Sodie

I have made mistakes too. Fortunately, I have not made one that resulted in a sentinal event. I did have a patient respond to a med (the wrong one) that I administered one time. Fortunately, the MD was present and ordered a reversal drug to help minimize the problem. The patient suffered no ill effects. Even though things turned out well for the patient and myself, I will never forget it. You learn from the mistakes. You are right, things will not be the same again. You will check your meds and recheck your meds when you hang them.

I had this same question regarding the heart cath lab because my cath lab is a high risk one. We do many high risk procedures. Many of our patients fly to us very unstable. We stabalize them, do the procedure, place a balloon pump, and do all of the crititcal care procedures that an ER nurse or MCCU, ICU, nurse etc would perform. However, we are not considered critical care nurses. The reason that I understand is that all cath labs are different. This sounds funny when you think about it, but there are cath labs that are only diagnostic. They only do heart caths. Therefore, if someone says they have experience in the cath lab, which one was it? A high risk cath lab or a diagnostic? It could be the same for an ED. I say that becasue we own two hospitals with different types of ED's. One is in an area that has a younger population, so the patients coming in are more likely to be young adults, children and infants. If they get a heart attack victim, they stablize and send them to the cath lab at the other campus. The campus with the cath lab caters to the older generation (location is partly the reason, the other is due to our specialty). We recieve many geriatric and older adults along with middle age adults with possible heart attacks, chest pain, etc. It makes alot of sense if you look at the broad picture. Yes, we do critical care procedures in the ED and cath lab areas, but not all hospitals ED or cath lab are the same, so there is a difference in the rating of the critical care nurse. Like I said, this is the way it was explained to me. It is great experience and I think that if you want to transfer or switch jobs, you could list the skills that you have from working in your current ER position.

We have a law requiring that our name and title are displayed on our name badges. I actually thought it was naiton wide; maybe it is just a state thing. it is called the Lewis Blackman law. It's fairly new.

In SC, the Associate program that I went to required that you were 18 to go into clinical. Not only was the young age a problem, but I think that some insurances may not want to cover people under 18 in the profession. Some institutions require you to be 18 in order to have a paid job working with patients. I know that there are Volunteers that are teenagers, but they have limited roles in interacting with patients.

This is great news Heather! I am proud of you that you approached the doctor. Things did turn out well. A preacher friend of mine once preached on being righteous. The difference between doing things right and being righteous? Doing things right is what we should do. Being righteous is doing the right thing no matter what the cost. I think you learned a valuable lesson here. If you had brought the MD back in the moment you realized the problem, you would have saved yourself some grief, however I think God helped work things out and you have learned to not be afraid and and do what you know is right in the beginning. I believe that things happen sometimes for a reason. Many of them are caused by our stubborness and/ or fear. I know that when I keep my faith in God, it helps me through. Keep up the good work! I am sure God will continue to guide you in your daily walk.

You need to run to the recruiter and nurse manager. This sounds unsafe. You do not want to loose your license before you even get it! It's no wonder so many new gradutes leave their first job within the first year! One of my focus groups with my job is New Graduate Development. I love working with the new graduates and making sure that they get the training and support that they need to succeed aithout burning out. In my state, you can no longer work as a temp nurse. You either have your license or you work as a Nurse tech until you get proof of passing the NCLEX.

We all make mistakes. You have to learn to forgive yourself. At least you did own up to it. At least you took that worry away from yourself that the patient had the clamp inside and made sure the patient was okay before she went home. I am almost certain your manager has made a mistake somehwere in her career. Talk to her. As another poster said, tell her you learned from the mistake. I gave the wrong drug to a patient during a cath procedure one time. I owned up to it. The patient was okay after we gave a med to reverse it, but I was terrified. I wondered what others would say. I was not a new nurse. I had been a nurse for 14 years when I did that. I spoke with the MD later. I feel as though Physicians respect me more because they know that I will own up to mistakes. Many people told me that they would have never said a word about giving the wrong med; they would have treated the patient per MD orders, but would not have told. My conscious won't let me do that . I would rather turn in my nursing license than to put the patient's safety at risk. Always remember-- You learned from the mistake. You knew it was wrong not to say anything at first. You are paying for that, but you will never let it happen again. You are still going to make mistakes, but if this same or similar situation happens again--- you will speak up.

