Getting so busy and forgot to notify the charge nurse about a small med error

[georgya3, RN]

Hello everyone,

I work with someone who is been treating me like "stupid" for a few months now when she is charge nurse and no other RN is on the floor (I work nights, sometimes is just her and me on the floor and 2 other LPNs). Whenever I go to report her something she makes comments ... like a while ago I told her about one of my patient's magnesium being low and she said "I am sure it was already addressed by the evening staff". After a long talk she called the doctor and we got an order for MgSO4 IV. Thus, the problem wasn't addressed by the evening staff!

We had many episodes when she made me feel embarrassed! The worst one was last month when I had 7-patient assignment (on a surgical floor) at night with patient on insulin drip, one post op, one MRSA iso, one waiting for transportation to a different hospital, one C-diff ...however, the worst night ever. The charge nurse did nothing to help except to give me directions and to ask me to do things, give and bring and etc... and she wasn't so busy! I missed my break because I wasn't ready to leave at 2 am on the first break, so she said I cannot take the second break (3:30 am) because she was going to and I was supposed to cover the floor (being the only RN there except her). Well at 6 am I was almost crushing ... and I still had things to do, so I asked her to let me go outside for 10 min and she said "do whatever you want" not that she cared about me. After that night I filled a PRC with UNA and I had a meeting with my manager. I thought I was ok with this charge nurse and it is a learning process, she needed more time to learn how to get involved on the floor while being charge nurse.

Well last Friday I worked my first night after the meeting. I made a med error. At 00.40 am I gave Morphine 10 mg po to a patient. I picked up the wrong MAR from another patient. After I gave it, I found the mistake, my patient was on 5 mg IV/SC. And she got Morphine 10 mg PO. I started filling and incident report right away and I was called by one of my patients whose tub feeding was beeping. I finished the incident report going back and forth to this patient. I was planning to go to tell the charge nurse about the error and I got busy with another patient who was slightly bleeding from the surgical site. Well, I totally forgot about telling her about my error and at 2 am I want for break. After I came back at 3 am the charge nurse came and told me about the error. I tried to tell er that I totally forgot and I did incident report and my patient was ok. She kept telling me what it could have happen with my patient and how bad is and kept repeating me a few times that this could make me loose my license. Later I told her how I feel around her, I am very stressed out and every time when I get to her she makes me feel embarrassed, stupid and useless.

Last night I called in sick and tonight the same because she is in charge and I am terrified to work with this person when no other RN is around. I cannot function! I am planning to involve the union!

Did anyone experience something like this? Please let me know what to do!

[Sour Lemon]

You make it sound as if this charge nurse has absolutely nothing to do, but I'm skeptical that they pay her just to sit around and be mean to you. Is it possible that you're expecting too much from her as far as "jumping in" when things get busy? She may have duties of her own, although they may not be as visible as yours ...kind of like some CNAs perceive that nurses are "sitting around" when they're actually busy.

Reporting that you gave one patient another patient's morphine is really not a good thing to "forget" ...even for a few hours. The two of you may need to meet with a third party to sort this mess out. It's hard to make sense of it with only one side of the story.

[TriciaJ, RN]

First of all, I don't think you're going to lose your license over 1 med error. But don't you check the MAR against the wristband when you give meds? That is a step never to skip, no matter how busy.

I agree with Sour Lemon that you and your charge nurse might want to sit down with your manager for mediation. At this time, it is very important not to be defensive or portray yourself as the victim. Ask for constructive feedback on how to improve your communication skills. Ask what resources are available to you for the times you feel in over your head. And especially ask for a follow-up meeting to be scheduled a few weeks down the road.

The follow up meeting is important, because if the charge nurse is not following through, or if there's something you're still not getting, this will be an opportunity to evaluate and adjust the game plan.

Hopefully this gets your relationship on more secure professional footing. You'll both have a colleague you can trust and you won't have to dread drawing each other's name in the unit gift exchange.

