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?
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...
You are not being a rat. You are attempting to do the responsible thing. I do have one question. I am an insulin dependent diabetic. When I am hospitalized, my sugar is checked four times a day. If it is not, I am on the bell asking why it hasn't been checked? How old and how competent are your patients? I would report it to the chief operating officer and the nursing director, both in writing and verbally. You may want to follow up with your BON.
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.
I agree that ratting in this case is protecting the pt. BUT... is there any chance that she used another glucometer. We have 4 throughout our building. I just want to make sure you are thinking of other possibilities.
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:
Agree with the above, Treetop..... I, too, would be concerned... VERY concerned.
But give your DON the time she needs to investigate this.. it will all come out in the wash. Just keep caring competently for your patients.
I think I would have mentioned this to the coworker, however.. that you just happened to notice this as you had not been able to put in the new chip.. and found she had not been taking readings.. and ask if she could explain why? And how was it that there were readings noted in the MAR.
Is it possible that there is another monitor somewhere on the unit, or sister unit... ANYWHERE ?
Gotta go with this as well.. good advice.
Always be CERTAIN before you get ahead of yourself.
Did you ask the nurse directly if she used a borrowed monitor from another unit? Did you ask any of the patients if they remember getting a dstick at that specefic time? Before you accuse someone of falsifying records you need to make absolutely certain that is what happened and that absolutely on involves confronting that indivual with your information before you take it to a higher source.
Specializes in LTC,Hospice/palliative care,acute care.
Ummm...guys. This is America. A few of you have this nurse tried and convicted before her side of the story has even been told.
Let's try to be fair, ok? There MIGHT be a reasonable explanation!
If there isn't a really good explanation, THEN hang her out to dry. But geez, jumping to the conclusion that she's evil and a potential mass murderer?!
A tad overreactive, IMO.
well---Look at it this way----If your mother was one of these residents would you feel differently? I believe that I said that I would not be surprised if a nurse that would do this type of thing would be capable of escalating their behaviors and yes-becoming a mercy killer.....How do you know if a nurse like this is really giving meds? Doing treatments?The LTC population is predominantly helpless...It should NOT be a surprise to anyone that there are staff members that prey on them.....As I said in my post I have seen ALOT -including a housekeeper GO TO JAIL for raping a female PVS resident.....When I hear hoofbeats I think horses-NOT zebras.....If it turns out that the other nurse went to another unit to borrow the accucheck 2 days in a row (I doubt it) then I'll admit I'm wrong....But I don't think so---nothing surprises me these days....
Specializes in ER, ICU, Infusion, peds, informatics.
i agree that you did the right thing in reporting her, and did a really great job of collecting the data your don will need to act.
unfortunatly, s/he may not act on this info, and you will probably never know one way or the other, unless the nurse in question mentions something. but if i had to bet on it, i would say that your don will at least speak to the nurse about the situation.
all i can say is try to keep it from bothering you.
and, i did work with an er nurse not so long ago who used to bring her own glucometer with her to work. (it was one of her many quirks). now, there are several problems with what she was doing, but she was indeed doing her blood sugars (i think she got frustrated with not being able to find a glucometer when she needed it)
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.
This is EXTRAORDINARLY bad advice. You have uncovered a potential problem, specifically a nurse charting actions not done. (I'm not saying she did or didn't do it, simply sumarizing what the appearance is.) Further, she is taking action on the action not done. You have uncovered evidence that does give you a reasonable suspicion.
So, if something happens to one of these patients, like say, dying from a dose of insulin that was too great, and it becomes known that you were aware of the situation, YOU are just as legally liable as is the nurse who committed the act. You have done the right thing so far, and I don't know that I'd push it real hard. However, I would write up a statement saying exactly what you have described. Make it highly detailed, including the blood sugar readings you got, and that you did not find the other nurse's charted readings in the glucometer's memory. Keep a copy, and give a copy to the DON. Have her initial your copy as proof it was provided. No, it probably won't make her happy, but it will cover your butt. You have taken the appropriate action, and will now have documentation of that fact. If anything ever comes back, you can show that you took the appropriate actions.
It's clear you care about your patients and that's commendable, but especially where you hate confrontation, I feel you could have gone about tackling this dilemma a bit differently. If it turns out you accuse someone wrongly you are definitely going to be doing some confronting. First of all, you have only circumstantial evidence that the nurse didn't do the blood sugars. Like has been said, you could have casually asked a patient what her blood sugars were the shift before or something to that effect, to find out if they had been done. If this nurse is negligent, it will come out in other ways, too. Ask a pateint when her V/S's were done last when you follow that nurse. I don't think you are a "rat" at all, but I think you could have gone about this a bit differently to avoid possibly putting grief upon yourself needlessly. Contacting the BON is very extreme. Since you did tell your supervisor, let it go. If this nurse is not doing blood sugars, they'll be on it.
