First major error.

Emergent, RN · Mar 3, 2017

One thing I've learned is that an immediate rectal temp is in order if a temp cannot be obtained. More often than not the patient is hypothermic. This is from my experience as an ER nurse. You should have immediately gone to personally assess the patient.

You should go to the meeting with a union rep, with no excuses and utter humility. Priority #1 should have been, not making a mental note, but going directly in to see your patient.

Gampopa · Mar 3, 2017

While there's no way around what happened, having a union rep there may be a good idea. You said you feet guilty and numb for your mistake. If you go into a meeting with mngt feeling that way, they may just bull doze you, possible fire you, or report you to the board. A union rep will give another voice to speak for you. You will need this to help mitigate any repercussions for your neglect of this patient. The union rep may also help remind mngt of any chronic complaints about understaffing that may be going on at your hospital. A union rep can possible help to avoid a bad outcome for you.

Ldrpnurse11 · Mar 4, 2017

Emergent, there is no need to scold NightWatch about what they did or didn't do at this point. That is not helpful in the least and they already feel bad enough as it is. I hope you never make a mistake and others tear you down instead of hurt you, but build you back up like nurses do. I wish you good luck NightWatch.

Graduatenurse14 · Mar 5, 2017

I am a union rep for my unit and I was also in another union in my former career.

Take your union rep with you to:

-Ensure respect is given as the situation is discussed.

-Act as a witness. Your manager is allowed to have another manager or supervisor there too, most likely.

-Take notes. You can take notes too.

-Ensure your contract isn't violated during the meeting.

-Ask questions you won't think to ask or best asked by a union rep.

Things you must do:

-Write down exactly what you remember about the incident and give it to your union rep in enough time for them to go over it and clarify anything they don't understand. If you don't remember something, do not make it up.

-Write down what you remember about the shift in general which includes how many nurses were on, how many nursing assistants were on, if you have ratios, was anyone over ratio, acuity of all patients and were the high acuity patients distributed equitably (you may not know this information and that's ok as your union can get it), location of all of your patients. If you don't remember something, do not make it up.

-Not talk about the incident with co-workers even if they are close friends.

-Not talk about the meeting with your manager with co-workers even if they are close friends.

-Read your contract about your rights and the discipline process at your hospital. Ask your union rep to clarify anything you don't understand.

What your union rep must do:

-Request and receive the official "state of the unit" legal documentation which includes how many nurses were on, how many nursing assistants were on, if you have ratios, was anyone over ratio, acuity of all patients and were the high acuity patients distributed equitably, location of your patients and anything else that your contract and/or state deems accessible your union.

-Make sure that they understand the incident fully and prepared to defend the contract not the necessarily your action or inaction as they are two very different things.*

-Know the hospital policies on topics involved with your situation.

Do not be overly concerned if:

-The meeting is short and very cordial with no resolution at that time as a lot goes on after those meetings.

-Your manager has an already prepared letter of discipline. See next point.

-Nothing about a grievance is mentioned by your union rep at the meeting. If there is a contract violation and grievance needs be filed, it is done in a separate process that is laid out in the contract.

That is all that I can think of off the top of my head. I will come back and add anything else that I think of. Good luck. I hope it all works out for you. :yes:

* Sometimes the action or inaction of a nurse cannot be defended as it would not have occurred with a reasonable and prudent nurse in the same situation and the discipline process needs to happen.

*If the contract was violated in a way that doesn't have anything to do with your situation and was simply discovered in this process, a grievance can and should be filed.

Cowboyardee · Mar 7, 2017

If it's not too late...

1) Take a union rep. They won't hurt. Might help. And they've probably seen this situation or many like it before. You haven't.

2) Try to go in with a mature understanding of this situation. What else was happening at the time you received the report from your nurse aide? If you weren't already dealing with an emergency or medically pressing situation, your main problem wasn't merely that you forgot to recheck your patient's temperature but that you decided to check it later in the first place. In other words, you may have been prioritizing incorrectly. On the other hand, if you were already dealing with a number of emergencies or highly pressing issues, the problem may have merely been that you didn't immediately delegate one of the pressing issues to a fellow nurse who was less busy or even that the workload on your unit was a major contributor to the error. Just make sure to be honest with yourself in this process. If you don't yet know exactly how much priority an abnormally low body temperature should be given (or that an unreadable temperature typically represents hypothermia), then that itself was a big part of the problem.

The point is that it's better to go into that meeting thoughtful and determined to learn from this than to go merely bewildered and apologetic.