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

  1. 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!!!
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    About lorenwithano

    Joined: Apr '08; Posts: 58; Likes: 5
    Specialty: 2 year(s) of experience

    20 Comments

  3. by   SuesquatchRN
    State's not going to pull your license for improperly highliting a d/c'ed med. Calm yourself, girl!
  4. by   NurseyPoo7
    They're just being *******. Nurses have made MUCH worse mistakes... shoot, I know a nurse who gave a med the pt was allergic too and the pts coded and she still has her license. (Dont ask me how, but this girl can talk herself out of anything).

    Anyway, just relax. Everyone's made an error.
  5. by   bill4745
    A minor mistake. Most of us have done worse. Be calm.
  6. by   lorenwithano
    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.
  7. by   southernbeegirl
    i agree! not the worst thing that could happen. when state is in EVERYONE is all hyper and nervous. sounds to me like they are just trying to scare you about saying your license is on the line. don't worry about that! i know thats easier said than done but do try to calm down. mistakes get made...learn from it and move on!

    often times docs will start an antibiotic with the c/s pending. until you get the sensitivity back showing the antibiotic that was started is resistant, keep giving the med. but if it comes back resisitant, THEN yo ucan hold it pending the doc changing the order.

    but dont worry! believe you me...thats the least of their worries.

    they are probably scaring you because they might get a tag for it. theres probably not a one of us that works LTC here that hasnt caused a tag.

    i'm a supervisor in LTC. a few years ago the state was doing a med pass with one of my nurses. she came to me freaking out telling me that this one pt wouldnt take her meds and the state lady was really quizzing her on what she was going to do. i went in there, took the meds from her and FINALLY got the lady to take them all. guess what?

    i didnt wash my hands before OR after.

    we got a nice pretty taq for that! sure my boss threatened to hang me from a tree by my toenails...but she got over it, lol.

    hang in there! this is the worst week you will have all year!
  8. by   Bettie P
    If this is the biggest problem the state finds when they come to your facility, your admins should throw a party. Relax. A minor error (and this is one...believe me!) that has been caught, addressed and corrected is no cause for alarm.
  9. by   Savsas
    Everyone looses their heads when "state's coming" - don't take it personally. I was at a LTC facility where one freaked out nurse threw out ALL the eye drops off another person's cart because she thought they were expired. They weren't, she was just so panicked she misread the dates.

    Highlighting a DC'd med is NOT the worst thing in the world. Holding an antibiotic because you were waiting to hear back from the Dr is NOT a bad thing - heck, the girl the next day did the same thing !
  10. by   Whispera
    I see a few things here. First, you called the doctor and intended to hold the medication until you reached him to get his official ok, right? Then the day nurse did the same thing. Did you report to the day nurse that she should expect him to call back or that she should call him if he didn't? Maybe she dropped the ball on this. I don't think your actions were wrong in holding the med in anticpation of hearing from the doctor. If you didn't report it to the next nurse, though, that's a boo boo (not a terrible one though!). Then you blued it out (that means it's DC'd?). It seems the first order was changed to the second order, right? Then you didn't do anything wrong in this either, that I can see. You can't have two orders for the same medication going on, can you?

    I think it would be appropriate for you to write a late entry in your nursing notes to explain things...such as lab results received (date/time) blah blah blah...medication held and MD paged/called for order in relation to lab results. On date/time, spoke to MD and medication order given for Macrobid blah blah blah... Does that make sense?

    I actually doubt the state will find it or think a whole lot about it, but it's good to have it in writing for the future, because you will forget all about it in the months to come, and it's always possible the future will bring it back to you...
  11. by   snowyRN
    Dont hammer yourself over this...lesson learned!
  12. by   SteffersRN87
    As a nurse, you have the right to not give a medication if you are uncomfortable... And boohoo if the state takes offense to a blue hi-liter... Trust me... I know nurses that have killed at least one patient, and the whole units knows about it, and they still have their job and their license... If it bothers you that much (and it sounds like the higher-up-the ass people are kinda mean) get a new job... Just remember though, because you have a licence you must be able to back up your decision and be accountable...
  13. by   I love my cat!
    I am really sorry that you are having to experience this.
    The fear and drama created over things that could be resolved easily and quietly, is honestly, one (of many) things I HATE about Nursing.
    I have never understood why fear and threats are so commonly used in the Nursing profession.
    I have numerous relatives who are MDs, a Firefighter and a PT. I have friends who are Lawyers, Welders, Accountants, Engineers, Pilots, Sales and Professors. When I tell them the chaos and drama that goes on in Nursing, they are always really surprised. This is not to say that "drama" doesn't go on in their Professions, it is just that the issues are not as trivial as they seem to be in Nursing.

    I don't think that working under fear and intimidation creates good employees. I think it creates unnecessary stress and anxiety and really hinders the way that people work.

    The funny thing with State, IMO, is that they seem to ignore things that really should be addressed. They nit-pick over trivial nothings and major issues (um, like staffing!) seem to be a non-issue.
    They get upset w/ a Nurse for giving a med late (for example), but they neglect to look at the schedule and see that on that particular shift, another Nurse called in sick and the Nurse on shift was given 25 extra patients that he/she isn't even familiar with!
  14. by   Lacie
    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.

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