Opinion about a nurse's erros

  1. I'm an APN in a peds practice. Saw a 7 year old girl for a routine medication follow up, we do every few months and give refills.
    Hadn't seen her for 4 months and the MOA triaging her says, by the way, she lost some weight. I pull up her growth chart and she has lost 14 lbs! She is small to begin with (only 8th percentile for height and 13th percentile for weight) but now she has fallen off the growth chart. I went to my MOA and said she is only 30 lbs, are you sure that weight is right. She assured me she double checked it.
    So I did a thorough history about diet, appetite, any abnormal symptoms, everything seems to be going well. She doesn't even look terribly thin, but again, she is a small child.
    Did a lab work up and fingerstick glucose in the office, everything comes back normal. I said again to the MOA, "you are sure about that weight?" and she says yes. I'm thinking diabetes, cancer, any number of horrible things.
    They came back the next day to review labs and a nurse weighs her. She is miraculously back to her previous weight (actually up 2 lbs)!
    So the entire ordeal was due to a triaging error.
    i know this was technically the MOA's error but I am also feeling very guilty. Her extreme weight loss did not sit well with me but I trusted the vitals I was given (as I feel I should be able to)...but should I have just weighed her myself if I was skeptical? How many of you take a "if you want something done right" approach to things like this? I am so frustrated by this, for not just myself but the patient's family. I didn't make the error but I feel that I am ultimately responsible for what happens with patients. Some peers are saying no way, it is on the MOA. Thoughts? Opinions?
  2. 27 Comments

  3. by   Jules A
    It happens. If you were concerned enough to ask twice, especially if she didn't look underweight, I would have requested she re-weigh or weigh the kid myself. Like when you were a RN if something felt off double or triple check because chances are it is off.

    Although not especially productive to pay pass the blame game I think there is some responsibility on both sides. We should be able to trust those gathering information but it is ultimately on us. Take this as a valuable lesson and be thankful that it was only a matter of frivolous tests.
  4. by   Oldmahubbard
    Everywhere I have ever worked, for the last 30 years, as an RN and an NP, weights have been notoriously, notoriously and totally unreliable.

    So unreliable, that I have stopped paying attention, unless the patient looks different.

    This issue is also unfix-able.

    My opinion.
  5. by   NHGN
    You're a genius if your subject line was deliberate.
  6. by   chare
    What is an MOA?
  7. by   juan de la cruz
    I don't work in primary care like you do but in my practice, any objective data that looks off and can affect the direction I am going to take in terms of clinical decision, I will confirm that it's accurate and that includes labs, vital signs, and physical assessments done by those other than myself.
  8. by   traumaRUs
    MOA - medical office assistant

    I work heart failure and before that dialysis. If I had a question, I had the pt re-weighed...
  9. by   BCgradnurse
    If vitals look off I re-check them myself.
  10. by   Jules A
    Quote from traumaRUs
    MOA - medical office assistant
    In my state NPs are not able to delegate to MAs. They fall under the board of physicians domain. Obviously many do and it is being looked at legislatively but something for OP and others to consider depending on their state's regs.
  11. by   PNPss
    Unfortunately no. Typing on a small phone screen and didn't notice until I already submitted it. Relevant to that we all make mistakes? Lol
  12. by   BostonFNP
    I always always always recheck anything I didn't do myself prior to making any medication changes and/or going through an extensive workup. Anything from a technical error to a documentation error can result in a single outlier. I do the same thing with lab results: if it is an outlier if gets a repeat prior to any changes/workup.

    Did the patient say that she had lost weight? I guess I work with adults that are all to happy to tell me when our scale "isn't right".
  13. by   chare
    Quote from traumaRUs
    MOA - medical office assistant
    Yes, that was my assumption as well. However as the OP used nurse in the title, and made specific reference to "a nurse" weighing the patient on the return visit, it was somewhat confusing.
    Quote from PNPss
    i know this was technically the MOA's error but I am also feeling very guilty...
    As you should. The first error might have been the MOA's. The second was yours for not rechecking the patient's weight.
    Quote from PNPss
    Did a lab work up and fingerstick glucose in the office, everything comes back normal...
    And this was your second error. This, along with whatever you might have told the patient and her family.

    If the OP is going to be so quick to assign blame to others, without accepting any responsibility when she doubted the accuracy herself, perhaps she could be more precise in describing who she's throwing under the bus. Remember the old adage When you point one finger, there are three fingers pointing back to you.
  14. by   Libby1987
    14 lbs in 4 mos? If I lost 14 lbs even at my adult size I'd have to go buy all new clothes, my pants would literally fall off. 14 lbs is so dramatic, especially in such a short period, that if I couldn't observe or glean any insight from mom to confirm that great of a loss, I would have re-weighed her if only from a "that can't be right" perspective.

    Why are you referring to your medical assistant as a nurse? Do you think of MA as interchangeable with nurse?