Need some advice...please

[dusoleil264]

I have to start by saying I'm feeling so depressed, that as I write this, I feel like tears will soon stream down my face. I have been an LPN for 7 years, and just recently (4 months ago,), got my RN license. The truth is that as an LPN I didn't get too varied an experience, as I only worked at two nursing homes. Well, I got this new job about two months ago, working at a ventilator/telemetry unit, which is almost like a long term, step down ccu. I was so excited with this job at first, the pay is awesome and the staff appeared to be nice, but things are just going terrible. For starters, the unit manager is just rude and juvenile, she almost tries too hard to be stern, to the point that she is just rude and offensive, and I feel like I can't even talk to her. Anyway, to get to the point, the WORST thing happened to me a few days ago and today she reprimanded me over the phone and I just felt my world fall apart. What happened was that a few days ago I had a patient with a platelet count of 50k and the doctor gave the charge nurse T/O for one unit of platelet transfusion. When I saw the order, I went to secretary and stated that the patient had just received an order for blood product and if she had already printed out the labels for type and cross. She proceeded by saying "He got order for blood? He just had blood three days ago, let me call the lab to see if the last type and cross is still valid." While she was doing this, I went into the patients chart and confirmed that indeed, two days before he did have blood, so I went ahead and handed the chart back to her. She told me that blood bank said the previous type and cross was good, so she was going to order the blood and pick it up for me (which in my facility she is permitted to do). When I came back about 15 minutes later, she told me she had already picked up the blood for me and when she was about to hand it to me, the charge nurse said "no, what are you doing, that's blood, the patient needs to get platelets", and I said "yes the order is for platelets, not blood, ill return it to the blood bank now and get the correct product", and then the charge nurse starts complaining telling me I need to be more attentive. As I explained to her, Ive never given blood so I dont know that physically, platelets looked different from blood, but I wouldve noticed when reviewing the orders because the slip says "packed rbcs" vs "platelets" but she kept rambling on and so forth. SO TODAY, the evil witch of my unit manager who is so rude, said she had to speak to me regarding this error and that I was the one with the license and not the secretary. I explained to her that the responsibility of putting in the order of what kind of blood product was needed, was the secretary's and that she was the one who picked it up and as soon as she was handing it to me, we realized it wasnt platelets. She says she was told that I had asked a nurse to co-sign with me, and this nurse knew it was platelets and caught the error and stopped me, which was not the case. I think the charge nurse made all of this up and when I told her it didnt get that far, she said "Oh, if thats the case then its not your fault, but i need to speak to other people to get the story straight". Now I dont know what to expect, and Im very scared. I feel like this charge nurse, who I thought I could trust, misconstrued everything and I almost got in big trouble. What can happen from all of this? What can I do? Will I be written up or reprimanded? PLEASE HELP AND ADVICE FROM EXPERIENCED RN'S ...THANKS

[MrChicagoRN, RN]

It sounds like she heard one story, then backed off after talking to you. Take a deep breath and try to think about other things.

Worrying won't help

[dusoleil264]

I know, I just hope she doesn't just go by what she was told. It bothers me because the only nurse who couldve told her was the charge nurse who is her good friend, and since I'm new and she barely knows me, God knows if she'll even believe me. Ughh.. I dont even feel like working at this place anymore. I just feel like she's so impartial, and I guess the fact that other nurses on the floor warned me it would be this way, Im kinda disillusioned by the whole place. Thanks for the advice. Ill keep you posted lol

[evolvingrn, BSN, RN]

As a new rn , how would they take you off orientation without having hung multiple blood products. It would be concerning to me that a nurse who is off orientation wouldn't know the did fence at first glance. I'm not saying that as a judgement against you but the training / orientation you received

[RNewbie]

This also sounds like a system issue. How did the blood bank give prbcs when the order was for platelets?

[applewhitern, BSN, RN]

First, I am confused about why the blood bank gave PRBC's instead of platelets. Did the secretary actually order PRBC's? If so, then did you check her orders? Second, I am confused as to why someone would think you should stay on orientation until you have given multiple blood products. This is what nursing school is for. If you follow policy, it would be pretty hard to screw up. I wouldn't worry about it, because you did not give the wrong product, so no harm to the patient. Also, isn't this why we have multiple checks prior to giving blood?

[Born_2BRN]

I actually work with one of those type of evil witches. They do exist and yes if they don't like you you will be their main target. In reality you suppose to check all put in orders in the system against secretary's work to ensure all correct. If not you let her know. In this case both the nurse and secretary are at fault. You shouldn't be fired for that though I don't think. Everyone makes mistake in the nursing profession with type of working environment we are in. From these we will learn to be a better nurses as long as no harm has brought to the patients.

[evolvingrn, BSN, RN]

applewhitern, they don't learn to hang blood in school they perhaps review it but very few get the opportunity to actually hang blood (heck most of the new grads i have trained have never even started and iv) , but the safeguards are facility to facility and its such a high-risk activity that makes a lot of new grads nervous. at least where i work , we like to get them fairly comfortable with it to take the 'fear' our of it. (that most new grads have) i don't think the unit secretary is to blame. I think its a communication issues that lies at the fault of the charge nurse and the above mentioned rn. to quote the above post

"When I saw the order, I went to secretary and stated that the patient had just received an order for blood product and if she had already printed out the labels for type and cross. She proceeded by saying "He got order for blood? He just had blood three days ago, let me call the lab to see if the last type and cross is still valid." While she was doing this, I went into the patients chart and confirmed that indeed, two days before he did have blood, so I went ahead and handed the chart back to her. She told me that blood bank said the previous type and cross was good, so she was going to order the blood and pick it up for me (which in my facility she is permitted to do). "

There were ample opportunities to correct that miscommunication and that wasn't done. by using the word 'blood products' and not clarifying which type was needed when the unit secretary very clearly communicated that she thought it was blood. I guess i can't figure out how this wasn't fixed by the OP at that time? when you don't have an electronic mar/ documentation system for MD orders mistakes like this can happen so easily. thankfully no one actually got hurt here but if were the charge i would absolutely have reported that this happened. it was an error.

[Sadala, ADN, RN]

This also sounds like a system issue. How did the blood bank give prbcs when the order was for platelets?

Apparently, if I understand this correctly, their unit secretary orders and picks up blood products?... And the secretary put in the wrong order. That's what I got from it anyway.

[nurseprnRN, BSN, RN]

Any fool can transport a bag from the blood bank. I fought long and hard to get my hospital to let us send the secretary so we didn't have to remove an RN from the ICU at a time when hey! Somebody's bleeding! The checks occur at the blood bank (they have 2 people check the order there) and at the bedside (2 RNs). The transport mechanism is not part of that.

OP: Never call them "blood products" again. Say what the thing IS-- platelets, fresh frozen plasma, packed cells, leukopoor cells, whatever.

Your secretary is overstepping and made the error, and the blood bank ought to have had the order correctly too. Sounds to me like your UM has the right idea, to check everyone else's role in this foolishness. Stop worrying so much.