Preceptor telling me to cover things up....

[KayceeLeeRN, BSN, RN]

So I think it is safe to say that the honeymoon is offically OVER and I have stepped into REALITY :uhoh21: ...........

I have quickly realized that nursing school is pretty far from the truth when it comes to what really goes on. I am seeing a lot of "covering up" to protect yourself type of stuff. I actually feel terribly guilty about something. Here goes.....

So other day I got an order to give K-Dur 20mEq x 3 now. I gave the first dose....then I went about my busy day, and completely FORGOT to administer the rest. The next morning in report the night nurse mentions that I need to sign for the K, my heart jumped into my throat. Once she left I called my preceptor over and I told her that I had made a big mistake, and asked her what should I do, she said "The K is still going to be low, and the md will order more, so just give that." I asked her what would happen if I just came clean and told the md that it was never given, she told me that he's one of the "nasty" ones so just give it when he orders more, because the patient needs it anyway. She then proceeded to tell me that one of the most important things I have to remember is to "NEVER ADMITT TO ANYTIHNG."

Then yesterday I had to give Dilaudid (sp?) IVP, I went to go do it but the patients IV was clotted and no good. We called the IV nurse to come and put a new one in (she wouldn't be there for an hour or so). So I'm standing there with a syringe filled with a narcotic in my hand and I ask my preceptor what should I do with this? She tells me to put it in my pocket. I ask her again, "in my pocket? are you sure we shouldnt waste it?" She told me again to put it in my pocket, and if the IV nurse can't get a new lock in we will waste it. I felt very uncomfortable walking around with a narcotic in my pocket. But I wasn't sure if this was the right/wrong thing to do. The way she told me to "put it in my pocket" just sounded very shady to me.

I just feel so guilty. Covering up like that. Is this the norm? Does this go on everywhere?? I'm not sure if this is common, or if my preceptor is showing me bad habits. I feel so naive to all of this. Can someone explain this to me???

[SuesquatchRN, BSN, RN]

I actually like your preceptor. She trusts you not to take the narc and protects you from nasty docs. Sounds like heaven.

Kaka pasa.

[Tweety, BSN, RN]

You're feeling guilty for a good reason....your preceptor is wrong.

We admit our mistakes, call the MD and deal with it. We immediately waste narcotics and do not walk around with them in our pockets (although PACU, ICU, and ER nurses will take exception to this, I'm talking by the book here).

There are some grey areas that you can fudge your way through that aren't by the book, but what you are describing isn't one of those times.

Talk to your preceptor that you're not comfortable with this type of stuff and would prefer to "go by the book" while you're on orientation and perhaps talk to your educator or manager.

[Tweety, BSN, RN]

I actually like your preceptor. She trusts you not to take the narc and protects you from nasty docs. Sounds like heaven.

Kaka pasa.

I hope you're kidding. I'm not sure because I don't know what "Kaka pasa" means.

[SuesquatchRN, BSN, RN]

I hope you're kidding. I'm not sure because I don't know what "Kaka pasa" means.

No, I'm serious. She's protecting her, not trying to string her up by her thumbs. Quite the opposite of "eating her young," no?

Kaka = "pooh pooh." Pasa = "happens."

[NurseyPoo, RN]

Not very professional of your preceptor. She may be trying to help you but in the end it is still wrong. I would have fessed up to the mistake and I certainly would never walk around with a narcotic filled syringe in my pocket! My question is why couldn't your preceptor put in a new IV? Or you for that matter? I put a lot of my own IV's in...is this a policy at your place that you cannot?

[neneRN, BSN, RN]

Its actually normal practice at my facility to carry your pt's narc (in a labeled syringe) in your pocket if you plan to use the remaining dose later on (this is in ER). Management has said either waste it and sign out more meds later OR carry it on your person...whichever way you're more comfortable. I'd rather save my pt a second charge and use the remaining med, also is more convenient to already have when pt needs more med.

I'm curious too why you and/or your preceptor didn't just restart the IV rather than delaying pain meds for an hour?

[Tweety, BSN, RN]

No, I'm serious. She's protecting her, not trying to string her up by her thumbs. Quite the opposite of "eating her young," no?

Kaka = "pooh pooh." Pasa = "happens."

Thanks for the clarification.

I disagree with you as my post above states. Fear of doctors is no reason to cover up a med error. Perhaps, one should check the policy though to see if it's o.k. to walk around with narcs in your pocket. It's not allowed here. :)

[SuesquatchRN, BSN, RN]

Thanks for the clarification.

I disagree with you as my post above states. :)

Hey, I didn't say her preceptor is right, but I still like her better than a by-the-book dictator.

:)

[Spidey's mom, ADN, BSN, RN]

Your preceptor is WRONG and teaching you very bad habits that will come back to bite you. Seriously.

Always admit your mistakes to the doctors. You are the patient's advocate and if you make an error, it is the patient you should be thinking about, not some doc's anger problem.

That is the professional and ethical thing to do.

As for the narc in your pocket - please check your policy. I work in the ER and we are allowed to do that in cases like an IV infiltrates. Oh and we start our own IV's so I would have started the IV and given the med. It is wrong to make a patient wait an hour for pain meds.

Your conscience was telling you something - that is why you posted here.

I think a preceptor who teaches you to hide things is an example of "eating".

steph

[pickledpepperRN]

I agree with Tweety and Stevielynne.

Always be honest.

That physician could send the patient home on a dose of K+ that could be dangerous on the assumption that the med was given.

NEVER chart something that is untrue.

I don't know your hospitals policy on narcotics in your pocket.

I think it best to find out and follow it.

Good for you for knowing this is not right.

[gonzo1, ASN, RN]

I'm voting for honesty here. I have fessed up to some sorry mistakes and this has always turned out to have been the right thing to do. Consequently the doctors and supervisors trust me completely, of which I am very proud.

Since I am in the ER we carry our meds sometimes and start our own IVs.