Nurse Not Doing Her Job

[TreetopAngel_RN]

Keep in mind I don't do well with confrontation, I usually get so angry I start crying...

Two weekends ago I had run out of blood test strips for our monitor on my last patient that morning. I removed the chip from the monitor, and grabbed a new box, intending to replace the new chip and put the new strips in the basket. I got sidetracked by a patient request and didn't follow through with my intentions.

When I got back to work that night, the box of strips was still unopened in the basket and the last readings were the ones I did that morning. The nurse who was on should have done 8 different readings. I also checked the other monitor (our back up) and there were no readings on it that coincided with the numbers the nurse had written in the MAR. Needless to say I was very angry, especially as she recorded that she had given sliding scale insulin to one patient.

I tried calling my DON on the phone to get her input on how she would like to handle this. No answer. I recorded everything on the monitor and the MAR. Worked my shift and reported off to the same nurse. She did the same thing that day. For two days the only readings on the monitor were the readings I had done myself at HS and in the morning on our patients who do not get sliding scale.

Luckily I did not have to report off to the same nurse on Monday morning or I would probably been fired for verbal abuse of a co-worker...

I did, however, write up a two page letter to the DON, highlighting the readings, the falsified numbers in the MAR and the circumstances that led up to it. As of last Tuesday, nothing has been done about this. The DON did tell me on Tuesday that she had gotten my note. I asked her what had been done, she said, "Nothing yet."

I am very upset by this. What should the next step be? Talk to my Administrator or the BON?

Thanks in advance...

Elizabeth

[NoCrumping]

Keep in mind I don't do well with confrontation, I usually get so angry I start crying...

Two weekends ago I had run out of blood test strips for our monitor on my last patient that morning. I removed the chip from the monitor, and grabbed a new box, intending to replace the new chip and put the new strips in the basket. I got sidetracked by a patient request and didn't follow through with my intentions.

When I got back to work that night, the box of strips was still unopened in the basket and the last readings were the ones I did that morning. The nurse who was on should have done 8 different readings. I also checked the other monitor (our back up) and there were no readings on it that coincided with the numbers the nurse had written in the MAR. Needless to say I was very angry, especially as she recorded that she had given sliding scale insulin to one patient.

I tried calling my DON on the phone to get her input on how she would like to handle this. No answer. I recorded everything on the monitor and the MAR. Worked my shift and reported off to the same nurse. She did the same thing that day. For two days the only readings on the monitor were the readings I had done myself at HS and in the morning on our patients who do not get sliding scale.

Luckily I did not have to report off to the same nurse on Monday morning or I would probably been fired for verbal abuse of a co-worker...

I did, however, write up a two page letter to the DON, highlighting the readings, the falsified numbers in the MAR and the circumstances that led up to it. As of last Tuesday, nothing has been done about this. The DON did tell me on Tuesday that she had gotten my note. I asked her what had been done, she said, "Nothing yet."

I am very upset by this. What should the next step be? Talk to my Administrator or the BON?

Thanks in advance...

Elizabeth

Just do your own job, and unless you see something done in front of you, keep your mouth shut. Are results downloaded ? If so, it will catch up with her. My advice is always "dont be a rat"..but, obviously, you allready are one or you wouldnt have this dilemma. Why are you comparing readings anyway? You can remember what reading you got a day ago? Seems to me you were looking for trouble. Just because you found it doesnt make YOU right.

[Joeknee]

Just do your own job, and unless you see something done in front of you, keep your mouth shut. Are results downloaded ? If so, it will catch up with her. My advice is always "dont be a rat"..but, obviously, you allready are one or you wouldnt have this dilemma. Why are you comparing readings anyway? You can remember what reading you got a day ago? Seems to me you were looking for trouble. Just because you found it doesnt make YOU right.

I'm not sure what you should do next but I have to disagree with NoCrumping here. She's not being a "rat", she's looking out for her patient's wellbeing and trying to ensure that they receive safe nursing care.

I think I'd call the BON and ask them what to do.

[TreetopAngel_RN]

Just do your own job, and unless you see something done in front of you, keep your mouth shut. Are results downloaded ? If so, it will catch up with her. My advice is always "dont be a rat"..but, obviously, you allready are one or you wouldnt have this dilemma. Why are you comparing readings anyway? You can remember what reading you got a day ago? Seems to me you were looking for trouble. Just because you found it doesnt make YOU right.

I was comparing readings because it was OBVIOUS she had not done her job. She never set up the monitor to do the readings for the day. And yes, I can remember readings from a day ago, I keep track of how my diabetics are doing on a day-to-day basis. I also chart the readings in the MAR and they are in the memory of the monitor.

I am sorry you think I am a rat for caring that the patients I turn over to another nurse are getting the proper care when I am not at work. It just so happens I care about them and want what is best for them. Obviously you think it's alright to not do a proper job and put your patients at risk...I don't think that way...

[markjrn]

Keep in mind I don't do well with confrontation, I usually get so angry I start crying...

Two weekends ago I had run out of blood test strips for our monitor on my last patient that morning. I removed the chip from the monitor, and grabbed a new box, intending to replace the new chip and put the new strips in the basket. I got sidetracked by a patient request and didn't follow through with my intentions.

