Fleet enema

  1. 0
    Last week, I was super busy with my hospice patients and made a mistake. I ordered a fleet enema for a patient with severe constipation. She takes miralax and had had no bm for 6 days. She requested the fleet enema.

    Our medical director has, in the past, specifically told me that I don't need to call him for orders for enemas or suppositories. Based on this, I went ahead and ordered the enema so the patient would get some relief.

    My boss has been after me for several months now trying to find errors of any kind. She bullies me continuously and loves to tell me things she thinks I am doing wrong in front of my co-workers.

    I forgot to document the verbal order that day and my boss figured it out. I apologized and said I forgot and that there was no excuse. I explained to her what the medical director had said to me on a number of occasions. I filled out a med error form/incident report and went on with my day (after she cursed at me and told me how incompetent I was etc). Well, it seems the medical director is denying he ever told me that and so I am having a disciplinary action taken against me, and it is possible that she reported this to the board of nursing.

    Bullying aside - any suggestions? I am falling apart. This same boss called the board of nursing about me 2 years ago because I had held a patient's insulin (and documented it) because her blood sugar was 40. I had to go through months of stuff with the board of nursing but no disciplinary action was taken. I am afraid that this will turn into a really big deal.

    I don't know what to do.
  2. 9 Comments so far...

  3. 4
    I don't have any advice other than in the future, it doesn't matter what a doctor says about not having to call/contact him for certain orders or how long he's been telling you that...you do it anyway and CYA. And if you do end up in front of the BON for this, have a lawyer with you to help minimize the damage.

    If your boss has been gunning for you for some time now, perhaps its time for you to start up the job search and find something else.

    Best of luck.
    GrnTea, Altra, jadelpn, and 1 other like this.
  4. 3
    If you carry your own malpractice insurance, NOW might be the time to give them a call and ask for advice. And as PP said, consider a new job.
    GrnTea, Esme12, and Meriwhen like this.
  5. 4
    Also you might consider avoiding social media postings. Things can come back and bite you.
    KelRN215, GrnTea, Esme12, and 1 other like this.
  6. 0
    I would NOT discuss this with anyone except your malpractice carrier.....all nurses should carry malpractice and if anyone says they will "cover you" NEVER believe them. If they aren't willing to write a standing order....there is No order for they will toss you under the buss at a moments notice.
  7. 2
    Quote from Esme12
    I would NOT discuss this with anyone except your malpractice carrier.....all nurses should carry malpractice and if anyone says they will "cover you" NEVER believe them. If they aren't willing to write a standing order....there is No order for they will toss you under the buss at a moments notice.
    You reminded me ----

    Your quote "I'll cover you" is my nomination for the world's 2nd most sucker line.

    The first - "no, darling. I'm not married".
    KelRN215 and jadelpn like this.
  8. 0
    There has been a great deal of talk as of late regarding a fleets and their dangerousness in older patients and palliative care patients.
    I just read on my company email an educational blurb regarding this. So a fleets is not the first line of thought for constipation in a chronically/terminally/geriatric patient due to the effect on electrolytes and kidneys. It also went on to talk about fleets being put in the pharmacy, and not out on the floor (as some facilities, you have them in the supply room).

    I would call your malpractice insurance, speak to a union rep if you are a union facility, and going forward, suggest that you look into getting a bowel protocol and standing orders for your palliative care patients. This would be something that your DON can bring to the medical staff and pharmacy.

    No matter what an MD says at any time, I would always be on top of getting an order for anything. If nothing else, I would also question why it took 6 DAYS for someone to realize the mirilax was not working, and there was no BM. This is a process error and doesn't bode well for patient care.
  9. 2
    ...and stop referring to it as "bullying", as doing so is tantamount to self-portrayal as a victim, leaving you open to future bad behavior by others.

    That term has been reinvented and redefined during the past few years in the media, and is becoming so commonly used, that its original context is lost (sort of like yelling "Theater!" in a crowded fire ).

    As for administering any medication or treatment without a proper order, that was a screw-up to which you admitted. You have learned from it; move onward and upward.
    GrnTea and Kidrn911 like this.
  10. 1
    NEVER administer ANY medication without any order either standing or direct from an MD. If your employer is gunning to get you I'd get away from that employer.
    jadelpn likes this.
  11. 0
    I always work under the assumption that if a doc doesn't want to be bothered with a particular problem they'll write an order for that possible eventuality. We have a doc that doesn't want to be called with bowel issues. If he doesn't order something for constipation, I'll call him regardless; he should have ordered a PRN. After enough calls a doc should get the message. He's the doc, he went to med school, I'm not and I didn't.


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