Very concerned

[ButterflyRN90]

I'm going to make this as clear as possible . I work nights at a hospital on a tele floor. I'm currently on orientation and am towards the end of it. So, one night I had a pt who was in ARF, dialysis, and a Type 2 DM. So the pt BG drops to 44mg/dL and when asked states "I don't feel so well". I run in there to give OJ to which pt states "I don't want anymore ". Protocol is 50u of D50 if unable to give PO. So I gave 50u D50W. Pt shot up to above 200. I offered milk and pt refused (was also ineffectively coughing/ had fluid in lungs). Offered graham crackers (refused). After the elevated BG I administered the Levemir that was scheduled. 10 units of levemir which has no peak. Anywho out of my 4 pts I rounded on this pt the most because they had fluids and labs that I did. Pt had no BG checks during night (we don't do them). Every time I rounded I asked how pt was feeling (pt is aaox3). My last round was during lab draw around 0545. Pt actually told me "thank you for your help" and when asked if she was in pain (pain assessment) or if she felt weak/off (BG) pt stated "no I'm good, just want to get some sleep."

Gave report to day nurse who sees pt asleep and goes and continues getting report from other nurses. I was now giving report to other nurse and to finish charting.

1.5 hours after handing report to day nurse, preceptor runs to me stating "pt has a BG of 14! I run in and pt is non-responsive. Day charge nurse was pushing 2 amps D50 when I wheeled computer. When I mentioned pt only had LEVEMIR given preceptor yelled "WHY WOULD YOU GIVE THAT WITH A 200mg/dL BG!?" I'm a T1DM so it wasn't that I have a med I knew nothing about. So I told preceptor "but why wouldn't I?" She gave me a look of hatred as Rapid Response was called. Pt taken to ICU.

I sat at the nurse's station in tears. I'm being looked at as the one who did this even though my pt was aaox3 BEFORE report and pt wasn't checked after I gave report. I'm freaking out. They're investigating and pt is ok. What would normally happen? Would I lose my license or job? I'm really freaking out to where I have chest pain.

[Sour Lemon]

I did. It was 200mg/dL. ARF is acute RESPIRATORY failure. I'm seeing a lot of confusion where I wrote ARF. That's why she didn't want to eat or drink. She was coughing. She'd aspirate.

I've never seen ARF used for respiratory failure. I think ARDS is used, commonly.

In any case, thank you for keeping us updated. I was hoping that you'd already heard good news by now, though. Hopefully you will soon...

[ButterflyRN90, ASN, RN]

I've never seen ARF used for respiratory failure. I think ARDS is used, commonly.

In any case, thank you for keeping us updated. I was hoping that you'd already heard good news by now, though. Hopefully you will soon...

I know it looked weird when I saw it in the pt chart, I'm still getting used to abbreviations used here. (as-aspirin, card-cardiology, ivf- iv fluids (pt was also pregnant so I thought of in vitro fertilization lol) but yea I'll keep it updated. Hopefully soon.

[Horseshoe, BSN, RN]

I know it looked weird when I saw it in the pt chart, I'm still getting used to abbreviations used here. (as-aspirin, card-cardiology, ivf- iv fluids (pt was also pregnant so I thought of in vitro fertilization lol) but yea I'll keep it updated. Hopefully soon.

In my experience, ARF is usually used to abbreviate acute renal failure. Considering your second sentence out of the gate was "So, one night I had a pt who was in ARF, dialysis, and a Type 2 DM", putting the ARF right next to the word dialysis would tend to imply that you did actually mean acute renal failure. Granted, dialysis would not normally be a first line treatment of ARF, but depending on severity, could be used. I think the confusion was understandable.

[ButterflyRN90, ASN, RN]

Updated: they decided to fire me. So I'm appealing at least to clear my name. Let's see how this goes.

[Sour Lemon]

Updated: they decided to fire me. So I'm appealing at least to clear my name. Let's see how this goes.

I am sorry to hear that. There are doctors who would have ordered to continue the long acting insulin despite the low blood sugar ...and although the blood sugar should have been rechecked, you did at least assess the patient for symptoms of hypoglycemia throughout the shift. It seems like you deserved the benefit of the doubt and another chance to meet their expectations.

[Ddestiny, BSN, RN]

Updated: they decided to fire me. So I'm appealing at least to clear my name. Let's see how this goes.

Sorry to hear that. Though there were legitimate critiques to be given, I think it's important that employers encourage people to come forward with their mistakes so they can learn from them, rather than just hiding them. That environment is not created by punishing people for their mistakes.

