Getting thrown under the bus

[Sugarcoma]

So for the second time in my nursing career I have been basically accused of writing my own order. I am furious! The first time it happened the doc involved later admitted he had probably just forgetten and apologized. No reprucussions and no management involved.

I learned a HUGE lesson regarding this and now I ALWAYS repeat the order back exactly as I plan to write it and say "this is what you want me to order yes" and get confirmation.

I had an incident and called the doctor to advise on how they wanted me to proceed. Dr. stated to just leave until Dr. saw the patient in the am. I suggested several possible solutions but Dr. stated to just leave it. I repeated back DR. X you are advising at this time that this situation be left as is and handled in the am...this is the order I will write. Verbal confirmation given from DR. X and order written. I honestly don't know how I could have communicated this more clearly. Now Dr. X is saying they ordered me to intervene and has involved my manager. Management has said they believe me and nothing else has been said regarding this but I am still very fearful of what may happen. I wrote a note and the order to CYA but in reality what this comes down to is my word against Dr. X's.

I am now totally paranoid to take a verbal order from a doc. I have no idea what will happen over this situation, if my job is in jeopardy or if it ends with my managers investigation and I can relax now. Other Rns tell me as long as it is documented I will be fine but I am seriously concerned. I have a good rep and would like to keep it.

Any one else ever in this type of situation and have any recommendations on how to proceed?

[JoytoWorld]

Quitting is never a good idea if you intend to continue working and it seems you do. Though I applaud your husband's support. You will always be better positioned for new employ while currently employed, especially if in a sticky situation. MDs can behave badly everywhere unfortunately, so a new company will not guarantee that you do not experience this again.

[massrn116]

I agree with JOLIE, don't ever take a telephone order from that MD unless you have a witness. He has lost his priviledge in giving telephone orders.

[Sugarcoma, RN]

The incident was reported to risk management not by the MD but by his PA, so it probably would look like retaliation at this point. The MD's response to the report was that he ordered me to intervene and my response to the report was that he did not and to show my documentation to back it up. My manager states they believe me, but I am not sure if that is enough because I do not know how the process works after my managers investigation. It is all well and good that she believes me but I have heard nothing from anyone in risk management. My manager has answered my concerns by telling me that she believes me but at this point I am not so confident in that answer. I plan to speak with her for further clarification of how things proceed after this and if I need to start looking into getting an attorney and such but I have to wait until tomorrow when she is in. Its very nervewracking to say the least.

Joy you have been an invaluable source of information! Thank you!

[JoytoWorld]

Unfortunately there is no standard for performing an INTERNAL INVESTIGATION in response to a complaint. Internal meaning that it is performed within the facility. For less than enlightened organizations they can be witch hunts. If your company has a risk manager that is a good sign, that someone will attempt to do a decent job.

Law Courts advise but do not require, a PROCESS like this:

Complaint received. Investigator interviews the person complaining first, then witnesses, then lastly the person complained about. The investigator then summarizes findings and writes recommendations to decision maker. Brief FEEDBACK is given to the complainer - 'we investigated and action is being taken' or 'we investigated and case was dismissed'. They are NOT supposed to inform the complainer WHAT personnel action was taken against you. Who the DECISION-MAKER is depends on how serious the complaint was. Mild issue decisions usually go to the supervisor of the person accused. The more serious, the higher up the totem pole the decision is made - supervisor - dept chief - risk manager - company attorney - CEO/Administrator.

'Believing you' is nice but does not mean anything if the person making the decision is not the person who made the statement. Also the decision outcome usually depends on how serious the issue is. Judge by DEGREE OF HARM/ INJURY the patient experienced and how important the patient is to the facility (celebrity, doctor's mother, patient's son is a lawyer, etc.). In this case how important the complainer is also computes. The fact that the PA complained and not the MD is in your favor. Degree of harm: A) Did patient experience harm that resolved within 24 hours (ex: BP up and HR down but normal in 24 hours). B) Harm occurred but resolved in 2 weeks (ex: arm painful and numb but normal in 2 weeks). C) Harm occurred and has not resolved. (ex: paralysis, death, kidney failure, etc.).

If Harm is C get a lawyer.

Remember some lawyers will give you 15 to 60 minutes free to assess your case. Some may ask for $75 to $100 as an initial review - that may be all you need. Get clear on money before you start. Listen to everything they tell you in general and in relationship to your concern. Practice telling your story in short, brief sentences so most of the time is spent with you asking questions or listening to their advice, rather than in you listening to yourself talk.

If the harm was "A" they may do investigation, write a report but take no action in relationship to you. If harm was "B" you may see some disciplinary action against you. If so, get a lawyer.

If "A" or "B" ask the manager who "believes" you who the decisionmaker is for the concern, if a decision has been made, ask was there any decision made in relationship to you?, if a decision has not been made yet - look at the TIMEFRAME. The longer they take to make a decision the less likely it will be in your favor. "A's" can get wrapped up in a week. "B's" in 2 to 4 weeks. If they ask you to sign anything, pleasantly let them know you would like to consider it overnite first. Then get help. Talk to a family member/friend who was a manager or in HR or who is a lawyer.

Check the laws in your State, you may have a right to see your personnel file. If so, ask to see it now and ask again when issue is resolved. Usually you review it with your manager or someone from HR present, this proves you did not alter it or take anything away. If the law allows you to have a copy ask for a copy of your file. If they make a decision against you, the worse their investigation format is (meaning no real written procedure) the better it is for you IF you get a lawyer.

Remember, stand firm. Don't let fear overtake you. Trust in Truth, but take every step to educate yourself and to protect yourself.

[beewink]

this happened to me once, too. my nurse manager called the doctor involved to her office, snapped a picture on him and posted it on the white board at the nurse's station with a sign saying "don't accept verbal orders from this man." when he demanded that she take it down, she said "man up and sign your verbal orders or it stays up."

he signed.

whatever happened to nm's like that??!! i would love to work under such support - i had a doctor scream and drop the f bomb on me and my nm later called me at home to tell me that nothing would be done...

[Who?Me?]

What??!! Were you suppose to stand there and count the patient's bites of food? How absolutely ridiculous and it is a good thing the MD has retired.