I hate my supervisor

[kikwon89]

(moderator edit of name) called my cell phone 2 am to write me up for errors that she had found because she didn't have anything else better to do than looking to write employees up for making tiny little mistakes she likes to pick on. The case was regarding a very brittle diabetic patient whose blood sugar was 70. I decided to hold her 50 units of novolin 70/30 because I know she is going to bottom out like she usually does the next morning. (moderator edit of name) stated that I do not have the authority to hold a medication without the doctor's order and that i was wrong for me to make such a decision. Do we as nurses really need to make unnecessary calls to MDs about situations like this? Tell me, criticize me, and teach me on what I did wrong and what you would have done if you were me in this exact situation?

[Rose_Queen, BSN, MSN, RN]

What did the order say? Was there a blood sugar reading that the order said to hold the insulin for? If not, IMO, you made what sounds like a medical decision, and went outside your scope of practice. Especially with the words going to bottom out like she usually does the next morning. What if the next morning she didn't bottom out, and now you're playing catch up?

[Coffee Nurse, BSN, RN]

I agree with Poet. Unless you had an MD order written with specific parameters for holding the dose, it was not your place to decide to hold it. Withholding a prescribed med is as much a medical decision as giving an unprescribed med.

[caroladybelle, BSN, RN]

Second, what you did does fall under "medical" care . Yes, you may have had the best intent, but holding that much insulin without an order or even discussing it with the MD, from a diabetic, ESPECIALLY a brittle diabetic, is not wise because they can easily swing way up on their sugars. Yes, they also drop, but the MD needs to be aware of these issues so s/he can make a judgement to affect appropriate change.

Yes, (moderator edit of name) could have waited until morning to tell you, but I suspect she was trying to reinforce the gravity of the situation, plus will probably be the one that "pays the price" when the MD is notified, or she has to deal with the repercussions, if the pt has issues.

[totally_nuts]

I agree with the other posters, if you withheld meds without the dr's consent it is out of your scope of practice and the supervisor was right to pull you up on it.

[caliotter3]

You may have even bigger problems if the employer gets wind of this thread. Suggest you consider changing it up or even deleting the entire thread. People have been fired for talking the wrong stuff on a public website.

[ANnot4me]

Personally, I would not have given the insulin without calling a doctor and then noting I had done so. In this case, giving the insulin without question it could have resulted in the same situation for a different reason. 30 percent of that 50 units is regular insulin that would have bottomed this pt out. If you give it you are responsible also. Again, I would have contacted a physician and noted that I had questioned the order. I would have only given the insulin at that dose after the patient ate something.

[traumaRUs, MSN, APRN]

You may hate unemployment more than your supervisor!

If you feel you need to hold insulin than you either:

1. Need to get a one-time order to do so.

2. Get parameters set up so that if BS is

Good luck.

[mauxtav8r]

Sad for you. How you react to this situation is very important.

Getting that MD order IS YOUR JOB. Deciding to hold the insulin is THE MD'S JOB. Bummer to say, but writing you up is YOUR SUPERVISOR'S JOB.

Didn't mean to shout, but hey, this big.

[Davey Do]

Dear LilKwonie:

This is one of the toughest things we have to do in our profession: Make a decision and deal with the ramifications of our actions.

I commend your action in seeking feedback. The next step is rectifying that situation. And, gosh-darn-it, that's difficult.

At times like this, and I have experienced similar situations, I like to think of something Joseph Campbell said: (And I most definitely paraphase for directness) "Consciousness is changed through trials and tribulations and the subsequent illuminating revelations."

In other words, in order to achieve a higher consciousness, to be more understanding of others and our environment, we must experience discomfort and get beyond our suffering.

Your peers have given you some sound advice. That's what you asked for, and I again commend you for that.

Now, you have to do, as I had to do, when a supervisor once made a difficult request to me: "You don't have to like it, you only have to do it."

Go forth with the idea that you will learn and grow from this experience.

The best to you.

[fiveofpeep]

man thats nothing. my supervisor writes people up for mislabeling IV tubing :)

what about holding insulin when a patient is NPO? especially when you work night shift, this is a decision Ive seen others make. I usually give it if patient is on D5 but would hold if NPO and w/o D5

[mauxtav8r]

@fiveofpeep...check the hospital's policy. Ours just changed to a much more strict interpretation allowing for zero holding of meds without spelled-out parameters without md order.

So in practice, this encourages the md to write orders for what should be held. Even if a patient refuses a med the md has to be notified unless it is previously accounted for as a prn med or with parameters.