renewyou62

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.

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.

Agreed. In this situation, there is no charge nurse or supervisor. Physician notification and charting notes have been non-existent. Agreed that it is pathological behavior, as she will begin to fabricate lies, and try to turn the tables with accusations against me when confronted about her behavior. In this instance she tried to blame my following existing orders for mealtime boluses as justification for what she was doing on nights to deal with the low BG. She even stated in the message that she finally sent to the physician that the patient had dropped to 30 mg/dl at ine point. There is no way that should ever happen as the pump will begin to alarm when BG drops below 80, and carb correction should have begun at that point. Also no charting notes for this supposed instance, no documentation of nursing interventions and outcomes, etc.

The pt does not reside in a facility, but rather in a private residence along with his brother who also requires around the clock nursing care. There is no nurse supervisor in this scenario. I have informed the CM in the past of similar incidents by this nurse, and other night shift nurses, who are dumb enough to share their unethical and illegal (false documentation, and failure to document) during morning report. He has chosen not to act in the past out of fear of nurses quitting and we are chronically short staffed on dayshift. One of the nurses in particular is a bully and complaints have been lodged against her by many present and past nurses. This time, I threatened to get other people and agencies involved is nothing is done to correct her behavior. I really just snapped after the last bullying incident and self report of disconnecting the pump the other day. Realizing that thus could result in cancellation of my shifts ( I am an agency nurse working there long term) I just could not in good conscience work in this environment any longer. Let the cards fall where they may. I have chisen not to leave voluntarily, because in doing so, nothing changes for my patients and I am supposed to be their advocate ans protector. They are both DD with many complex co-morbidities. I’ sure they do not want an investigation launched by the county or state. The pump in question is a Tandem with G6 technolgy and a Dexcom sensor for CGM. We often fingerstick to confirm and calibrate if readings are abnormal and questionable. The pump info is usually uploaded by the endocrinology office during quarterly visits. These same night nurses have confessed to delaying or withholding the administration of bedtime Tresiba for the other patient, even though they have signed it off in the MAR and have not informed the physician. I just cannot work in this environment anymore. I have stayed due to not being required to get the Covid jab and it being only a 15 minute drive from my house. At this point I am just ready to do the right thing and hand it over to God. When one door closes, another one opens.

You are right about that. I will have to look back through the pump history. After checking the pump history, I can’t quite figure it out. The only times I can see that pumping was suspended were for short time periods that were most likely when the insulin cartridge was being changed out, so I can only guess that instead of stopping the insulin as you would do when disconnecting to change the cartidge and infusion set, that she is only disconnecting it from the infusion set and letting it flow freely so it doesn’t show up in the pump history. Also, the pump alarms after having the insulin stopped for more than 15 minutes, so I really think the above is how she is operating. My conversation with her about undermining the physician in this way, and the legalities of what she is doing must have triggered a small amount of fear in her, because she did send a message to the endocrinologist through mychart yesterday, and he responded with orders to change 2 of the night time basal rates, just as I told her he would if she notified him of the problem. This felt like only a small victory in this ongoing situation, as she has also self reported to me that she withholds or delays the administration time of the basal insulin of the other patient in this home (they are both DD with type 1, and brothers) because he also often has lows that require correction with carbs during the night. I had another conversation with the CM about this yesterday. Unfortunately, there are other nurses within the home engaging in this type of behavior, and I am at the point of wanting to escalate this. The CM has been made aware in the past, but is very non-confrontational. We are always severely short staffed for daytime nurses, and he is afraid they will quit if subjected to disciplinary action. This home actually has requirements of 2 nurses in the home, 24/7. I am actually contracted there through a staffing agency, and have worked there almost full time for the past 3 1/2 years if that tells you anything.

You are right about that. I will have to look back through the pump history.

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?