I need advice before Wednesday

  1. So I started working at a brand new private hospital since end of February and was given 3 days orientation (I only had 4 months work experience at the time) and everything has been going great except...

    I gave report to an oncoming Day RN about one of our patients, she is a 60something female <18 hr post op for total knee replacement. I tell the oncoming nurse that she's got a a PMHx of CAD and a (day rn didnt know what that stood for, and she didn't know what a hemovac was when i was going over the drains the pt had), HTN, DM. The patient is on a morphine PCA 6.25 mg/hr maxes out at 25mg/ 4hr. She gets oxycontin/acetaminophen (Percocet) every 4 hours PRN, she also can get Dilaudid but has been refusing dilaudid. Anyway, I told this day RN that I gave her last percocet at 4 am (can get every 6 hrs) and that her morphine PCA syringe will run out around 7ish (I gave report at 6:50AM). I told this day shift RN that I couldnt replace the morphine syringe for the pca, because its not stocked in pyxis and there is NO night pharmacist at this facility) and the night supervisor says to just pass it in report so they can contact pharmacy at 7:30AM. The patient's pain has been an 8~10 all night.The patient also had a CPM to be on 4hr off for 3 hr (turned it off at 5AM) This nurse is an older Indian nurse who just finished her 3 day orientation. I also offered to go in the room with this oncoming nurse to show her what's going on with the patient and she said she was OK.

    After I gave report to her, I documented on the computer that report was given.

    I go home and sleep for a few hours and I get phone call from our new med-surg supervisor (she just started at this facility 2.5 weeks ago, i've been here longer than she has) "Hi... How are you?..." I tell her I'm good, and then she screams "You gave HORRIBLE PATIENT care. You let this lady suffer in horrible pain all night." I told her I did not, and I documented giving medication and the PCA pump in my notes on electronic charting. Documentation is also in the paper MAR and withdrawing from Pyxis. So I'm covered in 3 different places documentation-wise. This supervisor screams at me "NO YOU DIDNT DOCUMENT. YOU LET THAT PATIENT SUFFER" I tried to calmly explain that I did, and she can check the paper MAR (also has her pain score). I was trying to also explain that I didn't get the chance to replace the morphine for the PCA because there is no night pharmacist and its not stocked in the pyxises. She ignores what I tell her and then screams at me how the call light was out of reach (It wasn't since the tech and I did rounds together on that patient) and how the CPM was off ALL NIGHT (I documented that I put it on). She also screamed at me about how the IV tubing was hanging off the bed (it wasn't on a rail, it wasn't touching the ground, and of course its going to dangle a little to give it some slack.

    So this supervisor said I am suspended for two shifts until her "investigation is complete" I am not quite sure how to handle this situation when I meet with her Wednesday. I just feel that it is wrong that I am being suspended and accused of giving "HORRIBLE" patient care.

    What is going to happen to me? Even if she discovers that I DID document and medicate the patient appropriately, I know she won't apologize to me. I am just really stressed out and it was hard enough finding a job.
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    About kitkatRN

    Joined: Aug '09; Posts: 12; Likes: 4


  3. by   cicatrixx15
    oxycontin/acetaminophen (percocet) every 4 hours prn, she also can get dilaudid but has been refusing dilaudid

    i thought percocet was oxycodone and acetaminophen.
  4. by   kitkatRN
    my mistake it is.
  5. by   cicatrixx15
    Hang in there !!!
  6. by   Rabid Response
    It's impossible to know what happened exactly because we only have your side of the story. What you seem to agree with your supervisor about is that your patient reported 8/10 pain all night. Matters of documentation aside, I can't really find that acceptable. It doesn't sound like your facility is adequately staffed or equipped or that your new nurses get a proper orientation. What sort of hospital runs out of morphine? Sheesh. Those issues should be examined/addressed during your supervisor's investigation of you, but perhaps that is too much to hope for.
  7. by   Katie5
    I agree with above poster. The patient's pain was an 8-10 all night long. You really shouldn't offer- you should go in there and offer options on what could be done to lessen this patient's pain.

    Even with four months on the job, you have more experience/hours than the other nurse does.

    How very unprofessional for your superior to yell at you. She should learn to speak in low modulated tones, no matter how upset she may be! That even carries more ferocity than actually yelling.
  8. by   Katie5
    About the advice, you can simply wait and see, then you can tackle it.

    But, did you offer to go in immediately? In matters like this, the more time passes, the more it is allowed to ferment.
  9. by   kitkatRN
    Yes! I asked if I could go in the next day to meet with this supervisor and she said "No I need to investigate"
  10. by   JenRN22
    First of all, If you documented pt c/o pain 8 out of 10 and after offering dilaudid pt refused and percocet given or something to that effect, you are covering yourself...If you didn't document you offered anything but pt c/o pain was documented throughout the night at 8/10 that's another story entirely.
    I have a hard time with nurses mistreating other nurses. In our job, yes some work harder that others but nurses all deserve the respect we earn for the job we do...She didn't even give you the courtesy to explain your side of the story from what you are saying. If you covered yourself like you say you did, I would just start looking for another job. A lot of times nurses look for things to get rid of someone after an event like this. You don't want to put yourself out there for that. It sounds like it may be time to move on...
  11. by   Blackheartednurse
    It sounds like your manager is trying to get rid of you and has someone ready to take your place....that happens,new managers come and bring in their own people..If I would be you I would start looking for another job,also do you really see yourself working for such people,now you will always be labeled as a incompetent nurse in their eyes,trust me I have been in your shoes.Start looking for a NEW job NOW,dont wait until you have three strikes and I'm sorry you are being treated that way..
  12. by   JoeMacERRN
    You should have plenty of documentation to cover yourself. however, it may come back to bite you also. If your trying to get relief, and what you have isn't working, 8/10 pain 1hr after pain meds would get me thinking. After another pain med administration, and no relief 30-60 min later, you need to be calling for new orders. Or at least notifying the doctor that the treatment regimine is not working. They may say, "well what else can we do, blah, blah", and you may end up with no changes. But at least you can document that you called a status report regarding the pain control and no orders received. That would show that you were doing your job ,AND THAT YOUR TRIED TO ADDRESS THE 8/10 PAIN. All you can do is wait, maybe ask to come in 1 hr before the meeting and request to review the chart. Good Luck.
  13. by   trigger0423
    i totally disagree for what your supervisor had showed, your supervisor should have said, you have to make an IR to explain the incident. remember our world doesnt rotate on nursing skills and knowledge, we should also be knwoledgeable about jurisprudence. IR is a legal document lets you voice out everythng that happened, even the incident your supervisor had shouted out at you, that is considerably unprofessional. initiate to make an IR and address it to the unit manager or anyone more superior next to your supervisor. it is your right to voice out your side.
  14. by   redbeads
    There are so many issues going on here it is hard to even know where to start. The most glaring issue I see is lack of adequate training for new nurses and poor support and communication.....this unit is going down fast! "Be the change you want to see"...or get out of this place would be my advice to you.