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'm wondering how anyone has the time to be so closely monitoring another nurse's work and get her own job done. And what is up with immediately jumping the gun and reporting someone to the BON?
You had better be darned sure, and I mean absolutely have all the facts and all your ducks in a row before you even remotely consider going to the BON. You could be in for a world of trouble if you wrongly accuse this nurse, and "Oops...my bad!" isn't going to make up for it if you're wrong.
Follow your chain of command in the hospital, and let admin. do their job. Leave the fact-finding missions for them. Your first responsibility is to your patients.
Yes, bad nurses need to be dealt with. But that should be the responsibility of the NM; she/he may be privy to information you don't have.
Giving sliding scale insulin without having a recent blood glucose level is a MEDICATION ERROR!! Same as not giving sliding scale insulin because you did not check the blood glucose level.
In the state I work in, a nurse is legally responsible to report such things, and is in violation of the nursing practice act if she doesn't. Nurses have a duty to report.
Yeah, everybody knows this.And we can all concur that this is the same in all states. However, the way this person wrote her "dilemma" lead me to believe she was actually looking back at glucose levels from another shift. That to me sounds not kosher, and it is a witch hunt.Because first of all, SHE DOESNT KNOW that the sugar wasnt tested. Shes assuming. I mean, c'mon, looking back to see if what you see charted was what you see on the glucometer? Puuuuulease. She has no proof of a med error, no proof of something not being done and charted as done. If I see something charted, i have to assume it is done, I have no proof it wasnt , even if I think it wasnt, I have to act like it was. Reporting to the BON?????????? A little overzealous, are we? I hope her coworkers, the ones she is actually working a shift with, knows what they are dealing with.... if shes looking up previous shifts glucometer readings... imagine the damage she can do while shes working right beside you.........scary, some people are.......
That to me sounds not kosher, and it is a witch hunt.Because first of all, SHE DOESNT KNOW that the sugar wasnt tested. Shes assuming. I mean, c'mon, looking back to see if what you see charted was what you see on the glucometer? Puuuuulease. She has no proof of a med error, no proof of something not being done and charted as done. If I see something charted, i have to assume it is done, I have no proof it wasnt , even if I think it wasnt, I have to act like it was.
The OP stated that she had good reason to question the blood sugars...the machine which would normally be used appeared not to have been touched. Added to that, she stated she has observed a pattern of behavior by this nurse that has led her to suspect at other times that she had not done her work. Trying to find evidence to match the charting is the next logical step. When that is in absence, she is quite right to be very concerned and very correct to report it to the DON for investigation.
The scary thing is that we DO have to act as if something was done if it is charted as done even when every bit of intuition we have screams to the contrary. Legally we must assume it was done because it is charted that way. If some of those patients have wacky blood sugars on our shifts and we record the true readings and what must be given to bring them under control, then the doctor is eventually going to adjust their long acting doses on the basis of that history. If the MAR has been falsified, how is the doc going to be able to make the appropriate adjustment?
A nurse who sees something not quite right and does something--that is a nurse whom I want to be working with. A nurse who does nothing, is not a good nurse. A nurse who would call another a rat because she has a concern for pt safety--don't let her near me or my family, there is something wrong with her judgement and I wouldn't want her working on us and I would not want to work with her either.
Whatever the reason, there is a concern for pt safety, and the posters that state that the nurse has a duty to report the inconsistancies are right on the ball. We are all mandated reporters, meaning, we are mandated by the state in which we practice to report any situation in which a patient is in danger. Treetop angel, you have my support. No Crumping, no flaming!
The OP stated that she had good reason to question the blood sugars...the machine which would normally be used appeared not to have been touched. Added to that, she stated she has observed a pattern of behavior by this nurse that has led her to suspect at other times that she had not done her work. Trying to find evidence to match the charting is the next logical step. When that is in absence, she is quite right to be very concerned and very correct to report it to the DON for investigation.
