Demerol 75 mg was given IV instead of IM. Fired!!!
Is it a misconduct? I was terminated and denied unemployment insurance.
Patient was not harmed. I started practicing under my RN license of Oklahoma 7 month ago. This was my first nursing job and I relocated for it (paid my relocation twice) from Texas to OK and back, when lost the job. The real reason for termination was a snow storm and I could not drive to work from the place I lived. I called the emergency truck to pick me up. My manager was furious and called me to her office few times for another reason. I was so fearful that she is going to fire me and I made an error. The time I found about it was next day in Human Resources, when I was fired. No variance report, no calling doctor for back IV order, no disciplinary, just simply terminated for misconduct.
Word MISCONDUCT bothering me. This is just a human error, which happens every day in hospitals!!! This was a personal issue not a misconduct. So, I filed the appeal for hearing with employer. At least my OK license is still displayed current online.
It is so hard to find an employment with only 7 months of experience! I believe that my 7 months of hard work 84 hours per pay period allow me to be qualified for unemployment insurance. I am just a human who wants to work, I am not asking for welfare.
Please, advise me what to do. If anyone was in similar situation. Thank you!
I'm not sure I will be adding much to the conversation, but it appears most are discussing the OP's med error (and rightfully so). However, what I'm taking from this is not just the med error, but a plethora of problems.
Failure to get to work. Okay, a snowstorm, or any storm for that matter, is coming. As a professional it is your responsibility to plan ahead. The OP states she called the emergency number/transporter or whatever. What is not stated is when the call was made. Was the call 15 minutes prior to shift start? That would make anyone in management quite angry - and justifibly. I think this set the OP up so when a serious med error occurred, the camel's back was finally broken.
I don't know what kind of floor the OP was working, most likely a med/surg floor, but it seems to me ANY pain medication that is going to be administered via IV, especially when the majority of times it will be IM (or PO) will warrent a second look.
Bottom line, I believe there are many other details that are missing in the OP's posting. Seven months and many problems is what I'm reading.
yes. I do accept I did make an error. First time incident, I moved on, I payed my move twice. Thank you for your reply.
I beg your pardon, but don't you see? This is exactly what everyone here is talking about. Just look at the statement you made above; do you think perhaps you can puff your chest out any more? Now, I don't know you, your boss, or your hospital, but just listening to your tone bespeaks volumes. As respondent MjMoon stated, it's all about attitude and I would bet that that was what irritated your boss more than anything else. Whether the med error was serious or not is moot; what is clear here is that they wanted to get rid of you. It probably wasn't any one particular thing, but a culmination of all your daily interactions and minor but cumulative transgressions over your entire length of employ that lost favor with your employer. But, they probably didn't have anything worth firing you for, that is, until now; that is, you making a "serious" medication administration error.
No offense, but sometimes, taking a serious hard look into a mirror is one of the most difficult things for a person to do. As you're just starting out in this field and likely have many more good productive years in the profession, my suggestion is that you first take care of your own human failings or else they may severely handicap any future employment.
Good luck. I otherwise wish you a long and successful career.
OP, there have been plenty of responses, but I am curious to YOUR response. Several posters have asked for more background info, and I was scrolling thru the posts to see your response. I only see one. Would you like to post an update?
it seems she was online today until around 8:50am...
so no, i don't think she wants to give an update.
if i had to guess, it 'seems' she's likely put off by most of the responses.
Looking in micromedex, the largest dosage range that I found for meperidine is an a continuous infusion/PCA with the dose being no more than 50mg/hr IV.
It's 35 mg per hour max for continuous infusion. But for IM, you can give up to 150 mg max. Elderly dosing is less, but also not really a drug you'd want to give to the elderly. Pca usually given around 10 mg max with good ol lock out periods.
Personally, I'm more inclined to think poorly of you for even considering filing for unemployment as a nurse. You work in about the most employable profession there is, so instead of being a part of the problem, lower your standards and apply for whatever job is out there. I'm personally beyond sick and tired of working more and more hours each week to pay for people that just don't feel like working for a job for which they're perfectly qualified and able to work. If you're honestly that lazy, leave the profession now and do all your future potential co-workers a favor - lord knows, they don't want to have to work harder to pick up your slack any more than the rest of us do.
I think this is pretty unfair of you to say and doesn't really help the OP's situation or her understanding of her errors. Whether she qualifies for unemployment or not, applying for it does not make her lazy. Jobs are scarce, especially for someone who has less than a year of experience and was fired. It's unlikely she'll pick up a job in the next week no matter how bottom-of-the-barrel it is and she still has bills to pay. Collecting unemployment doesn't equal being lazy unless you're not actively seeking employment at all.
NURSEW74- I did Endoscopy/minor surgery for 1year and Sameday surgery for 1 2/2 yrs Some docs still like to give Demerol IV as opposed to Propofol, Ketamine- they can get their proceedure done without having to wait for an avail CRNA, don't have to split any cost with the anesthesia dept. and can have the RN recover the pt without sending the pt to a PACU and having anesthesia sign off on the patient- Is it the wiser of the 2 choices- depends on which doc you ask!
I haven't given Demerol IM sine the early 1990's. Back then we also gave Demerol 24 hr infusions- there were no PCA's, no current literature, studies or EBP( a what, in 1990) on Pain management. We didn't have iphones or ipads or what ever. we looked these drugs up manually, learned them and consulted with the pharmacy. We learned our drugs in nursing school, their standard dose ranges, their routeof administration and especially their precautions( back then it was nursing implications) we had drug books attached to every med cart(no PYXIS)and the expected behavior was to use them!
