update on steppping on senior nurses toes

Nurses General Nursing

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Hi all! and thank you for the replys. Helped alot. However, now I have a addendum to that issue.

here goes, It seems that the senior nurse I was talking about has been trying to set me up for failure. The other day, she set alarms on a patient who was in RAF to go off whenever the hr dropped below 100. Being new, I did not know how to turn these alarms off, and frankly didn't need them on as I was sitting bedside with the patient monitoring him while giving diltiazem. Anyway, monitor ran out of memory because it records every time an alarm sounds, which was numerous, as trying to get this pts hr to decrease was my ultimate goal! Needles to say, all my data was lost for the last 2 hours of this patients stay in the ER. (I have since found out that I need to turn the monitor off and back on to get rid of the alarms! )

Then yesterday, before she left at 3:30 am, she came out to med-surg where I was because there weren't any patients in the ER and said there was nothing to report on. So I stayed out on med-surg and helped the other nurses. well, at 7:30 I received a phone call from the OR tech telling me there is a syringe of morphine laying on the counter and alot of staff walking through the ER. So I go and get it and return it to pharmacy.

Maybe I am just paranoid, I don't want to think these things were done intentionally, but this is all in 4 days. Just want to know if you think I am being paranoid or If you think the first incident was jsut what she said for patients safety and the second incident an error, after all, we are all human, right?! Trying to be oprimistic, but this very difficult.

b eyes

I don't really see where she is trying to set you up. Yes the alarms were set to go off at 100 but maybe because she was giving cardizem she didn't want the heart rate to go below 100 without adjusting the rate...maybe she had a reason for readjusting the alarm. They can be adjusted somewhat for each patient, it is our responsiblity that the alarms are appropriate for our patient every time we hook them up. As for the morphine the records should indicate that you were on med-surg unit and I would have called the nursing supervisor take care of the morphine issue. You were in no way responsible until you took it upon yourself to return the drug. If you had called the supervisor then she would have known that the other person left it out.

Just concentrate and keep vigilante that you are doing the right thing and quit worring about what the other nurse is doing. You are going to get so stressed out about this that you will end up making a mistake. Not to sound harsh but stop blaming others and start taking some responsibility for your own mistakes.

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Specializes in ER, Med-surg, ICU.
I don't really see where she is trying to set you up. Yes the alarms were set to go off at 100 but maybe because she was giving cardizem she didn't want the heart rate to go below 100 without adjusting the rate...maybe she had a reason for readjusting the alarm. They can be adjusted somewhat for each patient, it is our responsiblity that the alarms are appropriate for our patient every time we hook them up. As for the morphine the records should indicate that you were on med-surg unit and I would have called the nursing supervisor take care of the morphine issue. You were in no way responsible until you took it upon yourself to return the drug. If you had called the supervisor then she would have known that the other person left it out.

Just concentrate and keep vigilante that you are doing the right thing and quit worring about what the other nurse is doing. You are going to get so stressed out about this that you will end up making a mistake.

the morphine was returned to the pharmacy, and taken out of the pyxis by the other RN, pharmacy is aware of that.

And thank you for helping me see things from the other perspective. this other nurse is very difficult to many, and after I made up packets for admissions and transfers, she didn't like it. and was very vocal in telling me so. These things have since followed in a two week period.

But I do understand my responsibility to my patients. Tahnk you b eyes

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Specializes in ER, Med-surg, ICU.
I don't really see where she is trying to set you up. Yes the alarms were set to go off at 100 but maybe because she was giving cardizem she didn't want the heart rate to go below 100 without adjusting the rate...maybe she had a reason for readjusting the alarm. They can be adjusted somewhat for each patient, it is our responsiblity that the alarms are appropriate for our patient every time we hook them up. As for the morphine the records should indicate that you were on med-surg unit and I would have called the nursing supervisor take care of the morphine issue. You were in no way responsible until you took it upon yourself to return the drug. If you had called the supervisor then she would have known that the other person left it out.

Just concentrate and keep vigilante that you are doing the right thing and quit worring about what the other nurse is doing. You are going to get so stressed out about this that you will end up making a mistake. Not to sound harsh but stop blaming others and start taking some responsibility for your own mistakes.

I am not blaming others for my mistakes. I was asking if you thought that this could have been a possibility.. I am the first one to take responsibility for what I do and what I don't do.

b eyes

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This woman sounds toxic. I think it would behoove you to not work in this ER. She is trying to undermine you purposefully. If she changed the monitor parameters, her responsiblity would be to inform you that she did, and educate you as to the rationale, since she is more experienced than you.

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All it takes is a simple communication " b eyes, I changed the HR alarm to 100 so that we can titrate down the cardizem as needed". What's so hard about that? My collegues in ICU always inform me if they want to change the alarm on one of my patients, for instance an asymptomatic bradycardic pt who is sleeping, so their HR is dipping into the 40s.