We have to do one when we are hired and it may be required at any random time. I believe that there is going to be a day that the testing will be more regular. We also have the right to test students if there is a question or suspicion or if there are drugs missing. Students sign a release before beginning clinicals that they will submit if requested for whatever reason. Now, we haven't tested any, it's a just in case clause. However, I have heard of some hospitals in my state starting to require testing prior to clinicals. Criminal Background checks are being required on all students as well becasue our accredidation standards states that whatever is required of the employees, the same requiremnets have to apply to students that function in some of the same role as employees.

I think that she must have been upset about not being able to go the RN route to begin with. She might have been projecting or something. Why else would she tell you that she plans to go to school to get her RN? Why get a RN degree when you make as much money? She maybe really doesn't know what a RN makes. Around here, MA's only make $10 an hour if they get a job at the hospital working as a Nurse tech, but they do not do more skills that NT's.

Most of the male nurses I work with seek assistance from a female nurse to protect themselves. Male MD's have female chaperones for the same reasons. Alot could happen behind a closed door as could alot of untre accusatins. It protects these nurses and the patients. I do not mind helping them with these procedures. I have many male nurse friends that ask the patient how they feel about it as well. Many times the female patient is not comfortable with specific procedures being perfomred by a male nurse. Me-- I really don't care. When I am not well and need help, I frankly don't have a preference other than a nurse who is compassionate and meets my needs. I have had a few experiences as a patient and for the most part, I wouldn't trade any of my nurses (male or female). Some people wouldn't feel the same way.

My hospital has a policy that states Sleeping on the job or appearing to sleep on the job is cause for termination. I once had a friend who tilted her head back and closed her eyes for 2 seconds. I swear!! At that moment, the nursing superviser walked down the hall. The nurse immediately pulled her head forward and and spoke to the nursing superviser. I promise the girl had just closed her eyes. The next morning, when our shift ended, she was called to the nurse superviser's office and written up. The appearing like you are asleep gave her no chance to argue that she had not been sleeping.Her eyes were closed, her head was wilted back, end of story. I have worked both day and nights. When I was in nursing school, I worked 40 hours a week and went to school full time. I have never fallen asleep, although I wanted to. When I get tired, I get up and start cleaning. It works every time. The nurses station was always spotless after I worked a night shift. All the cabinents were cleaned out and everything restocked. But most importantly, I knew my patients were doing well because I did check on them. I didn't wake them, but I looked in the room to check on them. It is amazing how many of them are actually awake and invite you to come in for a minute. Sometimes they need to talk. Have I ever worked with staff who took naps? I think so. Never did catch them though. I have caught alot of other department staff members sleeping in strange areas though when I would get called into the cath lab in the middle of the night. Have I reported them for this? Yes! Were they terminated? Yes- Immediately.

I think for a nurse, it would be abandoning the patient.

