New to ltac and had a bad experience, any advice?

[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 would've 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 wasn't 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

[Marshall1]

In the end the RN is responsible for making sure the orders are input into the system correctly for the patients they are caring for - if your unit does not have chart checks every shift and every 24 hrs they should..yes, the secretaries place orders and some can make the run for some items that are ordered but the final check is w/the nurse. What I'm curious about is most facilities have a check at the blood bank - meaning whomever is picking up the item verifies with the blood bank/lab person that the product is the correct one and for the correct patient. Also, if you are EVER is a position to give a medication, perform a test or procedure and are not sure or have never done it ASK. I am surprised, honestly, that you were not aware of the difference in what platelets and PRBC's looked like..most nursing students I would think would come across this if not in text and clinical then just in text.....I can understand you being concerned..as to what comes next that is something you would need to ask your manager about. As far as her personality..it is what it is..you can either fight against it (which will make things harder on you), learn to work with it (not like it but work with it) or get another job. Nursing, especially in the hospital setting, is TOUGH these days - its not for everyone and not every unit is for everyone. Sometimes what we think is "our dream job" is exactly that - a dream not the reality of the job itself.

Check back w/her tomorrow or next time you are at work - be proactive so you can cut the worry down and most of all LEARN from this - in the end YOU are responsible for the orders that relate to your patient - making sure they are transcribed etc - just as you are responsible for making sure the diet or med orders are correct. Right or wrong, nurses are the stop end for the patient.

[bioniclewoman]

I think you will just have to learn to deal with the manager. If it makes you fill any better, managers usually don't last long. You might have a much nicer manager this time next year. Sometimes you have to spend a few months at a new job figuring out how to stay out of trouble, and off the managers radar.

We order blood products very differently. The nurse fills out a paper order sheet, and the unit sec calls the blood bank. The blood bank picks up the paper order, and then delivers the blood to our unit. Usually the unit sec signs for the blood, but no one opens and verify anything at that point. The blood is sealed in a cooler and the nurses usually open it at the bedside.

Blood is checked with two nurses for a reason. Why would you be in trouble even if you and another nurse checked the blood together and caught the mistake? That is the whole reason for the two nurse check.

Take it as a lesson: what platelets look like, you can't trust unit secretaries ever, and this co-signing nurse is a liar.

And I didn't know what platelets looked like either until I had been a nurse for a year.