Hello, I never see nurses post who have undergone the pain and humiliation of being turned into the board of nurses so here goes. I am in my fifth year of nursing at the age of 53. Yes I was a late bloomer. I was turned in to the board by my CNO for administering too much insulin to a pt. No physical harm done to pt thank goodness. There was a physician order and it was verified by pharmacy. I was working PRN at this rehab hospital and left for another position due to 1:10 nurse pt ratio. So I got called to help and I answered the call because I enjoyed the staff

there. Anyhow when the med error occurred it was a perfect storm one being that we were always too busy to locate another nurse to consign so we did it all at once at the end. That was one of the reasons I left full time.

When my boss and I spoke the next day after the med error I accepted responsibility and reviewed the nurse practice act which I was not following properly obviously. In our conversation I reiterated the fact that nurses had no way to communicate with each other at all and the wows weighed 200 lbs so it's extremely difficult to push them around to chase somebody down to consign with 5-6 insulin administrations. I had requested some sort of communication link for nurses before but it wasn't in the budget. She asked me if I was going to continue working there PRN and I said no because it's unsafe. Then came the letter. It was the worst thing I have experienced in my life. I was so ashamed and felt so incompetent and this was in my third year of nursing. Now it is present day at my current job 1.5 years and I am getting ready to complete my first year probation( I got 2 years from BON). Our unit manager stepped down due to the workload and the hospital clinical director stepped in as her position was done away with. Everything was going fine , she was aware of my board order and encouraged me to not let that stand in my way. I felt good about her as a boss and thought she may be a good mentor with all her experience and she started to trust me with some extra duties. It all changed when I questioned some new protocols that were being implemented and I just wanted more information about how they came to these decisions. She started treating me differently.

She started asking others about my work and second guessing me in front of my patients. She was looking at my scan rate which dropped significantly one month and I realized it was because I was not entering partial dose

into the computer the correct way and it would

register as a missed med scan. This was corrected for me by a fellow nurse who discovered it. Then she found what she needed. I had administered a Benadryl during the day shift for itching that was to be given PRN itching bedtime. I made another med error. I don't know how I did it but I am human and it happened. Well here I am now terminated and facing the BON(one of the toughest) yet again. I am so depressed and am having a hard time with all this. I'm a good nurse who has given thousands of meds including IV abx, blood transfusions and so many other medications. It's hard for me to tell anybody because there is so much shame. My only support system is a few close friends(not nurses) and my immediate family who believes in me 100%. I was never offered any type of remediation with either mistake. I am at a loss. Why are nurses unable to question protocol or unsafe practices. How did things get so out of hand that we are treated with so little regard and so easy to replace if you stand up for yourself. I have read posts where nurses reply just go with or suck it up or I wish I had your problem. I didn't want to believe in the phrase " nurses eat their young" because I could never treat another human being any less than I would want to be treated. Well I sure believe it now. Two highly trained nurses that I put my faith in as bosses and mentors turned on me. This is all I have to go with and now I'm at a crossroads as to whether I want to go down this road anymore. My family needs the income but I can't get a job to save my life now. Just asking for some helpful suggestions and please no judgement.

Sounds like you really have some stuck up, snobby superiors. I know of nurses who caused sentinel events that weren't reported to BON. Sorry to hear what you're going through. My biggest piece of advice is to remember the outcome of your patients. Was any harm done? A benadryl prn itching at bedtime isn't going to hurt anyone if you gave it at lunch time. It also sounds like the insulin dose you gave caused no harm either. You can always defend that nothing bad happened and the errors were due to EMR. You sound like a good person and your heart is in the right place. Sorry to hear you have to go through all this.

Do you have legal representation? I would check with TAANA for someone in your area.

I am so sorry this is happening to you!! This is the exact kind of thing that will cause med errors to go unreported. This Dark Ages punitive approach is one of the reasons that place is unsafe.

So essentially you were terminated over benadryl given "early" and some wonder why some people become disillusioned with nursing. Most supervisors would have admonished you to be more careful, if that, and everyone would have gone on about their day.

That's awful; I think you will find sympathy here for this scenario. I have no doubt these occurrences have shaken your sense of confidence and well-being. I do think you should contact an attorney to help you with BON interaction. It might also be worth it to find a professional with whom you can discuss what you're going through.

I didn't want to believe in the phrase " nurses eat their young" because I could never treat another human being any less than I would want to be treated. Well I sure believe it now. Two highly trained nurses that I put my faith in as bosses and mentors turned on me.

Please try not to think of nursing this way based on these occurrences. I think it's possible in both of these scenarios you were treated harshly as part of their program to preemptively reject any responsibility for the working conditions and/or to cover up institutional deficiencies.

Realistically, neither one of these errors warrant you having difficulty with your license or with being employed as a nurse. I don't have advice, but I do send positive thoughts your way, that you will encounter the right legal help so that what has transpired can be put into proper perspective with the BON.

(Oh, I did a little searching online out of personal curiosities related to your general situation, specifically about reporting medication errors to the BON. It may be worth it for you or your lawyer to be familiar with the ISMP's "Just Culture"/Patient Safety article(s). Obviously I don't have all the details of your situation but the ISMP's recommendation of having a "Just Culture" with regard to medication errors does consist of quite a few concepts that are in your favor.)

Yes I do and she represented me in the first

Complaint. She is an RN and an attorney. Thanks for the reply.

Huh? How utterly evil and punitive to report you to BON over these two issues and whatever happened to just dealing with the situation at work? Little wonder no one would self-report anything which caused no harm, that 'non-punitive' stuff is just so much bulls*it from management. Sorry you had to go through this. Way back when I was new I made a mistake or two as have we all.

I don't have much to add, I just wanted to say that I am so sorry this is happening to you. It sounds like you are accepting responsibility for your errors, and are a conscientious nurse working in a difficult environment. I hope this all gets sorted out quickly in your favor, and you go on to find a much more rewarding position in the nursing field.