Dear Nurse Beth,
Trying to cool my jets so will bounce this off some of you fellow Nurses.
I am a RN working in primary care clinic as part of a larger hospital system. I have 20+ years of experience and have worked ER/ICU most of my career. Have been working primary care to slow down a little prior to retirement.
One of my duties is close management of our diabetic patients. I call patient and record their Blood Glucose readings as they tell me or sometimes they will fax or email to me. I then discuss with the doctor I work with. (Her desk faces mine in same room). She will tell me what changes she wishes to make to patient's insulin dosing and I will call patient back and relay that information to them and make sure they understand. (Sometimes when I have patient on phone I will discuss with doc and give the instructions right then. I then enter what I told patient in electronic chart and send note to doctor to counter sign. A couple of days ago someone in QAI decided that I was titrating insulin without a protocol and recommended disciplinary action on me.
Now my manager is on the same band wagon. Really??? I am not giving the insulin. I am merely passing along information to the patient that doctor told me to and documenting. Am I losing it or is this a little extreme by QAI person. I have never been disciplined for anything in all my life as a professional.
Dear Cool My Jets,
This sounds like a practice based on provider convenience more than anything.
The most important thing is to follow your facility's procedure. It does not seem likely that a facility would have a written procedure to manage insulin dosing such as you describe.
The process is overly casual with no safety checks. It's possible to see where the order could get lost in translation and errors could occur.
What is the policy on taking a verbal order? Is there a read back requirement? Is there a reason the doctor does not enter the prescription change herself??
No one is judging your expertise, it's the process that is problematic.
Your manager should make it perfectly clear what is expected of you, and not leave you out on a limb. It's not helpful to blame you and not give clear instructions. Likewise, the doctor should follow procedure.
Think about how you would feel if a patient overdosed on insulin and the doctor had not yet countersigned your "note", or even refused to sign, claiming it was not the dose they prescribed.
Maybe once you see this in a new light, you'll be glad this happened so you can protect your license.
Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!