I made a pretty big error while I was on orientation for my current position in the ICU. It scared the crap out of me and I'm very glad and lucky that I caught it in time before it had any lingering implication for my patient. I had multiple talks with my boss and my preceptor about it, what I needed to do differently, what I had learned, etc. Several months after all of the dust had settled I was part of a peer review process. It, also, was scary, but I was never made to feel like I was stupid...just that I made a mistake, and I was more than willing to swallow my pride and learn from it. I wrote about it on here if you're morbidly curious.

I hope you can find a less punitive environment in your next position, OP.

[NormaSaline]

I wrote about it on here if you're morbidly curious.

Can we be just curious?! I'd like to read it.

[Ddestiny, BSN, RN]

Can we be just curious?! I'd like to read it.

Sure, just check out my previously written stuff under my profile. I think it's titled "Peer Review".

[ButterflyRN90, ASN, RN]

That was a concern for me. In this appeal process I'm going to write as much as I can about my experience. What comes up as a red flag was that maybe I should've refused to work those 2 last night shifts with my day preceptor because by the last shift it was her 7th shift in a row. HR mentioned my not being safe around patients, however working 7 shifts in a row with an orientee isn't safe at all, especially if the two shifts are not your regular shifts. I had a feeling she was running on autopilot because she gave me the whole team when I was still only supposed to have 3 pts which originally didn't include that pt with the ARDS. She added her on to my load at the last minute. During day shift she'd check the pt MAR to the point it would annoy me how meticulous she'd be. She'd comment how this med was given 15 min late or how could I have given this med with this bp. Yet, I never heard her catch my "error" until shift change. That's how I knew she wasn't on her game, so to speak. I'm the baby nurse and instead she threw me under the bus. I'm going to see if I can at least have the opportunity to complete my orientation on another floor/unit. I shouldn't have been crucified this way. They actually questioned if I was a safe nurse. That was a huge blow. Let's see how this appeal turns out.

[BlinkyPinky]

Well, I'm sad to hear you were fired. But not totally surprised. Perhaps it's " for the best?". ( Please no screaming at me ). I mean - if that's how this place operates insofar as " preceptor- ing..."?

Not a good outcome BUT , you have no choice now but to do your appeal , and you must move on. I know Easier Said than Done , etc. But I've done it and you really have no other choice , now do you

If you want to remain in the nursing fieldthat is.

Personally, if I was younger I'd have run far and fast and done what I wanted to do all along -- but it's too late now , for me.

Hospital s btw , are Dog- Eat - Dog places regardless which one you're at

[MountainMedicRn]

It was a learning experience. You're a student...those are the mistakes that will happen, just remember to bounce things off your preceptor or charge nurse constantly. That's how you learn...I wouldn't sweat it, and I can see why you make the choices you made. Hind sight is 20/20. Pick up and move on. Forget about it all and you're going to be a great nurse.

[Ddestiny, BSN, RN]

That was a concern for me. In this appeal process I'm going to write as much as I can about my experience. What comes up as a red flag was that maybe I should've refused to work those 2 last night shifts with my day preceptor because by the last shift it was her 7th shift in a row. HR mentioned my not being safe around patients, however working 7 shifts in a row with an orientee isn't safe at all, especially if the two shifts are not your regular shifts. I had a feeling she was running on autopilot because she gave me the whole team when I was still only supposed to have 3 pts which originally didn't include that pt with the ARDS. She added her on to my load at the last minute. During day shift she'd check the pt MAR to the point it would annoy me how meticulous she'd be. She'd comment how this med was given 15 min late or how could I have given this med with this bp. Yet, I never heard her catch my "error" until shift change. That's how I knew she wasn't on her game, so to speak. I'm the baby nurse and instead she threw me under the bus. I'm going to see if I can at least have the opportunity to complete my orientation on another floor/unit. I shouldn't have been crucified this way. They actually questioned if I was a safe nurse. That was a huge blow. Let's see how this appeal turns out.

Be very careful in your wording. This quoted post sounds like you're putting all of the blame on your preceptor (" I'm the baby nurse", "I never heard her catch my "error", "I had a feeling she was running on autopilot"). This may be a reaction to how she responded during and after the event, but it will not serve you in any kind of appeal process. Own your mistake. Express what you learned and what you will do differently in the future. Your preceptor should have her own part of having to be in the appeals process as well (at least that's how it was in my review), but you might not ever know about it since a) you're no longer there and b) any punishment she receives is none of your concern. Make your statement about you, and how this error will never happen again.