Another nurse got fired because of me.

[arelle68]

I discovered a pretty serious medication error last week, (Signed, but not given. Involving blood pressure.) and had to file an incident report. I called the resident's family per protocol. The resident's daughter told me something like, "Well, I'll take care of it. I can guarantee you this won't happen again!" Apparently she did, because I got to work today, and found out that the nurse had been fired. It's a tough economy, and I hate to see anyone lose their job right now. I know I had to do what I did, but I feel bad for this nurse. Anyone can forget to do something sometimes. How am I supposed to feel about this?

[Ruby Vee, BSN]

the op did what she was supposed to do. she reported a med error. she did not intend for the other nurse to get fired, and feels badly about that. she has learned a hard lesson. why keep beating her up over it?

we keep "beating her up" over it for two reasons. first, the op still didn't "get it" (see my last post and the post i quoted). and second, there are a lot of other nurses on the thread who apparently haven't gotten it, either. i figure threads like this are good learning experiences for folks who would have done exactly what the op did and don't see anything wrong with it. better they learn here in this fashion than by being retaliated against at work by the friends of the nurse who got fired.

[melmarie23, MSN, RN]

I dont understand why the family was notified and not the patient themselves. It should have been up the the patient if they wanted to formally lodge a complaint?

this is a weird policy that your hospital has...

[carluvscats]

The OP has already stated that she is going to talk to her mentors about the situation. She already said how terrible she feels that it went down the way it did. Most of us as new nurses go to work every day with the fear of God and losing our jobs and killing somebody in the forefront of our minds. She just did what she was instructed to do!!!

Grace and peace to you, OP, and may you find wisdom and clarity as you grow in your career.

[ghillbert, MSN, NP]

was there harm to the patient? if yes, report. if no, don't.

have you noticed that this nurse consistently signs off medication patches without giving them? if not, just give the patch, sign it and re-time the subsequent doses. if yes, talk to her about it. if nothing changes, then start writing them up.

whatever you do, sign what you did and don't try to cover for anyone by false documentation. but unless there's harm to the patient or it's a pattern, no reason to report. and if it is a pattern, investigate. could be she's always late because the med doesn't arrive from pharmacy (or wherever yours come from) until two hours after it's due. or the patient is always playing bingo when it was do and she signed it off meaning to give it after bingo and forgot. could be the admin times need to be changed because the patient only wants the patch on her back and doesn't want to take her shirt off until bedtime.

but please don't go running to the supervisor over every little thing. and if i were you, i'd apologize to all and sundry for your part in this nurse losing her job.

i just can't tell you how much i disagree with you here. granted, i have not worked in an environment where you'd get fired for one error such as that described in this thread, so i'm sure that may change my mind but:

1. do you genuinely expect a new grad nurse to assess whether sufficient harm occurred to report it? to investigate whether it's a pattern or a one-off, or the reasons for the error? really? that is not her job.

2. who decides if sufficient harm occurred to warrant reporting? you? as far as i'm aware, that's not within a nurses scope of practice. yes, it was "only" a blood pressure med. what if the patient has a stroke during the time that the bp med was not being administered? does the effect on bp matter then? i just think this is a slippery slope to be on.

3. i hate to be accused of being a goody-two-shoes, but i was trained at nursing school to never sign something off until i gave it, or did it. i never have. it is not true that you have to - you can't take a signature back once you've written it.

sounds like the op would be better to go to your bosses, explain your concerns and mention that firing people for such incidents just means that less will be reported, possibly resulting in further harm to your patients.

i agree that in an "ideal world" you wouldn't have to report on coworkers - but there's no way in hell that i'm risking my license or my patients' health in order to protect someone who may or may not do the same for me.

[roser13, ASN, RN]

"How did you know she signed and did not give the drug???"

OP explained early on that the catapres patch was not new - not currently dated. The patient's BP was rising.

[Indy, LPN, LVN]

I feel for the OP. Good grief, simple stuff can get so complicated. Even just following directions can get to be a nightmare sometimes. When I was new, we had a patient get a coumadin dose with evening meds instead of at 1700 per facility policy. The reason of course, is that the order was written late and the med simply wasn't there to give at the correct time, then when it was, it was time for shift change. I was on orientation.

The night nurse explained the timing of the med to the patient per protocol. No problem. Then the patient twisted what the explanation was, the next day, and my interpretation was off. Of course it was off, it was like that game you play in elementary school with people whispering to each other. So I'm thinking some nurse told the patient I don't know how to give meds on time. My preceptor lost it when we were discussing this, I simply was discussing it over lunch. She marched my butt to the DON's office and insisted that I tattle. With her behind me and the DON in front of me, I stated what happened, including that I was probably just being oversensitive and it was no big deal.

OH my god. The nurse was gone very shortly after that, and there was supposedly a pattern of her nitpicking on new nurses or somesuch. It left a very bad taste in my mouth. Especially later when this nurse and I had a talk about the incident. She was forgiving, but still lost a job. So anyhow, I try now to err on the side of discussing things more and leaving room for misunderstandings where there is room. That doesn't mean I don't write up errors; it means I remember that feeling of "oh god did I have to help put that last straw on the stack?"

Cut the OP a little slack, this person seems to have analyzed it thoroughly and definitely sees the different sides to this situation. Seeing that now doesn't help you when someone in authority over you, is breathing down your neck shoving policy under your nose.

[Ruby Vee, BSN]

i just can't tell you how much i disagree with you here. granted, i have not worked in an environment where you'd get fired for one error such as that described in this thread, so i'm sure that may change my mind but:

1. do you genuinely expect a new grad nurse to assess whether sufficient harm occurred to report it? to investigate whether it's a pattern or a one-off, or the reasons for the error? really? that is not her job.