My ER is considered Critical Care because we get a major amount of MI's coming in. I haven't exactly worked in the ER at my hospital, but I have many friends who have. They love it. They thrive on the busy moments. As with any nursing, there are the occassional need to deliver food or those little "accidents". I think it depends on what type of patient you want to work with. I know that I am not cut out to be a nurse that works in OB, pediatrics or cancer. Why? Because I had an experience in nursing school with a fetal demise and I decided I didn't want to deal with that if I could avoid it. With cancer, I found it depressing and I didn't handle that very well. I started in med-surg-urology and ended up in cardiac 2 years later. After 10 years of telemetry, I went to the cath lab. The difference between cath lab and the telemetry unit? The patients that are in for diagnostic purposes like heart caths are generally "walkie talkies" that are scared of what the results are going to be. They do not come to us with infections or the flu. They have to be well to have a catheter stuck in the heart (no fevers, no active infection, etc). The emeregency MI's, are fast and furious as we work to save their lives. The patients are sedated, but awake. They communicate. I love working with one patient at a time and being able to hold their hand and get them through the procedure. We do occassionally have to hold patients so long due to high census, so we do have the occassional trays and other things to deal with. It's not that I don't like working with patients on a nursing unit, I really did enjoy that, but after working on a unit for many years, I needed a change. The stress got to me. The cath lab is stressful at times, but I do only have to worry about one patient at a time. I really like giving one person all the attention. One person suggested shadowing other areas. That is an excellent idea. I think this could work for you. I always encourage shadowing somewhere if you are not sure where you want to be. This can heko clear up any questions about different units.

This does happen a lot. I have never had a relationship or an affair with a doc, but I know many that have. It is very obvious. I know that I have been suspicious of some of them. If you wait long enough, it usually comes out. You never have to talk about it or get involved in gossip, you basically figure it out.

I have seen both sides as well. I have also worked in the cath lab. One day I was called in at 2 AM to do an emergency heart cath. I called the unit to give report at 6:30 (we had just finished the procedure) and was told that we need to wait to shift change. Fisrt of all, we can't just sit around with a patient we are on call becasue we never know when the next one is coming. We have offered to bring the patient up and stay in the room with them a little longer to help the nurse get situated. At least this way, we can give report and move on if we get paged. I have been around in the ER alot as well and many times the patient really isn't ready to go up ntil closer to shift change. I have seen doctors hold the patient in the ER until a MD comes in to see them as a consult or the patients GP comes in and decides to admit the patient. If the MD waits until the office closes to come and see the patient in the ER (during the week), the admission time is going to fall closer to shift change in my hospital because most nursing units do 12 hour shifts. I have seen games played on both sides though. I worked on a nursing unit for 9 years before the ER and cath lab. There is a policy that the ER uses now. If they call two times and the nurse will not take report, they take the patient to the room and give report when they get there. I have called the ER as a staff nurse before and asked them to give report on a patient that had been assigned to the room 2 hours before. They thought I was crazy. The ER nurse could not believe that I was asking for another patient. I told the ER nurse that it was a great time for me to do an admission becasue the other patients were eating and I had caught up on the paperwork. They gave me report and brought the patient up right then.

One time a nurse in my unit gave something that another nurse drew up. It was neosenephrine. It was 10 times the dose that it should have been. Fortunately the patient didn't have any residual effects. I never give anything that someone else drew up or mixed other than a pharmacist that has labeled the syringe. It has been my practice for 16 years; I have shared this with all nurses that I have precepted and I discourage it today as I teach IV therapy classes. Most of the nurses that I have spoken with about administering meds that they did not draw up state that they don't do that either and never will.

RN with MSN, as close to 40 hours a week as possible (salaried), 16 yrs of nursing, Days only (no weekend, nights or holidays), Columbia, SC. It is important to note that I have been at the same institution for 14 years. This increases the amount of pay. Many hospitals in my area give credit to nurses for experience (even if you were a nurse assistant before starting as an RN). I am not going to list my personal salary in case someone might be able to identify who I am. I do not like to tell others what I make and the hospital discourages it. I can say however, that I know new graduate RN's were starting at $19 hour a few months ago. There are 5 hospitals in my city alone making the pay fairly competitive. Cost of living is also a factor that needs to be considered. For instantce, the cost of living in Charlotte, NC is higher than the cost of living in my area (1 hr 45 mins away). Therefore, I think that the salaries might be higher there. I have a cousin that has been a nurse for 20 yrs or so in Upstate NY- I think she makes about $18-$20 hour. She has never worked at any other hospital.

