how would you handle this nurse?

  1. Nurse works in a Hospice setting. She has administered phenergan 50mg via a port-a-cath less than 24 hours ago and the wife has called upset that her husband has been sleeping since the medicine was administered and she is convinced that the nurse who did it gave too much medicine, and that she does not want that medicine or the port used again, BUT she insist on having the nurse that caused this mess come out and clean it up. After calming the wife, you instruct her that a nurse will be out to check him. You specifically give instructions to the nurse to find and teach the wife an alternative medicine and route, and that she is not to give the phenergan again or use the port. She visits the patient. You recieve a phone call from the nurse that she gave another 25mg of phenergan via the port. When you question why, she tells you "because he was vomiting." When she returns to the office she informs you she sent the patient to the hospital and as she sits down exclaims " I hope I didn't kill him!". What would you do as her supervisor?
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  2. 6 Comments

  3. by   ACNORN
    I would help her to find another field of nursing. She doesn't sound well-suited to hospice nursing. You obviously can't trust her to follow your instructions and to call you before proceeding when she thinks another course of action is in order. I wouldn't be comfortable letting a nurse who has shown insubordinate behavior and poor clinical judgment in the past to go out to a patient's home and perform independently.
  4. by   traumaRUs
    I guess I would have to ask, did she follow MD orders? Phenergan 50 mg IV is an accepted dosage for vomiting. But, if the insubordination is the problem, please don't send her to ER nursing either - lol.
  5. by   canoehead
    Ummm, she thought it might have killed him? And still did it?
    Is she out of her mind?

    For going completely against a supervisor's instructions AND the expressed wishes of family she gets put on probation, plus supervised shifts with a preceptor for a week, and a swift dismissal on the next occurance. This is assuming she becomes aware of the gravity of the situation after counselling. If she states that she would do the same thing again, without calling you for an FYI I would boot her so far and so fast.
  6. by   PhantomRN
    I would also say 50 of phenergan is an appropriate dose to give the patient. You do not state why she initially gave the first dose.....was he sick, was it scheduled?

    You also did not tell us what happened when she got back out to the house.......I know if it where my family member I would have been watching that nurse like a hawk If I suspected she gave to much med. So did the family ask for the med to be given on the second visit because the pt was vomiting?

    I do understand where you are coming from she went against what you told her to do. I dont understand why she made the comment she did in your office.............she hopes she didnt kill him? I sounds like she needs some re-education on her role, med administration and interprsonal skills, at the very least.
  7. by   pebbles
    If you think it is a knowledge gap or difficulty in communication, consider having this nurse be buddied with another RN in some way - someone besides you who will be keeping an eye on her and checking her meds and procedures. I think the first step is a long talk to find out her thought processes - why she gave the med, why she ignored your directive, etc. This is potentially a very dangerous situation!
  8. by   nehi
    She gave the first dose because "she thought that's what he needed." Less than 24 hours later she was back at the house trying to make things better. I just couldn't figure out for who. The patient was hospitalized by insistance of the family and passed away 2 days later. After a brief talk with the wife,she stated that "the nurse did for him what he couldn't do for himself, she killed him." Although the family considered it a blessing and harbored no hard feelings, I still terminated the nurse for poor nursing judgement, insobordination and improper procedure. This wasn't the first problem or complaint with this nurse.

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