Weird meeting with manager

fezz · Mar 21, 2017

All I can say is I totally get the feeling. Absolutely everybody makes mistakes. It feels rotten when it's happening to you. In your case there was no harm to patient and that's the most important thing. You did not harm your patient. You know you did not steal meds. Most mistakes are system mistakes and not one single person is to blame. If it's this easy to make a mistake they might need to look at their system. You'll learn from this mistake but you will make mistakes again if you stay in your job. It's a part of being a human. At my job it's very difficult to administer medications without documenting because of the way the system works. Not because we are all super on top of things all the time. ER sounds like a challenge. Keep up the good work !

AJJKRN · Mar 21, 2017

Are there other options for employment in your area? This sounds like a punitive work environment that blatantly overlooks system errors and/or your manager is not supportive in creating and maintaining a safer work environment.

Been there,done that, ASN, RN · Mar 21, 2017

"There was one incident where I forgot to chart a narcotic. "

In some facilities, not charting narcotic administration will get you walked out the door. You cannot blame the system that "where it's easy to pull a narcotic on the wrong patient and administer it to a different patient. " We are professionals that work with the system we have.

It was not a weird meeting, you are now on administration's radar for narcotic errors.

Find out what you need to do to work with the system, and prevent another narc error.

One more could cause you a lot of grief.

cleback · Mar 22, 2017

You always need to chart given medications, particularly narcs. Although there may be a systems component to the error, i hope you can find a way to overcome them to make sure this happens. I agree it's weird that they think you're a diverter now. Technically you can do that and still chart... Maybe sit down with your manager again to address charting concerns and present your action plan. That way she knows you aren't sweeping it under the rug and are making an active effort to prevent future errors. May be overkill but you might need to do that to rebuild some trust.

amzyRN · Mar 22, 2017

The manager said that she is looking into making the pharmacy require an active med order by a physician a requirement to pull the narc. I think that is a good start. In the ER, narcs are probably the most common med given next to zofran. I am not the only one "on the radar" as they admitted that many people are making errors. I have never had a manager, however, exude the degree of distrust that they did at me. I have also never worked in a place that had that system. They push us to give pain meds out like it's an emergency to boost their survey scores and when we try to do this, more and more narcs, there are going to be more errors. I did forget to chart that day probably because the computer broke down like it often does, the scanner not working and I have the guy his dilaudid who begged me for pain meds. He had pancreatitis, a confirmed painful diagnosis. I advocated for him to get his meds and rushed to give them to him in a timely manner. His pain was my priority in the moment, not the scanner. There is a serious problem with the healthcare system when everyone is a suspect, even people with high-performance evaluations, good recommendations, and never any prior incident of med error. This makes me want to step away from nursing, find a profession where I am valued more than a cog to generate a profit by my employer. The only thing that keeps me in nursing, really keeps me in it is the patients.

crazin01 · Mar 22, 2017

It sounds like there are quite a few other staff who are having similar/the same issues as you've stated in OP. management should take notice & try some interventions to aide the staff. There seem to be quite a few programs not being as user-friendly, as some. Have other staff reported their issues to their supervisors?

Rather than just going into managers office to communicate their concerns, have you and/or other staff been able to discuss issues & hopefully trying to come up with some type of solution to the problem?

Sounds like its time to CYA, as always and be extra diligent about documentation

amzyRN · Mar 22, 2017

That's a great idea to reach out to other staff to reduce errors. I will definitely CYA more. I'm going to start printing a sticker for each patient I have or pull narcs on from now on. If it slows me down, too bad. It's not worth the possible mistakes with patients who have similar names. I do at times go through 16 to 20 patients on a busy day.

RNperdiem, RN · Mar 22, 2017

It sounds like your department gives out narcotics like candy. Is this normal? Do you attract a lot of drug seekers?

klone, MSN, RN · Mar 22, 2017

They push us to give pain meds out like it's an emergency to boost their survey scores .

They've told you this?

allnurses Guide · Mar 22, 2017

The manager said that she is looking into making the pharmacy require an active med order by a physician a requirement to pull the narc. I think that is a good start. In the ER, narcs are probably the most common med given next to zofran. I am not the only one "on the radar" as they admitted that many people are making errors. I have never had a manager, however, exude the degree of distrust that they did at me. I have also never worked in a place that had that system. They push us to give pain meds out like it's an emergency to boost their survey scores and when we try to do this, more and more narcs, there are going to be more errors. I did forget to chart that day probably because the computer broke down like it often does, the scanner not working and I have the guy his dilaudid who begged me for pain meds. He had pancreatitis, a confirmed painful diagnosis. I advocated for him to get his meds and rushed to give them to him in a timely manner. His pain was my priority in the moment, not the scanner. There is a serious problem with the healthcare system when everyone is a suspect, even people with high-performance evaluations, good recommendations, and never any prior incident of med error. This makes me want to step away from nursing, find a profession where I am valued more than a cog to generate a profit by my employer. The only thing that keeps me in nursing, really keeps me in it is the patients.

No matter how long you have been a nurse or what environment you practice in you must always follow the five rights and slow down enough to prevent these kind of errors. What you are describing is sloppy practice. I'm sorry I don't sound more supportive but having been under BON supervision for five years in my past I will tell you it's no fun. It is also very expensive. You must improve your own practice as well as advocating for a better less error prone system.

Hppy

amzyRN · Mar 22, 2017

They've told you this?

They tell us that the HCAPPS are low because of pain management. They tell us that we need to advocate better pain control for patients and that we are falling behind and that the nurse being the patient advocate needs to speak up. Pain is the 5th Vital sign. In fact a pain crisis will bump acuity up in the ED and management of it becomes the greatest priority second only to life-saving intervention. We are reminded of our low scores at least once a week. Our charts are monitored if someone is above a 4 on the pain scale, they will ask us why we have not treated the pain.