help

  1. Hopefully someone can offer me some advice. On May 1st, I had a medication error. I have been a nurse for six years and I have never had one. At that time I was employed as a research coordinator. I had enrolled a patient into a trial after being called in at 0300 to do so. The medication was supposed to start at 36cc/hr for 2 hours and then decrease to 17.6cc/hr for 70. I reversed the two and started it at 17.6cc/hr and then increased it to 36cc/hr. It was thankfully caught 13 hours later by the bedside nurse. It was an honest error. I thought I knew exactly what I was doing. The infusion stopped early to ensure that the patient received the total dose she should have received but she received it early. Thankfully, she suffered no adverse events. However my supervisor placed me on final performance improvement counseling - the last step before being fired - she termed my error as gross negligence; placed me on administrative leave pending a fitness for duty evaluation by a psychiatrist; and then asked for my transfer. This has devistated me. So I left, taking vacation time to find another position. The administrator of the division would not let me return to the icu - where I had shown competency- I was the charge nurse and I was not about to work with my supervisor anymore. So I took a position quickly and I am very unhappy in the position that I am in. I have filed a greivance and it has gone all the way to a full panel review that is set for Thursday. I have many friends who have had medication errors but received nothing more than informal counseling for the event. I do not want to go to this hearing because the supervisor will be there with the administrator and the cheif financial officer by her side. I am having trouble getting nurses to come forward to even admit on paper that they had a medication error and did not receive as much punitive actions as I have. Does anyone have some suggestions or citations on the issue?
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  2. 10 Comments