[georgya3, RN]

when you see a charge nurse chatting and sharing pictures from the phone with other while you are running back and forth, what would you think? do you call this being busy?? and looking over on you many times??and the wrong route was given at 00.40 and at 2.00 I was on break!

[georgya3, RN]

After the PRC I had a meeting with my manager and UNA. My manager asked me if I need mediation, I said no, I thought I am ok with this charge nurse but apparently I am very anxious when I see her. I heard that this one changes the assignments made by the evening charge nurse. She doesn't help on the floor at all as other charge nurses. If I have questions and I ask someone from the small unit with have (like a satelyte with more specialized RNs) this charge nurse gets mad. She is the only one I have problems with. At night there is no one I can ask questions and this charge nurse is not too experienced. I heard some senior RNS saying that this charge wasn't ready to be charge yet! She is very happy when she is in charge ...time for sitting down!!I am sorry, that's just my opinion. I am waiting for my manager tomorrow! In the meantime, I am just very stressed out!

[Sour Lemon]

when you see a charge nurse chatting and sharing pictures from the phone with other while you are running back and forth, what would you think? do you call this being busy?? and looking over on you many times??and the wrong route was given at 00.40 and at 2.00 I was on break!

If you hadn't gotten to the notification yet, that might have been a better thing to say. When you say you "forgot", it makes it sound like you're trivializing the error.

And I always wonder ...how does someone so busy with their own work manage to keep track of what other people are doing all shift?

[georgya3, RN]

After the PRC I had a meeting with my manager and UNA. My manager asked me if I need mediation, I said no, I thought I am ok with this charge nurse but apparently I am very anxious when I see her. I heard that this one changes the assignments made by the evening charge nurse. She doesn't help on the floor at all as other charge nurses. If I have questions and I ask someone from the small unit with have (like a satelyte with more specialized RNs) this charge nurse gets mad. She is the only one I have problems with. At night there is no one I can ask questions and this charge nurse is not too experienced. I heard some senior RNS saying that this charge wasn't ready to be charge yet! She is very happy when she is in charge ...time for sitting down!!I am sorry, that's just my opinion. I am waiting for my manager tomorrow!

And by the way, I am talking about a surgical floor, not long term care where it's a different story!

[georgya3, RN]

Sour-Lemon,

I don't think you ever work a night shift with 7-patient assignment, one on insulin drip, one post op, one C-diff, one waiting for transportation and being awake the whole night and one MRSA who has pain meds q3h and paraplegic and another one unable to pee the whole night! Insulin drip not even prepared by the previous shift ...

I would love to see you how you were going to manage this asignment and to have charge nurse sitting down the whole night just checking the MARs and giving you directions, even to prepare a packed breakfast for a guy because she is "too busy" to look for the NA for the breakfast.

However, thank you for the replay and for your time!

[georgya3, RN]

First of all, I don't think you're going to lose your license over 1 med error. But don't you check the MAR against the wristband when you give meds? That is a step never to skip, no matter how busy.

I agree with Sour Lemon that you and your charge nurse might want to sit down with your manager for mediation. At this time, it is very important not to be defensive or portray yourself as the victim. Ask for constructive feedback on how to improve your communication skills. Ask what resources are available to you for the times you feel in over your head. And especially ask for a follow-up meeting to be scheduled a few weeks down the road.

The follow up meeting is important, because if the charge nurse is not following through, or if there's something you're still not getting, this will be an opportunity to evaluate and adjust the game plan.

Hopefully this gets your relationship on more secure professional footing. You'll both have a colleague you can trust and you won't have to dread drawing each other's name in the unit gift exchange.

Thanks a lot, this looks like a very good plan, it looks very constructive to me!

