NEW NURSE: Help! Tell me why what I did was wrong??

[ricksy]

Hey guys. Need your input. New nurse- 5 months LTC. Great and helpful DON. Breezing along pretty well, then got to work today and called in by DON. We have a 70 yr old beginning dementia patient who is diabetic. Her much younger husband signs her out on Saturdays and Sundays in the mornings and brings her back at end of day. I have never worked on days but do know that the other nurses note when they give him her oral meds to take. I always assumed he read her accuchecks and gave her coverage. The other night he called me and said that he had checked her BS and it I read HI. She was asymptomatic, as usual, and he had not planned bring her in for a few hours. I know the policy is to call the physician if over 400, so I did...and he gave me his order. I called the husband at home and told him the units ordered. When he brought her in a few hours later, she was checked again and it was down. I charted and SBARd. I was pulled in today and told the legal department was called by our DON and that I was not to do this.....please explain. I feel that my patient need the coverage, and knew he was not going to bring her in. Also, should I find out if any of our nurses supplied him with the insulin, or just let that go. Help!

[TheCommuter, BSN, RN]

In LTC, once a family member takes a resident out of the building on pass, that resident becomes the legal responsibility of the family member who signed them out for the duration they're out of the facility.

We, the LTC staff, no longer assume responsibility for any resident who has been signed out. Once the resident has returned to the facility, we once again become legally responsible for his/her care.

You assumed responsibility for a resident who was not in the care of the facility by calling the physician and obtaining orders. Another problematic issue arises when you obtained doctors orders without personally seeing the resident, totally based off assesments that you did not personally perform and glucometer readings that you did not obtain with a machine that the facility did not calibrate. All of these are potential legal issues, although no harm came to your resident (I assume).

I know it may seem confusing and nonsensical, but facility policies are put in place for a reason. Good luck to you.

[ricksy]

Thanks for your help. I can't quit thinking about how dumb it was. The resident is fine, but I can't quit thinking about it and how dumb the DON must think I am ....UGH

[ktwlpn, LPN]

I had a fella go OOP with family one Sunday afternoon and right before the end of my shift a family member called and told me to "call the doc and get an order for antibiotics,dad has blood in his urine-you can start them when he gets back". Really? They had not checked his temp ,he was alert and confused as usual, I asked the son what the urine looked like and all he would say is" it's got blood in it,I tell you this means dad has a UTI" After conferring with my supe I explained to the family how I could not call the doc without assessing the patient myself and I told the family to pick 1 of the following -#1-call 911 or #2 bring him back right now....Well , they choose to finish dinner and watch the football game. They brought him back to the home at around 10:30.He had a dime sized bloody clot in his drainage bag, the urine was clear yellow and it turned out he did not have a UTI.

[ricksy]

..now that you put it that way, I see. I am so mad at myself right now. My DON told me not to beat myself up over it, that I was new, but I feel so horrible. I keep thinking I will be let go. UGH

[NurseGuyBri]

Stop being mad at yourself. YOU LEARNED! The point is now to A) not repeat the same mistake, and B) apply this information to other issues that can (and will) arise. This is why you shouldn't beat yourself up. If you do it again, by all means, punch yourself in the face. You done wrong, but you learned. That's real nursing!

[SuesquatchRN, BSN, RN]

Bri, do NOT be mad at yourself. You did what a conscientious, prudent new nurse would do - tried to take care of your patient to the best of your ability. Now you know, and won't make that mistake again. Next time, ask the husband to please bring her back if he wants so you can assess her yourself and get orders. Chart that. If he does not comply you and the facility are covered.