I am an RN. I manage a unit and LPNs do the floor work. They are subordinate to me, in licensure and hierarchy. I do NOT play that up.
This morning, a "floating" nurse had the 6 a.m. medication pass and missed meds for 4 patients. Most were not critical, one was a huge dose of insulin for a diabetic whose blood sugar has been out of control.
The LPN notices the meds were missed. They are now 1 1/2 hours out of range for compliance with being given at the right time. The night nurse was still in the building so I verified with her that she had NOT given the meds. I told the current nurse to give them. She said nothing.
At 1130 she tells me that the patient who gets the insulin has a blood sugar of 463. I asked, "Even after the 36 units of Lantus?" She says, "I didn't give any Lantus. It was out of the time range." "Did you give everyone else their meds?" "No, I can't. They're late." Now, "nursing judgment" is the prerogative of every nurse, but the supervising RN supersedes the LPN. I've been an LPN and know how frustrating that is, but LPNs work under the direct supervision of RNs. And I am responsible for what happens when I am the supervising RN.
At this point I have to call the doctor AND write up the night nurse for med errors. What should have been simple is now a big hairy time-consuming deal. Of course, he tells me to give all the meds as none are that time-sensitive and need to be given.
I note all the charts and tell her to give the meds.
And I write her up.
All hell breaks loose. Even the aides are yelling about how unfair it is that A made an error and B is getting written up. I leave the unit for 20 minutes to compose myself. Meanwhile, I have a resident running two separate IV antibiotics and have administrative tasks to perform and am now behind because I spent an hour writing up errors, calling doctors, and writing up people. None of which whould have been necessary had she not just been defiant.
2 pm comes and I notice that she hasn't given the meds. I start passing them. She actually says, "Are you giving those 5 am meds?" "Yes." "You need to write orders for them all." "Um, no, the system will mark them at the time they were given." "Yeah, but no one will know they were late unless you write a note." "You think I didn't write progress notes two hours ago when I gave you the instructions to give them?"
WTH?! HOLDING 36 UNITS OF INSULIN? THAT'S NURSING JUDGMENT BY HER? And holding glyburide on someone else, who gets only that all day for her BS?
