What would you do? Moral Dilemma

RNBSNGRADUATE · Sep 25, 2007

Hey FirstYear:) ~~

That IS a little dilemma. And, you are right -- we will making these decisions on our own shortly. Now -- if that was the case -- and I was already on the job -- PERSONALLY, I'd definitely report it. In your situation, there's the middle-man aka your clinical instructor that seemed to shrug it off. I feel the appropriate thing FOR HER to have done would have been to report it. (We ARE supposed to be the patient's advocate!) If I was in your shoes -- well, I have made some very good connections a wee bit up the ladder @ my school...so, I'd probably discuss it w/one of them in order to get their wisdom & insight.

I'll be interested to see others' responses.

Best of luck to you:)

RheatherN, ASN, RN, EMT-P · Sep 25, 2007

I would ask to speak the the NS on board that day. Personally i would HAVE to say something. Like SNW says, we are the pt advocate. Also, ask yourself, if you were not in clinicals in school and were the actual next shift nurse, would you report it then? I have had to ask myself the same thing at times, because certain instructors in the past treat us like "students".

SW_07 · Sep 25, 2007

Definately report it. Whether it will or will not harm a patient doesn't matter it was still a med error. It may have not had ramifications this time but what if that same nurse forgets another time and it does.

wooh, BSN, RN · Sep 25, 2007

Not sure how the lines were set up, but:

Are you sure it was the med in the line that didn't run in? It could have been IVF or flush that backflowed into the line, and then someone clamped it off. I've clamped lines after IVF flowed back into them, and if I didn't know better, I'd think it looked like the antibiotic hadn't been given. If you're going to report something, you'd better be sure of what you're reporting.

rn/writer, RN · Sep 25, 2007

Not sure how the lines were set up, but:
Are you sure it was the med in the line that didn't run in? It could have been IVF or flush that backflowed into the line, and then someone clamped it off. I've clamped lines after IVF flowed back into them, and if I didn't know better, I'd think it looked like the antibiotic hadn't been given. If you're going to report something, you'd better be sure of what you're reporting.

You can't always be sure of what you're reporting. But you still might strongly suspect or even know that something needs to be highlighted and at least questioned.

The safest way to report something is to limit your statements to observable and objective data. Once you're on your own, you can ask your charge nurse to take a look at anything questionable, and the two of you together can decide what you're seeing. This will suffice while you are a newbie.

After you've been there for awhile and you have a better idea of what's cooking (or even now if you are certain), concentrate on reporting the objective facts regarding the event and not on the person you think is responsible. If you stick with factual information, you don't have to sound or feel accusatory. Say, "I found the antibiotic solution bag empty, but it doesn't appear that the inner chamber was opened and mixed with it," rather than, "Nurse XYZ didn't mix the antibiotic properly." Or, "it looks like this med was missed," instead of, "Nurse Suzy forgot to give this med."

If you concentate on the "what" rather than the "who" or the "why," you'll be in safer territory. Let the charge or nm scope out the rest. Maybe Nurse Suzy held the med and forgot to document (another problem, to be sure, but at least you didn't make a false accusation).

Most of us dislike blowing the whistle on someone else. We know very well that we have forgotten things or made other mistakes. The best units use these things as teaching opportunities for everyone. Even if they don't, problems and lapses still need to be reported. In order to avoid the appearance of "pointing a finger" at a peer, keep your attention and reporting confined to the situation at hand and then you can let the chips fall where they may.

Jo Dirt · Sep 25, 2007

There are some things that can slide but if you start to notice a pattern of complacency/neglect you should voice your concerns, not necessarily by running to tattle but talk to the nurse about the mistakes first and if she still keeps on then you should go higher up.

laurajane12 · Sep 25, 2007

I agree with m-writer. :)

steelcityrn, RN · Sep 25, 2007

This should be reported to the higher ups, then they can investigate it and handle it from there. Always best to error on the side of caution, then not speak about it after that to any co-workers. It may have not been a medication error.

EmmaG, RN · Sep 26, 2007

I have been orienting and I went in to give my patient his once daily dose of IV Neupogen that he is getting x5 for his Stem Cell Harvest and eventual autotransplant and I noticed the the nurse that had been on the previous day shift had not opened the line and it hadn't run in. I'm pretty sure he didn't get it since the patient reported no bone pain the previous day. I told my preceptor and she just shrugged. Should I have reported this or is it better just to pretend you don't notice this type of thing if it probaby won't harm the patient. (They will do a WBC count before harvesting the cells.)
I left it in my preceptors hands but soon I'll be making these decisions for myself. I don't want to get another nurse in trouble. On the other hand, what if an error has ramifications for the patient? And how will this nurse get the feedback to know he/she needs to be more careful.

It should be reported as described above. The patient was to receive 5 doses of this medication in prep for the transplant. The doc needs to know of the possibility one dose didn't infuse so that another dose can be ordered if need be.

KenCCRN · Sep 26, 2007

I have been orienting and I went in to give my patient his once daily dose of IV Neupogen that he is getting x5 for his Stem Cell Harvest and eventual autotransplant and I noticed the the nurse that had been on the previous day shift had not opened the line and it hadn't run in. I'm pretty sure he didn't get it since the patient reported no bone pain the previous day. I told my preceptor and she just shrugged. Should I have reported this or is it better just to pretend you don't notice this type of thing if it probaby won't harm the patient. (They will do a WBC count before harvesting the cells.)
I left it in my preceptors hands but soon I'll be making these decisions for myself. I don't want to get another nurse in trouble. On the other hand, what if an error has ramifications for the patient? And how will this nurse get the feedback to know he/she needs to be more careful.

FirsYear:

I think WOOH is right....it could have backflushed into the piggyback bag. I frequently run the piggy back dry and then open the pump chamber and the primary fluid back flows all the air and bubbles back out and up into the piggyback....sometimes I let too much in and it looks as though there may be some med left over. I would not report that especially if it was a day from when you noticed it....way too long.

Ken

EmmaG, RN · Sep 26, 2007

FirsYear:
I think WOOH is right....it could have backflushed into the piggyback bag. I frequently run the piggy back dry and then open the pump chamber and the primary fluid back flows all the air and bubbles back out and up into the piggyback....sometimes I let too much in and it looks as though there may be some med left over. I would not report that especially if it was a day from when you noticed it....way too long.
Ken

An objective report of what was found will help the doctor decide whether an additional dose is needed, particularly if the counts aren't at the level expected. This isn't about placing blame, rather making sure the patient gets the full pre-treatment needed for the transplant.