Back in them days I think with the lack of technology we learned better- the information "processor" was in our own brain. We were not allowed to have a calculator in a nursing math test- we had to show the math on our "handwritten" tests. I think this new technology has removed alot of that Learning and making It stick" We carried these"functions" onto the units in our practice. Each step was meticulously gone through. It taught us invaluable habits- if you are unfamilar with a drug- you looked it up. Technology is fine but it has made it dangerous. That "process" is not learned. It is skipped over in the human and done inside the instument, the human learn to depend on the technology instead of the learned process in themselves. To this day- I still look up drugs the old fashioned way. The more information and experience you have packed into your brain. the better critical thinker you are. All these techno peices can not be hauled into a bedside during a code. Who has the time in a code to be "programming" when they should be "recalling"!
personally, i'm more inclined to think poorly of you for even considering filing for unemployment as a nurse. you work in about the most employable profession there is, so instead of being a part of the problem, lower your standards and apply for whatever job is out there. i'm personally beyond sick and tired of working more and more hours each week to pay for people that just don't feel like working for a job for which they're perfectly qualified and able to work. if you're honestly that lazy, leave the profession now and do all your future potential co-workers a favor - lord knows, they don't want to have to work harder to pick up your slack any more than the rest of us do.
as for iv instead of im, its not the end of the world. it's not the "major" med error that people are describing it to be, i don't think... to me, a "major" error would be something along the lines of giving vistaril iv or giving lantus iv. giving something by the wrong route is still an error, and shame on you for even considering asking the physician to change their order to cover your mistake, but at least the route was correct and the dosage was still within acceptable parameters. basically, and i hope you know this already but, you got very lucky. they taught us the five/six rights in school for a reason.
what do you mean by this? the route was not correct (gave iv instead of im) and the dose was therefore not within acceptable parameters. it would be rare indeed to ever give a single dose of 75mg iv unless very very close supervision and monitoring was possible, such as when giving iv sedation.
Right ROUTE. Your medication rights? That is enough to be fired over, especially given the other things you mentioned. We all make mistakes, but whenever you give a med, especially by IV, you need to triple check that. When you give anything IV, it hits the system almost immediately.
My state's unemployment insurance only pays if dismissal is "no fault." Fired for cause = no unemployment insurance. I assume the OPs state is similar. Different institutions have different standards. The person who put Morphine in a PCA instead of Demerol would most defiantly have been fired at my last facility, as would have the OP. Anyone doing the 5 rights could not have made those errors. I don't think it is harsh, I think it is a natural consequence. Yes, we all make mistakes, but we must pay for them. It sounds like the OP is paying for it, even if she hasn't quite taken all that there is to learn from it (but I'm only on page one, perhaps she has a different perspective by page 5, lol). In any event, good luck to you. Live and learn. Updated to add: ok, read the whole thing and realize she didn't learn squat. You know, I'm getting pretty tired of all these kids getting on here, whining, begging for advice and then bailing when they don't like it.
Wow, you guys are harsh. She made a human error. I think being fired for the first offense is wrong. We are human, we error. No one said she didn't acknowledege her error.
I made a pretty bad error a few months in as a float on a busy med-surg floor. I put a demerol PCA Syringe in instead of a Morphine. No adverse event, except the patient was in pain, but was even on the morphine. A doctor caught my mistake. He was OK with it, but said he couldnt turn a blind eye and gave me the chance to self report. And I did. I cried to the nurse manager. She said we are all human and we error and as long as we recognize our mistake and learn from it, we should not be punished.
I'm glad I wasn't fired. I made a few small mistakes since, but I also made some pretty decent catches. I became an ICU nurse and saw a caught a few patients going sour (mine and not mine) before coding and was able to fix these problems before they did code.
I was scared to become a nurse in fear of making a potenially life altering mistake. But I put that fear aside, because this world needs nurses. They do good, and are human at the same time.
Thank you. I think nursing culture is cruel. No support, no compassion. That's what I encountered at my work. They eat new nurses. In this hospital LPNs hate RNs, because I just came from school and make $2 more.
Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
The error is a HUGE misconduct. Just because this pt this time did not suffer because of your mistake doesn't mean that a pt could not have been affected gravely. There is a big difference between giving a med iv or im. You need to recheck doctors orders over and over and give the med as ordered. You also need to own up to the mistake as a medical professional. When you were fired the facility did not want to take the chance that you would make an error again. Why should a pt's life be put in jeopardy because you believe you deserve special treatment. Patient's have DIED when a med was given the wrong route. Memorize the five rights of medication administration before you take another job.
It's 35 mg per hour max for continuous infusion. But for IM, you can give up to 150 mg max. Elderly dosing is less, but also not really a drug you'd want to give to the elderly. Pca usually given around 10 mg max with good ol lock out periods.
j621d
223 Posts
I'm not sure I will be adding much to the conversation, but it appears most are discussing the OP's med error (and rightfully so). However, what I'm taking from this is not just the med error, but a plethora of problems.
Failure to get to work. Okay, a snowstorm, or any storm for that matter, is coming. As a professional it is your responsibility to plan ahead. The OP states she called the emergency number/transporter or whatever. What is not stated is when the call was made. Was the call 15 minutes prior to shift start? That would make anyone in management quite angry - and justifibly. I think this set the OP up so when a serious med error occurred, the camel's back was finally broken.
I don't know what kind of floor the OP was working, most likely a med/surg floor, but it seems to me ANY pain medication that is going to be administered via IV, especially when the majority of times it will be IM (or PO) will warrent a second look.
Bottom line, I believe there are many other details that are missing in the OP's posting. Seven months and many problems is what I'm reading.