I have never in my nursing career been so angry!!
That said I need advice. I work on an acute Ventilator unit where pain and anxiety reign supreme. After dealing with 2 pts who were in such a state that one was ripping her skin to shreds and the other was pulling at her trach/trach tubing so badly that the tubing and HME were filled with frank blood.
After trying relaxation, diversional and communiction techniques to no avail (done by myself, resp therapy, 2 other nurses & the CNAs) I asked the med nurse (A float, unfamiliar with the floor) if they were due for their prn meds.
Ready? She told me that the off going med nurse had told her under NO circumstances were these pts to be given their prns!!
I showed her the MD order, I showed her the VS I had taken other than the normal elevations you would expect to see with pain/anxiety they were stable & then I told her that she needed to use her own nursing judgement at which point she started to cry. ( I still feel like a turd) She did give them at my request with a positive effect inside half an hour.
I then went to the Nursing Supv. explained the situation & she asked me to write it up. I explained that this would be a fruitless gesture as the offgoing nurse is favored by my UM. This nurse gets away with yelling, swearing ( daily ) and has even thrown the med keys at other nurses. Withholding prns is not new for her, she has been seen telling pts no she will NOT give then pain meds as they are NOT in pain.
In the end I did write it up & gave a copy to the nursing supv & the DON, bypassing my UM. However I know that I have effectively put my head on the chopping block. I know there will be hell to pay from my UM no questions asked.Her response to our various complaints r/t this nurse is always "oh thats just her way", "Oh, thats our girl". How much more frustrating can you get??!!
I know in my heart I did the right thing. On further investigation it was discovered she had given the same directives to another float nurse.
Other than letting me vent, TY. I would like to know if anyone has any idea if this is a state reportable offense? besides the fact I don't think that there will be any repurcussions for her, only me.....This whole thing has really gotten to me & I want to make sure that I do everything I should but I don't want anger to cloud my judgement!
Aug 2, '03
I realize this which is why it makes me so angry. Being angry & making decisions have never gone together well.
My ideal would be that the facility will take care of this and not make me suffer for it. So do I take a wait & see attitude or will it then be to late? Will I then be in trouble STILL for not reporting it to the state ASAP.? To be clear I am referring to the Nurse who instructed her NOT to give them.
Last edit by Squeeta2 on Aug 2, '03
Aug 2, '03
If you wait and nothing happens, then you'll be asked WHY you waited whenever you'd go to the state.
Why did the off going nurse tell her not to give the meds I'm wondering. Only times I have been told that you are to withhold a med is if the pt. is experiencing bad side effects, swallowing difficulties (assuming it's a pill), or by MD order. And whenever a med is to be withheld, to call the MD to get an oder to hold it. If a med is being withheld by a nurse, and the pt. is asking for it, and there is no order to hold this med, then why was it being held. Even though sometimes the instincts may say that someone might be saying they are in pain, and are acting in pain, yet you step out of the room and they are mysteriously calm, yet you have to believe when they say they are in pain, that they are. When it's THAT obvious they were in need of their medicine as you described, that's flat-out wrong.
Look back on the facility, and any other problems they might have had before this one, did they take care of the problems when they were alerted to them? If not always, then it's a toss up on whether they will this time, bad as that is to say.
If it were me, i think i would wind up being liable for not reporting it. What our facility's guidelines state is that even by just seeing or witnessing an incident, you're just as liable for not doing something about it.
It puts you between a rock and a hard place, I know.
Last edit by Marie_LPN, RN on Aug 2, '03
Aug 2, '03
SQU, Assuming that your account above is accurate:
1) The offgoing nurse countermanded an MD order, which is practicing medicine without a license which is, of course, against your state's laws. and
2) The oncoming nurse accepted this countermand order and ignored the original MD order, which is ALSO against your state's laws. Crying or not, the MD order is the one she was obligated to follow. (Did she really think a verbal order from an RN--whether the offgoing RN or you) superseded a written order from an MD? If so, she obviously needs some further training.)
Last edit by sjoe on Aug 2, '03