Fired Again ~ HAHAHA!

BHolliRNMS · May 27, 2004

I believe the appropriate nursing measures to be taken were to hold the insulin, treat the hypoglycemia, then recheck the blood sugar. If the BS didn't come up, contact the MD for further orders. We have a standing protocol for the treatment of hypoglycemia in our facility. It would have been inappropriate to administer the insulin. Also inappropriate to just hold the insulin and do no follow up care and documentation.

Beth, DON, long term care.....ps I hate mindless robots who cannot think for themselves and expect me to tell them everything to do. All nurses graduated school and took a test. I expect competency.

Maybe someone could suggest to this LTC to adopt some guidelines in treatment of hypoglycemia to prevent any injury to their residents.

Town & Country · May 28, 2004

to prevent any injury to their residents.

I don't think that is the priority: I think the priority is possible defecits and ratings of the the facility.

The poor patients are just an afterthought....

NursesRmofun, ASN, RN · May 28, 2004

Not sure what the DON was thinking. I could understand it if she simply asked if you advised the doc....but I couldn't see giving the insulin (no matter what kind it was) with a BS of 45.

cannoli · May 28, 2004

So what did you get fired for?

BHolliRNMS · May 28, 2004

well, I know a facility that received a G citation on quality of care because the nurse gave insulin ac breakfast and didn't check to see that the resident ate. The resident's BS bottomed out later that am.

Don't see how anyone could get fired for holding insulin when the BS is

Tweety, BSN, RN · May 28, 2004

Withholding a medication without an MD order is outside the practice of a nurse. The MD should have been called with the low blood sugar and the nurse should have covered her butt with an order. Nurses shouldn't blindly follow MD orders, that's not what I'm saying. I would have held the insulin too and gotten further orders. Perhaps the MD would have changed the doses. Diabetics need their insulin, and this patient might have needed some adjustments.

Always cover your butt.

That DON sounds like an idiot.

Town & Country · May 28, 2004

I could understand it if she simply asked if you advised the doc....but I couldn't see giving the insulin (no matter what kind it was) with a BS of 45.

It wasn't me.

What did I get fired for? No good reason, that's why I can laugh about it. I just feel sorry for the residents.......

well, I know a facility that received a G citation on quality of care because the nurse gave insulin ac breakfast and didn't check to see that the resident ate. The resident's BS bottomed out later that am. Must be a little more to it.

Nope, that's the whole story.....that's why I say it's so bizarre......or that's what was told to me anyway. :coollook:

GibsRN · May 28, 2004

I agree with 3rdShiftGuy --- While this DON sounds like an ultimate idiot :rotfl: the nurse was practicing out of her scope. Like he said, holding the insulin is a nursing judgement for the protection of the patient but she should have contacted the doctor and received an order for alternative action. Perhaps the doctor would have wanted something given and a recheck of the sugar after a certain period of time.

Always protect your behind!

longtermcarern · May 28, 2004

Withholding a medication without an MD order is outside the practice of a nurse. The MD should have been called with the low blood sugar and the nurse should have covered her butt with an order. Nurses shouldn't blindly follow MD orders, that's not what I'm saying. I would have held the insulin too and gotten further orders. Perhaps the MD would have changed the doses. Diabetics need their insulin, and this patient might have needed some adjustments.
Always cover your butt.
That DON sounds like an idiot.

Tweety in the LTC setting most Doctors don't want to hear from you (at least in my area). Yesterday I called the doctor because my Patient had a blood sugar of 464 and only had an order to cover with 4units if over 200. I was told please don't call my office, write it down and fax it. I wrote it down and faxed it, 1 hour later got an order to give 6units L in the am :uhoh21: Most LTC have a policy in place regarding low blood sugar and that is what should of happened. Beth was right about treating and rechecking, then calling the Doc if not corrected. Jean

GibsRN · May 28, 2004

If there are standing orders for a nurse to follow than by all means. But what happens at night if you are out of parameters for the standing orders???

If there were standing orders and I was adhereing to them that DON would have been one unhappy person when I got done with her :angryfire [of course I'm pretty protective when I deal with someone who's an idiot] I guarantee you I would not have been fired! I would have quit with a two week notice - but she darn well would not have fired me

Dixiedi · May 28, 2004

I agree with 3rdShiftGuy --- While this DON sounds like an ultimate idiot :rotfl: the nurse was practicing out of her scope. Like he said, holding the insulin is a nursing judgement for the protection of the patient but she should have contacted the doctor and received an order for alternative action. Perhaps the doctor would have wanted something given and a recheck of the sugar after a certain period of time.
Always protect your behind!

I have to agree with the majority on this one. The nurse seems to have been at fault for not following through. That of course does not excuse the DONs statement (assuming everything said was as we hear it here.)

Was holding the insulin properly documented? Was the MD notified? Was the BS checked again an hour later? ac and 1/2 and 1 hr pc or as often as needed? Did the nurse make the extra effort to make sure this pt ate/drank all she is supposed to and nothing extra? CNAs often give a little candy to encourage cooperation from a feisty little old lady. Of course they shouldn't, but it's rare for a CNA to completely understand diabetes and diet so they "cheat" just a little to make life seemingly easier for all.

I think there has to be a lot more to the story than we are hearing here, though I have worked in a couple of places where the DON seemed to have slept all the way through school! LOL