Reprimanded for reporting medication errors and so much more

[reprimanded]

I'm currently a nursing student and while at a clinical facility I noticed that another student failed to give insulin to a patient. So before the end of shift I went over the MAR to make sure that everyone had documented and to do a narcotic count before leaving. I brought up the medication error to the instructor and the instructor informed me that the issue would be taken care of. The instructor sends out the students to the med cart to rectify the issues. One of the student, who missed the insulin, begins to shift the blame on me and then proceeded to argue with the RN who was in charge of the cart.

The RN told the student that when she was instructed to give the insulin, why did she withhold it? The student begins to give her reasonings to why she did not give the insulin and in the end, even after taking another glucose reading, she needed to give the insulin because the pt was on a sliding scale and needed the insulin even with the new reading.

Anyhow, there are many incidents that have happened while I was at this facility and each and every time I had brought it up to the instructor, I was told that it would be taken care of.

Today, I just found out that some instructors at this institution are saying I'm the cause of problems at the clinical sites and in a classroom setting.

The same student who made the med error confronted me in front of the class making remarks like "how did you pass term 2, if you don't know how to assess the abdomen". She over heard another student and I discuss about how to differentiate between high pitched and wave like sounds from the abdomen. I never once stated I knew everything about nursing. This is why I'm enrolled in a program and attending daily because I never had previous medical exposure and if I claimed to know it all, I wouldn't be in any program.

After this incident took place, I never felt the need to run and tell to the directors or instructors about the cattiness that took place in the classroom. She said whatever she wanted to say, and I also did the same.

Now, it's apparent that instructors are starting not to like me because of my ethics and willingness to comply to rules and regulations enforced by the board. They are trying to find any flaws that I might make to kick me out of the program.

I posted a status on my FB about the insulin incident. Warning my fellow nursing friends to not make the same mistake and I was brought in by the clinical instructor and was told that my FB status was "unprofessional". Yet, students who came to clinical hungover, late almost every other day and students who believed that taking multiple smoke break is important versus taking care of the patients while on duty. I just have a whole list of "unprofessional" things that were done by the other nursing students. I'm upset that these adult professionals who are instructors are going around my back talking about me in unprofessional ways without once contacting me directly to inquire about the hearsay that has been going on.

I no longer feel safe to step a foot onto the campus and I wake up not wanting to go to class to finish my program. I'm harboring these feelings and thoughts that I haven't been able to tell any instructors or individuals who run this program in fear of being retaliated against.

I need to know what should I do?

[The_Optimist]

The OP possibly has (had?) good intentions:).

The tone of your online missive is a bit questionable and unless that was strictly your intent, then it may have rubbed people the wrong way. Sure, you passed on the information to your clinical instructor, correct, but you should also have stayed away from your colleague at that time. No good was going to come out at that time in the midst of heavy emotions.

I might compare it to some Southern States, where you can be soundly insulted and then "bless your heart" is used as the cover up. Unless you are asked for it, I feel you should leave the teaching to the instructors. The Law of nature will play out and weed out the good from the bad. No need to sully your name in the process.

[MECO28, BSN, RN]

Oh man, I don't know where to begin with this. I know you have some good intentions but I'm gonna be candid with you:

Here's the deal: You will make mistakes when you are out of school and employed as a nurse. No matter how careful you are, you WILL eventually make a mistake. And when you do, I sincerely hope that the person who catches it has the grace to come directly to you and say "Hey, noticed you made an error here; you may want to do something about it.". And hopefully, they will continue about their day and will not go home and post something snarky on Facebook about your error. And hopefully it will be a lesson in humility and you'll be thankful for that person who noticed your error and handled it in a professional manner.

Here is the appropriate way to handle concerns while in nursing school: "Hey Student Nurse, I noticed you forgot to give a med; just thought you might want to fix that." If the Student Nurse blows you off then perhaps it is appropriate to take the instructor aside if you genuinely have a concern for the patient's well-being. But for Pete's sake, be discreet and professional about it. You are not there to police your fellow students and being a patient advocate does not mean throwing another nurse under the bus.

[Future FNP 14]

Welcome to nursing!!!!!! Get ready for a roller coaster. It's a shame that we as nurses make our job more difficult. You did the right thing.however everyone makes mistakes so be careful.

[RedHeaded2bNurse16]

I agree with PSU-13. I'm a student and happen to be on top of my class. I would NEVER do that to one of my fellow students. First of all looking into pts that weren't yours is just wrong and correct me if I'm wrong but also a HIPAA violation. At my hospital you are not to be looking up other patients info. If you happened to know of something, I would've approached to student first in a supportive manner. Of course, being insulin there could have been life threatening repercussions so if the student didn't act on it I would feel obligated to tell either the Nurse or Instructor. As far as the FB thing... It just comes off as arrogant. You don't want to make enemies and now you've put a target on your back. So I agree with the others that say keep a low profile. I am lucky that I with a class where we support each other immensely. I would most certainly want my fellow students have my back instead of sticking a knife in it and I would hope the same for my Nursing career. Good luck to you!