  3. by   haddair
    Marnae, I am very sorry to hear about your situation. This is my first time on this internet site and I start clinical tommorrow so I really can't offer too much advise. The only thing that I see you can do is pray about it and hope that everything works out in your favor. Let them know that this was a honest mistake and that you have definitely learned from your mistake. I do know that it is not appropriate to ask your friends to be there. The reason you have to go this hearing is b/c of your mistake, they are not the one on trial. It is probably best to let them realize that this is a problem that you made and only you. Don't compare yourself to the others or they may not realize that you learned from your mistake. Good luck!
    Originally posted by Marnae:
    Hopefully someone can offer me some advice. On May 1st, I had a medication error. I have been a nurse for six years and I have never had one. At that time I was employed as a research coordinator. I had enrolled a patient into a trial after being called in at 0300 to do so. The medication was supposed to start at 36cc/hr for 2 hours and then decrease to 17.6cc/hr for 70. I reversed the two and started it at 17.6cc/hr and then increased it to 36cc/hr. It was thankfully caught 13 hours later by the bedside nurse. It was an honest error. I thought I knew exactly what I was doing. The infusion stopped early to ensure that the patient received the total dose she should have received but she received it early. Thankfully, she suffered no adverse events. However my supervisor placed me on final performance improvement counseling - the last step before being fired - she termed my error as gross negligence; placed me on administrative leave pending a fitness for duty evaluation by a psychiatrist; and then asked for my transfer. This has devistated me. So I left, taking vacation time to find another position. The administrator of the division would not let me return to the icu - where I had shown competency- I was the charge nurse and I was not about to work with my supervisor anymore. So I took a position quickly and I am very unhappy in the position that I am in. I have filed a greivance and it has gone all the way to a full panel review that is set for Thursday. I have many friends who have had medication errors but received nothing more than informal counseling for the event. I do not want to go to this hearing because the supervisor will be there with the administrator and the cheif financial officer by her side. I am having trouble getting nurses to come forward to even admit on paper that they had a medication error and did not receive as much punitive actions as I have. Does anyone have some suggestions or citations on the issue?
  4. by   Doey
    Marnae, I too am sorry for your situation. It can be quite devestating when a med error is made. It's too bad the facility you work for feels that a punitive reaction is the solution. I have been a nurse for 23yrs. and believe me no one gets by without a med error in their nursing career. We've all been there. No one makes an error on purpose and instead of laying blame, which is not only damaging to the self esteem of the person involved in the error, but to other nurses in the facility as well. Doubt, suspicion, anxiety, anger are just some of the emotions that are the fallout of such action. Instead, along with your input, they should be trying to find out what the circumstances were that contributed to this error and how can things be changed to lessen the chances of it happening again. I've read a few articles on this and they are all stating that we should start with the premise that errors will be made, not with the nurse will never make an error and if he/she does they will punished. We are all human and the fact is errors will be made. Punishing someone does not take away the fact the someone else can and probably will make the same error if the system isn't changed. There are a few things I am confused about. First, were all three jobs you mentioned in the same facility or the same organizaton? Second, why did you get a "final performance improvement counseling"? Was this your first time being disciplined for a med error or any other type of performance problem? And third, why the fitness for duty eval. by a psychiatrist? It is a pretty serious allegation to make that someone is not fit for duty for whatever the reason (intoxication,substance abuse, behavioral problems). It seems to me that if that were the case they should be involved in trying to get you help with your particular situation. I understand your feelings regarding other nurses who made med errors and their handling of it. But I wouldn't say too much about that. People have a way of relating what happened to them inaccurately. Either because they don't see the whole picture, aren't willing to admit what role they played, have difficulty accepting any criticism, or enjoy the "drama" of the story telling and administration bashing. Find out your institutions policy on med errors and bring that with you. Check out the policies on fit for duty and final performance improvement counseling. Be prepared. I find that if I rehearse in my head the points that I would like to make and how I want to say them, it helps to remember to get everything in. Also, don't sound whiney. Be as professional as you can be. "Yes I made the error and since then I've thought about how and why it happened. I have some possible solutions that may prevent it from happening in the future", some thing like that. Whenever anyone starts raising their voices or getting whiney, those that are listening start to shut off. Think of yourself in the position of the listener. Haven't you found yourself doing that? That's some of what I've learned through my nursing career in dealing with anyone. Also I believe you have the right to bring someone of your choice with you as your "witness" so to speak. It shouldn't just be you and "them". Maybe you would want some legal advice on this and a visit to your facilities employee assistance program might be helpful for you. If you have a union go to them for info. and assitance. Don't be afraid to state how you feel or how you see things, but be professional about it. I wish you luck Marnae. Let us know how things go.
  5. by   Marnae
    Doey, thanks for your input. I wanted to answer your questions. Yes, this is my only performance issue ever in the seven years that I have been employed at this institution. My supervisor bypassed several steps in the performance chain i.e. informal counseling, warning, and written performance improvement counseling to get to the final performance improvement counseling. I have many emails from my supervisor praising me for my job performance prior to this error. The reason I feel she requested the fitness for duty evaluation is because I made the stupid mistake of telling her that I had started taking an antidepressant. I was searching to find an answer within myself for the reason I commited the med error. And that was the only reason that I could come up with. So I guess to get her off my back and to place blame on something other than myself at the time, I told her of the antidepressant. All jobs discussed are within the same institution. I do not want to leave this institution in bad standing. So, I will stay until this matter is resolved or I have finished the six months required by the final performance improvement counseling. There have never been any allegations by my supervisor or anyone else about substance abuse use, alcohol use, or behavioral problems. Thank God. I will be using your advice tomorrow. Thank you again! Marnae.
    Originally posted by Doey:
    Marnae, I too am sorry for your situation. It can be quite devestating when a med error is made. It's too bad the facility you work for feels that a punitive reaction is the solution. I have been a nurse for 23yrs. and believe me no one gets by without a med error in their nursing career. We've all been there. No one makes an error on purpose and instead of laying blame, which is not only damaging to the self esteem of the person involved in the error, but to other nurses in the facility as well. Doubt, suspicion, anxiety, anger are just some of the emotions that are the fallout of such action. Instead, along with your input, they should be trying to find out what the circumstances were that contributed to this error and how can things be changed to lessen the chances of it happening again. I've read a few articles on this and they are all stating that we should start with the premise that errors will be made, not with the nurse will never make an error and if he/she does they will punished. We are all human and the fact is errors will be made. Punishing someone does not take away the fact the someone else can and probably will make the same error if the system isn't changed. There are a few things I am confused about. First, were all three jobs you mentioned in the same facility or the same organizaton? Second, why did you get a "final performance improvement counseling"? Was this your first time being disciplined for a med error or any other type of performance problem? And third, why the fitness for duty eval. by a psychiatrist? It is a pretty serious allegation to make that someone is not fit for duty for whatever the reason (intoxication,substance abuse, behavioral problems). It seems to me that if that were the case they should be involved in trying to get you help with your particular situation. I understand your feelings regarding other nurses who made med errors and their handling of it. But I wouldn't say too much about that. People have a way of relating what happened to them inaccurately. Either because they don't see the whole picture, aren't willing to admit what role they played, have difficulty accepting any criticism, or enjoy the "drama" of the story telling and administration bashing. Find out your institutions policy on med errors and bring that with you. Check out the policies on fit for duty and final performance improvement counseling. Be prepared. I find that if I rehearse in my head the points that I would like to make and how I want to say them, it helps to remember to get everything in. Also, don't sound whiney. Be as professional as you can be. "Yes I made the error and since then I've thought about how and why it happened. I have some possible solutions that may prevent it from happening in the future", some thing like that. Whenever anyone starts raising their voices or getting whiney, those that are listening start to shut off. Think of yourself in the position of the listener. Haven't you found yourself doing that? That's some of what I've learned through my nursing career in dealing with anyone. Also I believe you have the right to bring someone of your choice with you as your "witness" so to speak. It shouldn't just be you and "them". Maybe you would want some legal advice on this and a visit to your facilities employee assistance program might be helpful for you. If you have a union go to them for info. and assitance. Don't be afraid to state how you feel or how you see things, but be professional about it. I wish you luck Marnae. Let us know how things go.
  6. by   rhollandrn
    Be strong Marnae! God has thrown an unexpected challenge in your path to test your faith. When it is your turn to speak, stand up proud and look your supervisor in the eye, secure in the knowledge that your past performance will speak for itself. Think of all the patients you have helped, and how you made a difference in their lives.
    Good luck, and i will be thinking of you.
    Rhonda
  7. by   Doey
    Marnae, thanks for answering those few questions for me. I can't believe the fit for duty thing is all over an antidepressant. That is totally ridiculous, and the fact that some steps were bypassed in the performance chain makes me feel your institution is walking on thin ice. Those e-mails were good did you happen to save any of them? Also what about any written evals. like yearly ones etc. Do you have any copies of those? Hang in there Marnae. Be secure in the fact that your past performance was good (and still is!!). And do what rhollandrn says, look your supervisor and anyone else straight in the eye and stand proud!! It's a shame that many times we nurses don't treat each other as we were taught to treat our patients, with compassion, understanding and empathy. Good luck and I will be thinking of you. Please let us know how things turn out!!
  8. by   KT
    Marnae,
    I too am sorry about the situation you are in. I have also been there and I am sure every other nurse has been or will be. I agree we are human and errors will happen. Show me a pharmacist or physician that hasn't made an error. I am currently in a management role and have been on the other side of this situation many times in the last few months. I try to always approach the nurse that made the mistake with an open mind. I do however agree with everyone else, admit your mistake and look for ways to prevent it from happening again. I have had to put staff member on final warning for problems before but they should be allowed to discuss this matter and look for solutions which is what we try to do together to better the company not ruin the nurse. One med error does not make you a bad nurse. GOOD LUCK let us know what happens..
  9. by   PPL
    It sounds to me that they have failed to follow their own policy, by disciplining you by bypassing their own procedures for disciplinary action. This may give you a leg to stand on. Also, if they are discriminating against you because of your use of a medically prescribed antidepressant, I believe it's against the law. Do not hesitate to seek legal counsel, if the outcome is unsatisfactory to you. I am wishing you the best of luck. It could be any one of us in your position. Try to own up to your mistake and remain calm and above reproach when you meet with them. Let us know the outcome. Chin up!
  10. by   BadBird
    Wow,
    I have a few questions, l. do you belong to a union that has a grievance process since your supervisor violated the policies you have a leg to stand on. 2. punishing you for antidepressant meds sounds like discrimination to me, did you consider filing a complaint with EOE?

