I think I was a morning snack

[RiverNurse]

Hi all,

I just got home from work (night shifter here - woo hoo!) and wanted to "process" something that happened at work this morning as I was on my way out the door.

I'll tell the whole story from the beginning and am hoping for a reality check - just be merciful... LOL...

I received report last night on a pt receiving coumadin. I don't remember clearly at this point if the nurse giving report told me that the patient had received her evening dose or not (it was due at 1700 during the nurse's shift). I went through my shift, passing meds, noting the patient's INR and seeing that the previous nurse had "scored" through the dose timing and had initialed that the coumadin had been given.

I reconciled the MARS and sent the appropriate copies to the pharmacy and filed the other copy with the chart on my floor.

Right as I was walking out, the nurse from the day before approached me with coumadin in hand saying, "You mean you didn't give the coumadin to the patient? She didn't get it?" It had been several hours, so I wanted to check the chart to determine if I'd made some sort of med error. I went to the patient's chart and looked at the MAR I'd reconciled a few hours earlier. The timing (of 1700) had been scored through by the nurse and initialed by her. I asked her if there was something I'd misunderstood or had done wrong. She really didn't reply to that but did say that the patient had dropped the med the evening before and that she (the nurse) had ordered another dose and it wasn't on the floor at the time she left.

So, after looking at the MAR, again said the patient dropped the med - then - she circled the previously scored dose timing (indicating that the med HADN'T been given) and made a note on that MAR that the patient had dropped the med and that the med hadn't been given.

That's all well and good - for her - but...

1. The patient didn't get the med - and since this is coumadin - I regard this situation as a very serious one.

2. If anyone (particularly the docs) looks at that MAR that is in the chart, it will appear that the previous nurse indicated that the med had not been given and that I simply didn't give the med on my shift. On the surface, it will appear that I was negligent.

3. I feel I have just been "eaten".

Now, if I really "had" to prove myself here - it would be as simple as getting the duplicate sheets from the pharmacy - unaltered by her - showing that it appeared as though the med had been given during the previous shift.

I just feel that this is an ethical issue. and I really do not like the way this situation feels. I feel I have been compromised.

I know this will blow over, but this also feels like something I need to address but am so new at this, that I really don't know how.

Anyone have any advice? Many thanks.

Shawna

[LydiaNN]

Document, document, document... good luck.

[nservice]

It is probably in your hospital P&P to fill out an incident report for medications missed and notify the MD. I would fill out an incident report describing exactly what happened. The day shift nurse is at fault. Medications should only be charted when they are actually given. There is a reason for the process of signing off medications given...Safe patient care!

[NotReady4PrimeTime, RN]

I agree with both posts above. I also think you should get the copy of the MAR you sent to Pharmacy to support your version of what happened. Your coworker is hanging you out to dry for something SHE did. Come on, if the patient dropped the pill on the floor, why didn't she tell you that in report? She's covering her own butt, but her shield is pretty flimsy. Altering charts is illegal and she's got bigger problems coming over that, for which she has no defence.

[lpnstudentin2010, LPN]

I agree with both posts above. I also think you should get the copy of the MAR you sent to Pharmacy to support your version of what happened. Your coworker is hanging you out to dry for something SHE did. Come on, it the patient dropped the pill on the floor, why didn't she tell you that in report? She's covering her own butt, but her shield is pretty flimsy. Altering charts is illegal and she's got bigger problems coming over that, for which she has no defence.

good thought with getting a copy of the mar sent to pharmacy,

[RiverNurse]

Thanks for the posts, everyone. I did get a copy of the MAR sent to the pharmacy. I will be following up with this. My heart is heavy at the thought of following up on this.

Many thanks -

Shawna

[lpnstudentin2010, LPN]

good luck. :icon_hug:

[shlru0404]

It would be nice of people could buy integrity like milk every time they fall short. I will look over my MARs more carefully now.

[Scrubby]

I really do hope that you write up an incident report. You should always cover yourself in this sort of situation. She actually signed that she had given it when she hadn't which is not good practice.

It's hard having to do this sort of thing. I had to do something very similar to a friend of mine and i remember agonising over it. At the end of the day though it's your registration on the line.

[CABG patch kid, BSN, RN]

Ugh, she should have told you in report if the patient dropped the med and it wasn't given. Even if she forgot to tell you in report, she shouldn't have pointed the finger at you the next morning. Something is fishy here.

Good luck talking to your manager or doing whatever you have to do. I'd watch my back around that nurse.

[Sabby_NC]

Thanks for the posts, everyone. I did get a copy of the MAR sent to the pharmacy. I will be following up with this. My heart is heavy at the thought of following up on this.

Many thanks -

Shawna

You are doing the right thing.

You are being your patients advocate and preventing this nurse doing something more harmful down the track.

Be professional and speak your mind clearly and succintly.

I wish you the very best in all of this.

[tulip928]

I agree with writing up an incident report. I should have done this in several instances as a new nurse where another nurse was slacking and I took the blame. I only realized in retrospect, that it was easy to pass off the problem on the new nurse, and I was so unsure of myself that I too easily took the blame.

One time in shift report, (NICU) I was told that pharmacy would be sending a vaccine over for one of my babies. After checking at the desk several times, and not finding it, I called pharmacy and was told it had been sent hours earlier, before I came on shift. It had been buried under paperwork in front of the unit secretary, and was no longer usable. Guess who got written up? ME. I was told that it was a vaccine that was very expensive, and the unit would have to cover the cost. For some reason, the off going nurse didn't do her job, and was protected by her friends.

So protect yourself and do an incident report: make sure you write your version of events.