i am a new grad and was working at a snf for 3 weeks when i had an incident where the day shift nurse went home with the only backup keys to the treatment cart so i did not have access to the resident's insulin before their meals. notified the rcm and charge of the event and did what i could at the time which was to check the resident's cbg. none of the # were critically high/low that would required me to proceed with the hyper/hypoglycemic protocol. i was told by the rcm to recheck the residents cbg after their meal and administer the ordered dose of insulin. i did what was told and rechecked their cbg after meal and administer insulin according to this second value. a week later was let go due to "inadequate quality of work, insubordination, and poor use of judgement regarding insulin." the dns said i made a med error because i was supposed to administer the insulin according to the first cbg not the second. in addition, i was not supposed to the implement sliding scale for a resident after his meal (even though it was dr. order to give a scheduled dose and an additional sliding scale if it's over xyz before meals). i explained to the dns what i was told to do by the rcm but was told that that was not what the rcm was trying to convey. looking back i understand why it makes more sense to give insulin using the first cbg but i guess i got a little frantic and went with what the rcm said. *sigh, what bothered me the most was that i was given 3 days to follow 3 different nurses and was tossed out there to fend for myself. they claimed that they had extensively educated me on diabetic management which consisted of what to do if a resident was hypo/hyperglycemic and how to take t.o. orders regarding insulin! funny thing is they offered me a position as a cna, which i worked for them as before i got my license. of course i declined and thank them for the short opportunity.
so my question is: is there a general policy regarding insulin administration that pertain to my situation or did i just fell asleep during the diabetic management lecture??