Someone else makes a mistake, I get in trouble

Nurses General Nursing

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So today I get onto my shift at 0630, and I read through the RAND and do my physical assessments/checks of my patient... at 0715 or so, one of my preceptors walks in and asks me for a report. I tell her the patient's diagnosis, secondary diagnoses (including DM type 2), and then she stops me and asks what the most recent blood sugar was. Now, from what I remembered from reviewing the RAND was that my patient has q6hr fingersticks, the last one being before my shift started at 0600, the next being 1200. So, we look up the latest BS level and it hadn't been taken by the night shift. So, this leads to me being thrown into a big mess with the preceptor and an instructor going on and on about how critical thinking and good judgment required that I should have immediately noticed the absent BS check, and then done it myself or reported to someone else to find out why. I didn't do this initially because I thought that I didn't need to worry about it, since I read the RAND and it said that I didn't have a blood sugar due until 1200... so I didn't even bother checking since I thought it would have been taken care of before my shift -- hence, not my responsibility. What do you guys think, am I clinically neglegent, or am I paying for someone else's mistake? Would you have checked blood sugar levels for the previous shift if you were in my situation? Ever have a similar situation happen to you, and what did you do?

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Specializes in RN- Med/surg.

I think you're both at fault. When I have a DM pt...I want to know what the last BS is so I know what to expect. BUT- the miss itself wasn't your fault. I would have just admitted I should have checked..and would make sure to learn from it.

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Your unit needs to initiate a policy where a board or sheet with vitals and BS are always avaliable. That way if it neglects to get mentioned and you forget to ask you can just grab it and look. One place I work had a computer printout that came out with BS and vitals for the change of shift. We only reported on abnormals in report but I always grabbed the sheet and had a look. And yes I have failed to notice a lapse on the previous shifts part, but I was merely told about it once, no one went on and on about it. The biggest thing we missed was the fact that blood work did not get drawn. Sometimes we caught it sometimes not. Was it night turns fault for not noticing or was it daylights? Didn't matter, we all caught heck. Nursing's like that, you hear plenty about what you did wrong very little about what you did right.

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I'm for CYA too!

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Specializes in ICU, ER.

Yes, you are both at fault. Nights should have done the sugar and you should have known the most recent sugar on a DM pt. You should also know if it was covered and with how many units.

Learn from this - never assume somone else did something - "CYA" - protect yourself, protect the pt.

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Specializes in CCU,ICU,ER retired.

sorry, I have to say this. Yes but I would have looked at the 0600 BS. I would have wanted to know if it was covered because you give the AM meal. I would want to know if they had given insulin to or a snack before breakfast.

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Specializes in ER, ICU, Infusion, peds, informatics.

i'm going to disagree with most of the other posters.

[color=#483d8b]if you were truley quizzed about this info only 45 min after getting on shift, i would say that it wasn't your responsibility yet.

[color=#483d8b]when i precepted, i always emphsized to my orientees that even if a particular mistake was made on the previous shift, at some point, that mistake becomes yours if you don't catch it in a timely manner.

[color=#483d8b]the examples i usually used was either iv fluids or vasoactive drip rates. meaning, if you are told in report that the pt is getting ns, and the med sheet says the pt is getting ns, but the pt is actually getting d5w because that is what the previous shift hung, that mistake belongs to you as well as the nurse that acutally hung the wrong fluids, if you don't catch it in a timely manner.

[color=#483d8b]for vasoactive drips, the example i use is that the patient is on dopamine at 5 mcg/kg/min. however, the previous shift programmed the pump incorrectly, and the patient is actually getting the wrong amount of dopamine.

[color=#483d8b]again, since verifying pump settings is part of your assessment, this mistake becomes yours, as well as the nurse's that made the mistake, if it isn't caught in a timely manner.

[color=#483d8b]the question then becomes: what is "in a timely manner?" in my opinion, that depends on the particular situation.

