Help - Suspended

[AnnetteER]

I am a new nurse. I worked for a couple of months in the ER but then I transferred to a Med/Surg unit. I administered insulin coverage for a high sugar before a procedure. He was NPO. The next day, our Nurse Clinical Instructor said that she would have given the coverage also because the sugar was so high. I know that you don't normally give coverage when a pt. is NPO. He went & returned from his procedure & was sleepy but arousable & he even took some PO meds & talked. He actually yelled at one of my co-workers. About 1 1/2 hours later (approx. 6 1/2 hrs after receiving the coverage), I checked his sugar, & it was 9. I know that seems unreal, but it was. I initiated hypoglycemic protocol Stat & he went to ICU for a day but then returned to our floor & is talking & eating. I did everything that I was taught. I asked my Preceptor & she said that I didn't do anything wrong. He's doing great. I have been suspended since Wed. without pay. This happened on Tuesday. They just told me to go home Wed. afternoon. I never would have known that I was suspended if I didn't call HR & ask them my status. I received notice from my manager that they will call me on Monday to set up a meeting & that she is meeting with HR on Monday to investigate further. I asked them to send me somthing in writing that I am suspended & the basis for it, but they haven't. I saved the man's life. They mentioned that I should have called a code, but I ran for the D50 & yelled out that I needed a blood draw stat. They didn't call a code when they went into the room either. They also want me to make some late entries in the chart, but how could I? I'm suspended without pay so therefore, I can't & I shouldn't do any work.

It's not looking good. I feel they are looking to fire me & I can't understand why they are doing this to me. I just got my 90 day evaluation on 2/14 & I met expectations on everything, including pt. safety. I can't believe that this is happening.

Can I lose my license for this? I didn't do anything wrong, that I know of. If they fire me, does that affect my license? Do they make a complaint with the Board of Nursing? Does anyone have any advice for me? Please help me. Thank you.

Does anyone have any advice?

[NurseeTee]

If I called a code for a pt with a low blood sugar, I think that would get me in more trouble than bottoming out the sugar in the first place! Codes where I work are for respiratory or cardiac arrest only (or someone who is darn close), so to picture the whole code team coming up with the intubation kit and defibrillator and chaplain and the whole works...well it's unnecessary. He got his D50 and blood draw. People make mistakes - you didn't do anything maliciously or even negligently in my opinion. Next time you will call the MD to clarify orders, it was a learning experience and ultimately the patient is OK, lesson learned. I really hope you get nothing more than maybe a slap on the hand.

[PoohGirl]

If I called a code for a pt with a low blood sugar, I think that would get me in more trouble than bottoming out the sugar in the first place! Codes where I work are for respiratory or cardiac arrest only (or someone who is darn close), so to picture the whole code team coming up with the intubation kit and defibrillator and chaplain and the whole works...well it's unnecessary.

I'm with you on that. If I had called a code everyone would've been real pissed. They would just roll in and say give the D50, monitor the pt and leave us out of it.

As is, the deal with long-acting and short-acting insulin when pt is NPO is so hazy on our floor. Our diabetes CNS tries to educate the MDs about the ins and outs, but being a teaching hospital with residents coming and going there's always confusion. Every time a pt is NPO I'll ask the doc to hold or give. They'll usually then ask me what's normally done... THen comes the issue of giving the long term insulin but make sure you run some D5NS or D51/2NS to balance it out... ASK the MD and document!

I think you handled the situation very well....

[WVUturtle514]

I agree with the last couple of posts.....I would not have called a code unless this patient was unresponsive or in respiratory distress. You did what you needed to do (give the D50, monitor the patient and call the MD). IMO calling a code would have been unecessary and you would have had a bunch of people running their butts off for something that you had already handled appropriately.

[Daytonite, BSN, RN]

I don't think the problem is how the BS of 9 was handled. I think it was the fact that it was discovered so long after the initial BS that was high for which the patient received insulin. Also, something is amiss with your charting since they are wanting late entries added to the chart. So, the charting is lacking in some way. I find it odd that after a high blood sugar and sliding scale coverage with regular insulin a patient comes up with a blood sugar of 9 six and a half hours later. Several questions come up in my mind. Are you sure you gave regular insulin and not NPH? Did you chart you gave the insulin? Is it possible that someone else in the procedure room came along, checked the patient's blood sugar and thinking he had an untreated high blood sugar gave him another dose of insulin? If so, was the wrong kind of insulin administered by a second nurse? Not knowing anything else but what has been written I'm guessing this is being treated as a medication error that almost killed the patient (ended up in ICU, right?) and is probably being proved by serial blood sugar levels that are showing low levels consistent with the trend of an intermediate acting insulin. Otherwise, this patient wouldn't have needed to be treated in ICU. This is why so many places and so many nurses have another nurse double check their insulin before they give it. If there is another nurse involved in giving this patient another dose of insulin of which you are unaware, it would be totally appropriate for the hospital to place you both on administrative suspension while the incident is investigated. As a manager, I was involved in a couple of incidences where this was done. If you are found innocent of any med error or serious wrong doing you will be paid for the time off and reinstated in your position although you will probably receive some sort of disciplinary action for the failed charting.

