JRP1120, RN 4,295 Views
Joined Apr 26, '11.
Posts: 160 (36% Liked)
I've been having a bit of an issue with this one nurse that I follow, 95% of the time (we both have set schedules so I usually take report from her and give her report when I'm going off). I don't know what to do about it as I don't want to "report her" but it's becoming an every time thing. We usually have the same patients every week as well so we both know them pretty well. First of all, she comes in 15 min late which leaves me 15 min to report off to her as our unit has been under the gun to get out no later than 20 after or we get a nasty gram from our manager (apparently there have been a select few who like to stay late on the clock, so much so the higher ups have brought it to her attention and now we all must hurry along and get out "on time" so as to not create the extra min=more money coming out of our budget). I realize sometimes it cannot be avoided. However, this nurse comes in late every single time she's on. My guess is that she keeps doing it because she's been allowed to get away with it for so long. She was on time the last morning I had to report off to her though and was watching the clock and telling me we needed to hurry so I could get out on time so I guess maybe the NM finally said something to her as she did mumble something about getting a nasty-gram email about getting in and out on time. I hope it lasts!
As I've been following her though, it seems more and more, meds on her shift show up as "late" and appear to be not given. There are things like Colace or Nystatin, etc., and those are not real biggies as usually she tells me why. One night though, she told me of one of our pts blood sugar checks, which was like 159, at dinner time. This pt is to get 15 units of 70/30 with breakfast and dinner and then get sliding scale coverage. She said she didn't cover her and "she ate her entire meal". I asked her why and she didn't really have an answer for me; we got interrupted at that point and when we went back to report, she looked at the clock and said how she had to hurry to get out on time. Nothing more was said. So of course, at 2100 when I take her BS, it's 240! I am puzzled why she didn't give her the scheduled 70/30 and the SSI as ordered.
Another time, on another patient, they were scheduled to get their Inderal every 8 hours. She gave me report, never said she didn't give the 1900 dose so it showed up on my EMAR as late and not given. We are not supposed to have any meds due at that time as it's shift change (I wondered why the night before I was giving it to her at 3AM). So I notified the pharmacy and asked them to change the times of the Inderal admin so it wouldn't fall during shift change; that is protocol in our hospital, pharmacy knows this but it got missed and so that's why it was still set up that way (on previous nights I never saw it come up on my EMAR because the day shift nurses were giving it between 1800-1830). So I told her what I did the next AM when I gave her report and she told me she GAVE THE MED (No, I did not give her the 1900 dose, partly because I didn't know if she had given it but just didn't chart it so it just remained missed and I watched my patient closely throughout the night and after the pharmacy changed the times, I gave her my dose at 0100). She was upset with me that I had the pharmacy change the times and asked me why I did that. When I explained that it's protocol for our hospital that meds not be scheduled for during shift change times, she just rolled her eyes at me; now she'd have to give the med twice during her shift instead of just once. Well, I'm sorry, there's a protocol in place for a reason, so that meds don't get missed, just like this one did. Based on my pt's BP and pulse, she couldn't have given her the med. And this is what I don't understand: If you give a med, you have to scan it, then the pt, and it goes away on your EMAR and shows that you gave it and what time...how is she giving meds and not charting them? That's not safe practice! This has been going on for weeks now, and more and more meds are showing up as late, that she's not giving, insulins, BP meds, etc...not to mention she always says she's going to give so and so this and ask the Dr that, and then when she reports off to me she's like, "nope I didn't" She also doesn't sign off on things and do her chart checks. So I'm left picking up her pieces and doing a lot of her work she leaves undone. It's not so much that that bothers me, it's the potential harm that could be caused some of these patients by her seemingly lack of...I don't know what you'd call it, that scares me. I've only been a nurse a little over a year so I'm still trying to keep all my ducks in a row. I've never had to follow someone yet with so much left over stuff. Thankfully, I've been diligent and always ask my fellow nurses I'm working with if this is right, or looks right, or why did she leave this or that...I am determined not to make a med error because of her.
I don't want to report her (I've never reported anyone and would rather not ever have to). I guess I'll continue to ask her if she gave this med or that med and ask for explanations if she didn't and insist I get an answer before she leaves. It all just leaves me feeling uneasy and worried and honestly, a little like I can't trust her that she did what she said she did. So, I'm finding myself getting a fresh PEG tube feeding bag and hanging it on my shift and not relying on her "oh that's a new bag hanging; I hung it this AM" because the line isn't marked with a date. I realize things will get missed but I'm scared to death I'm gonna make a mistake as a result of her not doing the right thing, or what she's supposed to do. There are many more little instances here and there of things that I'm seeing coming from her that could be potentially bad and I don't know if I should just keep trying to fix them and tell her or finally get up the nerve to "report her". I know I would want someone to come to me and tell me things first and not just report me. I believe in team work and for the time I've been on my unit, most of the nurses do work as a team and help each other out. There are a few that would throw you under the bus in an instant and lucklily I don't work with them anymore. Thanks for listening to my "rant".
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I'm new too and I make myself lists and check-off when I've done them. I write everything down! At the beginning of my orientation I even had to write down a word or two to remind me what not to forget before doing my assessments on my patients or I'd forget now, I'm almost off orientation and already I don't have to do that part anymore...but for me, I still write a lot of things down that the more experienced nurses just know to do. It comes with time and practice. I find that forgetting the little things, even when they are important, happens because I'm new and nervous. When I would stress about this, for me, it would create more stress on my brain and it seemed I'd forget even more. So I just stop, take a deep breath, go over what I'm about to do in my head then write it down. Then it's there if I need the reminder and it gets checked off as I do it. Don't be so hard on yourself! However, I know what you're feeling. There have been many a time, I'd kick myself afterward and say to myself, "duh! How could you forget that, you idiot!" It's all part of being new. And remember, we can be our own worst critics so watch what you tell yourself too...when you do remember things you need to remember, start replacing that "ugh, you idiot" self-talk with a "yay! I did it". Negative self-talk can make things worse. Keep at it and you'll see that things get easier with time. I'm already seeing that. Good luck!
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