so "the state" is coming, and i dont know how to rectify what i did.

[lorenwithano]

i feel like im going to be sick!

i started working at this rehab facility in february... im still a new nurse (this is my first job, so ive been working 3 months). i hate to use this as an "excuse" but truly, i had no clue about the mistake i made, and i just received a phone call from one of the higher ups who wasnt very happy.

heres the situation. i have a patient who was admitted with "unexplained dizziness" from the hospital. a week after admission, the doctor put him on macrobid bid 100 mg x 1 week (his urine was dipped, but the c&s was not back from the lab yet). i work the 3 - 11 shift and received the lab via fax. wbcs were less than 10000... since i was not able to get a hold of the doctor that night I HELD THE MED @ 9pm... now i realize this was the dumbest thing i could of done because its not something like coumadin that will hurt you, but if someone doesnt have a UTI.... well im not a doctor, but i wasnt discontinuing the med all together, i simply was waiting to hear back from the MD. the next night, on my shift... i come in, and the 7-3 nurse said she had also held the macrobid. okay. so later on in the night i get in touch with the doctor, report the lab to him, and he says continue macrobid bid for 5 days. so me, being an idiot, i take a blue highlighter and color in the previous macrobid order... and wrote in the new order for macrobid bid x 5 days.

so this morning i get a phone call from the 7 - 3 nurse and she was ******. she said i needed to get a start and stop date for the precious medication (which i didnt, my mistake, the patient was started on the macrobid bid for 1 week and had it 2 days in a row... then it was held for 2, then restarted by me)... and i had no right to HOLD the macrobid the night that i did because it wouldnt of hurt the patient... and when the state comes in they will see this, since i used the blue highlighter its a HUGE SIGN that i did something wrong. then the "higher up" gets on the phone and basically said that i am not a doctor and i cant do what i did and its my license on the line.

im near tears right now! apparently, they are trying to fix the situation right now... but after talking to these women i feel awful, like i shouldnt even be a nurse. i dont even want to go back to this job now. the funny thing is, i am so new there, and everyone laughs at me because i am so quiet and timid, so when this situation was going on i felt like for once people thought i was doing something right... but its just all wrong. i dont want to lose my license over something so minor! i just dont know how to rectify this whole thing.

ugggghhh!!!

[Lacie, BSN, RN]

This is a perfect example of the old addage that "nurses eat thier young"!! I'm a DON not in LTC but in dialysis and we are anticipating the state to come in as they hit our sister unit last week. The Administrator is in full tilt stress mode and lashing out at anyone and everyone. Being the DON I'm getting the brunt and guess what we are ready and have been ready. They always panic and freak out about minor stuff. They will worry more about a fork in the break room sink then if we have enough epogen to cover the patients for the day lol. To be honest I would have no issue with how you handled it. You d/c'd once you did get the doc and wrote a new order of which it was "a new order". Sounds like the second nurse dropped the ball on this one and didnt follow up. If this is the worse thing you do in your career and honestly I dont consider it a mistake. Pat yourself on the back for questioning the order and considering that yes you dont want to make this patient resistant. I have alot of nursing home patients on dialysis and guess what dialysis patients usually have slight bacteria in thier urine but the regular docs will freak out, put them on antibiotics, cancel surgeries etc, then our nephrologist comes around and scratches his head and thinks they are too quick to start antibiotics. Dont let them get to you! It burns me the way seasoned staff treat new grads sometimes, I think they enjoy it.

[BEDPAN76]

We've been expecting the surveyors for about 6 weeks now. Today we were told that. "tomorrow is the day". I don't know how they know, but frankly I am ready to get it the hell over with. Our administrator and DON are acting manic-depressive and psychotic. And yes, they are dwelling on stupid things like something not d'cd on a care plan, instead of issues such as 9 falls on the weekend, 15 uti's, 3 acquired wounds.....you get the picture. I know it is crazy everywhere, before state comes. Doesn't make it any easier, though. We all need an Ativan patch! (yeh if only they would invent one!) :sstrs:

[lorenwithano]

funny how people act when the state is hot on their heels. i dont know if its the same at most facilities, and since im new to nursing im not sure if this is the case everywhere, but there is a 6 month window in which the state typically makes visits. january - june... so we are about due for a visit. i think the major issue for the nurses i work with is i should have written "d/c macrobid 100mg bid x one week" and then UNDERNEATH i should have written "begin macrobid 100mg big x 5 days". yes, i reported to the night nurse (11-7) about the macrobid issue, but he was from the pool so i dont know how if he relayed the message. when i came in the next day at 3, the day nurse had also held the medication after viewing the lab, but was unable to get in touch with the doctor. so i was the one who had to make the call. i dont know. its just very crazy, and im hoping they are able to fix my mistake somehow before the state comes in. *but does the state go through EVERYTHING?* i have never been in a facility where the state comes in, so i have no idea what to expect. * i agree with lacie, nurses eat their young! even when i was in nursing school (which was only a few months ago)... the instructors and even fellow students can be so cruel to each other. i am lucky that at the place i work in now there is ONE younger nurse who saves me a lot... and really helps me and doesnt talk about me... it seems the older nurses talk the most gossip and do everything in their power to make me feel like an idiot... which i know sometimes i may ask a dumb question, but truly, i am new and i dont know everything... sometimes i think i dont know anything!.... but its insane. how ironic that one of the most caring professions had some of the most nasty people. its just sucky for me because i am pretty quiet and try to avoid confrontation and whenever something is said to me such as "your license is on the line"... i just freeze up and let people talk to me that way*...

even though its not a huge deal, i am still freaking. i have a couple days off from this place so im going to try and find another job. but thats been hard too, which is why ive even stayed as long as i have.

