I HATE contingency orders

[Melanin]

This one was a heparin drip, and I misread the order, which said that if the factor Xa is above ___, turn off the heparin for 60 minutes and then restart the heparin but decrease the dose by 300 units/hour. Well, I for some reason I read the order as "turn off the heparin for 3 hours and then restart the heparin but decrease the dose by 300 units." So at 1400 I turned off the heparin, then at 1500 I told the oncoming RN that the heparin should be restarted at 1700 & decreased by 300. The evening RN asked if there were written orders for her to check, and I said that yes, the MD orders were there to read, in case she wanted to double check what I'd reported (that's certainly what I would do). At 1530, after finishing all my reports and charting, I clocked out. At 1600, while I'm on the train home, I get a call on my cell from the previous RN asking where I got the "3 hours" stuff. I did not have access to my work computer at that point, so I said that I THOUGHT the order had read "turn off for 3 hours" - had I misread it? The previous RN just shouted, "WRONG," then said she'd restart the heparin now.

I guess my question is, how much trouble am I in? I'm pretty sure the evening RN will report me, write an incident report, etc because she sounded pretty indignant on the phone. Sometimes I hate being a nurse, but I try and I try and I try to do everything perfectly.

[Melanin]

Understood. But like I mentioned, if I review charts before clocking in, as has been my habit, I have been warned by other RNs - some in a kind way, some in a sort of "if you don't get off my computer, you'll regret it" way - that I could get fired for a HIPPA violation, should one of them decide to report me for doing so. Sot it all comes down to time management during the shift. Time management is a catch phrase that comes up a lot when the staff is extra busy, such as when we're short-staffed. My own opinion is that little changes in processes and procedures could also go a long way towards helping RNs with this time management problem.

[Julius Seizure]

True! One barrier I run into is that we're expected to start the shift by taking report at 0700 so that the night shift can leave by 0730 - which seems like plenty of time, but there's a lot going on sometimes. . . From 0730-0800 we start passing the 0800 meds, and around that time the lab results from the night shift start rolling in & we check the vitals entered by the CNAs and fill out all of the sepsis reports and look at all the blood sugar results. So if anyone wants a PRN or has to go to the bathroom or has low blood sugar or has an am procedure & we have to help with the transfer, our time is pretty squeezed (though yes, when there's a high-alert medication we should MAKE time). I've made a habit of showing up prior to my shift to review the orders before I clock in (since, as I said, we're not allowed to punch in/out late or early). However, a few of the night RNs have expressed anger that I am taking up space at a computer at the nursing station ("you're sitting at MY computer," is what they say), and more than one has warned me that I could be reported for a HIPPA violation, so I'm wondering if this is an unsafe approach (for me personally, not for the patient).

You are looking up information for a patient care-related reason, and you have a need to know it to provide that care. This is not a HIPAA violation.

[BrandonLPN, LPN]

Understood. But like I mentioned, if I review charts before clocking in, as has been my habit, I have been warned by other RNs - some in a kind way, some in a sort of "if you don't get off my computer, you'll regret it" way - that I could get fired for a HIPPA violation, should one of them decide to report me for doing so. Sot it all comes down to time management during the shift. Time management is a catch phrase that comes up a lot when the staff is extra busy, such as when we're short-staffed. My own opinion is that little changes in processes and procedures could also go a long way towards helping RNs with this time management problem.

To play the devil's advocate, it *would* be nice of you, when coming in early to look up pt info, to go do it at a kiosk or something and let the poor night nurses sit at the nurses station. They've been up all night, you know.

And you shouldn't be working off the clock. If you need to come in early, then punch in. Maybe it's differnt elsewhere, but it's been my experience that management threats over OT for licensed nurses is just bluster.