[meownsmile, BSN, RN]

Considering that the OP is only 90 days into her job, i am wondering if they arent considering more and/or reeducation regarding medication. I dont know that termination is necissary but possibly some re-education from whomever did the policy/hospital orientation might be in order. It could be they are trying to set that up and until they can work her through that they prefer she not be on the unit(covering their backsides). They cant justify letting her continue to work if they feel she needs more orientation/ reeducation regarding meds and policy.

[SFCardiacRN]

NPO is "nothing by mouth". I don't see the problem with giving insulin when required by sliding scale. As an OR nurse, I would write up a nurse that sent a patient to OR with highly elevated sugars using NPO as an excuse.

[lsyorke, RN]

I think this brings up a subject that I've been talking about alot this week. Hubby is IDDM of 46 years(diagnosed at age 10). He has been in the hospital in the last few weeks and I'm amazed at how little nurses will trust their patient to determine their insulin needs. Not all, but most diabetic who are insulin dependent know exactly how their bodies will respond to insulin dosage. He's had residents try to change his Lantus dosage drastically due to one blood sugar over 180, instead of recognizing that it was a one time spike. He's had nurses try to hold his lantus when his dinner blood sugar was 70 (he takes it twice a day).

Bottom line is ask your patient how they respond to insulin. Hubby can tell you exactly how much humolog he needs to cover a meal, he can tell you how much lantus may have to be adjusted for an npo situation. Insulin dosing cannot be carved in stone. Talk to your patient... they usually have insight that we don't give them credit for.

Bottom line when npo is it's better to send the patient will a slightly higher blood sugar than a low one.

[zacarias, ASN, RN]

I am surprised that he was SO hypoglycemic 6.5 hours after the insulin was given. I mean that just seems so odd.

[lorster]

AnnetteER. You did fine. You prioritized your care. Getting the D50, getting the lab and letting the team leader know were the best initial steps. The guy had not coded so this would have been a wasted step. I may have had someone move the crash cart close to the room just in case. Don't beat yourself up. Seems to me that there is a bee in someones bonnet. When you go to the meeting, be professional and explain what happened and your rationale for each and everything you did. Accept constructive critisms that you may get and learn from them. I would have a hard time believing that this could get you fired. Good luck and keep us posted.

[gr8rnpjt, RN]

I am a new nurse. Does anyone have any advice?

Annette, congratulations! Great Save!. Your patient did not die and has no side effects. Like another poster said, don't imbellish or add to the story. The only thing I see that was wrong was that you should have called the MD to clarify what to do for the high blood sugar. You also probably should have checked the blood sugar on arrival back to the floor. Everything else was really good, you did a good job. Good luck with your meeting but I don't think you should worry about your job or license. You will not lose either, I believe.

[AnnetteER]

I still don't understand why I was suspended. They told me on the phone that I'm suspended without pay but wouldn't confirm it in writing. They want me to come in & do "late entry charting". Needless to say, I haven't been back to work since they sent me home. I'm suspecting that they want me to put stuff in the chart & then fire me. I don't know why I'm in the hot seat. I really don't. I've told all of you exactly what happened. None of my friends can understand this either. I must admit that if this is what nursing is about, I don't want any part of it anymore. I'm trying to keep a positive attitude that I will not be treated like this again by an employer. I worked as an accountant for 13 years & was never treated like this. It makes you feel miserable, especially when my friends are telling me that I probably saved that guy's life. I got a good hard kick for it. I hope that they will not put anything against my license.

[AnnetteER]

I'm positive I gave Regular insulin & I did document the sugar & the administration of the reg. insulin. I've since learned, 5 days after the incident, that he is a Brittle Diabetic. I never even heard the expression before this. I have looked this up online, & noticed that when a person is a Brittle Diabetic, they should have their sugar checked about every 2 hours. For anyone who isn't familiar with the term, a Brittle Diabetic's sugar fluctuates from high to low quickly.