I need advice before Wednesday

[kitkatRN]

So I started working at a brand new private hospital since end of February and was given 3 days orientation (I only had 4 months work experience at the time) and everything has been going great except...

I gave report to an oncoming Day RN about one of our patients, she is a 60something female

After I gave report to her, I documented on the computer that report was given.

I go home and sleep for a few hours and I get phone call from our new med-surg supervisor (she just started at this facility 2.5 weeks ago, i've been here longer than she has) "Hi... How are you?..." I tell her I'm good, and then she screams "You gave HORRIBLE PATIENT care. You let this lady suffer in horrible pain all night." I told her I did not, and I documented giving medication and the PCA pump in my notes on electronic charting. Documentation is also in the paper MAR and withdrawing from Pyxis. So I'm covered in 3 different places documentation-wise. This supervisor screams at me "NO YOU DIDNT DOCUMENT. YOU LET THAT PATIENT SUFFER" I tried to calmly explain that I did, and she can check the paper MAR (also has her pain score). I was trying to also explain that I didn't get the chance to replace the morphine for the PCA because there is no night pharmacist and its not stocked in the pyxises. She ignores what I tell her and then screams at me how the call light was out of reach (It wasn't since the tech and I did rounds together on that patient) and how the CPM was off ALL NIGHT (I documented that I put it on). She also screamed at me about how the IV tubing was hanging off the bed (it wasn't on a rail, it wasn't touching the ground, and of course its going to dangle a little to give it some slack.

So this supervisor said I am suspended for two shifts until her "investigation is complete" I am not quite sure how to handle this situation when I meet with her Wednesday. I just feel that it is wrong that I am being suspended and accused of giving "HORRIBLE" patient care.

What is going to happen to me? Even if she discovers that I DID document and medicate the patient appropriately, I know she won't apologize to me. I am just really stressed out and it was hard enough finding a job.

[redbeads]

There are so many issues going on here it is hard to even know where to start. The most glaring issue I see is lack of adequate training for new nurses and poor support and communication.....this unit is going down fast! "Be the change you want to see"...or get out of this place would be my advice to you.

[Kooky Korky, BSN, RN]

First, you must write out the whole story in detail. Make it in list form as much as possible. Do it now so you won't forget any details and so you have time to read over it for errors. Do it on the computer so it's legible. You have pretty much already done this, just leave out any editorializing.

Next, who is your immediate supervisor? If it's not this new supervisor, go to your own Manager and require that she be present at your meeting IF you and she get along and you think you might have an ally in her. If not, let this point go, I guess.

Thirdly, examine your heart. Review your behaviors and determine if there is anything you have left out or "mis-stated, in your favor or not.

If you have a union rep, have that person with you.

I don't really see that you did anything wrong. Too bad the patient turned down pain med other than the PCA. But you couldn't force it down her throat. Maybe she feared resp depression, constipation, etc.

One thing you probably should have done that you did not is notify your supervisor, the house supervisor, the pharmacist, or somebody that this woman was going to need a new PCA before 0730. Not that she couldn't have been helped by some p.o. pain med, but at least you would have made it known that she was going to run out before Pharmacy reopened. The Pharmacist could have come in at 0630 to get it for use at 0700.

Other than that, if you did everything you say you did, turn this back on the investigator. Let it be known that you had offered to go with the Day nurse on walking rounds and she turned it down. Let it be known that you do not appreciate being screamed at and write up the screamer.

Turn off your phone during the day from now on so you can sleep.

Go to the DON/CNE now if you can't stand to wait.

[scoochy]

You should have plenty of documentation to cover yourself. however, it may come back to bite you also. If your trying to get relief, and what you have isn't working, 8/10 pain 1hr after pain meds would get me thinking. After another pain med administration, and no relief 30-60 min later, you need to be calling for new orders. Or at least notifying the doctor that the treatment regimine is not working. They may say, "well what else can we do, blah, blah", and you may end up with no changes. But at least you can document that you called a status report regarding the pain control and no orders received. That would show that you were doing your job ,AND THAT YOUR TRIED TO ADDRESS THE 8/10 PAIN. All you can do is wait, maybe ask to come in 1 hr before the meeting and request to review the chart. Good Luck.