[color=#483d8b]in my iv fluid example, i would give you a "reasonable" amount of time to make initial rounds on the patient to check basic things -- are they breathing, is their iv functional, are the correct meds hanging. depending on your patient assignment, that could be roughly anywhere from 30 min to 1 1/2 hours.

[color=#483d8b](if that seems out of line to most of you med-surg nurses, please keep in mind that i've only worked er and icu, and i'm guessing about the time factor; in the er or icu, i would expect either mistake to be caught in 30 min max; less for the vasoactive drip mistake).

[color=#483d8b]i would expect the dopamine programming error to be caught more quickly, since that should be a higher priority.

[color=#483d8b]so, from what you said, you had been on shift for 45 min. assuming shift report lasted 15 min, and giving you another 15 min to quickly glance through your charts, that gives you 15 min to start to see your patients. to me, you should have at least the opportunity to do a "look see" on your patient before you are accountable for everything about them. i guess what i mean is that you should have the opportunity to catch the mistake before you have to own the mistake.

[color=#483d8b]i don't think that 45 minutes is enough time to hold you accountable for that. the exception would be if you had already gone in and seen the patient. (or, if they were on an insulin drip, since they would be higher priority; or, if they were getting insulin that you had to give and had already given -- you should always know the result of the last blood sugar before you give any insulin, even if it is long-acting insulin.)

[color=#483d8b]so, a long-winded answer to your question. i guess that means that (to me at least) it isn't a very simple/obvious answer. since your preceptor felt that you were accountable for the omission, i would ask her/him why they felt it was your mistake, too (at that point) and when they would have liked you to have caught it.

[color=#483d8b]listen to what he/she says, and adjust accordingly. you might need to make it a habit in checking your most recent vs/blood sugars (and the times taken) during or right after shift report. not a bad idea, though in some systems/set-ups, it could be time-consuming.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I agree totally with critterlover, well said!

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Specializes in icu, er, transplant, case management, ps.

If I had noticed that another shift didn't do a blood sugar, I would have done it. And when I recorded it, I would have noted the time I did it.

Woody:balloons:

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Critterlover, I understand and agree with what you're saying here. But this is the part of the OP that concerns me:

I didn't do this initially because I thought that I didn't need to worry about it, since I read the RAND and it said that I didn't have a blood sugar due until 1200... so I didn't even bother checking since I thought it would have been taken care of before my shift -- hence, not my responsibility.

Hence, (IMO) this nurse did own the mistake.

So, this leads to me being thrown into a big mess with the preceptor and an instructor going on and on about how critical thinking and good judgment required...
I have to agree with them. It's not that you are "paying" for someone else's error/omission... it's that you felt you didn't need to "bother" with knowing the value since you weren't expected to check a sugar until 1200.
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It doesn't sound like you were severely chastised or corrected over the situation. It was your responsibility to make sure that you knew the latest blood sugar level. Patients with DM can have pretty dramatic swings in blood glucose levels when they are hospitalized, even if the DM is not the primary reason they are there.

It's everyone's responsibility to monitor the patient. You are a student, so you are still learning. (By the way, you never stop learning in this field ) It appears to me that your preceptor and your instructor just wanted you to know how important that blood glucose level was. I know it's hard to be corrected, and at times it feels like criticism. But I've learned a lot of my best lessons from being 'corrected' by those who have a LOT more experience than I do. I guess I don't see the situation as you being in 'trouble' for a mistake. You have to be open to CONSTRUCTIVE 'correction' from the nurses you work with when you are a new nurse. Most of the time I think the seasoned nurses really do want to help you improve your practice. Of course, there are a minority of seasoned nurses who just want to tear you down, but in time you'll learn which nurses are which. Learn from the incident and move on. It won't be the first or last time you are corrected for an incident.

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Specializes in critical care.

i was just wondering...where was your preceptor when you were taking report? when i precept new nurses/new hire nurses, i always take report with them so at least i can catch whatever is missed or i can ask questions so the orientee will learn what/how to ask questions next time.

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