Relationships vs Protocols

[jmolinaRN]

Hey guys,

I'm writing to ask for your opinion regarding this mater:

2 days ago, one of my patient's parents insisted on discharge. Since there was no order from the attending physician (the main doctor), I had to ask the residents to issue one as well as the home instructions for the patient. About a half and hour later, the order came and the patient was discharged.

One of the home medications prescribed for the patient was "(salbutamol+guaifenecin) Asmalin 5 mL OD" which I transcribed in the home instructions as "Asmalin 5 mL once a day (8am)". Home instruction forms come in triplicate copies, one for the patient, one for the chart which goes to the medical records, and one stays in the nurses station, all three copies are signed by both the patient or his representative and the person who gave the instructions, in this case, myself. [i didn't realize that the generic name was really for Asmalin Broncho until the problem popped out]

Later that shift, the residents told me that the AP (Attending Physician) was angry since the home instructions were wrong, the AP wanted Asmalin Broncho drops and definitely not 5 mL. The two residents were asking me if I made a mistake and I showed them the home instruction form and their orders form the physician's order sheet. They were shocked, because it was as exactly as they ordered. After discussing with one another, one of the residents said "didn't we order asmalin broncho?" and they inserted the word "Broncho" in the physician's order sheet. This happened about 2 hours after the patient's discharge and my signature is in the home instructions sheet which clearly said Asmalin 5 mL once a day. Inserting the word broncho in the order sheet would mean I made the mistake, so I immediately told my supervisor who noted the incident (the head nurse was not present so the next in-line was the supervisor). He then confronted the residents that we nurses are aware of the order insertion.

The following day, the residents wouldn't talk to me, I found out later that the supervisor escalated the issue to our chief nurse. It became an inter-department problem. The NSD (nursing service division) insists that a confrontation is in order to prevent further incidents like these. For me, I informed the supervisor so that I could be protected IN THE EVENT that a problem should arise and the Attending Physician wold hunt down the nurse who gave the instructions. I was distraught and bothered, it ruined my entire shift. I'm working in the pediatric ward and these residents are pediatric residents, we work footsteps away from one another. Some senior nurses told me that I should have confronted the residents first prior to escalating the issue to the nurse supervisor, this is also how my head nurse feels; yet some nurses told me that I did the right thing and that the residents would be more than willing to serve my head in a platter in the event the AP pushes for a case against the nurse in charge.

I feel awful yet at the back of my mind, I think I did the right thing. I feel bad since those residents were in a good working relationship with me prior to this incident and now, they wouldn't talk to me.

Would really appreciate your input.

God bless,

- Josh

[Mijourney]

I'm going to jump in and write that no matter what you did, it look like a no win situation in my book. I think the residents did a disservice to you in the first place by trying to cover their tracks. You did what you felt was right and I certainly don't believe you did the wrong thing. The residents are starting out with unethical practices if I read correctly and I personally would not want to be their friend. Continue to do what you know is right and you will be fine in the long run.