Needing some support

[NewSchoolNurse14]

Hi everyone,

I joined this site because of the comments and advice and support I have come across over the years while researching certain topics and questions I have had... And I am now in need of some support. I have been a nurse for 5 years in the ICU setting and have just started in an elementary school as a second nurse. I am not yet certified but in the process... I have never in my nursing career made any mistakes that have made me feel so terrible and I need a place to discuss this...this is a long one...

so here it goes, yesterday I was the only nurse in our office due to the other nurses absence.. And a grandparent was sent in by a mother with her two kids' Ritilin pills..in a zip lock bag with no name of med or child or anything... (The script bottles are at the school and she comes biweekly to fill them) So I refused to accept them and explained the proper procedure into dropping off meds. Well the kids had no meds for the day.. It was 11:30am and they usually come down at 1 for the meds. I asked the grandmother if she could come back at that time (1:00) because I could not administer them and she couldnt and so I thought about how things are in the hospital, you're able to safely give a med hour before and after it is due.. It was busy in the office and that was what I came up with at that time. So the grandmother have the kids the meds at 11:30. Well mom called furious which made me realize how irresponsible it was of me to allow this. And I agree, I should have called her first and figured out a plan. The student had had his am dose 3 1/2 hours before and that never even crossed my mind. I let my administrative team know what had gone on and they were supportive but are also not nurses and do not feel the guilt I have. I called the student down twice to check on him and he was fine (without letting him knowing there was any concern) and then his mother called me at the end of the day apologizing for yelling but explained all of her concerns. And I of course apologized and explained my thought process at the time and what I should have done and how this is a learning experience from me. We ended the conversation on a good note but I have this enormous amount of guilt and I have not been able to think about anything else. Couldn't sleep all night and when I did I had nightmares about it. I've looked up the drug and the half life and side effects and I'm going crazy.

I know now it is over with and nothing I can change and have certainly learned from the situation but how can I stop thinking about it?? I'm making myself sick. Any thoughts or advice would be helpful. Thanks in advance.

[ktwlpn, LPN]

Plenty of people miss or forget a dose of meds, parents often forget their kids med's,people forget their pet's meds, it happens.

It's the PARENTS responsibility to make sure they keep the school supplied. NOT YOURS.The family could have returned later in the day with the labeled med per protocol.

Plenty of children take "drug holidays" on the weekend and skip their Ritalin those two days.

You are obsessing over something that was NOT your responsibility.

Sounds like the mother skipped her dose as well

[fetch, BSN, RN]

I hate the family issues that come up - grandma brings in meds and signs all the paperwork and is the only one ever seen in the clinic, but surprise! doesn't have custody and isn't authorized to approve a change in med time; or auntie is the one who always drops the kids off but isn't on the list of approved people to pick students up so when the kiddo vomits walking in she can't take him back home, ARRGH.

As for the dose too soon - next time, you'll remember to consider AM doses (this comes up with asthma kiddos too! parents give albuterol before school, kid shows up right away for another dose) and you'll remember to call the parent to double check. You ended up on a positive note with the parent. Try and shake it off and move on - the kid is fine, don't stress over it.

[OldDude]

I can understand why you're feeling like you are....being in the ICU that long has taught you there isn't room for error and the only acceptable nursing standard is perfection; ICU nurses scare me!! Having said that, the only error made here was by mom and grandmom and this med timing incident was no big deal. Geez, if dosing was that critical kids would be dying every day considering the way some parents handle med administration! This is only a glimpse of what you'll deal with in the future. Like Yoda said, "let go Luke!"

[rbytsdy]

I HATE the ziploc baggie drop off. All the parent has to do is tell the pharmacy a dose is being given in school and the pharmacist can divide into 2 containers. The parent is responsible here too. This is a controlled med and just handing a bag of pills over the counter is not acceptable.

But it sucks - you are just responsible for thinking about this child's meds - you have whole school of children with meds. For the past 2 weeks, I had a student who needed her inhaler q4h. She was getting up at 6:30am and mom asked me to give her the inhaler twice in school which meant exactly 10:30 and 2:30pm (which is dismissal time). The student is in 1st grade so she didn't remember. Her teacher didn't remember. And sometimes I didn't remember! One time, she didn't get her inhaler until noon. I had to call mom and tell her that I would listen to her daughter's lungs but I couldn't medicate her again during school hours. Another day, she didn't come down until 11:15am. I wound up staying until 3:15 and pulling the child out of aftercare to give her the 2nd treatment.

Honestly - you can only do your best! You juggle a lot of students in the nurse's office.

[100kids, BSN, RN]

No matter what people think this job is not easy. There is no documentation for you to look at for morning medication times and what was given when, but you have to be conscious of it. You will always be so in the future but don't beat yourself up here. This child's parent is responsible for getting you the needed medication in an appropriate container. If they had done their part there would have been no issue. Take a breath and move on. It all turned out ok.