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?
It was my time to watch the cardiac monitors as a pt went into sinus bradycardia, then a third degree heart block, continuing to deteriorate. The doc was calling his office telling them that he would be late and was getting ready to start CPR.
There was a nurse at the bedside, and over the intercom, I said, "Grouchy, get a BP, would ya?"
She came out of that room and said, "Ellakate, I don't like your tone!" She left the patient's side to chew my butt.
The doc ended up getting the BP and pt got an emergency pacemaker.
This happened a long time ago, but you can see how defiance and insubordination can directly affect pt care, if left unaddressed.
Don't tell me, you have some sort of timed computer scanning system and that is why the 2nd nurse didn't want to be late.....gotta love progress....on a paper MAR, there would have been no problem...
There is nothing that they can complain about except that I am not the guy I replaced. The crossest words I have ever spoken are, "Please lower your voice."
There is NOTHING. This is resistance to change, period, and their own insecurities.
And I am not easily replaced. There's a fairly steep learning curve in this spot, which I know the support staff does not get or they wouldn't snark that the unot managers don't have to do anything, but they are far easier to replace than I.
The worst that will happen is that I will swap units with R.
Don't tell me, you have some sort of timed computer scanning system and that is why the 2nd nurse didn't want to be late.....gotta love progress....on a paper MAR, there would have been no problem...
EVERYONE INVOLVED NEEDS TO BE WRITTEN UP....
Progress isn't the problem, nor is the computerized MAR, which I LOVE.
And why should everyone be written up? The nurse who missed the meds had med errors noted. The nurse who twice REFUSED to give the meds, even after I cleared it with the doctor, needed to be written up. I needed to DO the giving of medications AND ALL of the writing up, none of which would have been necessary if she had just given the stinking meds as directed.
I don't think it's better to be able to hide errors buried in paper.
Progress isn't the problem, nor is the computerized MAR, which I LOVE.
And why should everyone be written up? The nurse who missed the meds had med errors noted. The nurse who twice REFUSED to give the meds, even after I cleared it with the doctor, needed to be written up. I needed to DO the giving of medications AND ALL of the writing up, none of which would have been necessary if she had just given the stinking meds as directed.
I don't think it's better to be able to hide errors buried in paper.
i think the comment about the paper MAR, was aimed at the passive aggressive nurse being able to give it and not have it 'KNOWN" by her initials being linked in the computor......has she gotten her suspension yet?
i think the comment about the paper MAR, was aimed at the passive aggressive nurse being able to give it and not have it 'KNOWN" by her initials being linked in the computor......has she gotten her suspension yet?
Specializes in trauma, ortho, burns, plastic surgery.
(sometimes it's like the Mafia, Sue)
It is a Mafia and you could not fight against!
Be aware with the "open sweatheart kisses"... when they are nice with you ...kissing you on both cheacks, lol, listening to you , then you could ne sure that "la cappo" already let the tumb down for your head my dear!
Is an ugly game, but it is how it is!
Good luck and be strong if you want to fight, and mellow if you want to survive... i will give you some lemone.... just in case if you need to kiss somenthing ugly....lol .... be brave!
So she is there, probably because there's no one to replace her, but staying far away from me. My floor nurses aren't talking to me. It's like a vacation!
I wish I lived near you Sue, I'd come to work for you in a heart beat, ask them if they'd like to move to GA and buy a really nice horsey property for cheap...we could switch...LOL just a thought:D
.... be brave!
ellakate
235 Posts
It was my time to watch the cardiac monitors as a pt went into sinus bradycardia, then a third degree heart block, continuing to deteriorate. The doc was calling his office telling them that he would be late and was getting ready to start CPR.
There was a nurse at the bedside, and over the intercom, I said, "Grouchy, get a BP, would ya?"
She came out of that room and said, "Ellakate, I don't like your tone!" She left the patient's side to chew my butt.
The doc ended up getting the BP and pt got an emergency pacemaker.
This happened a long time ago, but you can see how defiance and insubordination can directly affect pt care, if left unaddressed.