I'm looking for valued input - as always
I've been a nurse for nearly 4 years now, however, I still have the need to post rants, vents and "what-have-I-done-now" situations. Here's the latest...
I've been working the night shift at a new job - I've been there for two months now. So far, so good. So, I arrive at midnight for my shift and receive the handwritten report left by the evening nurse - at this facility, the evening shift leaves right at midnight and we receive their handwritten reports when we arrive. There's not much in the way of overlap. Anyway... I find that there had been a pt transferred to the floor during the evening shift... still, so far, so good... The report looks brief and basic, but covers the main points for the pt.
I do my initial rounds - first one on the new pt. His IV pump is "beeping" and, in retrospect, I remember hearing a faint beeping in the background when I arrived on the floor before shift change. When I walked into the pt's room to examine the pump, tubing, IV site - I noticed a primary of NS and an IVPB of Mag Sulfate - the bag was full
::: shuffling through my papers::: Mag Sulfate? I didn't get in report that the pt had a Mag Sulfate bolus... So, I did a little digging. I found the pt's most recent Mag level. I looked for the medication hx and found that the medication had been administered at 1042. It was now 0100 the following morning, 14 hours after administration time, and, at the time the Mag was hung, the pt was on a different floor. At about 1500, the pt was transferred to my floor.
What to do? Do I just continue to let this delinquent bag of Mag infuse even though it's been hanging for more than half a day or do I call the physician for another lab draw and further orders? I chose "option 2". I called the physician to see if he wanted another lab draw and if he wanted more Mag to be infused. No to the lab draw and yes for another Mag bolus. He questioned why the delay. I had no answer - but he understood that I walked into this situation.
Next thing, because the the bag is still full, I have to assume that a.) the med was never administered, or b.) there might have been backflow from the primary set. Either way, I do not know for sure as I didn't get any information about the Mag bolus in report. Because the bag is full, I do assume that the medication didn't infuse properly. It appears to me at this point, given the information I have, that this is a medication error of some sort. I decide - yes - to cover my assets - to call the house supervisor as the physician knew about the situation and would be documenting on it. It was suggested that I file an incident report (which I was going to do anyway).
I'm sitting here thinking about quality assurance stuff - like - when an electrolyte is complete, take it down so there is no confusion, etc, etc. In safety huddle that morning, the incident report was conveyed to the oncoming charge nurse - who immediately started yelling about the incident report being filed. She said it wasn't worthy of an incident report and that it was a communication issue.
That night, when I arrive, the conference room is full of all the evening shift nurses. When I walk in, it is strangely quiet and not many are making eye contact. I put my things away and sit at the table. By that time, nearly all of the nurses have left the room, making comments to the nurse that had admitted the pt the day before - comments like, "Yeah, I know what you mean, that shouldn't happen to you" or "Yeah, some people..."
It's pretty obvious what's going on... Then, with one other nurse present, she confronts me, demanding to know why I wrote an incident report. I tried to explain to her - and when I indicated it wasn't in her report, she exclaimed, "I just forgot!" I get it... boy to do I get it... forgetting that is. BUT - if I'd had that piece of information, I might have handled things differently. She stormed out and left. In addition to that, she was acting as charge nurse. She left no safety huddle sheet, other paperwork not filled out and she should not have left the floor when she did. We are required to have two RNs on the floor at all times - last night when she left - it was just me and an LPN on the floor at shift change.
So - I talk to my manager about this whole thing. She says I probably shouldn't have filed an incident report because it was either saline solution or the Mag Sulfate in the bag. She said I could have just infused the Mag. She also encouraged me to try to see this from the other nurse's point of view - I get that... and that I should talk to her when this blows over (which I will).
In the meantime, I've been cautioned about making enemies where I work. There have been rumors about others' cars getting keyed and vandalized - but I have no proof. I'm concerned - and glad I drive an old battered up car. I'm also concerned about retaliation - although there is a "policy" in place "prohibiting" that. Rumor has it that nurses on this floor will look for things and pick other nurses apart - especially when one feels threatened or attacked.
Now I'm a little afraid to even go to work. I'm not sure what I will face, what kinds of attitudes and treatment. I don't exactly feel supported my manager, either. But, the best I can do is press on and hope for the best.
Any thoughts/comments? Just looking for moral support, I guess... that, and it feels good to process this among fellow nurses.
