What am I to do???

[PSYCH NURSE RN]

Hi.. I Am New To This Site..and I Am Very Frustrated Right Now! Last Week, Thurs. I Had A Pt. Who Appeared To Be Having Lithium Toxicity. M.d Was Called And Informed With Orders To Have The Pt Seen By The P.a. In The A.m. The Next Day, Fri. I Was Floated To Another Unit. I Had Told The Lvn To Follow-up On This Pt On Fri. She Assisted The M.d Via Telephone Looking For Any Abnormal Lab Which Indicated A Lithium Toxicity. There Was None In The Chart..all Was Documented And Charted.

When I Came Back To My Unit On Mon. The Noc Nurse, Lpt Who Is Responsible For All Labs Told Me That There Was Indeed A Lab In The Chart And That She Personally Gave It To Me On 9/26. When I Told Her She Did Not Give Me A Lab On 9/26 She Said,"well,i Left It On Your Desk." I Then Found That She Had Gone Back To The Communication Book And Wrote It In That She Had Informed Me Of This Abnormal Lab! I Could Not Beleive My Eyes! I Immediately Brought This To The Attention Of The New Adon. He Said He Would Talk To Me About This Later. He Did..he Wrote Me Up For Not Informing The M.d About This Lab Thus Causing The Pt. To Have A Lithium Toxicity!! I Told Him There Was No Lab To Report, And Why Would I Not Give This Info To The Md If I Had It? He Got Very Frustrated And Told Me That His License Was "on The Line" And He Would Not Stand For This Kind Of Nursing. I Am So Frustrated Right Now I Had To Call Off Today Because I Have A Migraine H/a. What Do I Do? He Put Me On Probationary Status For 90 Days. Who Can I Turn To? I Will Meet With My Medical Director Tomorrow @ 1100. The Lvn Will Attest To The Fact That The Lab Was Not In The Chart On Fri. Help!!!!!

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[sirI, MSN, APRN, NP]

hello, psych nurse rn and welcome to allnurses.com

i moved your post from an off-topic thread/forum to the general nursing discussion forum for a better response.

[TazziRN, RN]

Have the LVN write up a testament, and you need to document what you remember happening. Take a deep breath and good luck!

[ItsyBitsySpider, BSN, RN]

Why put up with that garbage? Quit and find a place that actually respects and appreciates their nurses. There are such places!

[Antikigirl, ASN, RN]

I go with the theory...if it isn't in their hands...I did not give it, and I expect vs versa! Things easily get misplaced on a desk, and if this was this important...it should have been handed to me, and verbalized! (even with a "I put a critical lab value on your desk, you will need to call the MD!).

Poor communication there, and that should be addressed as a facility probelm to work on! Critical info should be verbalized to the RN and MD and hard copies handed, electronically transfered, or at least faxed to RN or MD with a verbalized explanation of where it was sent and red flag it!

We have communication protocols, and this is part of it! When we get a critical lab, it is handed to the RN along with a statement of it being a critical lab (in case the nurse is deep in thought or flustered). This way it is red flagged as very important! Same with contacting the MD...we can not sign off fully unless the info got to the MD personally (we list how many times we try to contact personally though on our critical lab value communication sheets in each chart). That way if there was any confusion the RN is covered by documentation of trying to reach the MD!

I would certainly be proactive and discuss this with your manager as a defininate area that needs serious improvement!

[Tweety, BSN, RN]

Be honest, tell the truth. There's nothing more than you can do. Advise there is something wrong with the process of "putting it your desk" and then documenting that you were aware and that this kind of system needs to be changed.

If they don't believe you, then they don't believe you and you can choose to accept it or not. Personally, I don't think my pride would allow to work in a place where I was put on probation for something I didn't do and I would vote with my feet.

I'm sorry you're going through this. Good luck.

[P_RN, ADN, RN]

What a crappy situation. One thing we'd do is initial the lab page at the end of a shift to indicate that the latest labs to that point in time were noted. Panic labs are called by whoever is in posession of the lab report.....ergo no leaving on a desk. Also on the order sheet next to the lab order....the result and initials of whoever is in posession of it.

Your ADON telling you "His license is on the line" was totally inappropriate. If there is a counseling slip don't sign it until you enter your side of the story. I'd also get the LPN to write her testament and insist it be included in your record. Get in the habit of making copies of EVERYTHING in your record. You'd be surprised how often "termites" can invade personnel and do away with exhonorating info.

[humglum, BSN, RN]

That sucks. This is why most places have a "read back" policy with physician's orders and critical lab values.

I agree you should tell the truth. You could also participate in a RCA or quality improvement measure and suggest a policy change so that this won't happen again.