Sweeping med errors under the rug

Ruby Vee, BSN · Aug 20, 2016

I work at a nursing home. Over the last 8 months or so, I have turned in approx 15 med errors from the same nurse to my Unit Supervisor. A few of these had a potential for serious injury or death. Nothing has been done about this nurse. I have gotten excuses from the higher ups. I was brought into the office and given a lecture about comraderie. Then I knew I was on the chopping block. The very next week I was called in for not giving a patient her meds. (I documented that she was punching and fighting.) I refused to sign the write up. The DON is friends with this certain nurse who I'm afraid will kill someone. I'm looking for a new job and I know I need to tell a state person, but I'm a single mom who has to work. I can't do anything until I'm out of there, but I feel like I'm tearing apart my ethics and integrity every shift I work. Ideas??

It is your responsibility to document any genuine med errors that you discover, but you don't get to decide what the boss does with the information. Nor do you get to KNOW what she does with it. If your colleague is somewhere in the disciplinary process prior to losing her job, is undergoing remediation on medication administration or has been counseled -- that's none of your business. Your boss would be breaching your colleague's confidentiality if she reported to you what she did about it. For all you know, your colleague is one misstep away from termination.

Now, if only a few of these medication errors that you're writing up had a potential for serious injury, why are you writing up the rest of them? Are you trying to document a process problem, in hopes of getting things changed? Are you just nitpicky? Or are you TRYing to get your colleague into trouble. I suspect from the fact that you were spoken to about camaraderie, your bosses suspect that your motives are less than pure.

Please take a look at your own behavior and ethics and decide if these medication errors are indeed serious enough to require a write-up, nevermind a visit from the state. You wouldn't be the first new nurse to be over-vigilent about med errors that are, in the end, nothing to get excited over.

dawnall · Aug 20, 2016

I'm not a new nurse. As a matter of fact, I was DON at a facility for several years and chose to step down for my family. As a nurse with integrity, when do we choose which med errors we report? Only the serious ones? I think before you tell me to look at my own behavior, you look at your own integrity. I have never had a problem with this until this place. I've been a nurse for 8+ years. That may be new to some, but I'm not brand new.

Ruby Vee, BSN · Aug 20, 2016

I'm not a new nurse. As a matter of fact, I was DON at a facility for several years and chose to step down for my family. As a nurse with integrity, when do we choose which med errors we report? Only the serious ones? I think before you tell me to look at my own behavior, you look at your own integrity. I have never had a problem with this until this place. I've been a nurse for 8+ years. That may be new to some, but I'm not brand new.

Forgive me for assuming that you are new.

A nurse with integrity might report a Colace dose given at 21:00 or 23:00 instead of 22:00, and I've often seen new grads do exactly that. An experienced nurse might note that Colace given twice a day probably isn't especially time sensitive and give the 22:00 dose with the 21:00 antibiotic without necessarily thinking "Med error". If a new employee were to submit 15 or so incident reports based on that sort of incident, I might indeed call her into the office to discuss teamwork and getting along with one's colleagues. Given that you shared you were indeed called into the office for such a discussion, I thought it might be possible that were the case.

A midnight antibiotic not given until 1 am because the pharmacy didn't send it until 12:58 might not be a issue of integrity if it was a daily dose. If it's due every four hours, that might be a systems issue worth addressing.

If you were a DON, surely you know that you don't get to know about another person's disciplinary action. If you were just ranting, I'm sorry I spoiled your rant. I thought you were looking for advice and ideas.

dawnall · Aug 21, 2016

These are instances six as given a double dose of potassium, the wrong dose to a patient that even had the wrong patient, and charting that they giving Amiodorone on a patient with a pacemaker for 4 days when the medication was never even delivered. Those are only a few. I was basically told the comraderie is that we have each others backs which I accepted as hiding and covering up med errors. How many can this nurse do before there is a major incident? It would be my fault as well for not fighting more for the patients. That's my concern.

caliotter3 · Aug 21, 2016

I always found that the "have each others backs" rule only ever applied in one direction. When going against a "favorite" of the person in charge, one does not win, ever. I found that out the hard way, over witnessing actual abuse of an elder. I don't know what to tell you except that I hope you at least started your actions by talking to the nurse at the first instance (of the "milder" error). Hope you find a new job soon.

KRVRN, BSN, RN · Aug 22, 2016

You say nothing has been done about this nurse. How do you know?

dawnall · Aug 22, 2016

When I was brought into the office, the DON made excuses and said that we can't be sure that she really made a med error. I'm assuming that was her way of showing comraderie. I have an honest concern that this nurse's mistakes will end up harming someone. I am holding myself accountable because I feel like there is something more I need to do, but my hands are tied.

