Tips on successful confrontation - your suggestions?

[Kay Ciel, RN]

I'm a relatively new nurse in the ER, got off orientation about two months ago. So far, I'm loving it. However, there's been one experience that's soured the whole thing...

This guy comes in with 222/137 blood pressure. Doc orders a drug I've never given before, and the dose seems frightening high (of course, anything over 4mg of ANYTHING is scary to an orientee! :trout:). Of course, I check at least two drug guides and call pharmacy, in case there's protocols I don't know about. Everything confirms that this is safe. I basically make this patient my world for an hour and a half, vitalizing q5min, doing everything by the book.

Flash forward a couple weeks. Supervisor calls me in saying, "I heard you were giving a lot of (this class of drugs) a bit ago". She heard it second-hand from an older nurse. I said yes. She starts yelling that it was a huge dose and forbids me from giving any vasoactive drugs until orientation is over, and "why didn't you check any guides before you did that? He could've died!" I'm so shocked and on the verge of crying I didn't say that I did. My manager seems to believe that all drugs in this class are created equally, which explains why she went off the handle. :uhoh21:

Two months later: I'm sure what I did was within nursing practice, but now I'm utterly frightened of my supervisor. I've been completely avoiding her. At the same time, I'm angry that she jumped to conclusions and screamed without double-checking the facts. I want to show her a drug guide and educate that what I did was right, to prevent this sort of thing from happening again with anyone (let alone a new grad who is already believing that nurses eat their young, heh), and to prove I'm not "completely incompetent and a wild-child, renegade nurse who will kill somebody" if I don't shape up. My questions are these: should I bring it up with her? And if the answer is yes, how do I do it tactfully without attacking her? Email? Face to face? Is it even too late to bring this up?

I feel like I should say something, but have no idea how to go about doing it. This is really tearing me apart. Any suggestions from anyone? What would you do?

[TheCommuter, BSN, RN]

If you did the right thing, then you need to tell her.

I would approach her privately and ensure that only the 2 of you are capable of hearing the conversation. I would then tell her everything you have told us. In addition, have all your ducks in a row (drug book or internet printout of the safe dosage amount). Emphasize that you looked this med up before administering it, and that you know you were practicing nursing safely.

If she gets away with yelling at you once, she will definitely do it again unless you nip it in the bud. Good luck!

[CritterLover, BSN, RN]

if you were on orientation when you gave this medication (sounds like you were), then where was your preceptor?

he/she should be standing up for you to your supervisor, letting her know that you acted appropriatly; that you both looked the drug up, and called pharmacy.

and really, your preceptor should have been involved with the initial meeting with your supervisor, since he/she is partially responsible for your practice while you are in orientation.

[TazziRN, RN]

Preceptors are often not in on meetings when it's not the preceptor who flagged a problem. At the end of my orientation I was called in for an evaluation. Another nurse, not my preceptor, wrote me up for abandoning a code that I was lead nurse in. I remembered the pt, and I told the boss that a) I left the room because my preceptor had told me to get a piece of equipment, and b) as an IP still on orientation I had absolutely no business being lead nurse in a code and c) if this was such a problem why didn't my preceptor say anything to me?

Definitely say something. Be direct, non-confrontational, let her know how the incident makes you feel even now. Use "I" statements. And have all the documentation on the med that you can find: drug book, pharmacy insert, everything. Highlight the dose ranges.

[yes_I_care]

hi-

I would approach your preceptor and your boss and explain everything like you did here. If you checked and double checked everything you need to convey this to your boss.

I had my own wonderful experience with confrontation just yesterday. My boss called me into her office to go over a write up an LPN had done. What happened was I had a very confused pt who had removed his mitts on his hands and pulled his foley and iv line out. I gave the LPN wrist restraints to put on the pt with the help of the aides that were in the room while I called the dr at 2am to get ativan for this pt.

While I was on the phone I heard my LPN yelling at the pt and the roommate. The LPN came out of the room and yelled "I could've used your help in there and instead of computer work"

I just thought this chick had flipped. When I work with the LPN's they are all fantastic. What I was doing was putting the order in from the Doc so I could remove the med from our pyxis.

Well basically the lpnsaid I was yelling at the pt and left the room with her alll alone to put the restraints on. I told my boss what really happened and I told her I would rather not work with the lpn again.

[caliotter3]

Write up your side of the story in formal language, present her with a copy at your meeting, and keep a copy for yourself. You can almost bet the casino that this will come up again around the time of your end of probation counseling, or at your yearly performance review. You would do well to address all major criticism in writing, especially if you are right, so that you are not blindsided. You should also start a little book on yourself, write about all your above and beyond efforts, so that you have the basis for a rebuttal if your yearly review is unsatisfactory or if you are chosen for a layoff and they try to paint you as below standards. Good luck.

[TheCommuter, BSN, RN]

Write up your side of the story in formal language, present her with a copy at your meeting, and keep a copy for yourself. You can almost bet the casino that this will come up again around the time of your end of probation counseling, or at your yearly performance review. You would do well to address all major criticism in writing, especially if you are right, so that you are not blindsided. You should also start a little book on yourself, write about all your above and beyond efforts, so that you have the basis for a rebuttal if your yearly review is unsatisfactory or if you are chosen for a layoff and they try to paint you as below standards. Good luck.

This is excellent advice from caliotter3, since nursing is one of the most political career fields ever. You will need to defend your behind without sounding defensive, and you will need to maintain a paper trail.

[Agnus]

If I were an orientee or a preceptee I would have my precetor in on anything I had the slightest doubt about. You did not for reasons only you know. You can not undo the past. Admit your mistake. I would thoroughly research this med. and research it with pharmacy. Then if everything you find supports your actions bring this to the attention of your manager AFTER you acknoledge your error in not bringing your preceptor in on this. Verify your findings with pharmacy as you may need to have the pharmasist back you up on this.

If I am in doubt about a drug I will not only look it up but will often as not check directly with pharmacy and definately check the hopsptal's policy. It may be as safe as you say but you may have violated the hospital policy.

[EmerNurse, BSN, RN]

If I check anything with pharmacy, I document it in the patient chart. Pt. medicated as ordered, dose/route etc verified with Marigold in Pharmacy and MD before administration. (or whatever it is you did)

Nursing is a CYA career in a lot of ways. If I'm unsure, I check with a verified authority (policy, pharmacy, appropriate drug guide) and document that I did so. Even something as simple as blood cultures which are often ordered at the same time as an antibiotic. "blood cultures drawn and sent to lab per policy, then pt. medicated with XYZ abx."

It's sad but it's true - if you don't document, you don't have proof, regardless of how trustworthy you're known to be.

Good luck!

[jill48, ASN, RN]

Did you chart all of these calls you made to check the safety of the dosage? I would chart the calls: who I called, what time, the name of the person I spoke with, and their response- in quotes. I live by this motto: if you didn't chart it, you didn't do it.