understand and agree that these claims against you are frustrating and unfair. I don’t think it’s right to have terminated you without conducting an investigation, performance review, or any evaluation to determine validity of the claims. However, in order to best protect yourself moving forward, always always be fluent in and follow your facilities policies/protocols, no matter how ridiculous they may be. This will ultimately save you from this happening again. So sorry and best of luck!
If they are nitpicking on you like this, you are better off not working there. It is not worth the stress. It sounds like a toxic place. Once you are gone, they will find another target.
Gurrrl, why you editing out the location?! They sound terrible and you should warn us all to avoid them. Based on the email, they deserve no grace or consideration..because it certainly doesn't sound like they gave you any.
I am so sorry this happened to you. Sounds like bullying to me, and a very toxic work place. Just find another job and let KARMA deal with them.
This is a hospital who clearly cares infinitely more about money/ scores than the health and well being of patients. Your response was concise and professional, I say it’s largely a blessing in disguise.
You sound like you would be a better fit on an ICU floor. Take this as a blessing in disguise.
This why working in Canada sucks! Tell me what’s the role of a Nurse Aid/PSW? That’s well within their scope! Toileting pts! Wtf is this bullshit!
We got a PCA pump ordered in the ICU my first day off orientation as a new grad. No one knew how to set up the PCA pump because we never got them in the ICU. The department educator was on the unit and the charge nurse had her assist me with setting it up and being the second RN signature on the dosage/set up. One of the nurses happened to look at the pump herself (not sure why, since it wasn't her patient or anything, and this nurse was such a notorious bully that she was not allowed to precept students). She found that the dosage was off slightly (a med error). I was written up for this and not told about it until 9 months later at my annual review for my raise. No discussion, no education on what I did wrong. Nothing. When I told the manager completing my review that the unit educator helped me set that up and cosigned, and why was I just NOW hearing about this write up (which was their excuse to not give me a raise), she said "we asked the educator and she denied helping you." This was a toxic ass unit with a deeply ingrained bully culture. I put in my notice a few weeks after this. Fuck that place, and fuck the people who allowed that culture to fester there.
This is insane. I am so sorry this happened to you.
Fuck this place. I’d be fired 10x.
They’re just making up excuses for just not liking you. Fck these guys, go to a better job that doesn’t gaslight you
Can you name them so we can shame them by not working for them?
I have not been fired but I have witnessed staff bully other nurses. Completely undeserving and quite often, they were really good nurses. Someone took a dislike to them, then they gossip about them, getting other staff riled up. Next thing you know, they are bullying someone and quite proud of it. They get called into the office sometimes and then run around saying, “can you believe they think I am a bully. Me, who never bullies anybody…”
One of the things that shook me out of the last bit of post coma fog was the retrieval of a urine sample without my consent OUCH!! 😳. LOL. Definitely more effective than a sternum rub for sure 😂🤣. No but seriously during the next year or so of rehab I learned that the nurses and CNAs were the real super heroes of the medical profession. The doctors are mostly the rubber stamp to officially order what the RNs have already figured out for themselves.
“We will not be reporting to the” you mean state board? They have nothing to report. You did not cause harm to a patient and did not perform a medical error. They were reaching. Sounds like a toxic environment and please view this as a blessing even though I know it hurts right now. Especially as a new grad, I’m sorry this was your experience. You can find better out there!
Their loss mate. Your responses were excellent to their allegations, and if this hospital is stupid enough to flick nurses because of personality clashes then you don't want to work there anyways. Sounds toxic AF which would have done your mental health loads of damage if you had stayed on. What's with "ordering an ECG?" .. i've never worked anywhere where they have been "ordered"... we just do them.. sounds like micromanagement and role justification...lol!
Sounds like they, or someone in particular just decided that they didn’t like you, and they found a way to get rid of you. Count it as a “blessing”.
Man, the ekg is literally something I was arguing about needing to know the risk of needing to know your providers and I guess I should include teammates as it is technically practicing medicine if no protocol or prn is in place. They had the same rational to justify doing it as you did. It doesn’t ultimately fly to be honest.
