refused to dose patients with used bottles

[pn5437]

hey everyone,

i recently started working at a methadone clinic about 5 months ago. I made a mistake by started this position part time and starting another part time position at a clinic at the same time out of need. So basically I was a new nurse learning two different jobs at once and also working every single day with no days off. Eventually, I realized that I would forget what i was taught in one job and vice versa. It was as if only limited amount of info from each position was able to sink in. Out of frustration I quit my job at the cancer clinic to focus on one. I worked a couple days a wk at the methadone clinic until about 6 weeks ago, where I started full time. I have found to have learned a great deal more since starting full time, I was having alot more 'ah ha' moments, thank god. But apparently the two nurses that I work with have been well, very impatient with me throughout my experience. We work together in a small locked in pharmacy all day, and one who ill call Nancy, is continuously standing over my shoulder while i dose my patients, etc as if she doesnt trust that what i do is correct,even though i triple check my doses before handing them to patients. When the patients information pops up on the screen, she doesnt give me a chance to review it myself to see whats going on with the patient. After one or two seconds she makes comments like "make sure to do it like this' or 'do it this way'. I understand that she just doesnt want me to make a mistake, but its become increasingly annoying since i cant soak in the patients info as fast as she can, as shes been there longer, so shes quicker than me. She finds things faster and is constantly correction me in front of my patients. Another thing is there is specific protocols to follow with this position, but if i follow the rules of the facility or of my supervisor, they both make me feel like a horrible nurse. Example: its saturday and a patient comes to my window requesting for a 'take home' dose of methadone. According to protocol, we are not allowed to do so on the weekends.. Patient has a tantrum and yells "youre the only nurse that doesnt do it! i want my take homes!" Nancy right away comes to my window and i get reprimanded for not giving this patient his take homes. This happens almost every day, with a different scenario. I get yelled at by a patient for being the only nurse that does what she's told.

Recently we discovered we had med errors (we were over by 25 mg and short by 35 mgs which means two patients were accidently overdosed by 10 mg and two others were underdosed by 10mg) Of course, as usual, it was insinuated that i made the mistake, not her (which ive seen with my own eyes how they make mistakes constantly, but anyway) Immediately the other nurse started digging IN THE GARBAGE CAN FULL OF USED METHADONE BOTTLES. she stated 'we have too good of a variance record, i know how to fix this' (which they make mistakes all the time and 'know how to fix it' so theres not variance) She says she's gonna fill two used 25 mg bottles with 35 mgs each and give it to two unsuspecting patients tomorrow. Now i understand that nurses sometimes fix situations like these in order to avoid a variance and thats just reality, but to INTENTIONALLY overdose two of my patients with USED bottles? I couldnt do it. I said i preferred the variance. Am i wrong? What would you do in this situation?

[PNCC2001]

Unbelievable and scary that this kind of thing goes on.

[caliotter3]

Just sounds like some of the crafty things I've seen nurses come up with over the years. Of course, I am too dumb to come up with any of these ideas myself.

[SummerGarden, BSN, MSN, RN]

first of all, your more experienced nurses are bullies! stop listening to them...! they will never ever respect you, so you need to respect yourself. i know it is easier said then done as a new nurse because part of being a new grad includes seeking the approval of your co-workers... the problem with seeking such approval from such people in health care is that it is a waste of time. besides, if you actually make a mistake, they will throw you under the bus quickly. the reason they tried to hide their mistake rather then write it up is because they know that one of them made the error and not you....

secondly, if they give you advice in the future with which you disagree, nod your head but continue to practice safely within your scope. it is a waste of time to educate them or argue with them!!!!

by the way, in the future if you have confusion about policy vs. a real-world situation, then ask for clarification from the supervisor and bring up the posted policy. for example, "supervisor so-and-so, i have patients who want to get their 'take home' medications on such and such dates, but the policy says otherwise. does the policy need to be updated? or can i give the patient his/her 'take home' medications in this situation?"

what you are experiencing is one aspect of bedside nursing that i hate... the other parts include disrespectful doctors, aids, and patient families. gl!!

[canchaser, BSN, RN]

Uuggh, they dug in the trash??? May I refer u to the propofol scandal in Colorado. CRNA's were using propofol and somehow cross contaminated the vials with Hepatits. Big law suit. R these vials multidose vials or single dose vials.? The posibility of cross contamination is scary!! Take the variance.

[yolanda2]

in the end id choose the variance.

[littlemammanurse, BSN, RN]

Choose the variance.No use putting your hard earned license on the line!

[katkonk, BSN, RN]

Policy and procedure, policy and procedure. It all comes back to that. If they are telling you to do something that is against policy and procedure, make a note to that effect without pointing a blaming finger at anyone, and then cite policy. Tell them that if they would like to take an action that is not within the guidelines, to have at it, and sign the documents appropriately. Also, if you do not report someone stating that they will intentionally overdose an unsuspecting patient who might die or have another adverse event, then you are as liable as they are. Report them to the manager, and if they are fired or get angry...not your problem. There are other jobs out there. Keep a copy of ALL documentation and reporting that you give your manager, and if they fire you, take it to the governing state or city authority, if not the board of nursing. Play hardball...before they kill someone.

[HappyCHN]

Those actions will eventually catch up with them one way or another. At the next staff meeting clarify the policy on situations like that and be ready to give "case in point" examples/scenarios you have ran into. I know you posted this some time ago. Are you still even employed there or did you move on?