Nursing Judgement vs Physician Orders

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Mommavik, ADN

77 Posts

Has 32 years experience.

I'm glad you followed your gut and reported this situation.  I hope you have documented your conversations with this night nurse,  but even if you didn't,  I think the numbers will show what is going on. If the doctor has been wondering why his insulin orders haven't been keeping the blood sugars under control (before she called and got the basal rate changed) .  Even if this doesn't go your way,  I hope you don't let this stop you from reporting next time you have another situation that doesn't feel right or that you KNOW isn't right.  But next time you'll know DOCUMENT, DOCUMENT DOCUMENT! LOL.  Good luck. 

Specializes in EMT for 18 years, and licensed LPN.

I say emphatically, YES!

Several years ago, a nurse entered my hospital room in the dark and began doing something around my bed. I had no idea what she was doing, but she entered my bed area and kept reducing my oxygen several times. This was after I was moved into a standard patient room after being on the ventilator for several days after I went into respiratory failure. 

When my doctor entered my room the next morning and asked me about a spell I had. I looked at him with a puzzled look on my face because I had no idea what he was talking about. I just knew I was NOT able to tell if my menu was upside down or right side up, and I began stuttering.

Shortly after he left my room, I felt fresh air filling my nostrils, and it felt easier for me to breathe. I then realized he had ordered the night nurse to titrate my oxygen level down over several minutes in order to get me off the oxygen, but instead, it gave me a mini stroke. 

I don't know what that poor nurse did after that, but I do believe she was devastated after she saw what happened to me. 

I, on the other hand had to take speech therapy for several weeks, and my right side is weaker than my left side.

I did forgive that doctor after I fired him, because I knew that would make me stronger as an individual.

Specializes in Hospital and Ambulatory Nursing. Has 12 years experience.
On 3/23/2022 at 1:12 PM, Jedrnurse said:

Well, look at it this way. If you know for a fact that a co-worker is making an ongoing med error, don't you think that you would have some obligation to escalate the issue? As far as proof is concerned, I would think the device's history would prove the dosing changes.

I agree 100%. We do have an obligation. The obligation is to our nursing profession and credibility, as well as the patient safety. If the night nurse feels the patient's current plan will cause the blood glucose to drop overnight to an unsafe level, wouldn't it be prudent to notify the physician? The nurses judgment may be very valid. Just think, what if that night nurse is suddenly called away and another nurse  unfamiliar with the patient baseline simply follows  the orders. The patient may have a hypoglycemic emergency. I would get to the source as to why the nurse is not notifying the physician. Sadly enough, it's possible she's not willing to monitor the patient overnight so she's disconnecting the pump to prevent needing to monitor while she's doing other things. Maybe she's studying for her Masters, or watching her children sleep because she can't be there. I certainly don't want to think she's on Tik-Tok , but we all know it does happen. We need to stand up not only to protect the patient, but to protect that nurse from becoming complacent and a product of her environment. If someone would have stood up for RaDonda and notified her and management that what she was doing was dangerous, maybe she wouldn't be going to jail.  In essence, nurses are all siblings that we much watch out for, and sometimes we have to tell our parents when they are misbehaving to correct the behavior for their benefit and ultimately the patients.

Specializes in BSN, RN, CVRN-BC. Has 27 years experience.
On 3/30/2022 at 8:27 PM, renewyou62 said:

Well, I have done as advised and escalated this matter in an effort to resolve this situation and protect my 2 patients. The case manager chose to initiate a confrontation between me and two of the night nurses, including the main offender during shift change and report, and in front of the two disabled patients who have no idea what is happenning. It turned out just as I predicted and turned into a shouting match (the main offender is one of those people who believe that whomever is loudest is right). They lied about the number of times it occurred, tried to justify their actions by minimizing and by declaring nursing judgement, and tried to turn the tables on me and state that I have made a number of med errors that they haven’t reported (none that I’m aware of) and so on and so forth. I predict that the next thing that will happen is that they will try to find something to pin on me and/or threaten the case manager with quitting if they don’t get rid of me ( I am just the agency nurse that has been there for 3.5 years because they can’t keep day shift staffed in this house. There is never any problem with staffing nights, go figure, because they sleep most of the time). Keep in mind that this is a private residence with two patients, not a facility. There has not been any nursing supervision in this house since right before I started working there. The patients are DD and staffed by a home care agency that specializes in the care of DD individuals, so it is a unique situation. I have no nursing supervisor to report to, only the case manager. So, I predict, as is the case in most whistleblowing cases, the whistleblower will be sacrificed. Also, I cannot figure out on this forum, how to respond to individual posts, instead of responding to everyone in general in one post.

I'm sorry that doing the right thing went so poorly!  How are you doing?  Hopefully there was no retaliation.

bfreeman7559

3 Posts

It is time to report this to your state nursing board, also to contact Adult protective services.   Gather information and documentation. Document…Document….Document.    Everything     The more information with supporting dates and times, the better case you will have.  Also, look for another job pronto.

Mommavik, ADN

77 Posts

Has 32 years experience.
On 4/14/2022 at 3:11 PM, bfreeman7559 said:

It is time to report this to your state nursing board, also to contact Adult protective services.   Gather information and documentation. Document…Document….Document.    Everything     The more information with supporting dates and times, the better case you will have.  Also, look for another job pronto.

 

I agree totally; I definitely would be looking for another job. You've tried to advocate for your patients, but unless you've already got written evidence  (from charting or notes that you took when each episode happened) you've got a she said- she said circumstance. If both night nurses are ganging up against you then unless they've had this same charge before you're going to be coming out for the worse, I'm afraid. 

Has 14 years experience.

Fortunately things have improved over the last several weeks. The CM has obviously done some things to address the nurse’s actions and behaviors. While at first very standoffish and hostile during exchange of report, she and I have actually been able to calmly and civilly discuss the insulin orders, and other physician orders and appointments upcoming for the two patients in the past couple of weeks. I am still avoiding working a shift with this nurse (she is a night nurse but does pick up Saturdays a.m.), but we have been able to communicate about coordination of care and ordering supplies. It is sad that the CM did nothing to address the many issues that I reported over the past several years, and I had to resort to threats to involve other people and agencies for him to take action. We now have a supervising nurse coming into the home to address issues with the insulin orders, the MARS, etc which I anticipate will be a positive move. It seems as though even licensed professionals will behave badly in a non-facility setting with no nursing supervision. I do believe that in a medical setting with supervision that these nurses actions would have been much different. I guess many people do not have the ability to self-supervise and do what they know is right, or as they have been taught in their nursing education.  While this was a highly stressful situation for several weeks, I believe some positive changes will come about because of it. I thank everyone of you for the moral support received with guidance on how to handle this toxic situation.

Mommavik, ADN

77 Posts

Has 32 years experience.

So glad things are working better for you and your patients.  Hope things continue in this direction. Good luck. 

HiddenAngels

790 Posts

Has 9 years experience.

You're welcome and what a shame.  But you're right though, this would NEVER happen inpatient.  A nurse is not allowed to take it upon herself to adjust insulin for a patient.

I hope everything works out for you.🙏