Need Advice on Accused Medication Error

[Shannon Dull Dunlevy]

So, here is the situation. I started a DuoNeb treatment on my patient WITH my professor/instructor. Once the treatment was started we left the room and documented the treatment. I checked in on patient about 7 minutes and and everything was fine. At around 15 minutes I checked on the patient and noticed that someone had taken the face mask off the patient and turned the nebulizer machine off. When my instructor came back I reported that someone had turned the machine off. My instructor went into the room alone and reported to me that she had re-initiated treatment because there was still some DuoNeb in the reservoir. I was written up as having made a medical error because I did not personally take it upon myself to start the treatment again. My rationale behind not starting the treatment by myself is:

I wasn't sure who stopped the treatment in the first place. It could have been my instructor for all I knew.

I wasn't sure WHY the treatment was stopped. The patient may have been observed having adverse reactions for all I knew.

I do not feel that I as a student, working under another's license, should make the clinical judgement to restart the treatment on my own accord.

What do you all think is the best move here. I have a remediation meeting in a couple days.

I feel like the persons who made the medication error was #1, the person prematurely stopped the treatment and didn't document or notify anyone, and #2, my instructor who restarted treatment without knowing who stopped it in the first place and why.

[JKL33]

30 minutes ago, Shan said:

I would like to politely ask them, "If you were the patient, would you have wanted a student administering a medication on their own judgement that a licensed nurse had turned off?"

I am sure you mean well, but that question is rhetorical enough that there is very little chance of not having it also sound sarcastic or at best it will be taken as a direct challenge. Plus there is no need to give them the opportunity to provide a disingenuous or nonsensical (aka unexpected) answer; that's just digging your own hole a little deeper.

@Kooky Korky brings up a good point. OP are you being written up for not immediately restarting the med, or for some other aspect of this (such as having left the patient or not notifying your instructor right away when you discovered this, or ??? some other thing)?

[Shannon Dull Dunlevy]

4 minutes ago, JKL33 said:

I am sure you mean well, but that question is rhetorical enough that there is very little chance of not having it also sound sarcastic or at best it will be taken as a direct challenge. Plus there is no need to give them the opportunity to provide a disingenuous or nonsensical (aka unexpected) answer; that's just digging your own hole a little deeper.

@Kooky Korky brings up a good point. OP are you being written up for not immediately restarting the med, or for some other aspect of this (such as having left the patient or not notifying your instructor right away when you discovered this, or ??? some other thing)?

It is for not restarting the med. It is common to leave after initial start of the med and then come back and check on the patient. In fact, my professor and I started it together and then we left together to go document.

[Shan, RN]

1 hour ago, JKL33 said:

I am sure you mean well, but that question is rhetorical enough that there is very little chance of not having it also sound sarcastic or at best it will be taken as a direct challenge. Plus there is no need to give them the opportunity to provide a disingenuous or nonsensical (aka unexpected) answer; that's just digging your own hole a little deeper.

Yes, I should have clarified. I meant it completely as something I wish I could personally say to whomever decided to make this accusation. I 100% agree with the general consensus to approach it cautiously and professionally, but it would be nice to be able to fight for yourself and I'd be interested to hear their answer to that question.

[LPN Retired, LPN]

At the LTC I worked in, they required you to stay with the patient until the treatment was finished. That was one reason among many that I wouldn't go back to work there. The med round and scheduled treatments like this were overloaded and it was impossible to get the med round done in time frame under state regulations. You were lying at every med pass. If med pass is scheduled at 6 am it should be able to,be done from 5 until 7. Impossible. The RN who first trained me said I would have to start at 4 or 4:30. I also had fingersticks and insulin to give so I had to,make sure those were given on correct time.

[Nurse SMS, MSN, RN]

I am baffled that you would be "written up" for this and I am sorry it is happening to you. The patient was in your care, yes - but you weren't responsible for the patient's care per se. The patient's own nurse or respiratory therapist may have turned it off.

I wish you good luck with your meeting. In my school a med error was an automatic fail for the semester. I genuinely hope that is not the case at your school.

[Kooky Korky, BSN, RN]

10 hours ago, Shan said:

I would like to politely ask them, "If you were the patient, would you have wanted a student administering a medication on their own judgement that a licensed nurse had turned off?"

Don't do this. First, she will not endear herself to her Instructor or other authorities. She will risk making them angry.

Secondly, she really doesn't know who turned it off.

Don't buck the Instructor.

I might ask about the write-up, but very gingerly.

[Kooky Korky, BSN, RN]

9 hours ago, Shannon Dull Dunlevy said:

It is for not restarting the med. It is common to leave after initial start of the med and then come back and check on the patient. In fact, my professor and I started it together and then we left together to go document.

And you were both wrong to leave the pt. I told you why earlier. I don't care if it's customary, it is not right, unless you can see the pt at all times, which you probably could not.

But do what you want.

you already see that your Instructor has a screw loose, but go on and emulate her. Or him. Or whatever gender is involved.

The write-up is ridiculous.

3 hours ago, Shannon Dull Dunlevy said:

I apologize that you took such offenses. It was more or less being sarcastic. I believe women are great teachers and nurses as well. When I said that I was thinking of my brother who is very calm, I'm motivated teacher, and is absolutely very fairy non-dramatic.

Instead of apologizing that someone took offense(s), apologize for gender bashing.

[popopopo]

Ya'll just proving her point, it's hilarious. Good luck in the future Shannon!

[Ruixi13, BSN, RN]

21 hours ago, Kooky Korky said:

I agree. However, the pt should not have been left alone during this treatment, IMO.

The Instructor is in the wrong and is putting it on the student. The student, who is a first semester student, should have been told by her so-called teacher, to stay with the pt, who is only O x 1. What if the pt had begun coughing, vomiting, aspirating, whatever during the tx? Does this pt feed herself? Can she use the call bell?

But - the student should probably suck it up, take the heat, quietly defer to the Instructor, as Rionoir advices. Let the Instructor save face.

Student should make private notes about this, keep it quietly at home, discuss it with absolutely no one else. If anyone else jumps on her (school or facility Admin) or wants to do any more than write her up as they already have, then I guess she can reconsider her course of action at that point.

Hopefully this will quietly pass.

Maybe some "keeping the ears open" will reveal who turned it off and why. I would not verbally investigate.

Best wishes.

Just out of curiosity, you stay with your patients for the full duration of their nebulizer treatments?

[dianah, ASN]

Note: several posts hidden as off-topic and getting personal. Please post to the subject of the thread only.

Thank you.

[JadedCPN, BSN, RN]

On 11/23/2019 at 5:19 PM, Shannon Dull Dunlevy said:

..I do not feel that I as a student, working under another's license..

Just a reminder that this is not accurate. You are not working under another's license. Only the person that the license is licensed to is legally working under their own license.

[beachbabe86]

On 11/24/2019 at 1:04 PM, Orion81RN said:

First of all, your instructor was in the wrong for leaving the patient period. NCLEX world you stay with the patient the entire treatment time and assess. As a student you have the time to do so. In the real world it is the norm to leave and come back. But that is usually not policy. So there's that.

This. During survey time. this is counted as a practice deficiency. If your instructor is going to teach you about medication administration, it would be handy if she is aware of the facility policy.

I am, of course, aware of what happens in RL, However, IMO, you are not in school to learn workarounds or ways to circumvent policy.

As far as the meeting goes, I would NOT throw your instructor under the bus. That can only go one way, and it will not be in your favor.