Bullies at the work place.. vent

artsmom, BSN, LPN · Sep 27, 2012

You can check if a med was given by looking in the pyxis, if there was one. The OP didn't say what the omitted med was. Colace? Look the other way. However, I found that one of my co-workers accidentally discontinued dilantin from a patient's med sheet, and the pharmacy went along with it, despite no order. The patient went 4 days without, and when I found it, I reported it since the patient needed labs and it could have been serious.

The OP also mentioned that this nurse had more than one incident- even if they were just colace, or non critical drugs, it clearly needed to be brought to the nurse's attention that she wasn't paying enough attention. From what I read, the OP did nothing wrong.

JRP1120, RN · Sep 27, 2012

I've been having a bit of an issue with this one nurse that I follow, 95% of the time (we both have set schedules so I usually take report from her and give her report when I'm going off). I don't know what to do about it as I don't want to "report her" but it's becoming an every time thing. We usually have the same patients every week as well so we both know them pretty well. First of all, she comes in 15 min late which leaves me 15 min to report off to her as our unit has been under the gun to get out no later than 20 after or we get a nasty gram from our manager (apparently there have been a select few who like to stay late on the clock, so much so the higher ups have brought it to her attention and now we all must hurry along and get out "on time" so as to not create the extra min=more money coming out of our budget). I realize sometimes it cannot be avoided. However, this nurse comes in late every single time she's on. My guess is that she keeps doing it because she's been allowed to get away with it for so long. She was on time the last morning I had to report off to her though and was watching the clock and telling me we needed to hurry so I could get out on time so I guess maybe the NM finally said something to her as she did mumble something about getting a nasty-gram email about getting in and out on time. I hope it lasts!

As I've been following her though, it seems more and more, meds on her shift show up as "late" and appear to be not given. There are things like Colace or Nystatin, etc., and those are not real biggies as usually she tells me why. One night though, she told me of one of our pts blood sugar checks, which was like 159, at dinner time. This pt is to get 15 units of 70/30 with breakfast and dinner and then get sliding scale coverage. She said she didn't cover her and "she ate her entire meal". I asked her why and she didn't really have an answer for me; we got interrupted at that point and when we went back to report, she looked at the clock and said how she had to hurry to get out on time. Nothing more was said. So of course, at 2100 when I take her BS, it's 240! I am puzzled why she didn't give her the scheduled 70/30 and the SSI as ordered.

Another time, on another patient, they were scheduled to get their Inderal every 8 hours. She gave me report, never said she didn't give the 1900 dose so it showed up on my EMAR as late and not given. We are not supposed to have any meds due at that time as it's shift change (I wondered why the night before I was giving it to her at 3AM). So I notified the pharmacy and asked them to change the times of the Inderal admin so it wouldn't fall during shift change; that is protocol in our hospital, pharmacy knows this but it got missed and so that's why it was still set up that way (on previous nights I never saw it come up on my EMAR because the day shift nurses were giving it between 1800-1830). So I told her what I did the next AM when I gave her report and she told me she GAVE THE MED (No, I did not give her the 1900 dose, partly because I didn't know if she had given it but just didn't chart it so it just remained missed and I watched my patient closely throughout the night and after the pharmacy changed the times, I gave her my dose at 0100). She was upset with me that I had the pharmacy change the times and asked me why I did that. When I explained that it's protocol for our hospital that meds not be scheduled for during shift change times, she just rolled her eyes at me; now she'd have to give the med twice during her shift instead of just once. Well, I'm sorry, there's a protocol in place for a reason, so that meds don't get missed, just like this one did. Based on my pt's BP and pulse, she couldn't have given her the med. And this is what I don't understand: If you give a med, you have to scan it, then the pt, and it goes away on your EMAR and shows that you gave it and what time...how is she giving meds and not charting them? That's not safe practice! This has been going on for weeks now, and more and more meds are showing up as late, that she's not giving, insulins, BP meds, etc...not to mention she always says she's going to give so and so this and ask the Dr that, and then when she reports off to me she's like, "nope I didn't" She also doesn't sign off on things and do her chart checks. So I'm left picking up her pieces and doing a lot of her work she leaves undone. It's not so much that that bothers me, it's the potential harm that could be caused some of these patients by her seemingly lack of...I don't know what you'd call it, that scares me. I've only been a nurse a little over a year so I'm still trying to keep all my ducks in a row. I've never had to follow someone yet with so much left over stuff. Thankfully, I've been diligent and always ask my fellow nurses I'm working with if this is right, or looks right, or why did she leave this or that...I am determined not to make a med error because of her.