    Your supervisor should be advised that in the future her harsh retalliation may cause other med errors to be covered up for fear of reprisal from other RN's

    I would remind her that med errors are mistakes and not intentional acts to do harm to pts. Her focus should be on making sure no harm comes to pt's instead of pushing away good qualified RN's


    Good Luck
  11. by   Marnae
    Thanks everyone for your support. This morning I was getting ready to go this greivance hearing and I thought I would check to see if there was anymore advice. I was astonished that there were six messages. While reading them, chills went up and down my spine. I used all of your advice for the hearing. The hearing went well and I should know something within ten working days. I held my head high and looked my supervisor and the hearing officers straight in the eyes.And Doey, I took all the e-mails that my supervisor sent me with copies for everyone. Thank you all again. I can't tell you what it meant to have that support from colleagues that I have never met. To answer some of your questions: I did go to the Opportunity Development Center (they handle discrimination claims within institution I work for and they stated that we could not prove that my supervisor discriminated against me because of the fact that I took an antidepressant. So, I never took it any further. Tennessee does not have unions for nurses so I did not have any help from union representatives. I have considered obtaining legal counsel, but maybe it is time to move on and let this go. This has eaten up three months of my life. This institution is the largest employer in the state of Tennessee and it would be like fighting Golieth. I will keep you all informed. Thank you very much again. Marnae
  12. by   Doey
    Marnae, I'm glad the hearing went well and that you felt support from those that responded. I was thinking about you all day yesterday and told my husband I couldn't wait to hear how things went. Listen, I got chills just reading the messages and was thrilled when I would log on and see another one! Hopefully all our energy was with you! I definitely understand your feeling of "letting it go". 3 months is alot of time and stress. Definitely let us know what the results are. Be proud of yourself that you stood up to the challenge and met this obstacle straight on. As corny as this might sound, it was a learning experience, albeit a painful one, but then many are. Hopefully this has shown you what strength you have inside yourself and when you meet up with another hurdle, (and you will!!), you'll tell yourself, "Hey, I handled that other mess I can handle this!". Good luck to you Marnae. And please let us know what happens.

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