I had a patient who was prescribed IV dilaudid for pain and the parameters that the medication was not to be given if the systolic blood pressure was less than 110. I took her blood pressure three times and it was never above 95 systolic. However, I didn't chart the blood pressures and the patient complained to hospital customer service and I was fired because I could not prove my claims.
I know it was wrong not chart the vitals. However, I don't have a record of not charting on my patients. I also don't have a reputation for being mean to patients. I know that I did the responsible thing by taking her blood pressure and not giving her the medication. I think that people make mistakes and of all the mistakes you can make, I didn't hurt anyone.
It was not the first time I had been in trouble. I had lost a morphine sulfate tablet. I reported to the pharmacy and my unit manager. I was drug tested and the results came back negative. After that experience, I changed the way I passed my medications. It didn't matter because after that patient complained about me, I was fired.
I am not defending poor performance but can't you learn from your mistakes and do better next time? I mean apparently not.
It was a PRN? Huh...makes management's case for firing you even weaker, it seems, unless the patient really laid it on thick in her complaint (or maybe was a VIP or something).
The patient asked for pain medicine 3 times on your shift? Was she offered other pain medication? Perhaps that is why she complained?
I really long for the day when every place a nurse might work would adopt an educational/training approach to mistakes made by their nurses, instead of the punitive one that I've witnessed and heard about.
The patient asked for pain medicine 3 times on your shift? Was she offered other pain medication? Perhaps that is why she complained?
I really long for the day when every place a nurse might work would adopt an educational/training approach to mistakes made by their nurses, instead of the punitive one that I've witnessed and heard about.
Given the surplus of nurses on the market and the commonality of at-will employment, that's not likely anytime soon. It's easier to just terminate the nurse and replace him/her with the next Tom, Nicki, or Mary who's desperately in need of work.
Here's the deal, and I think you get most of it but are missing a small part:
You took a blood pressure three time, and each time she was hypotensive enough to not receive pain medication she was requesting. If I have your story correct, you did not document that you did this, you did not document the hypotension and thus the reasoning for not providing pain relief, and apparently you also did not contact the physician for alternative pain relief, not did you provide nonpharmacologic pain relief (or at least you did not share that nor did you chart it).
So there are a couple of issues here. One, you did not address the patient's pain. Two, you did not chart any education provided. Three, you did not chart the vitals nor the reason the pain medication was withheld. Four, you did not report this to the doctor.
While you potentially provided *safe* care for the client, you did not advocate for your patient at all. There are pain medications that do not drop blood pressure as much as dilaudid. Another issue is why was she hypotensive. Is that her normal BP? Was something else going on? A doc wants to know if you can't provide pain relief due to unstable vitals. To me, the issue isn't that you didn't chart the BP (although I think that is more serious than some people are suggesting--you have no proof that you even assessed her, on the chart it simply looks like you were unresponsive to her pain med requests). I think the more serious issue is that you let a patient suffer for an entire shift without making any attempt to alleviate her pain.
If you are very new, and already had made a couple of fairly serious errors, I can see why they let you go. This shouldn't be career ending by any means. Evaluate what you did wrong, what you did right, what you will do next time in this situation--in short, learn from it. Go to your next interview with your head held high, be factual in relating the issue, tell the interviewer what you learned and how you have grown from the experience. Everyone makes mistakes. You get to choose what attitude you take on this from here on out, though, and how it affects the rest of your career.
Specializes in Care Coordination, MDS, med-surg, Peds.
I agree, if it wasn't charted you can't prove it was done! I also am unsure why your other charting on the pt that night did not include something about holding the dilaudid. I am concerned, though, if the patient was in such pain that she requested the dilaudid x3, it was held, but she was STILL in pain, why wasn't the doctor contacted for pain control? This would have been charting to back you up, too. I was taught, and still believe, that if a patient says they hurt, then...THEY HURT. I may believe firmly, that they are drug seeking, or a wimp, or whatever, but I would still do EVERYTHING I can do to alleviate their pain. BOTH medication and NON medication methods, such as diversion, positioning, etc. I don't feel that you will never be hired, just be prepared to explain how you have learned and grown from the experience. Unfortunately, as nurses, sometimes we are only as good as our last mistake.
Given the surplus of nurses on the market and the commonality of at-will employment that's not likely anytime soon. It's easier to just terminate the nurse and replace him/her with the next Tom, Nicki, or Mary who's desperately in need of work.[/quote']
It seems to be shortsighted, though. You know what I mean? If you (the business) invest in a person, they are likely to invest back. It leads to not only a good place to work, but a good place to be a patient, which leads to good reputation, and so on. And yet, so many places have such high turnover and high dissatisfaction among employees AND employers. It seems like such common sense, let alone good business sense.
Here is something to remember that was drilled into my head in nursing school, " If it wasn't charted, it didn't happen." It's unfortunate that they were so harsh in firing you ): Maybe because the patient's family complained, they had to do something drastic to look good or avoid litigation? Hey they don't give you all that much of learning curve in school either, which I think is kind of stupid, student = still learning, will make mistakes.
I'm sorry this happened to you, lesson learned, sorry the punishment had to be so drastic:crying2:
She had been offered alternative pain medications and refused them. I also, I had to wake her up to do a stat blood draw on her that's part of the reason why she was awake.
Maybe you're already saying this, but it's unclear: so there was no BP charted on her at all - all night - that reflects her hypotension? Do you have CNAs? Do they do/chart vitals? Even if you forgot to chart your BP checks for the med clearance purposes, there should be some routine BP charted on her over the course of your shift, and it should support your position. Even if you forgot to chart your BP X 3, *someone* should have charted some routine vitals for her, which management could have looked at in your support.
Specializes in Nurse Leader specializing in Labor & Delivery.
She had been offered alternative pain medications and refused them. .
Did you chart *that*?
If I had to guess, either the patient was a bigwig, or you have a pattern of care that's not mentioned here, and this was the straw, rather then one isolated incident, that led to your dismissal.
Coffee Nurse, BSN, RN
955 Posts
It was a PRN? Huh...makes management's case for firing you even weaker, it seems, unless the patient really laid it on thick in her complaint (or maybe was a VIP or something).