Is this discrimination against nurse with prior brain injury?

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Dear Nurse Beth,

I'm an experienced nurse on a new position at a Rehab Hospital. I'm now wondering if I made the mistake by taking this position? I was a patient at this hospital over a year and half ago on the same unit I'm working. When I was hospitalized it was after a motor vehicle accident on a traumatic brain injury unit.

I recently made a liquid tylenol med error and my manager and my nurse preceptor has brought up my past injury when I was hospitalized there and questions if it had to do with my error and me being unsafe. My question is could a nurse lose her license from a liquid Tylenol error?

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Specializes in Tele, ICU, Staff Development.

You Are Not Going To Lose Your License

In and of itself you are not going to lose your license over a medication error. If that were the case, I wonder how many of us nurses there'd be left standing. Not many! ?

There are a couple of things to unpack here.

Discrimination?

It's shocking that your manager and your preceptor would immediately bring up your medical history and shame you with it. It crosses several boundaries (personal, professional, and possibly HIPAA) and it must have really hurt. It seems insensitive and unnecessary at best and hurtful and irrelevant at worst. It's a pretty safe bet that medication errors have been made by nurses who have not suffered motor vehicle accidents. 

You qualified for the job and you were hired with your employer knowing your full medical history as relates to your injury, including your discharge status and prognosis. Your ability was not an issue at the time of hire. (You didn't say you had a traumatic brain injury (TBI) per se but I'm going to assume you did because of the context you provided.)

By working at a facility where everyone knows your past injury you do face distrust and discrimination from your colleagues. It's tough to see how you could feel emotionally safe practicing in that environment.  

On the one hand, you have the lived experience as a patient which helps you relate and have empathy.

On the other hand, you'll be feeling vulnerable and wondering what others are thinking about you. You may feel unfairly judged. Coworkers may see causes and effects that don't exist. This all could easily take a big hit on your confidence. If you end up always second-guessing yourself, you are actually more at risk for making an error.

Cause of the Medication Error

By asking "Could a nurse lose her license from a liquid Tylenol error?" I wonder if you are minimizing the error because it involved Tylenol, or if you are naive to causes of loss of licensure.

To quote Rose Queen when answering a similar question here on site, "If you want to see what nurses lose their licenses for, go to your state's BON website. You'll find that the vast majority have zero to do with med errors and a lot to do with criminal issues, drugs, or alcohol. A medication given early (and not necessarily a full 2 hours because your facility likely has a protocol in place for meds having a window of time to give) is not a reason to lose a license. If it was, we would have a very very limited nursing workforce."

Critically analyzing the error is always highly important, whether it's Tylenol, Milk of Magnesia, or IV heparin. Often medication errors are multifactorial, with the nurse, being the administrator at the tail end of a long line of preceding activities/potential causes (ordering, dispensing, labeling, environmental distractions, etc.) catching all the blame.

What is your analysis of what caused the error? Did you follow procedure as far as all required safety checks, such as scanning and identifying the patient? Was there a conversion involved? Was it overly busy causing cognitive overload (otherwise known as multitasking)?

Valid Concerns?

Back to your manager and preceptor, I would want to know exactly what they were referring to in questioning if your medication error was related to your past injury.

I would ask them. If all they said was that your error was related to your injury, that is not only unhelpful but hurtful. 

But just because they were hurtful does not mean there are no valid concerns. Get to the bottom of it. Ask them to specifically clarify their concerns. Did they observe you forgetting something? Are they concerned about short-term memory? Was the error related to doing math? Ability to calculate dosages? Speed of information processing?

How about you? Do you feel you have any limitations or residual cognitive symptoms that you are aware of?

Those are the thoughts I have based on the brief scenario, and while they could be off track, I hope something may be useful to you. Let me know if I can help you further.

There's a forum here for nurses with disabilities and you might want to check it out.

Best wishes,

Nurse Beth

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