Did I just get thrown under the bus? Or I'm a bad nurse?

[proudauntie415]

New nurse and going on my first month in LTC (first nursing job) and boy, is it difficult. I don't get a break, barely pee and just overwhelmed. They say I'm doing a very good job and happy to have me, but I feel just like a bumbling idiot most of the time. I constantly question my interventions, and having a hard time building that confidence.

Here is my question, a very crazy evening and did not get a chance to check a blood sugar until about 10:15 ish, it was due at 9. It showed 62. For this resident that's pretty low, but I knew it wasn't critical. So I held the Lantus, gave a shake. About this time it was shift change, gave report and explained the situation to the night nurse, wasted my Lantus right in front of her because she said she would draw up her own. I informed her that my thought was it would be better for her to finish the shake, but wasn't going to give the Lantus until after she finished and waited a bit or so (30 mins -ish).

Well, now I realize, I really didn't need to hold the Lantus (its that slow) at all. residents blood sugar was very high the next morning around 450 something (that isn't rare for her anyhow) And resident was pleasant, calm, no s/s hyperglycemia, to her it was just another morning. But still, when I came on the next evening..... I saw that the Lantus was never given later that night after I left.

When I asked the night nurse about why she didn't give it she informed me that she can't give a medication that was ordered within my time to give. There is the "hour before and hour after" rule. But technically the Lantus is written for HS, only the BS check is for 9pm. Either way, why didn't she just tell me--hey, I'm not gonna give the Lantus? Or explain to me, "ya know, you don't need to hold the Lantus?"

So all in all, I made the error cause I made the choice to hold it, thinking I was doing the right intervention ( I did make a note on holding). Doctor of course gave me a stearn NEVER hold Lantus lecture. I respectively chalk it up to lesson learned....but I feel kinda like I got thrown under the bus here...and now I have a med error I guess? So frustrated. Just need some encouragement.

[imintrouble, BSN, RN]

You shouldn't have held the insulin. Having said that, I think the bigger offender is the nurse after you, who held the insulin in order to make a point. Or to make you look bad. She caused harm to the pt to get even??? To call attention to your mistake?? To make you feel bad??

Who knows. Where I work, the second nurse who didn't give the Lantus would have been reprimanded just as much as you. Especially considering you're new.

[maura_smiles]

You should have the doc write parimeters on when to give an dwhen to hold the lantus. I have several brittle DM's by morning they will bottom out if it is given with BS below 200, even with snacks given at HS and at 0300.

[chevy64]

I too am a new nurse and I have felt the same feelings you felt. Nurses do "eat their young" as they say but I can't help but to wonder have they forgotten how they too once were new themselves. Learning is what a new nurse does, its when you think you know everything and don't ask questions is when our patients are in danger. On the bright side, look at all of us you have educated on Lantus by posting this article!

[CrufflerJJ, BSN, RN, EMT-P]

PLease do not always give Lantus.

Obviously, healthcare settings vary (LTC, med/surg, ICU,...). I work in the ICU. If you have a pt with poor PO intake with scheduled Lantus, it may not make sense to give a big whopping dose of Lantus if their gluc is 90-100-whatever.

If you have a sedated pt on a vent, with tube feeding being held for whatever reason, and a pre-Lantus gluc of ~100-120, PLEASE consider holding the Lantus (especially if Lantus was ordered when the pt was receiving tube feedings). I can speak from personal (painful) experience that if you give a whopping dose of Lantus for pts like this, you may be quite surprised at the resulting Critical Low gluc 4-6 hours later.

Always question whether to give a med or not. Please NEVER blindly give a med (especially insulins, electrolytes, & antihypertensives) "just because it's ordered." Take the time to question the order, the pt-specific circumstances, most recent labs, and just plain common sense.

I'm not a robot - I'm a nurse with the requisite training, critical thinking skills, and willingness to question orders when appropriate.

[BrandonLPN, LPN]

I would add that whether or not the pt is symptomatic of hypoglycemia is at least equally important to the number on the glucometer.

[idesofmarch1118]

Aside from the insulin-related information, I think a key point to take away from this situation is how to help mentor newer nurses. I think there is a laundry list of ways that nurses "eat their young," and some might consider this situation as one! The more seasoned could have easily turned this into a teaching moment. By giving a simple explanation of the facility's policy/procedure (the hour before/after administration), to tell her where to look for insulin onset/duration information, and pointers for dealing with situations like this, and maybe even some time management tips. Newer nurses often find themselves trying to catch their tails during the shift, trying to be super nurse, not wanting to ask for help, and trying to complete everything during their shift, when in reality, nursing is a 24h job. We just can't do it all, and this could have been a great opportunity to give pointers and encouragement.

I doubt you'll readily forget this situation, and hopefully you'll keep it in mind down the road with other patients. This is how you learn! You don't get every experience in nursing school, but use your critical thinking, trust your "spidey" nursing sense, ask for help or for another nurse's feedback, and recognize when you just don't know what to do! Nursing is science and art, and a lot of teamwork!

[VANurse2010]

I've held Lantus ...and I would be hesitant to believe that I should "never" hold a specific medication.

Then you should education yourself about the different types of insulin.

[slevy1130]

I dont have any words of wisdom, I am about to graduate next month. But what you are saying is a big fear of mine and I imagine a fear of most new grads. Document Document Document is all I can say. We really do depend on the more senior nurses for guidance and I am disappointed to hear that the night nurse threw you under the bus.

[Sandradee0303]

In regards to nurses eating their young.....some do. I am a new nurse and during my orientation at a LTC facility the nurse orienting me and I were sharing the cart keys. I had my meds prepared for my pt, she was still finishing up getting hers. I said.."you have the keys and are gonna lock up right?" she said "yes". I came back to my cart with it unlocked and keys ON THE CART! She denied saying what she said. In that week there were a couple other small incidences that could have made me look bad. I now watch her. She is sickly sweet to me but I know there are daggers in her nails!

[butterfliesrus]

Oh goodness. I am still a nursing student but I worked at a LTC facility for a good hard while with plenty of experience in watching the new nurses get "thrown under the bus" by nurses who "eat" their young. Educating yourself is the top priority in being safe for your patient. My advice, don't ignore your gut and don't take another person at their word (especially if another shift is taking over). Had something happened to your patient, it would have been your fault (or at least others might feel that way). You can ask the other nurse to sign off that on that particular documentation of her saying she would give the med instead since she is the one taking over. Document like crazy for your own legal safety, but if you care more that your patient is safe (which I'm glad you do) make sure you do what should have be done on your shift- 'cause I know that the next shift might not care about the patient as much as you do and you personally will be mad that the next shift allowed a bad thing to happen to your patient (Past CNA bitterness coming out now.)

[merrywhiterose]

Welcome to LTC! It's probably the hardest place to work as a nurse! If these places had a better nurse to patient ratio, there wouldn't be so many mistakes!

[hav2nurse]

I don't think you should beat yourself up about this mistake. Believe me, you will never make that mistake again. The other nurse may not have know about Lantus either. Whenever your not sure about something, ask.

A mistake turns into a lesson once you learned from it.

[h=1]"True wisdom is knowing what you don't know" Confucius.[/h]