The scary thing is that we DO have to act as if something was done if it is charted as done even when every bit of intuition we have screams to the contrary. Legally we must assume it was done because it is charted that way. If some of those patients have wacky blood sugars on our shifts and we record the true readings and what must be given to bring them under control, then the doctor is eventually going to adjust their long acting doses on the basis of that history. If the MAR has been falsified, how is the doc going to be able to make the appropriate adjustment?
Thank you Aimeee! FYI, my "dilemma" wasn't if I should report it, I know that it should be reported. My problem was with a DON who stated that she had not addressed my concerns an entire week after the fact, this was information she offered me, not information I went digging for.
As it is, there were further complaints from other nurses about this particular individual, I was not the only one who noticed. The upshot...the nurse was moved to another, larger unit...more patients to not get what they need. I am very uncomfortable with this decision.
A nurse who sees something not quite right and does something--that is a nurse whom I want to be working with. A nurse who does nothing, is not a good nurse. A nurse who would call another a rat because she has a concern for pt safety--don't let her near me or my family, there is something wrong with her judgement and I wouldn't want her working on us and I would not want to work with her either.
Whatever the reason, there is a concern for pt safety, and the posters that state that the nurse has a duty to report the inconsistancies are right on the ball. We are all mandated reporters, meaning, we are mandated by the state in which we practice to report any situation in which a patient is in danger. Treetop angel, you have my support. No Crumping, no flaming!
Thank you, gr8rnpjt! It's nice to know that there are nurses who will report inconsistencies and not enable those nurses who don't do their work.
As it is, there were further complaints from other nurses about this particular individual, I was not the only one who noticed. The upshot...the nurse was moved to another, larger unit...more patients to not get what they need. I am very uncomfortable with this decision.
You might feel uncomfortable with this decision, but she may've been moved so she can be watched better---or because your accusation didn't bear out. Whatever the reason, you did your job, you reported what you saw, and now it is out of your hands.
Any more action on your part might be seen as a personal vendetta against this nurse when you have no idea of the outcome of the investigation.
Of course you can voice your concerns! But you need to understand that with such a varied group of nurses, there are going to be differing points of view.
I hope you didn't see my take on the situation as an attack, Treetop, because it surely wasn't meant to be. I understand your concern for your patients.
But also, throughout this thread I have come to understand that you're pretty much convinced of this nurse's guilt, no matter what your DON has uncovered in her investigation or how your DON sees fit to handle the situation.
Your choice now would be to either drop the issue or pursue it further. I offered my thoughts on what I would do. Certainly the choice remains for you, and only you, to decide to carry out.
I'm truly sorry if you feel that my responses have been attacks. I only meant to offer a different slant on the situation.
Specializes in med/surg/tele/neuro/rehab/corrections.
As a nurse wanna-be I'd like to say what a great teaching thread this is. All the different opinions give one much to think about.
Treetop have you ever considered Assertiveness training? Someone really recommended it to me once. She said it doesn't teach you how to yell at people but it teaches you how to effectively communicate without getting emotional.
I'm going to have to agree with Fab4Fan and Angie O'Plasty on this one.....I do think that we should all be aware of our surroundings and be patient advocates. I don't think I would have handled it exactly as you did, but what's done is done. The issue now is that it is not your job or mission in life to ensure that EVERYBODY is doing their job, as defined by you. You already could have potentially been wrong about the nurse, but now you are dictating that the DON has no clue about how to do his/her job.....It can't be that you are the only one in the facility that knows all things about nursing. I'm not trying to be rude, but you cannot right all the wrongs of the world and you certainly cannot right all of the wrongs you THINK there are in the world....again, your proof is a little shaky...and things are not always what they seem. I hope since you have gone through all this trouble that you were at least right about the situation....but you need to evaluate WHY you are beating a dead horse?? Why do you think the DON owes you an explanation re: any possible disciplinary action of another employee??? Although your original concerns are admirable, you follow up behavior leaves something to be desired.
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I'd like to say what a great teaching thread this is. All the different opinions give one much to think about. 
fab4fan
1,173 Posts
LOL...and it gets me into trouble from time to time, too!