2. who decides if sufficient harm occurred to warrant reporting? you? as far as i'm aware, that's not within a nurses scope of practice. yes, it was "only" a blood pressure med. what if the patient has a stroke during the time that the bp med was not being administered? does the effect on bp matter then? i just think this is a slippery slope to be on.

3. i hate to be accused of being a goody-two-shoes, but i was trained at nursing school to never sign something off until i gave it, or did it. i never have. it is not true that you have to - you can't take a signature back once you've written it.

sounds like the op would be better to go to your bosses, explain your concerns and mention that firing people for such incidents just means that less will be reported, possibly resulting in further harm to your patients.

i agree that in an "ideal world" you wouldn't have to report on coworkers - but there's no way in hell that i'm risking my license or my patients' health in order to protect someone who may or may not do the same for me.

you don't sound so much like a "goody two-shoes" as you do like someone who doesn't have much actual experience at the bedside. you're commenting about what you learned in nursing school, not your experience. therefore, i'm expecting that you don't have any -- or much. so whether or not you disagree with me is irrelevant.

yes, i expect a new grad to be able to assess whether missing one dose of a medication caused harm to the patient. most new grads would be able to determine whether or not the patient has signs/symptoms of a stroke -- one possible consequence of hypertension. i'm assuming this is ltc, not sicu, and my ltc experience is limited, but even as a brand spanking new grad, i could tell when someone was stroking.

i'd also expect a co-worker to call me and find out what happened if i signed off a med and it appeared that i hadn't given it. did i write the wrong date on the catapres patch i gave? did i sign it off just as i was about to give it, then the patient fell, coded, had a seizure or decked me and in the ensuing hubbub the patch got missed? did i place a new patch on her right arm, and take off an old patch on her left leaving an older still patch on her chest? did i get interrupted by a code in the middle of giving six medications, pick up the mar and sign them all off hours later believing that i had actually given them only to remember to my horror at 0300 that i'd forgotten the catapres patch?

i'd expect a co-worker whom i followed regularly to have an idea whether i habitually screw up, take the easy way out or shirk work . . . or not. and if i was an otherwise solid, reliable worker who made a one-time error, i'd appreciate the opportunity to contact the supervisor and tell her myself. if i was someone who habitually spent my shift at the desk eating bon bons while everyone else ran their tails off, perhaps i'd deserve to get written up and subsequently fired.

as far as your suggestion that the op talk to the bosses about the ramifications of firing the co-worker -- probably not a good idea.

[caliotter3]

Cut the OP a little slack, this person seems to have analyzed it thoroughly and definitely sees the different sides to this situation. Seeing that now doesn't help you when someone in authority over you, is breathing down your neck shoving policy under your nose.

Sometimes TPTB can take a situation that you have presented to them and use it as ammunition against someone that is under the gun to begin with and you know nothing about this vendetta. You get caught up in it whether you want to be or not. That is one reason why things should always be discussed with people first. We all have our own views about what should cause a termination or some other punishment. Most people don't want to be involved with "that final straw" if they can help it.

[rn/writer, RN]

Even if you disagree with what the OP did, please express your dissent in a professional manner. It isn't necessary to scold or shame or lay a terrible guilt-trip on her. Keep in mind that she is new to the field and doesn't have years of experience to fall back on. In lieu of that, she relied on the facility policy and the advice of her direct superior. Had she done otherwise and come here to vent that she got in trouble, I'll bet a great many responses would be scolding her for not understanding her place as a newbie and following the protocol.

Keep in mind also, that if a nurse doesn't report a med error, she can find herself in jeopardy if there is evidence that she knew or should have known about it. The professional courtesy of calling the other nurse and/or giving her time to correct the situation can backfire. Most of the time it probably wouldn't, but any time you step outside the P&P or established protocol, you do take the chance that you, too, will end up in the line of fire. Every nurse has to count the cost in her own economy and decide what she is willing--or not willing--to do.

I do find it ironic that a few who have taken this young nurse to task for not showing her coworker compassion and professional courtesy have done so without extending those same qualities in her direction. Even if you think she was dead wrong, you can express your views kindly and help her to understand your point of view. There doesn't appear to be any malice in what she did. If anything, the facility's policy is the villain here and the nurses who stand to be harmed by it should, perhaps, suggest a revision.

In the mean time, those who are saying incident reports ought to be educational rather than shaming or punitive have it right. A good place to start incorporating that philosophy is with the posts in this thread.

[NursePamela]

"How did you know she signed and did not give the drug???"

OP explained early on that the catapres patch was not new - not currently dated. The patient's BP was rising.

Could have been possible she put new patch on and forgot to take off the old. Then,,, the patient saw 2 patches and took off the wrong one. It could happen...

Point is - investigate - use your chain - go to the source first than up one step at a time.

[southernbeegirl, BSN, RN]

im only on page 8 so please forgive me if i should have finished the thread first. if i dont say something when i think it, i forget it. (dementia here i come!)

im VERYYYYY glad to know the OP didnt tell the family who the nurse was. that was the part that made me furious.

that said...

regardless of the policy about calling the family, IMO...an investigation should be done BEFORE calling the family. calling the family should be the LAST step in the process IMO. the reason? a million things could come up. the nurse could have actually given the med, held a med for a reason she forgot to chart...a million things you wouldnt know if you dont ask her first.

call the nurse, THEN write the report. or write the report and let the DON call her but for Gods sake...look into it before you call a family.

and to the OP....even tho it is not your job to investigate the error...do you think you should have notified the family before it was investigated??

do like my nurses tell me ..."YOU call the family, thats why you are the supervisor". lol, i may not want to either but they have every right to defer that to me. if your supervisor wont do it...leave it for the DON.

[southernbeegirl, BSN, RN]

i'd also be curious to know how your coworkers have treated you after this.