who is responsible for this error? Need Input!

TheCommuter, BSN, RN · Mar 21, 2013

You called the MD against the other nurse's wishes. You received the telephone order for the medication, probably against her wishes as well. Do you see where I'm going? Based on limited info you've provided, the other nurse sounds very unreliable and somewhat lazy regarding following up with issues.

Even though your shift ended, you cannot count on an unreliable nurse to follow through with the order you obtained, especially since she did not want to do the legwork in the first place. It only would have taken an additional minute or two to transcribe the order onto the MAR. If I write a verbal or telephone order, I carry it out because now my name is on the physician's order sheet.

In LTC (and in other areas of nursing), you will learn that you must do certain things yourself if you want them done right. By no means am I blaming you for the medication error, but you expected work from a coworker who simply did not want to do her job IMHO.

jadelpn, LPN, EMT-B · Mar 21, 2013

Hey everyone,
I recently started working at a LTC facility, this is my first nursing position out of school, for the most part things are going well. We have a resident who currently receives dialysis and has to travel for services. This person leaves in the AM and doesn't return to the facility until a few hours into the PM nurses shift. That is when the communication is relayed to the nurse about the events at dialysis. Recently I was getting caught up on my charting and the PM nurse received the pharmacy orders. She asked me why this certain med was ordered for this resident and I told her I had no idea what new medication she was talking about, I had not received any orders. Since this nurse would have just left the med and had me call the MD the next day, for some reason she refuses to contact MD's. I offered to make the call while she was sorting the meds. While she was standing NEXT to me I got the t/o from the MD with the dx and explained the order and gave her the order for her to place into the MAR. Since it was not my shift any longer I felt that it was not my responsibility to continue to act as the shift nurse. I had already helped her by contacting the MD during her shift. Well 5 days go by and I receive a call at home from this nurse asking be why the order wasn't placed in the MAR. I didn't know what to say considering that I was scheduled off the day after taking the t/o and then working a different wing the next 4 shifts scheduled. I feel she is trying to set me up for being responsible for this Med Error. She was aware of the order, she placed the med in the cart herself, and worked three shifts after. Fortunately the Social worker we have on staff is an RN and was replacing charts after MD rounds and observed me taking the t/o and giving it to the PM nurse. Thankfully she was paying attention and remembers this whole situation playing out. Do I have need to be worried about this med error falling on my lap? I no longer complete my charting at the nurses station, I have been finishing up in an empty office.

If you take the t/o YOU are responsible to write the order. You can NOT take the order then tell the other nurse about the order to write it herself. She did not get the order, you did. So you write the order, and she would be responsible to then put it on said MAR and note the order on the order sheet. If you wrote the order when you received it, it would then be her responsibility to take the order off, and note it. However, to do a complete follow through yourself may not have been the worst idea. As a general rule, and with all this being said, if the PM nurse received the patient, then she needs to do whatever it is that needs to be done--and you should not volunteer to get involved. Too many in the mix.

uRNmyway, ASN, RN · Mar 21, 2013

I agree with other posters. I think it was nice of you to try to help out your PM colleague. But here's the thing: you either do it or you don't, you know? You can't get orders for someone else then not write it down.

You want to know who was in the wrong? I think you both were. The nurse should have done her job and clarified the orders on her own. She shouldn't have relied on you to do so, and when you were nice enough to call, she should have taken note of it and certainly not thrown you under the bus.

On the flip side, when you started to do this for her, you should have seen it through all the way. Because if you take the TO from the doctor after having identified yourself, then the doctor gave the order to YOU. You repeating it makes it like a verbal order of a telephone order. Ever played the telephone game as a child? Personally, if I am putting my name to a TO, I want to have heard it with my own ears. You knew that this nurse was not concerned with doing what she should when she was willing to delay a dialysed patient's orders a whole day. You should have made sure your bases were covered.

Just learn from it. Helping colleagues is great, teamwork is an integral part of nursing IMO. But if you do, make sure you help properly. An order YOU receive is an order YOU document.

allnurses Guide · Mar 21, 2013

I agree with everyone else about who is responsible for entering a verbal order that you received, but if I understand your post correctly as she refuses to call the MDs, (plural) to the point that she would've waited until the next day to have you do it and not given the patient their new med. She needs to get over that as calling a doctor is an integral part of her job, and her phobia or whatever it is - is delaying the ordered med unnecessarily.

You sound like a very helpful and kind person, but I would in no way support or enable that behavior again, because it's dysfunctional and has the potential to negatively affect patient care.

Best wishes to you!

TopazLover, BSN, RN · Mar 21, 2013

Every nurse has to have the ability and willingness to call a doctor. In essence you trying to be helpful has covered for her inadequacies. You now can see what happens when you are cover for some one who can't or won't do the job. I would worry less about who could have been found at fault and make sure you are doing your own work and leave others to do their own. Should this nurse ask again for your help with calling a doctor, perhaps offer to listen in with her conversation so you can assist her growth, not do it for her.

drowningdaily · Mar 21, 2013

I spent several years in LTC, and I don't think you did anything wrong. If you recd and wrote order in chart, and told next nurse she had an order to take off, it is on him or her. You did right by your patient. In LTC you get in trouble for staying late, so I would have done just what you did.

The two nurses responsible for this are the nurse who didn't take the order off and the nurse responsible for 24 hour chart check.

morte, LPN, LVN · Mar 21, 2013

BINGO!

I spent several years in LTC, and I don't think you did anything wrong. If you recd and wrote order in chart, and told next nurse she had an order to take off, it is on him or her. You did right by your patient. In LTC you get in trouble for staying late, so I would have done just what you did.
The two nurses responsible for this are the nurse who didn't take the order off and the nurse responsible for 24 hour chart check.

ndlpn · Mar 21, 2013

Now looking back I realize that I should have just let her deal with it. It will obviously be a gesture that I will never make again. BUT to put things into perspective at the time this was my thought process when she asked what the med was when going through the pharmacy return........"Crap, It will just be myself and a MAII for the AM shift tomorrow, I am going to have to take the heavier line because otherwise I am going to be running back and forth over to that side anyway. I already have to complete 8 Medicare assessments, 6 dressing changes, and pull lab work on 3 residents. Besides answering the stupid phone calls that have nothing to do with nursing, being available to take the MD calls and call the MD when needed, and contacting family if there are any changes in any of the residents. So, If I just call him then it will be one less thing I have to do tomorrow." So I called him, and I gave her the order that I wrote, placed the pink/green slips in the boxes accordingly, gave her the yellow slip and put the white in an envelope to take to dialysis to be signed, and she told me she would follow through with it and then she never did.

And others that work in LTC do know that most facilities get angry when you collect overtime...It was only Wednesday and I already had 30 hours in....

TheCommuter, BSN, RN · Mar 22, 2013

And others that work in LTC do know that most facilities get angry when you collect overtime...It was only Wednesday and I already had 30 hours in....

Yes, I worked in LTC for 6 years (2006 to 2012) and I know that management at many nursing homes has an aversion to paying out overtime. However, the typical LTC nurse has a workload that is difficult to complete in 8 hours, 12 hours, or however long the shift might be.