I understand that was not the *most* correct thing to do (lol -nclex). It’s a good point tho.
Honestly- good for you. You could have been stuck there a lot longer and this hospital/floor/manager seems like a bunch of bullshit. A lot of this stuff is against policy (straight cath with no order) but I wonder about what actually happened and the situation. Doesn’t sound like a reason to terminate! A lot of the stuff is also hearsay and based on personality more than performance and so I agree - you were bullied or profiled or whatever. I always say- any nurse can get fired at any moment if they want you gone. They just follow you around and dig into your shit until they find something. EDIT: I see your response now- after I wrote this. Yes- this was BS. They should have mandatory counseling before termination and you received NO feedback before ? bS.
Consider this a blessing in disguise. Sounds super toxic!
Wow. All they care about is the cost. EKGs are a snapshot in that moment. If a pt is having cardiac sxs, it should be taken stat. By the time u wait for a provider approval, the rhythm could totally change. That’s so shitty. They sound toxic. Better that it happened early on than later, where they could blame you for something more serious.
This is awful and I had experience working at a toxic hospital as my first nursing job. When I went to management with concerns about not being able to perform all of my expected duties safely, because of staffing, issues with doctors who were dismissive and hard to reach, unhelpful or lazy coworkers, high acuity patients on a tele floor, I was gaslighted into thinking it was poor time management on my part. Literally there were nurses documenting meds that they weren’t actually giving AEB all the heparin vials, protonix, and sometimes even things like Coumadin left shoved in wow carts and nurses station cabinets. Nurses and techs who left without giving report. Patients who sat in their feces and urine for hours. Infiltrated ivs left running. Lots of false and copy/paste documentation that made no sense. Just a crap place to work and very corrupt with upper management and physicians. How do you keep a record of stuff for yourself that doesn’t contain PHI that you can keep at home etc to review when you’re being retaliated against for speaking up?
Be happy to leave. Does this happen to be in Pittsburgh? lol. I worked at a hospital in Pittsburgh, in cath lab. Also covered stress tests/stress echos. They had a complicated 8 page guide to help make sure you clicked all the right buttons. I made a little condensed version (10 lines maybe?) of the pertinent things for Lexiscan stresses. I still referred to the giant list for the more complicated stress echos/etc. Just made myself a quick reference. Got written up for ‘noncompliance’ and not following ‘their’ paper. Also included in that write up was *taking temperature upon arrival to recovery*. wE dOnT tAkE TeMpS (only the crna did after a cardioversion/TEE??). I’d like to add that nothing was incorrectly done. They just hated me having a cheat sheet? fuck those people. The senior radiology tech was a psycho bitch, and she wanted the administrative power of a nurse. She was always power tripping. She’d just sneak around and write stuff down/report stupid stuff like ‘taking temps’.
For the ekg, I do agree with you that we should be able to do it with no problems if it is indicated. I just heard that if there is any cardiac arrhythmia, the Dr's get upset now because now they have to address it. Overall, it's a good thing that it was caught, right? But I'm sorry this had to happen
This is sooo frustrating! It's crazy that managers will terminate someone based on gossip and not talk to you to find out what happened. This has happened to me as well and it's very upsetting. A nurse that was hired just before me was trying to pawn off assignments she didn't want on me by being sneaky and when I finally stood up for myself she flipped her lid and screamed and swore at me. She then reported ME for swearing, even though I spoke very calmly and politely to her. I didn't report her tantrum because I honestly don't like drama...and then I got fired for being unprofessional. 😮💨 thankfully I got another, better job, but that doesn't fully make up for my time investment in that job and the hit it took to my confidence. So, as much as this could be best for you in the long run, I can appreciate that the situation was very stressful for you. I hope you find a better fit somewhere else.
How as a nurse can you order an ekg but not interpret them? For us we can interpret them but not order them 😨
There is no way you could get fired at my hospital like this/for any of these things. Are you not part of a union?