This is a little removed from the topic, but even though a patient is alert and oriented doesn't necessarily mean that they are reliable.
I have had patients in the hospital that have said they were never told something, when I know darn well they were because I told them myself, also patients will sometimes say they didn't get something when they did. Forgetful, who knows, but you can't always go by what a patient says either.
It's clear you care about your patients and that's commendable, but especially where you hate confrontation, I feel you could have gone about tackling this dilemma a bit differently. If it turns out you accuse someone wrongly you are definitely going to be doing some confronting. First of all, you have only circumstantial evidence that the nurse didn't do the blood sugars. Like has been said, you could have casually asked a patient what her blood sugars were the shift before or something to that effect, to find out if they had been done. If this nurse is negligent, it will come out in other ways, too. Ask a pateint when her V/S's were done last when you follow that nurse. I don't think you are a "rat" at all, but I think you could have gone about this a bit differently to avoid possibly putting grief upon yourself needlessly. Contacting the BON is very extreme. Since you did tell your supervisor, let it go. If this nurse is not doing blood sugars, they'll be on it.
well---Look at it this way----If your mother was one of these residents would you feel differently? I believe that I said that I would not be surprised if a nurse that would do this type of thing would be capable of escalating their behaviors and yes-becoming a mercy killer.....How do you know if a nurse like this is really giving meds? Doing treatments?The LTC population is predominantly helpless...It should NOT be a surprise to anyone that there are staff members that prey on them.....As I said in my post I have seen ALOT -including a housekeeper GO TO JAIL for raping a female PVS resident.....When I hear hoofbeats I think horses-NOT zebras.....If it turns out that the other nurse went to another unit to borrow the accucheck 2 days in a row (I doubt it) then I'll admit I'm wrong....But I don't think so---nothing surprises me these days....
I think you're overreacting, frankly. And I've seen quite a bit too. Like I said, this is America. I've seen many more nurses unfairly railroaded out of their jobs due to this kind of thinking than I have seen nurses who railroaded them admit they were wrong to do it.
Please think about that.
Innocent till proven guilty. And after someone's reputation is destroyed, how do you plan to fix it?
I think you're overreacting, frankly. And I've seen quite a bit too. Like I said, this is America. I've seen many more nurses unfairly railroaded out of their jobs due to this kind of thinking than I have seen nurses who railroaded them admit they were wrong to do it.
Please think about that.
Innocent till proven guilty. And after someone's reputation is destroyed, how do you plan to fix it?
That's right. There may always be that cloud of doubt, even if proven innocent. Best to be sure, as it can't be taken back.
So, if something happens to one of these patients, like say, dying from a dose of insulin that was too great, and it becomes known that you were aware of the situation, YOU are just as legally liable as is the nurse who committed the act. You have done the right thing so far, and I don't know that I'd push it real hard. However, I would write up a statement saying exactly what you have described. Make it highly detailed, including the blood sugar readings you got, and that you did not find the other nurse's charted readings in the glucometer's memory. Keep a copy, and give a copy to the DON. Have her initial your copy as proof it was provided. No, it probably won't make her happy, but it will cover your butt. You have taken the appropriate action, and will now have documentation of that fact. If anything ever comes back, you can show that you took the appropriate actions.
Kevin McHugh
Kevin,
Thank you. I did write a statement and I kept a copy of it. I did not have the DON sign it, good advice.
Other Posters,
As stated, I did check our back up monitor. I did not check the others monitors in the facility...understand, this is not the first time I have noted this nurse not doing her job...it's just the most recent and dangerous. I have also reported all other instances, but this one I feel the DON has really let the patients down by not addressing it...by tomorrow it will be two weeks.
None of these patients has their own monitor and the nurse in question is demonstrably too lazy to go looking for another monitor on another unit.
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grannynurse FNP student
1,016 Posts
You are not being a rat. You are attempting to do the responsible thing. I do have one question. I am an insulin dependent diabetic. When I am hospitalized, my sugar is checked four times a day. If it is not, I am on the bell asking why it hasn't been checked? How old and how competent are your patients? I would report it to the chief operating officer and the nursing director, both in writing and verbally. You may want to follow up with your BON.
Grannynurse :balloons: