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?

[AnnetteER]

My manager made an announcement the other day that if a patient's BS is high, even if he/she is NPO, we should administer the coverage. Again, this just leaves me more in the dark about what the hell they are doing & not telling me anything. The main thing she told me I could be negligent on was not calling a code, which I never knew I should do. How could that be negligent?

[AnnetteER]

Thank you to everyone for your support. I'm at a total loss with all of this. I did everything I was taught & ended up suspended. Go figure. The last thing I heard is that they are having trouble regulating his sugar because he is a Brittle Diabetic.

[Skinny~Tech]

It would seem to me that with a BS of 9 you handled it correctly. Where I would question your actions is giving the insulin before surgery. Whenever a diabetic is not going to be eating, whether it be NPO or just lack of appietite, the doctor should always be called for more specific orders. Sliding scale does go by the accucheck results but you have to use your critical thinking skills and intervene as necessary. I'm sorry about what happened to you. Admit where you made your mistake, I doubt anything will come of it. CYA is more than likely the case with the higher ups. I don't think I would have called a code with a patient who was breathing and talking. Sounds dumb to me. Can you not get in trouble for calling an unnessary code? Peace

[Skinny~Tech]

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".

I would hope they would not encourage you to chart anything that is not totally accurate. It would smell like yesterdays garbage esp because it would have to be noted as "late entry charting". I would refuse to chart anything I didn't feel 100% comfortable with. Peace

Sorry I guess I should have combined these last two messages. I'll get the hang of it promise, I'm a newbie

[Nutmeg5575]

I'm so sorry this has happened. I hope everything turns out ok and please keep us updated.

[AnnetteER]

Lorster,

One of the charge nurses brought the crash cart to the room.

[AnnetteER]

Annette, congratulations! Great Save!. Your patient did not die and has no side effects. 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.

Thank you. My friends & a lot of my co-workers agree with you. We're all just blown away by this whole thing. I had a patient about 3 weeks before this happened that didn't look right to me, & I kept telling the charge nurses (we have 2), & the Clinical instructor. They checked my patient & said she was just having anxiety & that I was just a new nurse that was "freaking". They all got a good chuckle out of it. I kept an eye on her all day. I kept an eye on her vitals, pulse ox & I kept listening to her lungs. It bothered me a lot & I wished I was more experienced to realize what was happening. By about 5:00, her vitals started to change & she was having more trouble breathing. NOW, they took me a little more seriously. Turns out, she was going into CHF. We ended up transferring her to Tele before my shift ended.

They made me feel so stupid when I went to them in the morning for help. When I told them I was concerned about my pt. & wanted them to check her out. The patient's husband showed up by lunch time, & he saw that I kept on trying to get people to look at her. Him & I were both concerned.

I know I'm new & I know so little, but I don't understand treating a new nurse like she's stupid for being concerned about a patient. Nursing isn't what I expected, or is it just where I'm working that's just not right?

[Daytonite, BSN, RN]

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.

At this point I think you ought to just reveal to the powers that you are worried you are going to be fired. When we put people on suspension that was one of the questions that was kicked about in the meetings we had. However, in one suspensiion I was involved in the staff (3 of them: a new grad, a seasoned nurse, and a CNA) stood at the bedside of someone who had coded for 5 minutes (!) debating over whether he was a Code Blue or a DNR. The older nurse was madly searching through the patient's chart for the written DNR order which it turned out wasn't there. No one got fired or reported to the state board. It ultimately came down to the decision of the DON of the hospital. During the week that the three employees were on suspension we talked to as many people as we could and got documented writing of what had happened from everyone, supervisors, staff nurses and code team included. The patient, we found, was already going downhill long before he finally coded and the signs were consistently missed or ignored. In two shift reports nurses told each other that the patient was a DNR and the doctor himself told us he had discussed this with the staff nurses but never wrote the order because he had wanted to talk with the patient's family first, but he knew there was no hope for the patient. We found all this out during our investigation.

With regard to your charting. I would ask them to let you take a look at and read what you charted to refresh your memory. By now, I'm sure you have a good chronological list of exactly what went down. In fact, I'd make a list and compare it to what you charted. If you feel your charting was adequate, tell them so. Tell them there is nothing you feel you have to add to it. Then, ask what do they think is missing. I believe that the reason they are not giving you specifics right now is because they don't want to put words in your mouth, so to speak. They don't want the record falsified in any way either. Someone who has reviewed the chart must think something either wasn't done or it was done and didn't get charted.

So, make a very complete list of what happened from the start of your day with that patient up to his transfer to ICU. Consider the times you may have checked the chart for orders, called the doctor, gave report, what you said or was said to you in report. Think also about the patient's behavior. Was he talking and making sense when he got back from his procedure. Who saw him when he got back? When? How many times did he get looked or someone actually go into his room and look at him before being found hypoglycemic? I think that the period of time from his return to your unit to the time he was found hypoglycemic is probably what they are most concerned about at this point.

It could be that they just want to get the chart in order at the advice of risk management. If the patient has already been discharged there is a time limit within which the chart has to be completed for Medicare regulations. I've had plenty of brittle diabetics over the years. This is how you find out they are bittle diabetics--incidents like this. At some point, Annette, I think you have to just outright let them know that you're worried that they want to fire you. Perhaps knowing this they'll either put their cards out on the table, put your mind at ease or at least get the dreaded deed done. I know that with the incident I was involved in that I mentioned above, all the nurses were calling me because they were desparately worried about their fate. Actually, I didn't have many answers for them myself except that we were investigating and the DON and HR were the ones who were going to make the final decision about their fate. One way or another you will eventually get your answer.

[jgwe4e]

Not all hospitals are like this. I'm still in my first year, and ask lots of questions. On my unit, everyone helps out. We all go listen and look at each other's pts if there's any question about what's going on. Veterans help newbies, newbies help students, and educators and charge nurses are great at being supportive and answering questions. It's not perfect, but it's very supportive. Not all nursing is as awful as what you've been going through. I hope your situation improves soon.

[fergus51]

I think your only real mistake was not checking his blood sugar sooner. I think you were right to not call a code. A code means you need the code team, and you didn't. There is nothing worse than running to a code as part of the team only to find out you didn't need to be there in the first place and I have written one nurse up for it.

[GrnHonu99, RN]

Ok, so i'm a student and i'm a little confused.

I have read all the posts and I am having trouble understanding what the issue is. I guess I don't understand what the OP did wrong or what she should have done differently? If anyone could fill me in i'd appreciate it.

To the OP, i'm sorry this happened to you, waiting is soo hard. I really hope everything works out for you! It seems to me that you did everything right.