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

[georgya3]

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!

[happynurse49, BSN]

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.

The OP said charge nurse was sitting at nurses station playing on her phone. Perhaps the charge could have gotten her work done at that time and helped out on the floor after. That way they both go home at end of shift and not have to stay late. I get that charge nurses have things to do that we don't see but when you see them on their phone for a good part of the shift and you are running without a break that is wrong.

[georgya3, RN]

yes,Nurse Lengh, I am new to this floor and I do not have access to doctors' phone numbers! Everyone goes to the charge nurse and she is the one calling the doctors at list in this unit.

[georgya3, RN]

anyway, I have just had the meeting with my union. From my 5-page letter their conclusion is harassment! Now we'll see ... however it looks like my topic interested more nurses that I thought it would!

[NuGuyNurse2b]

The OP said charge nurse was sitting at nurses station playing on her phone. Perhaps the charge could have gotten her work done at that time and helped out on the floor after. That way they both go home at end of shift and not have to stay late. I get that charge nurses have things to do that we don't see but when you see them on their phone for a good part of the shift and you are running without a break that is wrong.

I tend to read these types of accounts with a grain of salt. What's "playing" on the phone? checking a text every once in a while (we all do that)? or playing that stupid Pokémon game? People who want to prove a point tend to embellish. And quite frankly, reading the list of wrongs done by the OP, a charge nurse playing on her phone (supposedly) isn't related to the price of tea in China at all. Something as basic as the 7 (or 8 or 9, I forget what we're up to now) steps med identification was completely missed! You can't pin that on the charge nurse.

[jena5111, ASN, RN]

True. I used to automatically start helping others when I caught up, but I noticed some nurses would slow down even more and just wait to be "saved". I still like to help, but I'm more selective. I help new grads, "elders" who've slowed down a bit, and people who help me when they're caught up. No more one-way-street helping.

I just started my tenth month as an RN on a tele floor (6:1 patient-nurse ratio on nights). I still ask for help from my charge nurse--though not nearly as much as in those first few months. The main thing I need is a second pair of eyes so I know whether or not to intervene, call the doctor, etc. I'm still learning in some cases what's normal/expected and what's not.

But I definitely try to reciprocate when I can. For example, I offer to help the charge count narcs, restock supplies, or answer call lights for the charge's patients. Helping out another nurse can also take a little weight off the charge's shoulders. A charge nurse can do ALL of my job but s/he has plenty of additional responsibilities that I can't help with. So I try to not always "take" help without giving a little in return.

[Cowboyardee]

yes I am an RN. ...I wasn't taught yet how to call the doctor (the phone numbers to call the extender at night).

Wait... what? Seriously, there are all sorts of things that seem messed up in this thread, but that has to be the worst by some margin.

Don't ever let yourself get off orientation on a job without knowing exactly how to contact a provider. You are, to put it bluntly, unable to perform the most fundamental duties of your job without this knowledge. Fix that first.

Then, continue to focus on making yourself less completely dependent on your charge nurse, and it will matter a whole lot less if the two of you aren't great friends. As a charge nurse myself, I fully believe that hospital units need a culture wherein everyone actively searches out their fellow nurses to offer assistance as needed, and that a charge nurse should lead this by example. But what you're describing is very different. If you're off orientation on a surgical unit and you don't know how to address a simple electrolyte imbalance without involving your charge nurse, that is a serious problem. Carry around an address book or laminated card with important numbers. Familiarize yourself with the hospital's directory (and while you're at it, its policy and procedure database).

Adopt the outlook that you are fully responsible for your own assignment (because legally and to your B.O.N., you are) and that your charge nurse is merely an asset in fulfilling your duties rather than a someone who is ultimately responsible for you (because legally and to your B.O.N., she's not).

[Conqueror+, BSN, RN]

The OP said charge nurse was sitting at nurses station playing on her phone. Perhaps the charge could have gotten her work done at that time and helped out on the floor after. That way they both go home at end of shift and not have to stay late. I get that charge nurses have things to do that we don't see but when you see them on their phone for a good part of the shift and you are running without a break that is wrong.

And I stand by my statement that the nurse might never learn good time management if someone else always jumps in and does part of her job. I have my job and you have yours. I shouldn't have to skip my break or downtime so that you can have yours. If the job is too much the nurse needs to find that out. If short staffing is the issue it is not my job as another EMPLOYEE to take up that slack. Best of luck to the OP.

[Cowboyardee]

And I stand by my statement that the nurse might never learn good time management if someone else always jumps in and does part of her job. I have my job and you have yours. I shouldn't have to skip my break or downtime so that you can have yours. If the job is too much the nurse needs to find that out. If short staffing is the issue it is not my job as another EMPLOYEE to take up that slack. Best of luck to the OP.

That depends heavily on the nature of the problem a nurse is having. Ultimately, repeatedly taking over the 'hard' parts of another nurse's job and bailing them out instead of showing them how to do it themselves tends to lead to one-way patterns of assistance and nurses who are permanently dependent on their more highly skilled coworkers to do their jobs. BUT... leaving under-skilled nurses entirely to their own devices tends to deprive them of the resources necessary for them to develop their skill sets in the first place.

A newer or less competent nurse will often be very task centered and very bogged down by their own work - so much so that they are unable to lift their heads to see how others are performing the same tasks, especially if the staffing is tight (which is more or less the norm in healthcare nowadays). They are often besieged by so many minor decisions a more skilled coworker might have to put little thought into that they have great difficulty in prioritizing properly or giving adequate thought to the big decisions they run into (look into the concept of 'decision fatigue'). An offer of assistance ideally does not merely lessen the workload for the nurse being assisted. It also provides them a model for how another nurse might handle a task or make clinical decisions. In a sense, it's a vital part of their training, and the most efficient way to make a skilled and competent coworker out of a floundering one.

IME, it is important to be able to distinguish a coworker who needs better modeling and more developed understanding of nursing practice from one who habitually avoids learning clinical and organizational skills and instead relies on recruiting others to do her work and thinking for her. The former can often benefit greatly from assistance and often becomes more efficient as a result; the latter needs to have her habitual dependency broken first before any other significant progress can be made.

The 'give a man a fish' vs 'teach a man to fish' parable applies here. Likewise, even a skilled and competent practitioner can often learn something valuable by seeing a coworker go about some task differently than they might or by having a little more time freed up to address their more complex clinical problems.

It's also important to note that there are times when a nurse's patients might need a skilled practitioner to step in even though the nurse responsible is simply shirking her duties, negligent, or otherwise at fault. It may not always be 'my job,' strictly speaking, to do so, but it has at times been my ethical duty.

[georgya3, RN]

Jena5111, I love your advice! I am expecting a meeting with my manager now and ... however I will ask (in front of this charge nurse) if I am allowed to do all of this and not to have her get upset if I do it! If my manager says yes in front of her, I get my wings!! This post should be seen by this girl I have problems with as it looks like the culture in this unit is to go to the charge nurse instead of calling the doctor yourself! I worked in long term care and I had this independence and self worthiness, I really miss it!

[georgya3, RN]

I just started my tenth month as an RN on a tele floor (6:1 patient-nurse ratio on nights). I still ask for help from my charge nurse--though not nearly as much as in those first few months. The main thing I need is a second pair of eyes so I know whether or not to intervene, call the doctor, etc. I'm still learning in some cases what's normal/expected and what's not.

But I definitely try to reciprocate when I can. For example, I offer to help the charge count narcs, restock supplies, or answer call lights for the charge's patients. Helping out another nurse can also take a little weight off the charge's shoulders. A charge nurse can do ALL of my job but s/he has plenty of additional responsibilities that I can't help with. So I try to not always "take" help without giving a little in return.

in my case, charge nurse doesn't have assignment!

[JadedCPN, BSN, RN]

After reading through all of these comments, I'm just at a loss of words....there's no way you've been a nurse for 20 years.

-A med error is a med error, own up to it instead of pushing the blame onto others.

-You (should) have the experience to know what is a safe assignment and what is unsafe - you shouldn't have accepted an unsafe assignment.

-Calling in because you don't get along with another coworker is only going to make things worse for you.

[happynurse49, BSN]

And I stand by my statement that the nurse might never learn good time management if someone else always jumps in and does part of her job. I have my job and you have yours. I shouldn't have to skip my break or downtime so that you can have yours. If the job is too much the nurse needs to find that out. If short staffing is the issue it is not my job as another EMPLOYEE to take up that slack. Best of luck to the OP.

And the OP should not have to run around trying to stay afloat while the charge sits at the nurses station playing on her phone. It's about team work. On my unit when we are short staffed we pitch in to help each other. In our contract it states we are entitled to breaks not to "down time."