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

Nurses General Nursing

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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!

Specializes in surgery.

Thanks a lot, I do work on a unit like that, unfortunately and there is no support at night, no one to ask if you have questions! I am planning on changing my position with days as soon as I can get something. I few months ago we were a nice team but it's a mess now especially since the management cut one staff from nights because of the budget!

Specializes in Med/Surg, Ortho, ASC.

Just curious. What constitutes a "small" med error?

Is there justification for a "small" med error as opposed to a "medium" or "large" error?

Is there justification for an error if it did not harm the patient?

Is there justification for a med error if the charge nurse was busy, legitimately or not?

Surely you get my drift. An error is an error. Own up to it and learn from it. Denial & excuses do no one any good.

Specializes in surgery.

Thanks for the comments.

Morphine 10 mg po instead of Morphine 2.5 - 5 mg SC or IV q2h. It was given at 00:40 am. The patient called at 2:15 am for another dose while I was on break. If you do some research you will see morphine 30 mg po = 10 mg parenteral. My patient said it did not even touch her. It was a pre -op patient. The doctor said in the morning when I reminded her about the error: "if the patient wants po, no problem, if she wants sc, no problem, no big deal, I will order it!"

On my unit someone gave codeine 60 mg instead of 30 mg and the charge notified the doctor in the morning, but we monitored the patient. I believe this was a more severe case. And of course it was another charge nurse (senior RN).

Specializes in Med/Surg, Ortho, ASC.
Thanks for the comments.

Morphine 10 mg po instead of Morphine 2.5 - 5 mg SC or IV q2h. It was given at 00:40 am. The patient called at 2:15 am for another dose while I was on break. If you do some research you will see morphine 30 mg po = 10 mg parenteral. My patient said it did not even touch her. It was a pre -op patient. The doctor said in the morning when I reminded her about the error: "if the patient wants po, no problem, if she wants sc, no problem, no big deal, I will order it!"

On my unit someone gave codeine 60 mg instead of 30 mg and the charge notified the doctor in the morning, but we monitored the patient. I believe this was a more severe case. And of course it was another charge nurse (senior RN).

You are not getting my drift. Truly, I don't need to do any research. You and you alone must deal with these issues in order to be successful as a nurse.

A med error is a med error. Regardless of the effect/no effect on the patient. Regardless of whether someone else made a greater error than you.

You and you alone are responsible for your error. Own it. Learn from it.

Specializes in surgery.

Hi Roser13,

I do not try to JUSTIFY anything, I am just asking if anyone went through this. I do not need you to blame me, I got it! I blame myself enough to not be able to function since it happened! And I have 20 years experience as an RN and it never happened to me. Do you know I am on Tylenol#3 for back pain because I broke my back in a stroke unit 2 years ago? Well welcome to my world! Maybe that's why it happened to me! I do not know!

You should just pray to not be in my shoes one day, you never know what future might bring you!

Specializes in Med/Surg, Ortho, ASC.
Hi Roser13,

I do not try to JUSTIFY anything, I am just asking if anyone went through this. I do not need you to blame me, I got it! I blame myself enough to not be able to function since it happened! And I have 20 years experience as an RN and it never happened to me. Do you know I am on Tylenol#3 for back pain because I broke my back in a stroke unit 2 years ago? Well welcome to my world!

You should just pray to not be in my shoes one day, you never know what future might bring you!

Perhaps your Tylenol#3 is causing some issues in your practice?

Specializes in surgery.

Thanks a lot for the effort, very useful! I got your opinion and advice! very helpful!

Specializes in Med/Surg, Ortho, ASC.
Thanks a lot for the effort, very useful! I got your opinion and advice! very helpful!

Perhaps your EAP department can help you with dealing with change? I found my EAP counsellor very helpful at one point.

Specializes in surgery.

I have never used them! I will talk with my manager and my union first (I hope tomorrow).

I am somewhat confused on the magnesium issue. As you are an RN, why do you need the charge nurse to intervene. Can you not notify the doctor on your own?

The incorrect morphine route and dose was, of course an error. You will not lose your license over this. I don't need to tell you to slow down and follow the 5 rights.

7 patients with one on an insulin drip is not manageable , and you never should have been given that assignment or accepted it. Next time refuse the unsafe assignment and notify the nursing supervisor.

That is all hindsight now. Certainly involve your union. Who know when and IF they will be effective in this matter. What was your manager's response in the meeting?

Charge nurse is not only not helpful, she is making it personal. You cannot keep calling in because of this.. you must deal. I would deal with it by documenting EVERY time she refused your request for assistance.. and beat the street for another job.

The situation will not change, soon enough remedy your situation.

Specializes in surgery.

yes I am an RN. But I am not trained to work as a charge nurse ...yet! After the meeting my manager started training me for charge nurse. I've had 2 days of orientation last week, I was supposed to see him tomorrow morning to schedule me for night charge orientation whenever he can find a senior RN working nights as a charge. These three nights he did not put me in for orientation because this new charge was the only one on the floor! I wasn't taught yet how to call the doctor (the phone numbers to call the extender at night). This charge nurse gets offended if I try to do something, I tried to ask for help from the seniors we have at night working on the satelite unit and she got upset!

I believe I am too weak and do not know how to refuse an assignment. I 've never refused any and I had a few very heavy.

Just to add another perspective, as a supervisor I have realized over the years that your nurses will NEVER learn time management if you rescue them everytime they get busy. My fellow sup's who do that end up watching their nurses leave at 7 while they are stuck at their desk finally doing their own work. I will help I will not enable. Part of being a good manager is knowing when someone needs help and when they need to learn to pull their own weight.

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