I have been working with another nurse for several years in a home care setting. We usually don’t do shifts together as she works night and I work days, however, during report she often tries to bully me into using what she calls “nursing judgment” when it comes to our type 1 diabetic patient, rather than follow the existing physician orders. The patient has an insulin pump with a Dexcom sensor. Basal rates and insulin to carb ratio are set by the physician, and the patient is seen quarterly. When I give the mealtime bolus, carbs and blood glucose are entered and the pump gives a calculation of the total units of insulin to deliver. The only written parameters are to hold mealtime bolus if BG is less than 100, and recheck one hour later to see if correction is needed.
Her complaint is that the patient's BG becomes low overnight and correction is needed to raise the BG to desired levels (parameters are also in place for this). An example of her most recent attack on me: Last night pre-meal BG was 166. Pt consumed 39 carbs. Pump calculated for 8.22 units and bolus was given. She is telling me that was way too much insulin, and I should use my nursing judgement. She disconnected the insulin pump overnight “so that he wouldn’t drop” as his BG was 119 at 2115 hours. So…pt does not receive his overnight basal rates. This is done often, and without notification to the physician, so he has no idea what is going on.
She does whatever she feels best with the patient’s insulin, without notifying the physician, and berates me for following physician orders. I have informed the case manager of what goes on and nothing is done. I don’t feel that it is my responsibility to notify the physician of her actions, and there would be no proof. What would you do?
