BSC_RN

I have never had so many med pass interruptions as I do at my current job. I work in mental health where the patients are ambulatory and medically stable for the most part. Translates to: patients are constantly at the desk! Pre-Covid they had access to water and other beverages in the day area. After Covid, they decided to put all the drinks behind the nurses station. Keep in mind, not only are the patients ambulatory, but most of them have poor boundary issues. They aren’t able to reason and see that the nurse is passing meds and this may not be a good time to ask for the 3rd glass of lemonade. I am not exaggerating when I tell you that I am stopping in the middle of pulling my meds to pour dang water or lemonade 20 times! I hate speaking on it because I know there are people who are going to think it’s just me being a nurse that doesn’t want to do basic tasks like get patients a drink. That’s not the case. It’s a real safety issue. Everything has changed with Covid and I’m not sure what the answer is, but having the nurses stop to pour lemonade during med passes is not it!

In ten years in this field, I have never reported a co-worker for anything. I am very laid back and I’m the kind of person who will approach an individual with an issue before I take it to a higher up. Even if I thought a co-worker was drunk (hypothetically) I would pull them aside and recommend they go home “sick” ASAP and never do it again! That being said, I was working on a travel assignment where an aide was often caught sleeping or just flat out not rounding on the patients. This was an adolescent psych unit so the kids require 15 minute rounding and are often caught trying to self harm during those rounds so they are CRUCIAL. I make it clear to my aides, I don’t care if you eat, use your phone, do whatever u gotta do... but do those rounds! I usually never have an issue and my techs love me. Well, I had confronted this tech about him sleeping and not rounding, but the behaviors continued. I took it to my manager out of genuine concern. While I was on vacation, I got a call from a supervisor who witnessed the same behaviors and he asked that I send an email just to document what I had witnessed and reported. I really hated to do that, but ended up being so glad that I did! This tech was in his late 20s. As I said, it was an adolescent psych unit. I was on shift when one of the kids confided that this guy had given her his phone number which she had been calling and speaking to him while he was at home. He was allowing her to use his cell phone while he was at work amongst other things. It was just a huge inappropriate boundary issue which I fully believe would’ve led to flat out pedophilia had I not reported him. Needless to say, when I got this report, I was FURIOUS because the man should’ve already been fired in my opinion. My manager’s response was to ask, “where were the nurses? Why did nobody notice this behavior?” UMM.. excuse me, MA’ AM! The behaviors that were noticed and reported were ignored! She said, “well, we didn’t know THIS.” My response... “true, we didn’t know THIS, but we knew he did not have the best interest of the patients at heart!” The administration really dropped the ball on this employee so when my supervisor suggested that I wait for my manager to come in the following morning and see how she wanted me to handle things, I did not. I reported this incident using the facility in house safety reporting system (which goes straight to all the higher ups to review in the morning safety huddle) and I also notified CPS as this was a clear case or exploitation. I didn’t go into many details, but he had told this kid he would come to her house if she didn’t answer his calls and all kinds of creepy stuff. guess what? They were upset that I had reported it! I was very vocal in letting them know that I didn’t trust them to report it cus the reports I made prior to this incident were swept under the rug and I refused to leave it in their hands! I only worked a few shifts after this incident because it really threw me over the edge the way the situation was handled and the vibes were just awful afterward. I had several weeks of my contract left, but told them I could not finish it: I agreed to finish out two weeks and they were happy with that. Unfortunately, I got an offer for a COVID crisis pay contract that paid more than that job and a PRN job I also had COMBINED! While I do value my reputation and my word, I had no problem emailing my manager to let her know I would not be returning to work. The new assignment required that I start immediately. Had all of this not happened, I would have felt a lot of guilt, but... I have been on this new job for over a month and getting paid almost triple what I was making working with the creepy guy trying to hook up with patients! I really feel it was a blessing that this job fell into my lap right after I did what I feel was taking a pedophile off the grid! My manager emailed my agency to let them know that she felt I “exaggerated” my complaints about the facility because I was looking for a way to take this new contract! That’s 10000% false as I had not even a clue about the new job until afterward. So, I had to email that manager and tell her that I’m a grown up and she should not flatter herself into thinking that I have to manipulate anyone... I quit because I wanted to and I can! That situation was actually very stressful for me and I never anticipated in my career having to report a co-worker to anyone, let alone authorities. It was so stressful having to think about what if I ended up in court and had to answer questions on the stand about what I did or failed to do after learning what I was told about this guy’s behavior. I knew the hospital would protect their own interests and not mine. I was looking up the nurse practice act and printed out the hospital’s policies and everything. What solidified my decision to go ahead and report against my superior’s advice is when I called to notify the physician. He told me, “you need to report to CPS. It’s your license. Don’t wait for them.” They were shocked when I told them the doctor ordered me to report. has anyone else been in a similar situation or had to make a report “going over administration’s head?”