[Kooky Korky, BSN, RN]

[quote=

--Going over the MAR's for patients that are not in your direct care is a violation of HIPPA.

.

Is it really a violation of HIPAA to look at MAR's of patients not assigned to me? What if there are several nurses on the same ward who cover for each other for breaks, who answer lights on all the patients, not just their own assigned patients? What if a doctor writes orders on another nurse's patients? She's busy, I'm not, she asks me to see what was ordered, fax med orders to pharmacy, etc. Since my help was requested, is this a HIPAA violation? I am having a hard time believing it so it must be true, but I sure wish someone could point this out to me in formal HIPAA advisory writing.

If I were just curious as to what a pt's meds are because I know the patient or something like that, I could see the problem. For example, when our supervisor gave birth at our hospital, we were strictly charged to not look at her chart. One person who did, stupidly, electronically was fired. This I could see. We really had no business details of her case, her history, her PE, etc.

But in the ordinary course of working with other nurses, we do sometimes get involved with patients not directly assigned to us. Like a fall happens when that person's nurse is in the restroom, on break, or tied up elsewhere. You might want to see what meds he's on or what his VS were last, labs, etc.

Or if you are Charge, you might not have a direct assignment but still needs to reach docs, family, Lab, Pharmacy, etc. re: someone else's assigned pt.

Help!

[JustBeachyNurse, LPN]

Different as employees covering for another staff nurse.

But a student assigned to Mrs X overhears/suspects classmate did not give Mr B their insulin. Decides to check Mr. B's MAR to confirm their suspicions before alerting instructor would be in violation of HIPAA as the student was not caring for Mr. B nor was the student asked to care for Mr B. The student was checking confidential patient records that they had no business viewing. The concern about a missed medication should be brought to the student caring for Mr. B and/ or the clinical instructor. The instructor would have a legal right to check Mr. B's records as the instructor is responsible for the students.

The instructor who is responsible for all the student nurses under her charge has implied permission to review the records of the patients assigned to his/her students to endure complete, safe, accurate and appropriate care is being delivered as well as being correctly documented.

A staff nurse assisting in the care of a patient who accessed a patient on the unit's MAR to enter orders or verify orders would be appropriately accessing PHI.

On the other hand, a staff nurse who decides to check the records of a patient transferred off the unit to another floor or the records of a friend or family member would be in violation of HIPAA as they have no valid work related reason to access the records.

[bsnanat2]

OP,

please don't make the mistake of suffering from an overly developed sense of righteousness. If you find that "others" are always making mistakes and making things difficult for you, it may be time to self examine. Yes, you pointed out errors of others, but was it your job to do so? Making errors is part of being a student. Don't be "the smartest person in the class" who mysteriously can't get a job. People do talk and have long memories.

[BuckyBadgerRN, ASN, RN]

I want to know what you found to be unprofessional about my FB post. Which part? All of it? Just posting about school related stuff is unprofessional? Using "ass"?

You basically called out your fellow students as not knowing anything about insulin. You also are telling them to man up and own any mistakes. Yes, that's what they should do, its not your place to announce on social media that they should.

Just like its not YOUR place to check the MAR and make sure all medication is given.

It would be unprofessional of me to really say what vibe I'm getting from your posts....

[KelRN215, BSN, RN]

Is it really a violation of HIPAA to look at MAR's of patients not assigned to me? What if there are several nurses on the same ward who cover for each other for breaks, who answer lights on all the patients, not just their own assigned patients? What if a doctor writes orders on another nurse's patients? She's busy, I'm not, she asks me to see what was ordered, fax med orders to pharmacy, etc. Since my help was requested, is this a HIPAA violation? I am having a hard time believing it so it must be true, but I sure wish someone could point this out to me in formal HIPAA advisory writing.

If I were just curious as to what a pt's meds are because I know the patient or something like that, I could see the problem. For example, when our supervisor gave birth at our hospital, we were strictly charged to not look at her chart. One person who did, stupidly, electronically was fired. This I could see. We really had no business details of her case, her history, her PE, etc.

But in the ordinary course of working with other nurses, we do sometimes get involved with patients not directly assigned to us. Like a fall happens when that person's nurse is in the restroom, on break, or tied up elsewhere. You might want to see what meds he's on or what his VS were last, labs, etc.

Or if you are Charge, you might not have a direct assignment but still needs to reach docs, family, Lab, Pharmacy, etc. re: someone else's assigned pt.

Help!

This is very different than the OP's situation. If you are a charge RN, you need to know what's going on with all patients on your floor. If you are helping out another nurse, of course you need to look at the orders to administer a med. If you're in charge of documenting during a code, you can access the chart of your colleague's patient. If you're just being nosy and want to see how your colleague documents or if she administered meds, sorry you can't go in that chart.

I don't understand why the OP would have come across this information at all and I fully understand what the instructor's problem was with it. If you're a student, you should be 100% focused on your assignment. If you have the time to go snooping in someone else's charting, why aren't you with your patient? As a student and even now as an RN, it would never occur to me to go checking up on my colleagues. The only reason I even look at anyone else's documentation now is because I'm a supervisor.

