When to complain to a manager and when to keep it quiet

Nurses General Nursing

Published

Specializes in ICU.

I'm just curious... how many of you turn your fellow nurses "in" to the manager when policies aren't followed? I picked up a team today and aside from a PTT that wasn't drawn on a patient who was on a heparin drip, one patient was taking home meds for 9 days even though policy states that the RN must bring the meds down to the pharmacy for identification before dispensing. I followed the rules, but was not too pleased to hear that the patient was taking her home meds and wasn't even told about the policy of identification. That only made my job harder to have to explain why she couldn't have the pills that she'd been taking for 9 days until pharmacy approved them. :imbar Thankfully, she was a very nice and understanding person.

How far do you have to be pushed before you go to your manager? I told the charge nurse about the problem, but it's doubtful she told our supervisor. I hate the thought of running to the boss everytime things aren't just right, but patient safety is number one in our jobs and it's sooooo irritating walking in on this sort of thing.

Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Sounds like that manager needs to get their nose a little closer to what is happening on that unit. A suggestion of that sort might get things started without you having to actually write up co-workers.

Specializes in med/surg, telemetry, IV therapy, mgmt.

How important is it to you to let the manager know about this? The reason I ask is because as a manager I can tell you what will happen from the management side of it. If I were conscientious and following my job to the letter I would have to start an investigation. I would go back through the chart and find out who admitted the patient and all the subsequent nurses since who signed for the doses of home medications. I would have to talk to each of these nurses and get some sort of statement from them. Written reports would have to be generated. All kinds of incident reports would be generated and disciplinary actions or counselings done on each and every one of the nurses involved in permitting the infraction. This is a medication error. It will be the talk of the unit. Everyone will want to know who the person was that reported the error that got everything started. If you're brave enough to admit to others that it was you, you're going to get a cold shoulder from most of your co-workers for a long time to come. Many will look for a reason to report you for something just to get back at you.

I, personally, wouldn't give this another thought. I'd have taken care of business with the pharmacy to get the meds identified and approved and moved on my merry way. I mention it in passing to other nurses that we, not I, finally got the home meds approved by the pharmacy for the patient to take. Maybe it's not what others would do, but, you know what? No one was injured here and there's bigger fish to fry. Lots of rules don't get followed for a lot of different reasons. I chose to follow the rules, especially when I know what they are. I go home feeling OK about myself. I can't make others follow those same rules.

Although I understand the fall-out from ratting out your co-workers, I have a problem with knowing things like this occur and doing nothing. I work in a small unit where stuff like this happens all the time, and when I've complained, the supervisor says things like " Oh, that's just how billy-bob is, or doe's things!". That is not okay! I don't want people fired, just educated and brought on board with the rest of the team.:angryfire

Specializes in Med/Surg, Ortho.

I know there are a lot of things that go overlooked or ignored in this area. Yes you have to pick and choose battles wisely. However, a reminder to unit staff is definately in order in this case. Im not advocating writing everyone up that didnt strictly follow protocol because as was said before, there are bigger fish to fry sometimes. As long as there was a doctors order for the patient to take their own home meds, and they are listed individually with dose and route etc. its not the end of the world (and i wouldnt necissarily call it a med error) if they arent inspected by the pharmacist immediately. Sure it shouldnt have taken that long for someone to pick them up and send them to pharmacy, but how long does it take pharmacy to "get to" those little tasks, and would the patient have been waiting for their home medication doses and for how long would they have been delayed? A lot of factors may have come into play.

So,, try not to dwell on it, ask the Nurse manager of the unit to please remind people that it has to be done if someone is to take their own home meds.

Specializes in NICU, PICU, educator.

First, speak up to the person that is not doing what they are supposed to be doing or as someone else said, at least ask the unit manager to bring it up in a unit meeting. Personally, I 'd be more worried about the PTT than the meds.

Specializes in med/surg, telemetry, IV therapy, mgmt.
Although I understand the fall-out from ratting out your co-workers, I have a problem with knowing things like this occur and doing nothing. I work in a small unit where stuff like this happens all the time, and when I've complained, the supervisor says things like " Oh, that's just how billy-bob is, or doe's things!". That is not okay! I don't want people fired, just educated and brought on board with the rest of the team.:angryfire

Then take on the role of educator. Why do you have to pass the problem off? Track down the person who made the original mistake and share your knowledge with them. Nothing wrong with a team member doing that. So many people who are clearly capable of handling problems are perfectly content to pass the buck onto the next person up the chain of command when the problem can also be solved by taking a few moments of your time. If it were a matter of educating a patient there wouldn't even be a discussion here. Why do so many have a problem helping out our fellow nurses?

Be sure when you report 1 who you are reporting you may slander the wrong persons reputation.

Specializes in Critical Care.
How important is it to you to let the manager know about this? The reason I ask is because as a manager I can tell you what will happen from the management side of it. If I were conscientious and following my job to the letter I would have to start an investigation. I would go back through the chart and find out who admitted the patient and all the subsequent nurses since who signed for the doses of home medications. I would have to talk to each of these nurses and get some sort of statement from them. Written reports would have to be generated. All kinds of incident reports would be generated and disciplinary actions or counselings done on each and every one of the nurses involved in permitting the infraction. This is a medication error. It will be the talk of the unit. Everyone will want to know who the person was that reported the error that got everything started. If you're brave enough to admit to others that it was you, you're going to get a cold shoulder from most of your co-workers for a long time to come. Many will look for a reason to report you for something just to get back at you.

I, personally, wouldn't give this another thought. I'd have taken care of business with the pharmacy to get the meds identified and approved and moved on my merry way. I mention it in passing to other nurses that we, not I, finally got the home meds approved by the pharmacy for the patient to take. Maybe it's not what others would do, but, you know what? No one was injured here and there's bigger fish to fry. Lots of rules don't get followed for a lot of different reasons. I chose to follow the rules, especially when I know what they are. I go home feeling OK about myself. I can't make others follow those same rules.

First and foremost, I also would have bee more concerned for the missed PTT than for the home meds.

I can certainly understand the frustration you, as a manager, would have to endure to make sure the policies of your faciltiy are carried out. It seems that there is a MAJOR lack of concern about the policies. Why have them if no one cares if they are followed?

Yes, it could be a huge undertaking to take care of the problem. Does it necessarily have to be everyone since the patient's admit? Why not talk with the admitting nurse and see why she decided not to do things in the correct manner? That's where the problem started and unless you require every nurse to check every order on every shift, you can assume the other nurses trusted that things were done correctly in the first place.

Do you have a med reconciliation procedure? Maybe that would be one answer to this if it were to continue. It might impress on some people the importance of doing things correctly the first time.

tvccrn

Then take on the role of educator. Why do you have to pass the problem off? Track down the person who made the original mistake and share your knowledge with them. Nothing wrong with a team member doing that. So many people who are clearly capable of handling problems are perfectly content to pass the buck onto the next person up the chain of command when the problem can also be solved by taking a few moments of your time. If it were a matter of educating a patient there wouldn't even be a discussion here. Why do so many have a problem helping out our fellow nurses?

You can NOT educate some people! Several of the nurses on the unit have been there for 20+ years and can do no wrong. I've tried being nice about things (like asking, "Is it okay to clean up around the IV site(exposed in process of re-taping) with the same washclothe you just wiped their face with?) to outright, I don't think that we are allowed to adjust that swan line (she was going to manuver it in a lttle further). Only one person on a sinking ship here...:o

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