I say give a notice, mainly because you never want to burn bridges if you can help it. Sometimes the problem with units or institutions is the people running certain parts of it. Well, as I have found out over the past 16 years of nursing, positions aren't permanent. Once day, the situation in your area may improve and you might want to give it another shot. As for not reporting working there, I would not advise it. Even if you have not been there long. I think that an institution will view it better that you did not feel the position was right for you vs. lying on your application. What if you find a job that you really like and you fit in well. Then along comes a person that you previously worked with, even briefly, in your knew job? Did you know that lying on an application is terms for immediate dismissal? Even years donw the road? I know people that have been fired 5 years after emplyment when it was discovered that they omitted a previous place of employment. What are the chances that someone would find out? You never know!! Also, HR exit interviews are not designed to hold against anyone. I know that my HR department is very sincere in knowing why people leave. I think you should do the interview, be honest, but professional. Think about how you want to relay the information or tell them the issues. Maybe others before you did the interview and gave the same information. You have to admit that when everyone that is leaving is saying the same thing, they are eventually going to have to listen. But please remember... In this profession, seriously, you don't know when you are going to meet people that you have worked with in the past again. You don't want anything coming back to haunt you.

Check with some of your local hospitals about shadowing oppurtunities. We offer shadowing through my insititution in various areas so that people who are interested or curious in a career in the health field can come in and see if they think this is what they want. They can come in as many times as they would like for 3 hour observations.

YOU ARE NOT A LOSER!! The staff who made that assignment should be ashamed of themselves for doing that and the staff who was aware that you had the horrible assignment obviously knew better. What could have been a nice learning experinece for you turned out to be a horrible experience. Now, those nurses won't have your help again! They have not only hurt you, but they have hurt themselves. It amazes me that nurses do not realize that acts like this keeps them short. Who would want to be treated like they treated you? I respect you for sticking with the shift and taking care of your patients.

Wow!! I suppose that you didn't think that shift would ever end. I really shudder the thought that administration is pointing fingers. We have a duty as nurse to advocate for our patients. We also have a duty to report on them acurrately. First of all, is there a written policy not to give fresh open hearts to agency? Or is it a policy understood between the staff nurses in the unit? Second of all, doesn't the hospital have an obligation to provide appropriately trained staff to the appropriate patient? In other words any nurse (agency or not) should not be given a patiet that they are not qualified to take care of. Another thing, I have heard the abandonment threat before... but the charge nurse should have reconsidered the assignment. The charge nurse is at fault for failing to listen to your concerns. Unfortunately, it is the charge nurses word against yours, but I would keep record, for future reference in case this issue arises again. If you have an issue such as this, I would contact the nursing superviser and have it documented that you expressed concern about the assignment, however the charge nurse declined to change it. In view of the fact that you had a patient that coded only a few minutes into your shift, I do not see how it was possible for you to actually assess the other person any sooner. It is policy of our institution that a code team responds to the codes.. When the team arrives, the nurse who has the patient remains in the room and maybe one other staff (possibly charge nurse) however, the rest of the staff has the responsibility to check on your other patients while you are caring for the coding patient. This way, others are not neglected. I know that everyone is busy, but if you go to a courtroom, no one wnats to hear that it wasn't my patient. A nursing staff should be a team. Somehow or another the rest of the staff on the unit shuld assist the nurse with the unstable patients (this includes that charge nurse). As for the sorry report--- This has happend to me before. I got a bad report on a patient on a PCCU. Her heartrate went up to 150 during the night, they suctioned her without an order because they didn't want to call the MD in the middle of the night. I was told "She is fine now and resting comfortabley"Well, hello... If you have never had to suction a patient in the past 3 nights that they have been there and the HR goes to 150, wouldn't you think something is going on? When I entered the room, the patient was blue, foaming at the mouth with a sat of 68%. I called RT and gave the patient oxygen, we suctioned her, called the MD, stablized, etc.. 2 hours later her ICU bed was ready. My co-workesr checked on my other patients and gave my meds. Thank God for them helping me catch up because after I got back to the unit, another patient started having chest pain, she coded, then died. If it hadn't been for my co-workers checking on my patients, they wouldn't have seen a nurse until 4 hours into my shift. I really hate it for you that you got into this situation. It always seems that the nurses that are really trying to take care of their patients get into messes like this. It is so difficult when you do your best to have someone else not care about what they are doing. It sounds like you really did what you could to care for your patients. I would do as the others have suggested. Write it down. If you continue working in this institution, you may have issues like this again. One more question-- We have a process that we do in instances where "incidents" like your scenario are investigated. You probably have heard of it-- Root cause analysis (RCA). Maybe they only do a RCA in sentinal events leading to death, but we have done them in near misses like yours to review the process. Why did this situation occur? What were the forces? Was it the process that the institution used that contributed to the occurance or the outcome? Why was this patient moved out of CVICU when he was? Was he actually stable when he left CVICU? ETC.... It can be a good information session. Generally, someone from administration, the manager of the unit, the persons involved and any other staff members that can help review the occurance attend. It is not to point fingers, but to look at the occurance from many angles and perspectives... an information gathering session, so to speak to identify contributing causes. It sounds like this approach to your situation would be helpful in identifying several key things that took place in this scenario that can be changed to prevent it from happening again in the future. By the way, why was the secretary written up? What was her involvement? Also, what was the PCA written up for? Finally, why wasn't the charge nurse included in the write up?

