Fired Again ~ HAHAHA! - page 3

:rotfl: Fired again from LTC and I don't care. Here's one of the DON's shenanigans: one of the other nurses was telling me about it - they had a patient who had very UNSTABLE blood sugar... Read More

  1. by   leslie :-D
    Quote from 3rdShiftGuy
    I know. I have the same problems docs don't want to here from me at 3AM either. But when the do do hits the fan do you have a leg to stand on when when in front of the BON, "the docs usually don't want to here from us, so I did..........."
    that's a fact....that's tough toodles for the md. furthermore there was one doctor who gave me such a hard time when i called him and i had difficulty in obtaining an order. so i told him that i was going to document his refusal to treat his patient and i hung up. he called back within 5 minutes with an order and never had a problem again.
  2. by   barefootlady
    As nurses we all know that you just don't hold a medication and not do any type of follow through. Sounds like this nurse did not do proper follow through and the DON was giving her a warning, GO BY THE PROTOCOL! Doctors often want to ignore their long term care patients, but they have a duty to these patients, so I think telling the Doctor that it will be documented he gave no orders for care was great. We all know we have to go the extra mile at times for those we are caring for, even when we don't think the organization appreciates our extra work. That is called nursing. That is what we do and, I hope, do well.
  3. by   mattsmom81
    Quote from wannaBEanRN
    That is incorrect information. You should give the long-acting. So what if I'm not a nurse yet? I'm a Type 1 diabetic, and know my way around insulin. Long acting insulin will NOT affect the already low BS. Delaying it will mess with the time-table the diabetic is on.

    If you don't believe me, ask any endocrinologist. I have.
    Great point Whitney...its important to look at the big picture and not make a snap judgment to just simply 'hold' long acting insulin without followup. Knowing the type and the patient is paramount....and with long term patients who have been treated for this awhile and their docs know them, probably a drop in blood sugar that is unexpected IS due to the patient not getting their nutrition the past 12 hrs for some reason. That reason needs to be investigated.

    If a nurse isn't sure whether to give the Lente etc, they should at least consult with someone more experienced before just holding it altogether with no followup....then like Tweety says ya got a blood sugar of 450 next check and a doc who is pizzed 'nobody told him of a problem earlier.'

    Gotta love our endocrinologists...who give us the best standing orders and parameters on our DKA's and acutely ill diabetics, etc...they really know their stuff .
  4. by   Keysnurse2008
    Quote from earle58
    hell, i've given nph to pts w/low blood sugars (50-60) followed by orange juice then their breakfast...i just make sure they're eating throughout the shift.. and YES, i'm a damn good nurse with good assessment skills.
    earle 58 and others.........please go back and read.....this pts blood sugar was 45 that we are talking about.Id have notified the doc and followed orders.....but to give any type insulin until that bs came up is crazy...and potentially lethal.Id call the doc, feed em, watch their loc and after I rechecked their bs one hr later Id have given the long term insulin.Perhaps Im misunderstanding you guys.....you cannot be saying that you would check a pts bs and see that it was 45 and just say"oh well" and draw up aload of lente.I have been an er nurse for years and yes a med surg nurse too......and when you drop down to the 40s they are getting pretty darn near trouble.To just blow off a reading of 45 and give that insulin is crazy.And ...for the student nurse that is a diabetic......my heart goes out to ya hon.....bc if your taking long acting insulin with a bs of 45...you will be on dialysis before long.When you complete nsg school......and have seen pts in hypoglyemic comas talk to me....its not a pretty scene.I have to have misunderstood you guys...either that or you guys forgot the blood sugar was 45.Id have held the Insulin, notified the doc, fed the pt, rechecked it in one hr,and then followed the docs orders as to when to restart.Most docs will not agree to allow insulin to be given till that bs is over 70.If the pts bs was 70...and they were fixing to eat...h*** yes Id have given the long term...but NOT NOT NOT with a bs of 45....thats too low.I agree with the nurse for witholding the Insulin for a pt with a bg of 45...i say again 45....but Id have probably fired her too for not calling the doc.Shes not the doc.But guys.......45??????thats so low that your pt is heading towards not even having enough glucose floating thru the old veins to mainatin meatbolic processes.
  5. by   Keysnurse2008
    Quote from barefootlady
    As nurses we all know that you just don't hold a medication and not do any type of follow through. Sounds like this nurse did not do proper follow through and the DON was giving her a warning, GO BY THE PROTOCOL! Doctors often want to ignore their long term care patients, but they have a duty to these patients, so I think telling the Doctor that it will be documented he gave no orders for care was great. We all know we have to go the extra mile at times for those we are caring for, even when we don't think the organization appreciates our extra work. That is called nursing. That is what we do and, I hope, do well.
    Amen barefoot lady!
  6. by   Town & Country
    I don't know that there WASN'T any type of follow-through - I just assumed there was, because that was the only thing the nurse mentioned: that the DON had questioned her refusal to give the insulin in the first place.
    For all I know she could have called the doc fifteen times that day; she was just rushed telling me the story so I didn't get all the details....
  7. by   marymary
    Quote from Shezam!


    Fired again from LTC and I don't care.

    Here's one of the DON's shenanigans: one of the other nurses was telling me about it - they had a patient who had very UNSTABLE blood sugar - there was an order for insulin at "X" time (say, 8pm).
    The nurse did a fingerstick on her and her blood sugar was way low - something like 45! So naturally, she held the insulin.....
    ...would you believe....the DON got onto her the next day - she told her she was "working OUTSIDE OF HER PRACTICE" by withholding the insulin (it was routine not prn), and that she was supposed "to follow doctor's orders!"

    Yuk Yuk

    The nurse telling ME about it was flabbergasted. So was I...I said, "You're NOT working outside of the scope of your practice when you protect a patient!"

