Bullies at the work place.. vent - page 2
I am so angry .. I turned a nurse in awhile back for a med error .. she confronted me and I told her that I had to do it because the pt did not receive the medication that was ordered .. she got... Read More
Sep 27, '12I beat myself up EVERY DAY over a medication error that cost me a job that I loved. I was ordered to administer a bolus of normal saline because the patient was having hypotensive problems. I confused the line-A and line-B on the IV pump and the patient ended up getting an undetermined amount of potassium. (She had maintenance IV fluid of D5 and 1/2 Normal Saline with 20 Meq of KCL per 1000 ml bag which was supposed to be running at 40 ml/hour on the A-line.)
I beat myself up EVERY SINGLE DAY over this error. I filled out an incident report, called the Doctor, took orders. The Doctor ordered to check the patient's postassium level in one hour and call him if abnormal. The potassium level was within normal limits. Her blood pressures had stabilized. The nurse that took over her care had confirmed to me the next day that she had been fine the entire night after I had gone home.
I reported myself, because I was the one who caught the error, and the potassium level could have potentially even been fatal for the patient! I don't think I could have lived with myself if something adverse would have happened, or if the next nurse would have gotten
in trouble for something that was my fault.
To this day, I do not know HOW this happened! How I confused Line-A and Line-B of the IV pump!?! I consider myself to be much more consciencious than this. I beat myself up over this EVERY DAY.
A few weeks later, I reported to the on-coming RN that I left the scheduled Ativan and Haldol in a hospice patient's room. The patient was a hospice patient who was in Isolation for Clostridium Difficile. I should have prepared the meds OUTSIDE of her room, then took the prepared meds in to administer them. Not use the built-in medication dropper to administer the meds accurately! DUH! I had placed the medications out of sight high on the cabinet to the side of the patient's bed, not at the bedside within her reach. I was told that a family member COULD HAVE stole those meds and used them and overdosed. A visiting child COULD HAVE climbed to the top of the shelf and overdosed. I agree, these things COULD HAVE happened. Thank God, they did not.
I was brought into the office and told because of these "medication issues", they had to "let me go." They then offered me the option to resign.
I beat myself up EVERY SINGLE DAY over this. EVERY SINGLE DAY.
Of course, If the nurse hadn't "thrown me under the bus" and tattled on me, I'm sure management would have found another issue to get rid of me. Why couldn't the nurse have questioned ME about why I hid the medications in the room?
I have learned from these mistakes, I admit I did the wrong thing. But I learn from managers/co-workers being upfront with me, telling me that I made a mistake and offer suggestions to improve my performance. I thought management was very unfair to "let me go."
Sep 27, '12I've written up med errors if it's something that needs to be reported.
But I do try to tell the person that I had to write up the error so they aren't blindsided when it's "investigated."
Sep 27, '12I would go to the person first and then they could do a penimic on themsleves. Everyone makes mistakes, and "turning someone in" does not excactly makes people work together better.
Sep 27, '12I would say it depends on the situation, as others have said. Asking the person should always come first in my opinion. For all you know, they did give the med but forgot to document. What happens then? You assume she didn't administer, write her up, and you give the med (probably after letting the doctor know of the error and being told to do so), double-dosing the patient. Could have A)been avoided if you confronted the nurse first B)been an altogether different incident report for not documenting as opposed to not medicating.
Sep 27, '12Quote from sweet~revengeI find this a funny statement coming from somebody called "sweet revenge".So why didn't you talk to her about it before you ran off and tattled on her?
How do you know she didn't give the med? Are you one of those people who pours over someone else's charting in hopes of finding something to get them in trouble for?
Sep 27, '12It's been a good while since I passed any meds, so I'm a little in the dark here, but how exactly do we know for certain the nurse didn't actually give the med and just forget to sign it out? Are all of the meds that strictly controlled these days that the count would reveal one way or the other? I don't understand why OP couldn't have gone and simply asked the other nurse first if she had indeed given the particular med, before going to the extreme of writing her up. I'm almost with the other writer who said something to the point of the OP being on a power trip and looking for things to write people up for. A write up used to be used as a last resort, and were a taken as a serious incident. It sounds now as if they are used by anyone and everyone almost like a Saturday night special. Used injudiciously, they are about as useless as willpower over diarrhea. As long as the patient wasn't harmed and no schedule was interrupted, you need to learn to pick your battles. Again as someone else has already said, a missing dose of Colace isn't going to kill someone, nor should it needlessly, adversely affect someone's career.
Sep 27, '12I think using the hot button word "bullying" here is completely off base. She was upset, made a couple of comments. Approached you once. Being upset does not make someone a bully. This word is being seriously abused these days. You had a human interaction, you were not bullied.
Sep 27, '12IF ONLY reporting a med error or writing someone up was for catching a problem and fixing that problem.
Unfortunately these days they rarely are for the above good purposes. They are usually done to build a paper trail in order to demote or to get someone fired. Sad but true. Probably as much as 70 percent I'd guess are baseless reports, or, only reported to cause harm to the employee. Hardly anyone cares about the patient anymore.
So, OP, that nurse jumped at you because of this. You may have done it for catching and fixing. But since it rarely means that anymore, the other nurse feels she has one foot under the bus.
Sep 27, '12Moved to Nurse Colleague / Patient Relations.
Sep 27, '12Quote from FMF CorpsmanThis is sooooooo my new favorite phrase!!they are about as useless as willpower over diarrhea.
Sep 27, '12Um yes you threw her under the bus and it was wrong.
Theres two types of errors, intentional and unitentional. Question, was the patient harmed? Was it done intentionally? Or was it done unintentionally?...If the nurse has done it unintentionally, you should have pulled her by the side and discuss it with her. You should have encouraged her on how she could avoid mistakes like that. If she is the type of nurse that is sloppy, then her actions could be considered intentional AFTER you confront her and she continues to give the wrong medication. Was the patient harmed? If so then you should obviously follow the institutions policies. I dont know if your a new nurse, but EVERY nurse makes mistakes, You have and you will also make mistakes. How would you want someone to react to a possible medication error that you have made? Dont throw people under the bus unless they deserve it.
Sep 27, '12You can check if a med was given by looking in the pyxis, if there was one. The OP didn't say what the omitted med was. Colace? Look the other way. However, I found that one of my co-workers accidentally discontinued dilantin from a patient's med sheet, and the pharmacy went along with it, despite no order. The patient went 4 days without, and when I found it, I reported it since the patient needed labs and it could have been serious.
The OP also mentioned that this nurse had more than one incident- even if they were just colace, or non critical drugs, it clearly needed to be brought to the nurse's attention that she wasn't paying enough attention. From what I read, the OP did nothing wrong.
Sep 27, '12I'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".Last edit by JRP1120, RN on Sep 27, '12 : Reason: Paragraphs...don't know why they didn't show up!