[Sour Lemon]

Sour-Lemon,

I don't think you ever work a night shift with 7-patient assignment, one on insulin drip, one post op, one C-diff, one waiting for transportation and being awake the whole night and one MRSA who has pain meds q3h and paraplegic and another one unable to pee the whole night! Insulin drip not even prepared by the previous shift ...

I would love to see you how you were going to manage this asignment and to have charge nurse sitting down the whole night just checking the MARs and giving you directions, even to prepare a packed breakfast for a guy because she is "too busy" to look for the NA for the breakfast.

However, thank you for the replay and for your time!

I've had just as bad and worse. I know it's not easy for you, I just don't know the other side of the story. I hope you're able to get your issues resolved.

[caffeinatednurse, BSN, RN]

I think TriciaJ gave some very solid advice re: handling this situation.

It is possible that she's not pulling her part. I used to work on a floor, also on night shift, where it was typical to see new grads (myself included) never sit down and usually never get a lunch. I used to stand in the hallway that my patients were assigned and chart, because I knew that a call bell would inevitably go off and I couldn't rely on anyone else to answer it. The other new grads would have probably helped, but they were swamped as well. Almost every time I walked through the nursing station, I would see more experienced nurses (and charge nurses) playing Candy Crush Saga on their phones, sharing pictures of their dogs, taking selfies with coworkers or even eating their dinner. It wasn't that they "looked" like they weren't busy - they actually weren't. They used to brag about how "easy" and "quiet" their night was, while new grads struggled to keep their head above water. Asking for advice/assistance resulted in a parceling out of advice that was only half-truth. (Meaning their way of doing things was what they did, but if a supervisor caught you doing what they did, you would likely be written up.)

If you're working on a floor like that - and I really hope it isn't that way - the next best step is to set up an appointment with your manager. Even if you feel like it won't help at all, they need to be made aware of the situation. Hopefully they will be able to help you (and her) sort out the situation so that you can work together in the future without so many issues.

One last thing. I have made a medication error before, and unfortunately I'm sure that there will likely be another in the future, not because I intentionally want to hurt anyone but because sometimes systems fail, we get tired, we get busy, and errors happen. It would be difficult to find a nurse who hasn't made a mistake that affected a patient during their career.

But... It was basically drilled into my head from day 1 that the moment you realize you made an error, you need to assess your patient and report it to your supervisor. At my facility, we did the incident report after the fact - it was more important to assess the patient, notify the charge/supervisor, and notify the MD if needed. Your facility may differ, but I would seek clarification of the policies and procedures either on your own or via your manager, just to be sure. That knowledge can only benefit you in the future, in case you make an error later on down the road at the same facility.

Also, a good way to not make this mistake in the future is to ask their full name & DOB while comparing the wristband (since those can come off, be switched, etc.) with the MAR. That way you know for sure that you're medicating the right patient. Of course it's more difficult when they have dementia or delirium, but in most cases it will help prevent that from happening.

[Graduatenurse14]

I work in a hospital and I don't have to tell my charge nurse if I made a med error. I have to call the patient's MD and file an incident report. Now if a Supervisor is working rather than a floor RN who is made to be in charge, that is different.

Interestingly, I recently called the AOD about a med error I made (gave IVP BP med that can only be given while on a cardiac monitor and she wasn't. She was an NPO GI service's patient to rule out a blockage which is off service for my floor and I thought that was why the patient was ordered the med this way and not PO.)

The House Manager asked me if the patient was harmed and I said, "no" after MD assessed and she said, "Then I would even bother to do an incident report." That felt all kinds of wrong so I filed one and didn't even get talked to by my unit director but we had an education piece in our weekly email about the routes meds can be given. If I didn't file an incident report and something happened later on or TPTB found out through the grapevine, I could've been in huge trouble and rightly so.

My point is this: Is it the policy for you to have to tell your charge nurse? Is calling the MD and an incident report enough? I know all facilities have different policies about this stuff but if this charge nurse is as you describe, does she just think she was to be told or is that the policy of your facility?