Quote from bth44
Does anyone here work at a hospital where there is not a policy r/t double-checking insulin? I know that there are some places where it's not policy, but the nurses do it anyway because of safety. I graduated last June and was hired with some other people from my class at the local hospital. Policy at our hospital is that insulin is to be double-checked by two RN's. Sometimes, doing the double-check feels like like a pain but I feel it's always better to be safe than sorry.
Well, I was hired to a med/surg unit with fellow new grad who I went to nursing school with. He's always been a cocky, confident, know-it-all individual, and it continues here at work on the floor. Whenever I ask him to check my insulin with me, he won't even look at the syringe that I've just drawn up, but he'll say, "Looks good" then walks off. If he's in the medication room getting his insulin ready while I'm in there, I'll offer to check it with him. He'll say, "I guess, if you want to", and that tells me he was planning to give the insulin without a double check. I've confronted him about it and he told me that double-checking insulin is "lame". He said that insulin is just like the meds we draw up for IV pushes, and we don't double-check those, so he feels that double checking insulin is a waste of time and he said he's skeptical about an extra unit or two of insulin causing real harm to the patient. I'm one of those "go-by-the-book" type of people, especially when I'm in "nurse-mode". I'm not a timid or nervous nurse, but I feel that if I follow the policy of the hospital and try my best, then the chances of something bad happening diminish greatly. I expect myself to do a good, safe job at work, and I expect the same from the team I work on. I feel that he's cutting corners and he's being a lazy. He just applied for a charge position on our unit, and he got it. I find that really scary, and I'm seriously considering applying for a postion on a different shift, because I don't think I could work under a charge nurse that I don't trust or respect as a safe practictioner.
So, all you more-experience nurses out there: Can getting an extra units of insulin be critical? Personally, I definitely think so. I also feel that giving the wrong type of insulin by accident because you didn't double check can also be big trouble. Or do I just sound like a fussy nurse?
How do you feel about my coworker's attitude? I'm afraid that this attitude of his is going to get him in a lot of trouble later. If you were in position, would you address any of this to the unit manager? How would you go about doing it? Remember, he just was granted a charge nurse postion, so I'm pretty sure the unit manager thinks highly of him.
I'm still a student, but I think the term you want is "standard of care". In a lawsuit the action of a defendant nurse (or other health practitioner, or even other professional) is compared to what a prudent practitioner would do. While I've heard that many folks don't double-check insulin dosages, if checking insulin with another student is what is taught and what is common practice, you are playing legal Russian roulette to do otherwise. I would check the policy & procedures manual at your hospital, as well.
We learned in school the 4 most dangerous drugs we can give by the
Did I Kill Him
for digoxin, insulin, potassium and heparin.
One of the problems in giving less or more units of insulin, or any other drug, is that others rely on the veracity of the amount of drug given and patient response in order to make judgments about further therapy. Does he get the air bubbles out of the insulin he draws up, or not? I mean, if he's not concerned about 1 unit more or less, then why bother getting out air bubbles?
By the way, I'm not sure (since I am still a student)--but don't some of the places where two people check, both sign off on the amount? Or am I thinking of just blood product administration?
P.S., one way of addressing it, "sideways", is to ask the unit manager about the policies and procedures on double-checking insulin--you may want to start out with how you learned it at school, and is that the policy here? Then you might ask the manager what would be the proper way of handling it if you saw someone not doing this--or how the unit manager would handle it.