I don't want to report her (I've never reported anyone and would rather not ever have to). I guess I'll continue to ask her if she gave this med or that med and ask for explanations if she didn't and insist I get an answer before she leaves. It all just leaves me feeling uneasy and worried and honestly, a little like I can't trust her that she did what she said she did. So, I'm finding myself getting a fresh PEG tube feeding bag and hanging it on my shift and not relying on her "oh that's a new bag hanging; I hung it this AM" because the line isn't marked with a date. I realize things will get missed but I'm scared to death I'm gonna make a mistake as a result of her not doing the right thing, or what she's supposed to do. There are many more little instances here and there of things that I'm seeing coming from her that could be potentially bad and I don't know if I should just keep trying to fix them and tell her or finally get up the nerve to "report her". I know I would want someone to come to me and tell me things first and not just report me. I believe in team work and for the time I've been on my unit, most of the nurses do work as a team and help each other out. There are a few that would throw you under the bus in an instant and lucklily I don't work with them anymore. Thanks for listening to my "rant".

BlessedbyGodRN · Sep 27, 2012

I'm a new graduate RN. I don't even start my first RN job until early next month. Even I know that when a medication error occurs it is the nurses RESPONSIBILITY to notify the charge nurse, an incident report needs to be filled out and the patient's physician needs to be notified so that the doctor has the opportunity to take corrective interventions on the patient's behalf if needed. I'm surprised that people are talking about tattling and all other kinds of nonsense. Tattling is not the issue. The patient is the issue plain and simple... I hope that as I gain experience as a nurse that I never get so big headed to think that I am above being corrected. When you get to that point you are a danger to your patients. And please, don't proceed to tell me to wait until I've been nursing for a while to give my opinion. I am new to nursing, but not healthcare. I have been a Respiratory Therapist for over 12 years and I'm still learning. That's what being a healthcare PROFESSIONAL is all about...constantly learning and improving. How can you learn anything when no one can ever correct you?

Makes me wonder how some people ever got a license to practice anything...

Ruby Vee, BSN · Sep 27, 2012

I am so angry .. I turned a nurse in awhile back for a med error .. she confronted me and I told her that I had to do it because the pt did not receive the medication that was ordered .. she got mad and yelled "I would never throw anyone under the bus the way you did me."
I explained that we are here for the pt's and it was the right thing to do .. she got mad and said "next time you find something i missed have the courtesy to talk to me first."
I thought what the heck?
Then someone found mistakes she made during a audit she got angry and said I'm sick of people throwing me under the bus .. I'd never do that to any of you. She went onto say I do alot to help you guys and all you do is throw me under the bus.
I have never heard anyone so angry. I tried to explain we all make mistakes.. and she said "I would never do what you do to people."
Has anyone ever worked with a co worker who got mad because you threw them under the bus? It's the pt's who lose out not her.. grrrrrr and thank you for listening to my vent...

You threw her under the bus. You should have had the courtesy to talk to her first -- UNLESS you've caught several med errors, have talked to her frequently and she paid no attention when you tried to talk to her. We all make mistakes . . . she did, too.

We see many, many posts here about bullying -- and "turning someone in" without talking to them first is one thing that is often construed as bullying. If you wouldn't want it done to you, don't do it to someone else.

Ruby Vee, BSN · Sep 27, 2012

I think there's one like this in every facility. I wouldn't tell her anything! She sounds like she'd cover it up or just lie. Your responsibility is to your patients and yourself. You don't want to get involved in some sort of conspiracy! Keep doing what your doing, if she harasses you, go to H. R, don't let her bully you

I don't understand "there's one like this'? Are you talking about the nurse who made the med error? Or the OP who threw her under the bus?

The OP didn't really give us enough details, but I'm leaning toward thinking that the OP is the bully in this scenario.

Ruby Vee, BSN · Sep 27, 2012

I believe you did the correct thing to fill out an occurrence report. The patient did not get the medications as prescribed and that is a PROBLEM. Of course, there is a difference between a missed dose of Colace and a missed dose of Coumadin but that is not the POINT. The point is an error of omission occurred and it needs to be reported b/c if it is happening a problem exists, Yes.... it is true most errors like this are a systems problem with many layers to them and systems cannot be corrected unless we report.
The nurse was reporting the incident not necessarily the nurse that made the error. There are times that going directly to the individual when there is a problem is a wise course of action. That is when the problem is one of an interpersonal nature. I think you would not find any policy that states you need to go to the nurse that made a med error instead of or before you fill out an occurrence report.
Instead of the nurse freaking out and misinterpreting the situation as"throwing her under the bus" she should first learn to grow up and take responsibilities for her professional actions or inaction. Perhaps that way she could actually take in the error so she can learn from it and try to prevent any in the future because that is what a wise mature person would do. I would also tell her that as well.
If the problem was of another nursing nature such as something that could have been better or differently..well than yes I would go directly to the nurse BUT not a medication error.

Errors of omission don't necessarily have to be reported immediately without talking to the other nurse. If there was harm to the patient -- a missed dose of Coumadin or Vancomycin, for example -- of course they have to be reported. But if I were the nurse who had made that error, I would hope the nurse reporting it would have the courtesy to shoot me a text message, an email or CALL me to let me know. If it was something minor like Colace, I'd hope they'd wait and let me self-report.

If this was a missed Colace, I find it hard to criticize the other nurse for "misinterpreting the situation as throwing her under the bus." In that case, I'd criticize the OP for bullying behavior.

