advice ..I'm freaking out

LadyFree28, BSN, LPN, RN · Aug 31, 2014

chiandre · Sep 1, 2014

The concerns your director brought to your attention are very serious because they are patient safety issues. I am happy that you realized the implications. You could have harmed your patients.

Depending on the outcome of the investigation, my suggestion is to use your resources: know your policies and procedures, ask questions, read nursing journals, take continuing education classes, get a unit based mentor, and think of going back to school.

If they report you to your State Board of Nursing, make sure to get an attorney (preferably nurse-attorney).

Good luck.

Guests · Sep 1, 2014

If they report you to your State Board of Nursing, make sure to get an attorney (preferably nurse-attorney).

And, look for another job asap.

Any place that would report a newbie to the BON over such issues is a nasty and vindictive place.

iluvivt, BSN, RN · Sep 3, 2014

Did you read the blood transfusion protocol they have in place before you hung the blood and do you understand why that may be their policy? The goal for you is to learn from your mistakes so you can perform to the standard of nursing care. I am concerned that you do not understand the scope of your nursing practice. Not sure if you are in the US or not but you need to read your nurse practice act so you have a complete and working understanding of what you can and cannot do. Why did you not ask someone with more experience in both situations? That is also a concern you never want to seen as a loose cannon nor practice in that fashion. You may not have meant harm but that sentiment will not go far is someone is harmed. You need to base your decisions on policy,standard of care in any particular situation and you must practice within your scope of practice. I agree, these are serious concerns!

imintrouble, BSN, RN · Sep 4, 2014

I'm surprised your fellow nurses didn't offer some constructive criticism regarding your critical thinking skills.

We bounce ideas off each other all shift long.

The 15 minute rule with blood is almost carved in stone, it's so universal.

Not giving the ordered dose of any med, just makes me scratch my head.

I might hold a drug, but to calculate my own dose and give what I thought the patient needed? Never.

I have had those "what was I thinking" moments myself, so I'm not trying to pile on. But the mistakes you made, indicate a dangerous tendency to ignore very basic universal policies.

SCBlueICU · Sep 5, 2014

I agree with in my. If you have a place that speaks with you about an issue for the first time and then pulls in the CNO to investigate you, you should get out of there ASAP. Nobody knows everything and a "most transfusion issues happen in the first 15 minutes, so stay with your patient next time" should be good enough for a first time missing.

As far as the insulin thing goes, if I have a diabetic patient that appears to know their diabetes well and they tell me not to do something, I don't do it and I would say 95% of the time they have been right on. Diabetes is different for everyone and while blanket protocol orders that the docs click may work for many people, they don't work all the time. That's why nurses are people with reasoning ability and not machines. Yeah, don't fractionate the dose next time, just hold it, but sounds like they are being a little harsh. It would be more concerning if you gave them more insulin because you thought they needed it. You had your patient safety in mind which is the important thing. I see more problems caused by mindlessly following a protocol without applying it to the situation.

I see the issues as needs for improvement on your part, but please don't let this convince you that you are a horrible nurse. Find a new job that will teach.

fms2004 · Sep 5, 2014

My CNO talked to me and educated me and sent me to a peer review where I can receive anything from a write up to a reporting to the bon ....this experience has opened my eyes I learned from my mistakes and can hopefully continue doing what I love

RNKPCE · Sep 5, 2014

That's taking peer review to a whole other level. Maybe peer review in this manner works to the employees advantage because people who are at the bedside know what it is like vs management who may not have done patient care in ages.

NightOwl0624 · Sep 6, 2014

Sorry you are experiencing this.

It can be very difficult figuring out the culture of any facility, particularly when you are a brand new nurse. Policies do not always spell out every little thing, and blindly following protocol can also get you in trouble. I doubt that your critical thinking skills are lacking, as some posters in this thread have implied. I also don't think you are dangerous or a threat to patient safety, given what you described. Both situations should have been teaching moments, not a threat to go to the BON.

In my hospital, it is not our policy to stay with the patient for the first 15 minutes (as I discovered when an argument came up at work regarding this subject). However, I choose to stay with my patient because that is what I was taught and it seems like a good idea. Some of my co-workers don't, because "it is not required". If something were to happen to the patient in that time, I am sure that my hospital would throw the nurse under the bus even though it is not spelled out in the policy. In this case, it is more important to protect the patient and myself than following my hospital's policy. In the same regard, what if an emergency occurred in that 15 minutes with another patient? Would sitting with a blood transfusion to watch for a potential reaction still be more important if someone else's life was literally at risk during that time?

For the OP, I am assuming that it is policy to for the nurse to wait the first 15 minutes of a blood transfusion, but we don't know why the OP left the room. Maybe she didn't know any better, but maybe she had a good reason.

As for the insulin, I agree with the above poster. It is always important to listen to the patient (especially diabetics!). I would never give the patient more insulin than they were comfortable with. NEVER - even if it was protocol. I think the OP showed excellent critical thinking skills; the only mistake was not to contact the physician first to discuss. However, if it were properly documented that the patient refused the amount of insulin ordered for night time coverage, I don't think this is a safety issue the way it was described. It would have been much more dangerous to give the patient too much insulin and have him bottom out by morning.

OP, best of luck to you, I hope your peer review goes well.

amzyRN · Sep 7, 2014

I've given less insulin before if I knew the blood sugar would drop. I've given the dose the patient usually takes at home, then I talk to the doc to get the order changed if the dose is not appropriate. That is quite common on the unit I work on, for nurses to give less insulin as to avoid drops in blood sugar, this is often based on a discussion with other nurses, the patient, or the physician. The nurse who just blindly follows the protocol and gives the brittle diabetic too much insulin, can potentially send the patient to ICU with a critically low blood sugar.

With the blood transfusion, it is really a best practice to stay with the patient for 15 minutes. It is always better to err on the side of caution with things like that. Like others have mentioned, I think malpractice insurance would be a good idea. And don't think you are a terrible nurse because of not staying with the patient. Now you know and will make sure to stay next time. I think you were right about the insulin though. It is also very important to discuss issues with physicians so they can make changes to medications. If the blood sugar has been too low in the morning that is something the physician needs to know about.

Good luck with your peer review and take this as a learning experience so that you will be an even better nurse. Don't let it sink your confidence.

blondy2061h, MSN, RN · Sep 7, 2014

The 15 minute rule with blood is almost carved in stone, it's so universal.

Nah, not the policy at my facility.