[kloopRNBSN]

Oh, wow, I know most of this has been said but I will respond with my thoughts (its long, sorry, I couldn't help it).

First, the tone of this FB post comes off as very rude, and could cause you to have a very very hard time in the nursing field. I'm going to gamble and guess you're young, and you haven't learned the sad unfortunate lesson that you must pick your battles and speaking up and being headstrong is your last resort. I went to nursing school with some folks who said and did things like this, and although they had nothing but the best intentions, many of them never made it to the end of the program. I promise you, like, 25+% of your professor's opinion (a.k.a. your grades, how you are treated, whether or not they give you a harder time in general etc.) of you is based on your personality, what kind of people they like to surround themselves with in their life outside of nursing, and your ability to cope with this kind of situation properly. DO NOT FORGET they are not going to fit into the typical definition of the word "teacher" or "professor". They don't adhere to the same standards as say, an english professor. These people are NURSES FIRST who, for one reason or another are teaching you to be a nurse and if they don't "like" you they can make your life a living hell and they won't get in trouble, you might, and they will still have their license and an infinite supply of students willing to kiss their butt to become a nurse.

Now, if safety is an issue, by all means, tell someone, but try to begin with the student/nurse who you think made an error. Imagine if you had done that first how differently things could've been for you. That other student would likely have done one of two things, fixed it, or found out they couldn't fix it and told on themselves. Don't ever go snooping around and digging for things you think were done wrong, it makes you look silly and it makes other students begin to do the same to you. Also even if you gave meds, looking at another nurse's patients' info is against every hospital policy I have ever seen so, if you were a real nurse, you would have been reprimanded for that. By this point in life I am sure you know people don't like being told on, especially if they could have been alerted first and they could've silently fixed their error and learned from their mistake. You know the saying, "you scratch my back, I'll scratch yours."? If you don't know what it means you better look it up and learn it. They might be your best friend after you help them not screw up, but they might be your worst enemy after being told on.

Seriously I know this is probably making you mad, but that is not my intent, I am trying to convey how serious this is. I think you should take this whole thing as a lesson. Its like if you go on to be an RN and you screw up, and since you made a minor mistake (insulin is serious, but it wasn't that serious yet or the guy would've been seizing etc. and everyone would've been in way deeper doo doo), your co-worker tells the nurse manager before even mentioning it to you. Then you get written up, or worse, you already have been written up a couple times and this is the thing you get terminated for. Telling on people before telling them you think they need to check their work is okay when the person is like, stealing drugs, or doing majorly erroneous things, but a small mistake should always be brought up to the nurse making the mistake. You will learn this (I pray you are in a program where you have to take an ethics course).

Next lesson NEVER EVER EVER EVER ....EVER.......EVER EVER EVER post anything about school on Facebook. I don't care if it is something great. Just Don't. That post was totally inappropriate and I have no clue how you could look at it and think it was okay. If this were a nursing job you posted about and they got wind of it you would be fired, I guarantee that, 100% no questions asked. You insulted your professor, your fellow classmates, the employees at the hospital, and foremost the facility who was kind enough to allow you to do clinicals there. When you do that, they think about how someone else's opinion of them has been infinitely marred by your opinion (key word opinion, not fact). Bad, bad, bad, bad. Not to mention the implications you are making about your inability to maintain confidentiality. When your fellow students and instructors read this they knew EXACTLY who you were talking about, what hospital, what teachers, and what nurses and assistive personnel. If you do this about anything work related, especially a patient even if you don't say their name, if ANYONE can gather info from what you insinuate, and guess who you are talking about, even if you WEREN'T talking about who they think you are talking about, you can be in big trouble and it can be considered a violation of HIPAA. You may think I'm wrong but I'm not and I know this. You have to think of this in terms of real life when you become a nurse. Although your instructors may seem cruel and wrong now, they are right (even when they are wrong most times, they are going to be right in the end, I hope that makes sense). This field is different from anything else and I was appalled at first by the politics but I wanted it so I did it end of story.

P.S. Be careful to check your own work now because as we all know cattiness is unavoidable in life. I hope they aren't, but your classmates may be foaming at the mouth to see you make an error so they can tell the instructor instead of you after this. Put yourself in their shoes, this is their future career on the line. If you don't get this right before you're a nurse you could lose jobs because of it. I've seen nurses at my hospital leave of drama (fires they started that they couldn't put out). I'm sorry if I offended you, please don't take any of this the wrong way, we are all trying to help you I swear, some of us have been in your shoes and its tough but you have to know who to say what to, heck, it'll even be on NCLEX.

[BuckyBadgerRN, ASN, RN]

please note, OP has stated that the whole group was in trouble if there were errors made. Therefore, they (the OP) was trying to prevent that. Is this not being a team player?

I find it hard to believe than an entire clinical group of students would be held accountable for the error of one.

[kloopRNBSN]

Things like, Maybe that's how people were raised and taught, but I wasn't taught like that." should be eliminated from your vocabulary. No one who brought you up was teaching you to be a nurse. In nursing you pick your battles or you crash and burn my friend. You'll learn.