    HELLO
    Nurses are not *******' ROBOTS! We're supposed to use some nursing judgement when called for and that's what she was doing.

    WHAT DO THEY WANT, MINDLESS ROBOTS?
    Freakin' B****!

    Please, there must be more to this story. This has happened to me many times. But regardless there is always a supervisor around to contact LPN's cannot work unless there is a RN around somewhere to contact for followup.
    1. FS=45; give glucose (orange juice, follow with carbohydrate-long acting food source;sandwich, crackers, etc...)
    2. notify supervisor
    3. in 15 minutes check FS again, if over 70 give insulin (usually NPH is the order , insulin is also usually order around mealtime.With 70/30 iinsulin the regular portion is the lower percentage, it will be taken up in thirty minutes by the juice and meal. The NPH portion will peak in six hours or so when the person has their evening snack. Believe me you are covered.)
    4. then you are covered, write your note and include everything you did including notifying the supervisor. Believe me she will cover her buttock, you are working under her license. Then you are covered, remember work within your scope.
    This has happened to me many times. It does work, try it. I try to always learn something positive out of negative situations.
    Last edit by marymary on May 29, '04
  8. by   Tweety
    Quote from TNNURSE
    earle 58 and others.........please go back and read.....this pts blood sugar was 45 that we are talking about.Id have notified the doc and followed orders.....but to give any type insulin until that bs came up is crazy...and potentially lethal.Id call the doc, feed em, watch their loc and after I rechecked their bs one hr later Id have given the long term insulin.Perhaps Im misunderstanding you guys.....you cannot be saying that you would check a pts bs and see that it was 45 and just say"oh well" and draw up aload of lente.I have been an er nurse for years and yes a med surg nurse too......and when you drop down to the 40s they are getting pretty darn near trouble.To just blow off a reading of 45 and give that insulin is crazy.And ...for the student nurse that is a diabetic......my heart goes out to ya hon.....bc if your taking long acting insulin with a bs of 45...you will be on dialysis before long.When you complete nsg school......and have seen pts in hypoglyemic comas talk to me....its not a pretty scene.I have to have misunderstood you guys...either that or you guys forgot the blood sugar was 45.Id have held the Insulin, notified the doc, fed the pt, rechecked it in one hr,and then followed the docs orders as to when to restart.Most docs will not agree to allow insulin to be given till that bs is over 70.If the pts bs was 70...and they were fixing to eat...h*** yes Id have given the long term...but NOT NOT NOT with a bs of 45....thats too low.I agree with the nurse for witholding the Insulin for a pt with a bg of 45...i say again 45....but Id have probably fired her too for not calling the doc.Shes not the doc.But guys.......45??????thats so low that your pt is heading towards not even having enough glucose floating thru the old veins to mainatin meatbolic processes.

    We were responding to the person who said hold insulin on a patient for a BG of 75, if you go back and reread. LOL
  9. by   Tweety
    Quote from Shezam!
    I don't know that there WASN'T any type of follow-through - I just assumed there was, because that was the only thing the nurse mentioned: that the DON had questioned her refusal to give the insulin in the first place.
    For all I know she could have called the doc fifteen times that day; she was just rushed telling me the story so I didn't get all the details....

    Well then don't go gossiping about folks until you know the details. That's how rumors are spread.
  10. by   Blackcat99
    Quote from earle58
    that's a fact....that's tough toodles for the md. furthermore there was one doctor who gave me such a hard time when i called him and i had difficulty in obtaining an order. so i told him that i was going to document his refusal to treat his patient and i hung up. he called back within 5 minutes with an order and never had a problem again.
    :chuckle earle 58. What a great idea! I think I will do that to the next doctor who complains when I call him at 3am. :hatparty:
  11. by   Tony35NYC
    Still a student here, but the policy at the hospital where I'm in rotation is that the nurse should hold the insulin, treat the hypoglycemia, and re-check the glucose level shortly afterwards. The exception would be if its early am and the pt has a history of Somogyi.

    I don't get the protocol at your hospital at all. Giving insulin to a pt with a glucose of 45 seems pretty dangerous to me. Suppose you don't get a prompt response from the doc, would you give the insulin and watch your pt go into shock while waiting for instructions, especially if the pt has other complications such as nausea and vomiting, abdominal pain, or dysphagia, and they refuse to drink that OJ or eat that breakfast? Guess you'd better be standing by with that D50, or is an order needed for that at your hospital, too?

    Thankfully, in my neck of the woods nurses have much more autonomy than that.


    Quote from 3rdShiftGuy
    Diabetics need their insulin. They are diabetic because they don't make any or adequate amounts. If a patients eating they are going to need their insulin and it shouldn't be held. Obviously there are times when it should be held, or the dose lowered, etc.

    I love it when I get report. "I held their dinner insulin because their BG was 70". Later at hs I find their BG to be 400. Wonder why.?
  12. by   Brownms46
    Quote from 3rdShiftGuy
    Well then don't go gossiping about folks until you know the details. That's how rumors are spread.

    You know what Tweety...this scenario was messed up all the way around. First this pt. supposedly had a 45 blood sugar at 8pm??? Did this patient not eat supper let alone a snack? And 8pm is too early to be giving a long acting insulin, seeing how it would probably peak at about 0400 in the morning. Too many facts are missing to even comment on the first scenario anywho.
  13. by   CseMgr1
    Quote from longtermcarern
    I was told please don't call my office, write it down and fax it. I wrote it down and faxed it, 1 hour later got an order to give 6units L in the am :uhoh21:Jean
    You should have gone ahead and faxed him a blank copy of a Death Certificate with a cover sheet which read: "Thought you might like one of these AHEAD of time, since you don't want to be BOTHERED".

    What an a----! :angryfire

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