Med errors, but not mine... HELP please

[1136CD]

I have been toiling with this problem since I got home from work today. I work in home health care and I am the full day time nurse and there is a full night time nurse, both of us began this case the second week in May, patient just home from the hospital. In this time I have had several issues with the other nurse regarding her standard of care such as not giving a PRN med which the patient very much needed because she did not know what it was and did not bother to ask or look it up until 2 weeks into home care and I brought it to her attention. She is careless with items like suction catheters, leaves them lay and reuses, one day she pulled a catheter out of the trash to reuse it, does not ware a glove when suctioning the trach. She does not chart most of her meds properly on the MARS, when she charts them at all, so when I need to know when a PRN med was last given I have to go to her flow sheet and read down thru it to see when the last med was given BEFORE I can give it again. ( OK I am getting to my point ) When I took these problem to my supervisor she said she felt like this other nurse was having neurological problems and does not make transitions well from job to job and to give it more time and she would speak to her.. OK I said. But this week, while looking thru the medicine sheets today I noticed that the other nurse has been making med errors by over dosing with the patients Ativan, and Tylenol : ( too much too soon) and giving a couple other meds too soon together also and this has been going on for at least 4 days that I know of, ( I did not go back further than the past 4 days). So, I feel like I should go to my supervisior again, and I know I am going to feel very angry if she does not do anything about it.. I personally don't feel like this other nurse should be in a unsupervised atmosphere like this one. She makes SSOO many sloppy mistakes and now this. I also believe, as I recall that it is my duty to report things like this.. ??? even though this is a first for me. I have never had to work "with" a nurse who has made so many careless mistakes before and it is really going against my grain. It is very frightening and nerve racking to go to work and not know what delemma I am going to encounter of this type tomarrow. It is stressful enough to take care of a patient with special needs: et:

G tube. trach, breathing problems, head injury who is bed ridden without having to keep my eyes peeled for this sort of stuff. And I am fearful for my patient, very fearful. So, do I approach the nurse or go to my supervisor again, with the possibility that my super will think I am just harrassing her and tattling about this nurse who I definatley dont believe belongs in this home?? ..... HELP...Sleepless tonight!!!

[caliotter3]

If you do not think that this nurse is amenable to a "nurse to nurse" chat, which would be the right thing to do ethically; then, by all means go to the supervisor again with a written note. Don't leave anything out. Don't apologize, but state that you are trying to bring patient care up to standards. After all, you will be involved, if something serious happens, and you, having knowledge, have not attempted to correct the situation. You may be labeled a troublemaker by the supervisor; but if she is a good supervisor, she will realize that things need to be tuned up on this case. Good luck. (BTW, I found that 9.9 times out of 10, when you try to help out a co-worker (acting with the right attitude); it turns out negative. Most people get defensive and don't realize that someone is giving constructive criticism without criticizing the person.)

Added thought: As much as possible, try to keep negative info from the family. Families are quick to catch on when the agency and agency nurses don't work together and their loved one receives inconsistent care. This gives them reasons to develop a complaining viewpoint. You want to avoid that if at all possible.

[1136CD]

Thank You for the encouraging words... As this day began, I decided to talk to my supervisor about this. When I got to work I decided to double check my findings: et: MARS against the flow sheets just so I would not make myself sound like a trouble maker. As it turns out the two were in total conflict and neither relected the same things or times. Yeah, it was a real nightmare. So, when I went in to see my super, I started with a low key soft voice and explained both findings the best I could. She was very underdstanding and said she would check into it, and she could not be there to see everything and needed to know. I felt like I had unburdened myslef from the possible liability of too much knowledge. I still felt and feel embarassed and a little angry at the other nurse for not being more on top of things and relaying such misleading information, which could have gone bad if I was not paying attention to the total picture. I guess I still wonder how many times before she has screwed up. MAybe I should just leave that in the supervisors thoughts and deal with it, she is a sharp cookie.

Thank you for the advise about keeping a lid on the problem and not saying anything to the family. Some times, under stress and frustration, things like this come out unintentionally and a person wishes they had a zipper for their lips.. I plan on keeping my shut.

Thank You again.. all who read it. Maybe this will help someone else.

1136CD