When I got back to work that night, the box of strips was still unopened in the basket and the last readings were the ones I did that morning. The nurse who was on should have done 8 different readings. I also checked the other monitor (our back up) and there were no readings on it that coincided with the numbers the nurse had written in the MAR. Needless to say I was very angry, especially as she recorded that she had given sliding scale insulin to one patient.

I tried calling my DON on the phone to get her input on how she would like to handle this. No answer. I recorded everything on the monitor and the MAR. Worked my shift and reported off to the same nurse. She did the same thing that day. For two days the only readings on the monitor were the readings I had done myself at HS and in the morning on our patients who do not get sliding scale.

Luckily I did not have to report off to the same nurse on Monday morning or I would probably been fired for verbal abuse of a co-worker...

I did, however, write up a two page letter to the DON, highlighting the readings, the falsified numbers in the MAR and the circumstances that led up to it. As of last Tuesday, nothing has been done about this. The DON did tell me on Tuesday that she had gotten my note. I asked her what had been done, she said, "Nothing yet."

I am very upset by this. What should the next step be? Talk to my Administrator or the BON?

Thanks in advance...

Elizabeth

I don't blame you for being concerned, medicating diabetics without numbers can be a sure way to kill them.

I guess you could have brought up your concerns with the nurse in question. But you did pass the info along to TPTB, so it's not in your hands anymore. Do your job and don't carry around the burden.

And for what it's worth, I remember my patients sugars from day to day. Pressures too.

[TreetopAngel_RN]

I think I'd call the BON and ask them what to do.

Thank you for the advice. I am heading back into the weekend when she works again. I am not sure if I am going to report off to her and let her work her shift. I don't feel my patients are safe in her care.

[sirI, MSN, APRN, NP]

just do your own job, and unless you see something done in front of you, keep your mouth shut. are results downloaded ? if so, it will catch up with her. my advice is always "dont be a rat"..but, obviously, you allready are one or you wouldnt have this dilemma. why are you comparing readings anyway? you can remember what reading you got a day ago? seems to me you were looking for trouble. just because you found it doesnt make you right.

ignore this post, elisabeth. this is not wise advice!!! go with exactly what you did. follow up in a couple days and if it should happen again, you should report this to your manager and if nothing is done, go over the managers' head and report her/him, too!!!

good luck!! sounds like you are a true patient advocate!

siri, crnp, clnc, rlnc

[TreetopAngel_RN]

I don't blame you for being concerned, medicating diabetics without numbers can be a sure way to kill them.

I guess you could have brought up your concerns with the nurse in question. But you did pass the info along to TPTB, so it's not in your hands anymore. Do your job and don't carry around the burden.

And for what it's worth, I remember my patients sugars from day to day. Pressures too.

As I stated before, I don't do well with confrontation, in order not to blow up I will cry instead...not an effective way to handle things. But, that is my hang up and I am seeking ways to fix the problem. Peri-menopause isn't helping, either...talk about an emotional roller-coaster.

Thank you for your support.

[TreetopAngel_RN]

ignore this post, elisabeth. this is not wise advice!!! go with exactly what you did. follow up in a couple days and if it should happen again, you should report this to your manager and if nothing is done, go over the managers' head and report her/him, too!!!

good luck!! sounds like you are a true patient advocate!

siri, crnp, clnc, rlnc

thank you, i do my very best for all my patients.

i hope i never accidently end up in the hospital that "no crumping" works in...

[sjt9721, BSN, RN]

There is no reason you should have an outright confrontation with this individual. Take report, take care of the patients, and objectively report things if anything is amiss (just as you did previously).

Also please don't jump to the conclusion that the DON won't do anything about it. When accusations are made against an employee, management must conduct some kind of investigation and not act too hastily to avoid possible legal ramifications. (I'm not jumping up to automatically defend the DON, just trying to give her the benefit of doubt!)

Remember to be objective, "just the facts ma'am", when documenting such instances. And thank you, on behalf of your patients and the nursing profession for standing up for what is right. :yelclap:

[julieK]

The only thing I would have done differently would have been to confront the nurse before going straight to the DON. In fact, I think this is a boards-type question. You are always supposed to try and settle things among yourselves before going to management. There may have been another explanation?

Good luck.

-Julie in NYC

[UM Review RN, ASN, RN]

I would have to recommend asking the nurse face-to-face. There have been times when I've come to work and what appears to be a cut-and-dried situation in which someone was clearly at fault, was not.

For instance one nurse accused another of "causing" a patient's hematuria because "she let too much urine drain when she cath'd him and caused bladder spasms." This accusation was made when the nurse was not there to explain or defend herself and was made in front of several coworkers.

What really happened, and the nurse could prove it because she had witnesses, was that the nurse was in a hurry that morning and recorded the TOTAL output before and after she'd clamped the catheter for about 20 minutes. Her reasoning was that it's standard of care to let a certain amount of urine drain, then clamp. She didn't think it was necessary to record that she clamped it.

Anyhow, the point is, there may be a really weird but perfectly logical explanation for this. Who knows? Maybe she used her own glucometer because she felt it was less painful than the facility's.