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Specializes in ER, Med-surg, ICU.
This woman sounds toxic. I think it would behoove you to not work in this ER. She is trying to undermine you purposefully. If she changed the monitor parameters, her responsiblity would be to inform you that she did, and educate you as to the rationale, since she is more experienced than you.

Thank you Garden Dove, i was thinkng along those lines as well..

but yes, everybody else I do understand that it is still MY responsibility to ask and get educated if I don't know.

b eyes

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Specializes in ICU-Stepdown.

sounds downright nightmarish! Being new to an area is tough enough without having someone deliberately try to mess with you.

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Specializes in Rehab, LTC, Peds, Hospice.

Pet peave of mine! Expecting nurses to know how to set all equipment! It is rare that that gets addressed in report. How many times has this happened to me in many other situations - plenty! New CPM machines, pca pumps, IV pumps, accuchecks, monitors, wound vacs, TF - some prime for you, some give water for you, we change companies, we change machines but no one gives us the directions! I'm pretty techno savy, but you can waste a lot of time trying to figure out, find somebody who knows what they are doing, etc. Never mind pharmacy, they send over powdered mix medications now with a new set up thats pretty cool (Pre attached, just break the seal and pierce, also snap the plug seperating, which I never would've figured out on my own) Home care alot of time we attach the directions directly to the equipment in a bag, works great!

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There is one person that works the nightshift that habitually turns of the alarms because they keep ringing out and he doesn't like to hear them. I have reported him and reported him, and a couple of times I have missed

drops in sats because he turned them off. The only thing that has changed is now the Charge nurse is responsible for making sure all the alarms are turned on and guess who is in charge most of the time . He doesn't turn them off to set people up he does it just because he doesn't want to hear them.

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Specializes in ER, Med-surg, ICU.
There is one person that works the nightshift that habitually turns of the alarms because they keep ringing out and he doesn't like to hear them. I have reported him and reported him, and a couple of times I have missed

drops in sats because he turned them off. The only thing that has changed is now the Charge nurse is responsible for making sure all the alarms are turned on and guess who is in charge most of the time . He doesn't turn them off to set people up he does it just because he doesn't want to hear them.

Yes, and that is very dangerous. I did not want to turn the alarms off, I wanted to reset them. I did not know that the monitor would run out of memory, and I would lose all my data. I just didn't know that and nobody had told me. But I do know that now! thankfully nothing happened to the patient. I like to think that it wasn't a set up for failure, but... I don't know......

b eyes

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Pet peave of mine! Expecting nurses to know how to set all equipment! It is rare that that gets addressed in report. How many times has this happened to me in many other situations - plenty! New CPM machines, pca pumps, IV pumps, accuchecks, monitors, wound vacs, TF - some prime for you, some give water for you, we change companies, we change machines but no one gives us the directions! I'm pretty techno savy, but you can waste a lot of time trying to figure out, find somebody who knows what they are doing, etc. Never mind pharmacy, they send over powdered mix medications now with a new set up thats pretty cool (Pre attached, just break the seal and pierce, also snap the plug seperating, which I never would've figured out on my own) Home care alot of time we attach the directions directly to the equipment in a bag, works great!

Sorry, but cardiac monitors in a critical care area, and the ER is considered a critical care, are are the lifeblood of that area. And that is the first thing that you need to be very familiar with. Even back in the days when I was working full-time agency and literally floating all over, the first thing that I did was always check the monitoring system that was being used and how to adjust parameters. This is required many times with specific patients that do not have normal heartrates. Sure, new equipment comes out, but the basics are always the same. Even with the PCA pumps, the CPM machines, etc. They all work on the same premise and are usually easy to figure out. But a cardiac monitor and someone can die over it if the parameters are not set properly. Or someone had changed them from the default and you were expecting to have the normal settings. The nurse in the critical care are has the responsibility of knowing what the defaults are for that monitor and what they are set at for all times. If there are changes made to it and they are not aware of them, a patient can die over it.

And if you get a new piece of equipment on your unit and have not been inserviced on it, and use it, and there is a problem down the road; guess who is going to be hung out to dry. This is something that needs to be discussed with your nurse educator. All Home Care agencies that are accredited do have educators and you also have an RN that you can phone as your supervisor to ask these questions.

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Specializes in Day Surgery/Infusion/ED.
Have no idea of the other thread that you wrote about, but you have stated in your profile that you have 5 years of experience in med-surg and ER. Then you should not be having these issues. You should have been thoroughly trained on the use of the monitor and long ago. And who signed out that syringe of narcotic? They are the one that is responsible for it, no one else. And legally responsible for it.

Thank you.

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