I know this is an old post, but I’m too familiar with administering Ativan and have argued with other nurses about what warrants “agitation” til I’m blue in the face ? in my opinion, you did the right thing! You used your judgment based on what you knew about the patient’s behaviors the previous two nights. An elderly man who is up roaming the halls in the middle of the night is showing signs of agitation. Was he up and doing that yet? Apparently not, but the best predictor of future behavior is the past ... and he would likely be doing the same thing had you not given the med. I know people will disagree, but I think giving the man the med and assuring he gets a good night’s rest was much less of a risk than not medicating him and having him roam the halls and potentially fall. The doctor had it ordered, you using your judgment and gave it, no harm done!

You’ll be okay! We all make mistakes! Most important thing is the patient wasn’t harmed! I recently made what I know to be my first med error. It did not cause harm and was actually a lower dose of a narcotic than what the patient should have received. The pharmacist actually put an order in wrong and I gave a man a 5mg Percocet when he should’ve received 10mg oxycodone. I caught the error (after it was administered) and traced the mistake. Ultimately, it was still my fault since I’m the one who gave it... but I did not get written up or anything because it was an error that anyone in that position would’ve easily made and administration was very understanding. Don’t beat yourself up. All you can do is acknowledge your part in the error and learn from your mistake.

First, I do not work with post op patients. However, being a nurse in any setting, I think we can all relate when it comes to the fact that we all have different opinions and styles of practicing. I work with some highly aggressive patients and many of them are prescribed benz os to help manage their anxiety/agitation. Many of them are also patients who struggle with addiction. I work with nurses who will hesitate to administer the benzos or flat out refuse to do so. If I see a patient is agitated, addict or not, I am going to medicate them if they have an active order for the medication. It’s not my job to cure these people of their addictions. It is my job to keep the patient and everyone else on the unit safe during my shift. If the doctor says they can have it, who am I to decide that they can’t? I think the same applies to pain meds. Unless it is a real risk to administer the med (you’re concerned about respiratory distress, for example).... just administer the med. if not, you’re going to make your shift worse having to deal with an unhappy patient who may very well be in pain. Worst case scenario, if you think they don’t need the med and/or they’re abusing it... notify the MD and have the order modified or DC’d. I’ve had conflicts with other nurses over this but I feel pretty strongly about it. I have also notified doctors before that I think a certain med should be DC’d r/t abuse and with it being common knowledge that I’m liberal when it comes to administering meds within order parameters, they almost always DC the med. problem solved. No more arguing with the patients or debating in your own mind... it’s a simple, “you don’t have that ordered.”

I work in the mental health field where this is unfortunately common. I fortunately have never been assaulted, but I have witnessed it and am aware of staff who have made police reports. Honestly, I don’t think it does any good because the patients “aren’t in their right mind” supposedly. Sometimes that is true and sometimes it isn’t. Looking from an outsider’s perspective though, when a case comes across a desk and it’s “Jane Doe was inpatient at a psychiatric facility..” I think the people who review the case do show leniency because of the patient’s mental state.

I’m probably dgaf Dan! ? I have gotten the side eye by some staff nurses as a traveler because being a traveler with children, I’m pretty attached to my phone. I had some staff nurses who became dear friends confess to me that they would critique my documentation and wonder how I was getting my work done because I was “always on my phone.” I’m not afraid to say that I’m a great nurse, but I grew up with technology and learned on an electronic medical record. I would say that I’m a little bit Rebel Randy as well, but I won’t do things that require an order without getting that order first. As a travel nurse, I don’t have that rapport with the doctors, but I’m very confident and people do pick up on that and look to me when things are on fire. This was fun to read!

I would just ask tbh. I’m a smoker and I’m not proud of that, but I don’t feel it’s a deep, dark secret that anyone should have to hide. During these times, it amazes me that anyone can afford to pass on a good nurse because of a nicotine habit!