We have a policy allowing the numbing, however many nurses do not use it outside of the outpatient surgery area. In my experience (I have had several IV's for surgery, etc), the xylocaine to numb it hurt worse than the actual IV stick. I have used it on patient's that were especially anxious or on patients that requested it. I guess it all comes down to A-- does the institution have a policy and B= te needs of that particular patient

At my institution, we changed the policy recently that anyone who takes an order (LPN, RN or in some instances Repiratory Therapy) has to read the order back to the Physician. The process is to take the order, write it down on an order sheet and read the order sheet back to the MD. This process should decrease the amounts of errors in transcribing the order from taking it on the phone to the order sheet. It is not acceptable to write an order for anyone, ever. This is the policy. As we know, not following policies can lead to trouble. With so many things happening around us in the nurses stations, it's easy to get distracted and not get the order recording correctly. It's best to protect yourself and most of all, protect the patient. What would have happened if the LPN told you to take the catheter out of the worng patient and you did? Recently, a nurse told a student to take the NG tube out of a patient because the doctor told the nurse to remove it. The student approached her instructor and told her that she needed to remove the NG tube. When the instructor asked about double checking the order, the student pulled the chart and the order had not been written. The nurse told the instructor that she had not gotten to writing it yet. The instructor informed the student that she needed to understand that you never remove anything from a patient unless it is in writing or you took the order yourself. She also told her that she had to write the order on the chart before removing it so that she didn't forget to go back and write it afterwards. She let her student know that she did the right thing by asking before proceeding; that if she had removed the NG without checking, she would have recieved a failing mark for that clinical.

I thought it was a standard of care that the patient assignment was made based upon the acuity of the patient and the ability or the skills of the nurse. The ward clerk does not assess patients and she does not take report. She is not trained to do this. This seems out of line with standards of care issues to me. In my hospital, the ward clerks are trained to be monitor techs. Even thought they are capable of putting orders in the computer, their first responsibility is the monitor. My hospital specializes in the heart, so many floors are monitored. We have several telemetry units. It is a requirement that someone has to sit infront of the monitors at all times. When the ward clerk goes on a break, a nurse has to sit behind the monitors while she is gone. We usually divide her lunch break into 10 minute sitting times for each nurse to take a turn.