That Guy, BSN, RN, EMT-B · Sep 27, 2012

I would be mad at you too. Granted, I wouldnt act like she did, but you bet I would be mad. I hate that people cant confront the person first and let them know what is going on. You have an issue with something I did, hey let me know about it. I can fix it that way. Sure med errors do need to be reported but let me know why the firing line is gathering around me.

Ruby Vee, BSN · Sep 27, 2012

I'm a new graduate RN. I don't even start my first RN job until early next month. Even I know that when a medication error occurs it is the nurses RESPONSIBILITY to notify the charge nurse, an incident report needs to be filled out and the patient's physician needs to be notified so that the doctor has the opportunity to take corrective interventions on the patient's behalf if needed. I'm surprised that people are talking about tattling and all other kinds of nonsense. Tattling is not the issue. The patient is the issue plain and simple... I hope that as I gain experience as a nurse that I never get so big headed to think that I am above being corrected. When you get to that point you are a danger to your patients. And please, don't proceed to tell me to wait until I've been nursing for a while to give my opinion. I am new to nursing, but not healthcare. I have been a Respiratory Therapist for over 12 years and I'm still learning. That's what being a healthcare PROFESSIONAL is all about...constantly learning and improving. How can you learn anything when no one can ever correct you?
Makes me wonder how some people ever got a license to practice anything...

As a respiratory therapist, would you take it as helpful for someone to fill out an occurrance every time they found an oxygen tank at

Ruby Vee, BSN · Sep 27, 2012

I think using the hot button word "bullying" here is completely off base. She was upset, made a couple of comments. Approached you once. Being upset does not make someone a bully. This word is being seriously abused these days. You had a human interaction, you were not bullied.

I agree with you that the original poster was not bullied. I'm not so sure the original poster isn't exhibiting bullying behavior.

BlessedbyGodRN · Sep 27, 2012

As a respiratory therapist, would you take it as helpful for someone to fill out an occurrance every time they found an oxygen tank at
Did you read the part further down in the post that said, "then someone found mistakes she made during an audit," etc.? Her reaction was still getting mad and mouthing off about being thrown under the bus. Maybe if she would calm down and listen, she'd be prone to less mistakes. It seems like the nurse who keeps getting upset for being thrown under the bus needs to learn the difference between personal attacks and constructive corrective action. I guess after so many years of being in healthcare, I just don't take these things personally. Some people are too sensitive. Or maybe it's a pride issue. I don't know. I have a friend who somehow always finds a way to play victim in these kinds of situations. I have witnessed her sabotage her own career countless times, because she has never learned to just not take everything to heart. I recently went through yearly evaluation and received many excellent comments from my supervisor. She also included one very, very, extraordinarily dumb thing that I did earlier in the year. I am not Miss Perfect. She stated that there was no way she could not include it as a part of my evaluation. On our evaluations we get rated as does not achieve, achieves or exceeds. It's very difficult to get exceeds on our evaluations. Instead of getting upset for the one misjudgement that was mentioned, I chose to focus on the four exceeds that I accomplished. Surely, you understand that this young lady needs an attitude adjustment or she is just going to burn herself out?

BlessedbyGodRN · Sep 27, 2012

Did you read the part further down in the post that said, "then someone found mistakes she made during an audit," etc.? Her reaction was still getting mad and mouthing off about being thrown under the bus. Maybe if she would calm down and listen, she'd be prone to less mistakes. It seems like the nurse who keeps getting upset for being thrown under the bus needs to learn the difference between personal attacks and constructive corrective action. I guess after so many years of being in healthcare, I just don't take these things personally. Some people are too sensitive. Or maybe it's a pride issue. I don't know. I have a friend who somehow always finds a way to play victim in these kinds of situations. I have witnessed her sabotage her own career countless times, because she has never learned to just not take everything to heart. I recently went through yearly evaluation and received many excellent comments from my supervisor. She also included one very, very, extraordinarily dumb thing that I did earlier in the year. I am not Miss Perfect. She stated that there was no way she could not include it as a part of my evaluation. On our evaluations we get rated as does not achieve, achieves or exceeds. It's very difficult to get exceeds on our evaluations. Instead of getting upset for the one misjudgement that was mentioned, I chose to focus on the four exceeds that I accomplished. Surely, you understand that this young lady needs an attitude adjustment or she is just going to burn herself out?

Just thought I'd mention, the mistake I made did not involve patient care, but it was none the less financially costly for the department.

FMF Corpsman, MSN, RN · Sep 27, 2012

I think using the hot button word "bullying" here is completely off base. She was upset, made a couple of comments. Approached you once. Being upset does not make someone a bully. This word is being seriously abused these days. You had a human interaction, you were not bullied.

People responding to these post, please, please make a point of either quoting or referencing the person or persons you are addressing, and on a side note, spellcheck wouldn't hurt either. Spelling or an attention to details reflects well on a persons annual review, as does the opposite. If you are lackadaisical with your spelling and/or punctuation it reflects badly on you.