A situation arose in clinicals last week with a friend of mine. I would kind of like to get everyone's opinion as to how they would have handled the situation.
A combo med was ordered by the doctor but not carried by the pharmacy in the dosage ratio ordered. (Note that two doses had already been given on previous shifts in the available, NOT ORDERED ratio) The student asked the professor (who said to ask the charge nurse for that day) what she should do. THe charge nurse said to give it.. the student told the professor.. the professor said to give it... so she did. The doctor then ripped her a new one in front of the entire unit (patients included) and after she left proceeded to make fun of her in front of the staff and patients.
Our nursing professors are very laid back compared to the horror stories I've herd from other students... they take on the position that their job is to intercept and play moderator to student/charge and student/doctor squabbbles. This professor threw it on the charge nurse though. As the doctor is reeming her in front of the staff and patients the professor asked the charge nurse if she was going to defend her.. neither one did anything.
Just as a side note after the incident we discussed the issue among ourselves and agreed that if we were the "RN" we never would have given it without the order being changed... however because we were students we would have.. granted we are well within our rights to refuse to give a med.. even as a student, but how many of you would sit there and after being told to give a med by your professor would say no?
So then my question is how would you all have handled the scenario? Refuse to give the med (ideal I know but these are your professors you are saying no to).. or is this just one of those situations where you suck it up and just keep reminding yourself that you have only 181 days till graduation? Any other suggestions would be welcome.. we have clinicals with her for three more weeks plus next semester so now the rest of us are worried it may happen again.
Nov 18, '01
I also would have given it, but as a student, not an RN.
As a student after you have been instructed to give it and then the instructor does not back you should write a letter of complaint to the school, cc to your instructor. Issues being that you were told to give a med that was not ordered, that the istructor did not back you up, and that the doctor ridiculed you in front of the instructor and she did not assist you or model constructive assertive behaviour.
Have you had a conference with the instructor to talk about ow you felt, and how the two of you will handle the same situation in the future? Perhaps a discussion with your advisor will give you a different perspective as well.
Nov 19, '01
Wow!! That is a tough one.
With me being me, I probably would have refused to give the medication until the doctor was called to verifiy the order. I don't mind making waves if I know that I am right. If they still told me to give it without doctor's orders I would refuse and document why I refused to give the med, written a letter to my department chair and the instructor again telling them why I refused to give the medication (keeping a notorized copy for myself).
They teach us in school that we have to do things the right way and without a doctor's order for that specific item, it is not right to administer that medication!
Nov 19, '01
I am looking at this from the viewpoint of an LPN with lots of experience, and I would NOT have given it. I would have outlined my reasons, and stated that it is outside the scope of practice of ANY RN or LPN to give a medication without an order.....
I think I would have bucked the system on this one. Kept copies of my written explanation, and gone to the advisor at school, I think.
Just my 2 cents worth.
Nov 19, '01
This is a real dilemma!
I, being a student, probably would have given the med. Especially since the instructor AND charge nurse both said to do it. Plus the fact that it had been given twice before then. I think i would have made either my instructor or the charge nurse sign off on it though.
I would not have stood there and had that doctor yell at me. I would have turned around and walked to a conference room. If he still felt it necessary to yell at me he could follow me in there and do it in private. As for my instructor, you better believe there would be a few letters being written for him/her not standing behind me and backing me up. I think i would even go to administration at the hospital to have a chat about the nurse too.
p.s. I am going to print this out and take it to class tomorrow to see what my class and instructors say about it.
Nov 19, '01
as a nurse i would have more than likly given the med, it may have been dispensed by the pharmacy as whats called a "theraputic equalivlant", you don't ned a doctors orer to do this but a note should have been placed in the chart and a mar stating such, should have been in the med book.
as far as your teacher is concerned, she/he should have stepped in when the md started to rip at you, it is afterall his/her licenese on the line. some people are afraid to stand up to the docs, don't be one of them. if you see him at your next clinical pull him aside, tell him how unprofessional he was, you want an apology in front of the staff, and that you wont' stand for that again without hospital administration being involved.
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