Next action item,
Apr 20, '11
i listed what i thought was critical points of your post in bold and black
and responded with my response in bold and blue
looking for valued input
- here is what i have to offer -
receive the handwritten report left by the evening nurse - ?
the evening shift leaves right at midnight
we receive their handwritten reports
not much in the way of overlap.
report looks brief and basic
horrible that you received no verbal report no walking rounds and i assume no phone numbers to contact off going staff
initial rounds - new pt. his iv pump is "beeping"
retrospect....beeping in the background when i arrived on the floor before shift change.
i noticed a primary of ns and an ivpb of mag sulfate - the bag was full.
mag sulfate? i didn't get in report that the pt had a mag sulfate bolus
found that the medication had been administered at 1042...14 hours after administration time
1500, the pt was transferred to my floor.
i call the physician he questioned why the delay. i had no answer
a.)the med was never administered, or b.) there might have been backflow ... either way i do not know
i didn't get any information about the mag bolus in report.
i do assume that the medication didn't infuse properly
good initial assessment on your part with noted documentation of when a critical incident began and correct intervention
it appears...given the information....this is a medication error
i decide - to call the house supervisor ....would be documenting on it.
suggested that i file an incident report
thinking about quality assurance stuff ...take it down so there is no confusion
incident report was conveyed to the oncoming charge nurse
all complete and totally appropriate /reasonable actions on your part
started yelling about the incident report being filed
she said it wasn't worthy of an incident report and that it was a communication issue.
unacceptable response from day charge who rendered an opinion but not a corrective plan of action to error
to correct a potential sentinel event
room is full of all the evening shift nurses- it is strangely quiet / not making eye contact
nearly all of the nurses....making comments to the nurse that had admitted the pt
comments like, "yeah, i know what you mean, that shouldn't happen to you" or "yeah, some people..."
with one other nurse present she confronts me, demanding to know why i wrote an incident report
i tried to explain to her - and when i indicated it wasn't in her report, she exclaimed, "i just forgot!
clear example lateral violence and unacceptable leadership of charge nurse
but - if i'd had that piece of information, i might have handled things differently.
she stormed out and left she was acting as charge nurse.
she left no safety huddle sheet, other paperwork not filled out
she should not have left the floor when she did. we are required to have two rns on the floor at all times - last night when she left - it was just me and an lpn on the floor at shift change.
behavior that defines professional abandonment and gross dereliction of duty
she says i probably shouldn't have filed an incident report
because it was either saline solution or the mag sulfate in the bag.
she said i could have just infused the mag.
she also encouraged me to try to see this from the other nurse's point of view
that i should talk to her when this blows over (which i will).
all are entitled to opinions however what did supervisor direct you to do and what is policy of which it appears you followed
i've been cautioned about making enemies where i work.
rumors about others' cars getting keyed and vandalized
i'm also concerned about retaliation
rumor has it that nurses on this floor will look for things
pick other nurses apart - especially when one feels threatened or attacked
now we are talking about another situation that is a critical incident and entirely that requires action on your part for your safety
i'm a little afraid to even go to work.
i'm not sure what i will face, what kinds of attitudes and treatment.
i don't exactly feel supported my manager, either.
but, the best i can do is press on and hope for the best.
this place does not deserve you and the patients deserve better
you did nothing wrong -nothing at all friend
after much thought i suggest the following -
- consider your protection - regarding your safety personally and professionally -
- this hospital is the definition of a hostile work place -
- no professional should ever go through what you have gone through.
- never mind scratches on your car but do seriously be concerned about and worried aboutabout being brought up on false charges as retaliation.
document everything you stated regarding what actions have occurred.
- with no hesitation -give a written resignation but no work notice
send a copy of your detailed resignation to the don and hospital administration
file for unemployment citing hostile work enviroment
file a complaint and ask for an investigation with the bonregarding the nurse who abandoned patients without adequate / and left the floor against policy staffing ratios.
notify the state doh and jacho about the policy and method of reporting on patients at shift change
consider obtaining legal counsel for direction and advisement
conclusion and reasons for my rationale -
one may think this is over the top or dramatic however not when one considers the following both separate and in total :
serious and potentially lethal error of an iv medication
patient safety compromised by lack of adequate off going report
the very idea that a nurse has fear of retaliation due to historical rumors
the lack of support by a so called manager who clearly does not professionally
nurse manager is inept demonstrated by refusing to intervene with offending staff and more so refuses to insist on safe patient care and a safe working unit
duality of direction by manager/charge nurse and shift supervisor
willingness of nurses not to follow procedure /policy in reporting med error
willingness of nursing staff not to follow standards of care by the nursing profession
lateral violence by being yelled in front of others and tolerated by n manager
lateral violence by entire shift of nurses encouraged by a charge nurse
patient abandonment and serious violation of staffing policy
lack of report as a retaliatory action following incident
the suggestions are not dramatic but ethical appropriate and sincerely suggested for survival.
when nurses do no longer tolerate abuse and show that there is accountability for such actions directed toward us and our patients that such abuse will stop. when put in such situations of dangerous compromise it is appropriate to have consequence and actions that proportionate to such risk.
negotiation and denial of the veracity of such situations not only tolerates but promotes that which is clearly never acceptable as a person or as a professional.
i sincerely wish you well and safety on every level - i hate that you have gone through this.
Last edit by SilentfadesRPA on Apr 20, '11
: Reason: spelling and doc management