I am an RN. I manage a unit and LPNs do the floor work. They are subordinate to me, in licensure and hierarchy. I do NOT play that up.
This morning, a "floating" nurse had the 6 a.m. medication pass and missed meds for 4 patients. Most were not critical, one was a huge dose of insulin for a diabetic whose blood sugar has been out of control.
The LPN notices the meds were missed. They are now 1 1/2 hours out of range for compliance with being given at the right time. The night nurse was still in the building so I verified with her that she had NOT given the meds. I told the current nurse to give them. She said nothing.
At 1130 she tells me that the patient who gets the insulin has a blood sugar of 463. I asked, "Even after the 36 units of Lantus?" She says, "I didn't give any Lantus. It was out of the time range." "Did you give everyone else their meds?" "No, I can't. They're late." Now, "nursing judgment" is the prerogative of every nurse, but the supervising RN supersedes the LPN. I've been an LPN and know how frustrating that is, but LPNs work under the direct supervision of RNs. And I am responsible for what happens when I am the supervising RN.
At this point I have to call the doctor AND write up the night nurse for med errors. What should have been simple is now a big hairy time-consuming deal. Of course, he tells me to give all the meds as none are that time-sensitive and need to be given.
I note all the charts and tell her to give the meds.
And I write her up.
All hell breaks loose. Even the aides are yelling about how unfair it is that A made an error and B is getting written up. I leave the unit for 20 minutes to compose myself. Meanwhile, I have a resident running two separate IV antibiotics and have administrative tasks to perform and am now behind because I spent an hour writing up errors, calling doctors, and writing up people. None of which whould have been necessary had she not just been defiant.
2 pm comes and I notice that she hasn't given the meds. I start passing them. She actually says, "Are you giving those 5 am meds?" "Yes." "You need to write orders for them all." "Um, no, the system will mark them at the time they were given." "Yeah, but no one will know they were late unless you write a note." "You think I didn't write progress notes two hours ago when I gave you the instructions to give them?"
WTH?! HOLDING 36 UNITS OF INSULIN? THAT'S NURSING JUDGMENT BY HER? And holding glyburide on someone else, who gets only that all day for her BS?
Specializes in trauma, ortho, burns, plastic surgery.
I think you handled it just fine Suesquatch. I can just "see" that nurse after you told her to give the meds.....the passive agressive behavior, with her probably thinking, "Im not giving a med thats out of range no matter what she says." She has an attitude problem, and is obviously threatened by your seniority. .
Nop, nop, nop... is just a bad communication style from both parts and yes probably and some "personality" style issues.
Again NURSING IS NOT MILITARY!
INSUBORDONATION could be used when everything is CLARE and she refused to do it!
Attitude? I have BIG doubts on it! Both parts has attitude!
I know some time, many time we "the big RNs" we have RIGHT! But some time NOT! I know I know we have right.... but life teach me that EVEN when we have right, and we have proves that we have right.... depend how you TELL the right thinks.
And if we have right and we can not make us understanded ask for help from education departm, DON, management.
And if you don't have it, instead to work in ARMY with army methods... you are the only one able to choose your nursing style to be!
And better insted to tell is to WRITE!
If you want to write her up is NOT for insubordonation BUT IT IS for a BAD NURSING JUDGEMENT! And send her to education department and let her to write an agreement related what she will do in all other situation like this one.
Make an inservice for all nurses and let them all to know about and sign a agreement that they know what to do next time! And tell them what will be happen if they will elopes the contract!
And even like that, who had a bad nursing judgement..only HER? OR ALL the team????
NO ONE CALL THE DR FOR HIGH FS! THIS IS THE BIGEST PROBLEM, that I seen!
For me like RN, the situation wasn't clare at all!
1. She didn't had the DR ORDERS for meds that was in late, you needed to let her know that is a facility policy to not call dr and you notes already on patient chart.
2. Very bad judgement to give Lantus for a high level of insulin, WITHOUT calling the doctor first!
3. Who assesed the patient? I didn't readed NOTHING about?
SHE HAD THE RIGHT to have doubts! BUT what she did TOTALLY WRONG... is that she had doubts why she didn't call the doctor????? She did very bad because she didn't call the doctor by HER SELF!
And that was happend because :
- wanted to pass accountabilty on you...and she could be able to stay clean away of this mess
- think at her comfort first before to think to patient
- and yes Sue probably she dosen't like you because you are the boss (is happen always with all bosses, lol )
As far as the aides go....the hollering and questioning your judgement is unacceptable. They dont know the whole situation, and they dont need to.
Agree with it! They need an educational time related WHAT IS SCOPE OF PROFESSION for a aide, read and sign the educational paper, and let them know what will be good or bad measures if they are in or out of scope of profession.
Why I have the felling that many of your "subordonee" read AN and your postings??? :lol2::lol2:
1. She didn't had the DR ORDERS for meds that was in late, you needed to let her know that is a facility policy to not call dr and you notes already on patient chart.