GeneralistRN · Aug 22, 2016

I work at a nursing home. Over the last 8 months or so, I have turned in approx 15 med errors from the same nurse to my Unit Supervisor. A few of these had a potential for serious injury or death. Nothing has been done about this nurse. I have gotten excuses from the higher ups. I was brought into the office and given a lecture about comraderie. Then I knew I was on the chopping block. The very next week I was called in for not giving a patient her meds. (I documented that she was punching and fighting.) I refused to sign the write up. The DON is friends with this certain nurse who I'm afraid will kill someone. I'm looking for a new job and I know I need to tell a state person, but I'm a single mom who has to work. I can't do anything until I'm out of there, but I feel like I'm tearing apart my ethics and integrity every shift I work. Ideas??

On one end it sounds as if you are being victimized, but on the other hand how do we know that you are not just a hyper-vigilant pest and a busybody who is dealing with some consequences of tattling? Does your facility require you turn med errors into a supervisor? You couldn't have filed incident reports at this facility?

You should watch the 1990s movie "The Craft." What you put into the world, you get back times three. It's called the Threefold Law.

psu_213, BSN, RN · Aug 22, 2016

When I was brought into the office, the DON made excuses and said that we can't be sure that she really made a med error.

This still does not prove that nothing is being done about the situation, and it does not prove that this nurse has not been disciplined. Perhaps in the DON's mind, some of the reported med errors are nitpicky, and she is tired of hearing about them. Plus, she knowx that it is really none of your business if this other nurse is being disciplined, and this is her way to end the conversation diplomatically.

AutumnApple · Aug 22, 2016

I, unfortunately, did a few months supervising at a local nursing home.

That was, from the career perspective, eight months of my life I'll never get back.

You'll never see me on the clock, in a long term care facility again. There is a culture there that just triggers me in all the wrong ways. No matter how patient/safety focused you are, this culture eventually swallows you or spits you out. Sounds like you're in the process of being spit out.

That culture is: Whatever gets us through the shift is legit.

That's never been my approach to nursing, and it didn't become my perspective either so, I too got spit out. With me, I just walked away before the drama started is all.

Things I witnessed:

Nurses passing an entire shifts meds in one, mid shift med pass. Insulins and select antibiotics were the exception (they only did PO) thankfully. Then the books were signed to show all meds given at the proper times.

Meds that were not even available being signed off. Nurse 'A'' on day shift would sign off a med as given, then nurse 'B' on evening shift would go to give it only to find out that it needs reordered and has not been in the med cart for close to a week. This put nurse 'B' in a quandary because, when you reorder a med late, first thing it asks is "Did the patient miss any doses?".

One nurse did not like a specific patient who they considered a "drug seeker". She wanted nothing to do with him and limited her visits to his room. One way of reducing her trips to the room was to put all the PRNs he could possibly have that whole shift in a cup, give it to him and tell him "These are all your meds you can have for this shift. Use them however you want, but don't ask for any more." Obviously the patient loved her, till he realized she was serious about "Don't ask for any more." When he did complain that he needed extra and she refused.................. :banghead: ..............the twit even admitted what she had been doing (that's how we knew, she said so).

A nurse aid would disappear for hours at a time (not uncommon). Thing was, his absences were growing longer and longer. The day before I put a stop to it, he was gone for five hours straight (and yes, when he got back, he took a lunch break to boot). Thing was (the reason he got away with it for so long before I got there) was, often he'd return with McDonald's and claim to have been in the food run for everyone. Truth was (and this is why management backed me when I addressed the issue), he was going on dates with another CNA but staying clocked in. So it wasn't just him gone, it was two CNAs.

Those are the top three that I recall at the moment, but there was more.

I survived my eight months there by being mindful of two things: 1. There was a culture there that didn't agree with me and 2. That culture wasn't going to change.

I addressed things as best I could. I did actually solve a few things even, but more often than not, management would blow me off when I informed them of a problem and just let it go. They had been swallowed by the culture, and I was doing things that made them acutely aware of that fact. This made them resent me, at times. I was careful to know when to drop things.

In the end, I left. You said you're looking for suggestions............

You need to leave. Staying and fighting the culture is just going to make you look like the bad guy, and no amount of reporting what goes on in that place will save you from that.

Another thing to be mindful of is, you were a DON. At this place, you're a nurse. Don't give the management that you're judging them or you think you're the new sheriff in town. That will have you.......as you put it.......on the chopping block......with them looking for a very dull knife to use at the same time.

heron, ASN, RN · Aug 22, 2016

This still does not prove that nothing is being done about the situation, and it does not prove that this nurse has not been disciplined. Perhaps in the DON's mind, some of the reported med errors are nitpicky, and she is tired of hearing about them. Plus, she knowx that it is really none of your business if this other nurse is being disciplined, and this is her way to end the conversation diplomatically.

Could also be an indirect caution against gossip. Don't know that you are, but the level of frustration you express could lead a person to vent to co-workers. No bueno.

When I fill out a med error report, the only people I mention it to are the person who made the error (as a courtesy to a co-worker and to offer an opportunity for that nurse to do the reporting herself) and the supervisor to whom I reported it.