Agree with above; pain 8/10 despite IV PCA warranted further attention. Giving po narcotics along with PCA defeats the purpose of a PCA...patient-controlled. Was this patient using her control to the max? IMO, the dose of the PCA should have been increased, or the medication changed to Dilaudid PCA (if you have it at your hospital). As for not having a back up supply of PCA cartridges, that is just wrong!!! The nursing supervisor should have checked other units to see if they had any PCA cartridge back-ups. This is not patient-centered care. No patient should have a pain score of 8/10 all night. I would bet this hospital is not accredited by JCAHO. As OP said, I would look for another job......

[Kooky Korky, BSN, RN]

I agree that you should have contacted the doctor about the persistent high pain level. Another thing you could have done would have been to ask the charge nurse and the supervisor to advise you.

Still, your boss should not be screaming at you and you need to make it known that her behavior is not acceptable. She is supposed to be remembering that you are still pretty new and she should use this type of situation to teach, not screech.

Also, look back over the record to see what pain level the patient was reporting prior to you taking care of her that one shift. How long had she been reporting 8-10? Hopefully, it started long before your shift (not that she should be in pain, just that maybe it was something that had not been properly addressed for a long time). Also, what did the nurse who followed you do to reduce her pain? Or WAS it reduced? If reduced, to what? How and when? In other words, see if she was in bad pain all along or what? Also, what level of pain is acceptable and expected for patients in her situation? Don't just assume that all the other nurses did any better for her. It sounds like she was at least partially responsible for her own high level of pain, since she refused the PRN you offered. Say that real nicely when you say it in the meeting. God forbid the pt should be blamed for any part in this.

You should be humble and remorseful tomorrow but also call her on her unacceptable behavior. And make her tell you what you should have done differently, not just tell you that you did a bad job. Are they prepared to throw you away for this single failure or are they committed to working with you to help you learn from this and grow into an excellent nurse? Ask them. Express your hope that they ARE committed to your growth and development.

Make a separate list of your good qualities - perfect attendance, never have been late, any compliments you have received from families, doctors, patients, coworkers, other departments, even from your accuser.

List all the things you have learned so far, also. This will be good for you to be aware of and will help you feel better about yourself. When we're being accused of evildoing and told how rotten we are, it is good to remember that we really have already learned a lot and have come a long way from the starting gate. Gently let them know that it's not possible to learn everything in just 3 or 4 days of orientation and just a few months as an employee or as a nurse. (did you say you're a new grad?)

You might want to consult quickly with an employment lawyer, also. First consults are usually free. And if the meeting goes poorly with the screamer, appeal it to the DON. Go through all the channels.

Good luck, whatever happens.

Just curious - was the Dilaudid able to be given only p.o.? Maybe you could have given her some IV?

[Kooky Korky, BSN, RN]

It sounds like your manager is trying to get rid of you and has someone ready to take your place....that happens,new managers come and bring in their own people..If I would be you I would start looking for another job,also do you really see yourself working for such people,now you will always be labeled as a incompetent nurse in their eyes,trust me I have been in your shoes.Start looking for a NEW job NOW,dont wait until you have three strikes and I'm sorry you are being treated that way..

She might not be able to immediately find a new job, given the current job market.

OP, if you do decide to change jobs, you should probably not mention this job on your application/resume.

Also, the heck with what others think. I have been the "black sheep" on jobs before but I have just endured it and kept doing my job and eventually have been seen as a very good nurse by the very ones who've badmouthed me. They have even told me they were sorry they had believed the gossip and passed it on. It was hard to be in that position of being misunderstood and mislabeled, but finally right prevailed. Don't worry too much about what others think of you if you know you are doing what's right. A lot of people jump to conclusions or take what they hear, not what they see themselves or what you say to them directly, and start spreading innuendoes and half-truths or outright lies. They need to feel important, I guess. The H with them.