2. Very bad judgement to give Lantus for a high level of insulin, WITHOUT calling the doctor first!
3. Who assesed the patient? I didn't readed NOTHING about?
Huh? The meds were discovered as not given at 0730, well before her high FS at which time the doctor was, indeed. called.
Assess what? She's a diabetic LOL in LTC. She was her usual self and we checked her BS QH then Q3 then Q5.
The other nurse went nuts on me today. Stormed off, threatened to go home, screaming all over the facility. My crime? I asked if someone in pain could have a couple of Tylenol. She said she wasn't sure if there was an order. I checked the MAR, there was, gave the Tyl and marked it as given. She almost gave it twice, b;ah blah blah.
Well, my bad. But her response was out of all proportion and she was clearly looking for an excuse to pop her festering zit of resentment.
Called the DON. And also told her about the aide who sorta shoved me yesterday.
I don't know about your LTC facility, but at ours, we could not call the MD as LPNs. It was up to the RN. I think unless you have the experience of working with a nurse/CNA like the one you work with, it is hard to understand. Education and /or other traditional methods don't work. They have a everyone against me mentality. It is unbelieveble until you experience it.
LPNs can call here. However, had she just given the QD meds when we discovered they'd been missed there'd have been no issue at all, other than a med error for review.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Oh, my day. Called the DON. And also told her about the aide who sorta shoved me yesterday.
They. will. not. win.
This has gotten outta hand my friend. Sorta shoved you??? From what you have posted here you are a professional and fair nurse who is trying to get the best things for her patients. This level of insubordination should not be tolerated by your DON. Hopefully, a staff meeting will be scheduled STAT to outline what the expected behavior is in this facility.
These idiots don't realize, though, that there are a TON of LPNs hungry for days, as the DON told me a couple of weeks ago. And RNs, not so easy to find here.
These idiots don't realize, though, that there are a TON of LPNs hungry for days, as the DON told me a couple of weeks ago. And RNs, not so easy to find here.
This is your ace in the hole. Ms. I'm All That And Then Some seems to be in her own little world. Once your DON has decided she has had enough, somebody will be out on the sidewalk. I suppose for a lot of you, that can't happen soon enough. Enjoy your day off Sue, you deserve it.
Specializes in Gerontology, Med surg, Home Health.
Sort of shoved you??? I would be on the phone to the police first and then the union steward letting him know that one of the employees was about to be charged with assault. All well and good to be fair but don't ever let it get physical. If they shove YOU, imagine what they might do to a resident who couldn't fight back.
CCM, she managed to plow by me in a narrow space where I was fiddling with an IV pump, jostling everything. Obviously deliberate, yet short of actual battery.
These people feel threatened by you for some reason and they are acting out of frustration to attempt to get you in line. They don't want to change anything at all because they have it their way.
zuzi
502 Posts
Nop, nop, nop... is just a bad communication style from both parts and yes probably and some "personality" style issues.
Again NURSING IS NOT MILITARY!
INSUBORDONATION could be used when everything is CLARE and she refused to do it!
Attitude? I have BIG doubts on it! Both parts has attitude!
I know some time, many time we "the big RNs" we have RIGHT! But some time NOT! I know I know we have right.... but life teach me that EVEN when we have right, and we have proves that we have right.... depend how you TELL the right thinks.
And if we have right and we can not make us understanded ask for help from education departm, DON, management.
And if you don't have it, instead to work in ARMY with army methods... you are the only one able to choose your nursing style to be!
And better insted to tell is to WRITE!
If you want to write her up is NOT for insubordonation BUT IT IS for a BAD NURSING JUDGEMENT! And send her to education department and let her to write an agreement related what she will do in all other situation like this one.
Make an inservice for all nurses and let them all to know about and sign a agreement that they know what to do next time! And tell them what will be happen if they will elopes the contract!
And even like that, who had a bad nursing judgement..only HER? OR ALL the team????
NO ONE CALL THE DR FOR HIGH FS! THIS IS THE BIGEST PROBLEM, that I seen!
For me like RN, the situation wasn't clare at all!
1. She didn't had the DR ORDERS for meds that was in late, you needed to let her know that is a facility policy to not call dr and you notes already on patient chart.
2. Very bad judgement to give Lantus for a high level of insulin, WITHOUT calling the doctor first!
3. Who assesed the patient? I didn't readed NOTHING about?
SHE HAD THE RIGHT to have doubts! BUT what she did TOTALLY WRONG... is that she had doubts why she didn't call the doctor????? She did very bad because she didn't call the doctor by HER SELF!
And that was happend because :
- wanted to pass accountabilty on you...and she could be able to stay clean away of this mess
- think at her comfort first before to think to patient
- and yes Sue probably she dosen't like you because you are the boss (is happen always with all bosses, lol
)
Agree with it! They need an educational time related WHAT IS SCOPE OF PROFESSION for a aide, read and sign the educational paper, and let them know what will be good or bad measures if they are in or out of scope of profession.
Why I have the felling that many of your "subordonee" read AN and your postings???
:lol2:
:lol2:
Be carefull!