Protecting my license..

Nurses Safety

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This is a partial vent but I need documentation to back me up as well. ( first let me say Hi, its my first post) I just didn't know where else to turn.

I work in an assisted living facility. I have been a nurse for 16 years, I've worked in hospitals, nursing homes and alf. My current boss has no nursing experience, however does have thier Med Tech license. I was lamblasted tonight for clarifying a doctors order. MD wrote order for ( increase N 10 am) now, I know the doc meant increase humulin N to 10u in am, however patient was not on humulin N. So, in case the doc meant to write that on another patients order, I called to clarify. I tried to explain to my boss that I cannot assume the doctor meant humalog or that it was for that patient. The boss then stated if the doc orders a med for Mrs. V and he actually meant to order it for Mrs. W then by law I have to give it to Mrs. V. I tried to explain that as a nurse, I cannot do that, if I suspect any discrepency ( my spelling is off tonight) that by law I must clarify an order, and if I didn't I would (could) lose my license. The boss said (loudly) "you will not lose your license, that's the doctor's problem"

Where can I find the documentation on the net to back myself up. My boss thinks she is right, we know she isn't, but unless I can produce proper documentation, I don't have a leg to stand on in her eyes.

I love my job, my patients, am a huge patient advocate, and obsessive compulsive with my meds. I check, double check and follow all the rules. I just can't seem to convince the boss that just because a doc orders something doesn't mean we should give it.

Please help.

Thanks,

Piglets2

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You are absoulutely right. You are legally obligated to clarify any physician order that is unclear, that you dont understand, or is potentially harmful to the patient.

Your boss is not qualified to oversee a Registered Nurse.

I for one would not accept direction from her. I often seek suggestions from liscensed co workers. However they are just that. Any clarification of orders comes from the physician who wrote the order.

Also you as the nurse are responsible for the patient. Not your boss.

Continue to advocate for your patients no matter who attempts to stand in your way.

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Why in the world would anyone put a Med tech in charge of the nurses? As 911fltrn pointed out... that person is not qualified to oversee RN's. You know what is right. I would call my BON and have them tell you where it is in your state's nurse practice act.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

check your states board of health or department that regulates alf to see who's supposed to be in charge (not med tech).

clarifying orders should be in one of your nursing textbooks on med administration. will look to see what i can find.

thank you google!

when faced with questionable medication orders, caregivers have a duty to address all concerns. when a nurse fails to question improper medication orders prescribed by a physician, the court system holds both the nurse and the ordering physician accountable for resultant patient injury. to avoid liability, any nurse in this situation should document the fact that he or she questioned the order and received the physician's assurance that it was correct. also include the individual's name that approved the questionable order.

a safe standard of care for medication administration nursing ...

if orders are illegible, ambiguous, or confusing, the author of the order should be consulted to clarify the order before any medication administration occurs.http://health.enotes.com/nursing-encyclopedia/administration-medication

nurses' six rights for safe medication administration

the national coordinating council for medication error reporting and prevention defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.http://www.fda.gov/cder/drug/mederrors/

medication safety tools & resources

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Specializes in Psych, Med/Surg, Home Health, Oncology.

Hi

You are ABSOLUTELY right!! I agree 100% with all the above posters.

Plus, even if that order was on the right patient, we simply can't write or accept orders like that anymore. we are not to accept certain abbreviations any more and one of those is units--it must be spelled out. that is a Joint Commision thing.

Mary Ann

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

I would not only supply the "boss" with the information Karen has given you, I'd pass it along to her boss.

Somebody, somewhere along the line, should have a clue that the facility itself is also at risk.

Plus, you are documenting these conversations with your boss, aren't you?? If you get fired, you can at least talk to a lawyer. Your facility might also understand that publicity for firing a nurse who was attempting to keep her patients safe is not the publicity that they want.

I'm not sure how assisted living facilities are regulated or if they're inspected by the same folks that nursing homes are, but someone on that level might also be able to explain a thing or two to your boss and to her boss.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I presume your boss is more than just a "med tech". But has qualifications to be your boss, and just happens to hold a med tech. Sounds like she/he might need some gentle education.

You know you are 100% correct. Karen supplied you with good information. This boss needs to get some balls and stand by her/his nurses against MDs who complain about being bothered with clarifications, which is what I presume happened. The boss instead of taking a "how dare you question a doctor God" should thank you for being so conscientious.

Good luck.

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Specializes in Emergency Room.

Your "boss" sounds like an idiot who shouldn't be in a supervisory position. I hope you do exactly what the above posters have indicated and go above your boss's head to her boss (who hopefully has some nursing knowledge). Anyone with a little medical knowledge and a brain (common sense maybe?) should know that giving a med you're unsure of and assuming it to be the doctor's problem when something happens is a sure route to losing your license.

By the way, if your boss continues in that position, I would start looking for a new job. Being a nurse is hard enough without superiors pushing against us in the most basic things.

Good luck!

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Specializes in ED, ICU, PSYCH, PP, CEN.

You must always question any order that is not completely clear and understandable. Do not allow anyone to ever sway you on this. It is not worth your license or a patients life to keep management or the doctor happy. This is one of the very hardest lessons to learn in nursing. The patient's safety is paramount. Document every encounter you have with management regarding pt safety (meds) until this unsafe period of your employment ends.

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Hi, thank you for the responses and the links. I am an LPN, my boss is the administrator of the facility, no medical background other than medtech classes and inservices. I, despite what my boss says, will continue to perform my job safely and legally to protect myself and my patients. I left one facility because of neglect, lying, etc,.. I am beginning to think the entire healthcare system is corrupt and we are no longer to "help" patients but make the "powers that be more money". Different issue though. I just need to be able to prove to this boss that I am not incompetent and paranoid, there are legal ramifications if we choose to assume or ignore something so obvious. She is just one of those people that believes its her way or no way and she is more knowlegable than the government that regulates the health system. I am afraid the only way she will understand what I have been trying to tell her is if she is involved in a lawsuit and a lawyer rips her to shreds. Some people just have to be hit with a hammer before they "get it". The bad part is she is really a nice person, but when she gets under too much pressure, she just blows and says the above things, blames the staff for being incompetent saying "I just need to work back here for a week and get things straightened out again, the way its supposed to be!"

I can only do what I am trained to do, follow the regulations regarding nursing to protect myself and my patients and if she fires me then it will be for something assanine not negligence on my part and I will take it to court.

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Specializes in ED, ICU, PSYCH, PP, CEN.

Piglets2, you don't have to prove anything to anyone as long as you are doing the right thing. You can't make your boss understand something she has no training in. Just continue to do the right thing and all will be okay for you. It is far better to have her yelling at you than to be up on criminal charges for doing the wrong thing to a patient. Sometimes we have to try a few jobs before we find the right one. It sounds like maybe you are not in it yet. Keep up the good work and look on everyday, every experience as a learning experience.

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I hope everything works out for you in the short term and the long term.

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