OMGosh...she wrote me up! Update about the Narcan!

  1. For those that didn't see my post, I had a patient come in after surgery who was very sedated, however...didn't meet the criteria for using narcan. He had serious sleep apnea so his pulse ox went from the 70-90's dependant on what part of the snore he was on, had good color, breathing about 18-20. I had called the MD, I did everything correctly...I even came on here and discussed my actions which no one said I was incorrect for holding narcan for a pt with hx of being overly sensitive to IV medications, post large back surgery, and it being near 11pm! I was of the mindset to let him sleep it off, and I will monitor closely instead of stripping his opiate receptors and leaving him in uncontrolled pain!

    The nurse after me used the narcan X3!!!!!!!!! (did she wait to tritrate to effect long enough???!!!) And since she used narcan it needs to be investigated (protocol). She pointed the finger at me being at fault (just like I thought she would!). She said I didn't tell her about the pulse ox ...OMG yes I did, ad nauseum infact...and told her about the differences between breaths and I put him on 4L of O2, and that if she uses the pulse ox to wait a while and watch the trend. Guess she didn't. Also she said she couldn't wake the pt...I could...so I wonder what is up with that?

    SO again...I was called into the managers office to discuss this. My boss seemed very perplexed about the pointing of fingers...and I said I was not suprised at this at all...and told her my side of the story...quoting my own documentation, people that were with me for reference..and my clincial opinion of the situation. Needless to say that my documentation was beyond efficient (two pages of details), and the managers were all on my side! The poor pt had to go through 2 days of uncontrolled pain because of the narcan...and we will start up incident reports on that soon!

    Anywhooooooo they are going to talk to the nurse and get her side of the story...but in her documentation in the chart she actually wrote that I was at fault! That is not cool and I believe since it wasn't my fault...that is false documentation and proably more!

    I was very professional and to the point and stood behind my choice! Everyone was so proud of me! Including me!!!!!!!!
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  2. 30 Comments

  3. by   nuangel1
    it sounds like you did nothing wrong and you followed the golden rule document document document well done .and the other nurse needs to learn to doucument facts only not her opinion someone needs to call her on that.
  4. by   Lacie
    She documented in the chart it was your fault?? Wow, is this a big NO NO. Whether it was or wasnt it was still very inappropriate for not just you but the facility itself on a legal aspect. Charting is not for personal opinions but documentation directly related to the patients condition or immediate care performed by the nurse documenting it. It's areas like this that cause nurses to end up in front of the BON arguing for thier license or loose thier jobs. I read your previous thread on this and it appears you were very consciensous and knew your patient! After working CC for over 24 years I wouldnt have done it any differently myself. Hang in their and stick to your guns on this one.
  5. by   morte
    i wonder if the night shift "cutie' can spell slander
  6. by   santhony44
    Well, since you documented the sats, everything you did, etc and then she wrote something about you in the chart, she's the one who looks stupid.

    I'm sure that you did tell her about the pulse ox, but even if you had not, it's documented for to read, if she'd bothered. And yes, putting something like that in the chart is a big no-no- in documenting you just state the facts and let future readers draw their own conclusions about who did or didn't do what.

    It sounds like you did well both with the patient and with the aftermath. This other nurse is getting herself into trouble!
  7. by   P_RN
    In the first grade they told me that when you point a finger there are 4 more pointing back at you. She pointed the finger and it seems that she may have been covering her gluteal prominences with falsified charting. Do you do a written report? I used to keep one extra when I handed off. That way there is proof it was reported and put into her lying* little hands.
    * allegedly
  8. by   SmilingBluEyes
    SOMEBODY is unaware of risk management rules of thumb. NEVER assign blame in a patient chart. That is what occurence/incident reporting is for. Time for a powwow with the manager, ASAP.

    Hope you did an incident report to cover yourself-describing what happened as YOU know it.
  9. by   Simplepleasures
    Quote from morte
    i wonder if the night shift "cutie' can spell slander
    I agree wholeheartedly, I once threatened a nurse with slander after she kept trying to write me up on bogus crap! I told the unit manager that if she did nothing to protect me from this type of slander she would be testifying in my lawsuit. The nurse who slandered me quit doing it right after the meeting with my unit manager.:chuckle
  10. by   Antikigirl
    We do recorded report, but I stayed extra to hand off to her till she was done with her other pts initial assessments because I wanted to continue to have the pt closely monitored...and I also helped around. I told her EVERYTHING going on...down to the smallest detail before I left. In fact, I did it so much on this patient, I forgot to tell her another pt had a slight fever that I was treating and called her once I got home to tell her.

    Our noc shift has it out for me for some reason...and this one may just lead to proof that this is occuring towards me for some reason, and that I am a good nurse and they are being borderline harrassing towards me. Day and swing shifts and the MD's are awesome and I adore them, we work as a team...and so I spend half my days feeling great and being cherry, the latter half with a black cloud over my head wondering what I will be written up for this evening! This is proof of them being overly senstive towards me, and may negate their write ups!

    It was the proof I was waiting for! And I proved it through good clinical judgement, not placing any blame on anyone myself (I even just said..."that is her clinical judgement based on her experience...mine was different with a different set of experience...")., and bucket loads of documentation including names of people that helped me to back me up solid!

    I even mentioned..."if there was a case brought up about this...whos documentation would certainly win? Mine would!".
  11. by   BSNtobe2009
    Didn't you post earlier where they were going to promote you or something? Isn't this a relatively new job?

    If that is the case (and if it's not, I'll apologize for my bad memory now), then you have your answer: JEALOUSY!
  12. by   JentheRN05
    Triage, all I can say, is what I have said before. Your a great nurse. One I hope to eventually be when I grow up lol.

    That other nurse was WAYYYYY out of bounds, the patients chart is ONLY for information about the patient, NOT about a nurse taking care of the patient. I agree with everyone else here. You documented, and you rule. No questions asked. Great job, you will raise above this. Still keeping you in my thoughts.
    Jen
  13. by   P_RN
    May I nitpick here?
    This has nothing to do with Triage's post.

    Slander is spoken

    Libel is written (like in a Library book)

    Now back to our regularly scheduled thread.
  14. by   DutchgirlRN
    Quote from TriageRN_34
    In her documentation in the chart she actually wrote that I was at fault!...that is false documentation and proably more!
    I was very professional and to the point and stood behind my choice! Everyone was so proud of me! Including me!!!!!!!!
    I'm proud of you too triageRN_34! That nurse is in trouble charting that it was your fault. First it's legally WRONG! Second it's ethically wrong. Sounds like she was trying to CHA and the expense of yours. WRONG, WRONG, WRONG, I hope administration writes her up for this misjustice. Let us know what happens. You did great!

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