[SunnyAndrsn]

This calls for someone to go over policies/procedures with you, not to can you. Good grief, everyone gets so dang uptight when State is around. We are not even supposed to request a UA/UC until we have three symptoms by McGreer's (I think that's the name) criteria. Then we are not supposed to start the abx until the CULTURE comes back with sensitivities. In the meantime, we push fluids. If the MD wants us to start the abx before the UC is back, we're supposed to suggest the wait time.

You probably shouldn't have held the abx, but the nurse who followed you did the same thing, she/he must have had reasoning to do so as well. Also, this brings up the whole problem that I'm having with all the different areas that we have to document such changes--the MAR, the physcian's order page in the chart, and a narrative note. Too many places to make a mistake, IMO.

Hang in there, this will pass!

i know its not a HUGE deal... however, i think the point these jerks i work with are trying to make is... the previous order for macrobid bid x 1 week was held for 1 night (which im not a doctor i have no right to do... although i just didnt want the pt to become resistant and wanted to talk to the doctor first), and i didnt d/c the macrobid bid x 1 week in the patients chart (the physicians order sheet)? i dont know. they are very upset though. and im freaking! im still new so when she said its my license on the line i was thinking the worst. i hope it all gets straightened out. i feel so awful about it! im already so quiet and to myself at this place, its just another thing for them to point out. i know i definitely made a mistake though, i just hope they can fix it.

[3boysmom3]

When I saw the title of your thread, I thought "Oh no, what did this poor nurse do?" and was picturing some pretty dreadful scenarios as I waited for my silly slow dial-up computer to get to the page.

Girlfriend, if this is the worst thing that ever happens to you you'll be in great shape. I would have given the macrobid and passed the lab on to the next shift for reporting to the doc for further orders, but hey, you had your reason for holding it.

The main thing to remember is NO ONE WAS HARMED. You're not going to lose your license. I work in a hospital, and believe me, I know how freaked everyone gets over inspections, whether state or JCAHO, or whatever. You'll feel better once the state is out of your hair. Don't go looking for a new job yet, unless you really already hated it there before this happened. You will be all right! Time will give you some perspective.

[sissiesmama, ASN, RN]

Take some good deep breats and think about it. If that's the worst mistake you ever make as a nurse, then you're doing pretty darn good. I've been a nurse almost 20 years and I have made far worse mistakes than that. The fact that you were honest about it and feel bad about it shows you are an honest and compassionate nurse and you are a nurse for the right reasons.

If state sees it, surely they would find bigger mistakes than that to freak out about. Good luck when they are at your facility, they always made me nervous - but I bet you'll be fine! Don't let your co workers make you feel bad - their just being _____, in my opinion.

Anne, RNC

[cherrybreeze, ADN, RN]

even though its not a huge deal, i am still freaking. i have a couple days off from this place so im going to try and find another job. but thats been hard too, which is why ive even stayed as long as i have.

Please at least tell me that this post/"mistake" isn't the reason you're wanting to look for a new job, and that you were wanting to find one anyway....because I'll be honest with you; no matter where you go, there are going to be more mistakes. That's just the way it is, we're all human. I'm not saying big mistakes, or harmful ones, nothing like that. But they happen. Another place of employment isn't the answer to rectify THAT. I don't agree with management's reaction to it, I don't like the excuse about "state" coming, but unfortunately, I think too many places/people overreact (and by people I mean higher-ups, not you) when inspections are imminent. With some more time and experience under your belt, you'll be able to better keep errors like this in a more reasonable perspective, I promise.

The fact that this situation DOES bother you I think it a GOOD thing, to be truthful. If you were to blow it off, that would scare me more, KWIM? When nurses take the small errors and blow them off, that leads to the bigger ones, the ones that DO cause harm to patients, and to sentinel events (now, this paragraph sounds like it contradicts my first one, so I do hope you get my overall point, lol....I'm tired! ). Your integrity and heart are absolutely where they need to be, and that's so very important, so keep your chin up.

[shannieliz]

I am sure your facility will find a way to cover you in this situation, they have ways about this believe me, I have seen some pretty major errors get covered up by late entries, maybe the Dr. would even cover you with an order for that date stating to hold the med, I know these things don't sound right, but it does happen. I had a Dr. cover for me once to the state board of health, they even came in and questioned me about the situation, but because the Dr. happened to be our medical director, we got out of it with no tags. I was lucky and learned a valuable lesson, the only thing I did wrong was lumped my whole day of charting about this lady into one entry, which did look pretty confusing, but they found that I had done nothing wrong. I'm sure this will all blow over, and at least it was caught before state came, and not caught by them!!

[LilPeonNo1]

If that's the worst mistake you've made, you're doing good! EVERYONE makes mistakes. Owning up to ii, seeing what you did, knowing what to do and not repeat it is what counts. Go to your NM, or supervisor and let him/her know you made a mistake and tell him/her how you'll avoid it happening in the future.

If every nurse who made a mistake had their license pulled, there wouldn't be any nurses around...lol!