Will I get fired?????

[Furoffire]

I've been a good nurse for a long time but one year old in this new dept. Several days ago I took care of a DNR dementia patient that had runs of A-Fib. She was in a room that had a hard wire and it was. The blood pressure cuff remained on her too my entire shift but I did not let it cycle becasue she would scream her head off when the BP was taking, it would get tight, so I manually did them (I would push the start button each time) and comforted her, it worked. Well some way some how at the end of shift she had another run of rapid A-Fib, I was in an isolation room trying to keep a large man from falling out of bed and another nurse responded by calling the doctor and dealing with. Her BP became questionable and I showed the frequent VS sheet to the charge in report and he got curious, walked up to the monitor and several of the BP's that presented themselve on the monitor that I wrote down (I monitored her HR frequently and wrote them down along with the manual BP's I took plus a couple that were on the monitor.........although I said I was taking manual ones it was a crazy day and I guess I just did not think it through and just wrote down what I saw). Well the charge nurse made a big issue and asked if I basically made the BP's up BECAUSE several were not in the memory. Now how can that be, I don't know but I feel like my integrity and possible job may be on the line!!!!!!!!!!!! My director is wanting to meet with me and bring in a Union Rep.........does that mean my goose it cooked? I am so nervous and scared, if its not in the memory than it looks like I made them up? I guess they do not suspect the machine might be skipping or whatever? And what does a "wine garden right" or something to that nature mean? You know I could of lied nipped the whole thing in the bud by saying I did actual manual BP's with the rolling old fashioned things we still have on the unit.................BUT I told the truth but why am I being put through this??? I could go on and on, I have never been down this road before and not sure why I am all worked up even though I am innocent. Kitty Might Be Gone But Than What, who will hire a dishonest nurse if they will not believe, I have a squeaky clean record. Anybody ever have this happen to them?

[Tweety, BSN, RN]

Tell the truth, it's up to them to believe you or not or prove that you did something that prudent nurse would not have done, or if any policies were violated. Just keep telling the simple truth.

Good luck. It sounds like a very stressful time. The truth is never wrong, no matter what the outcome.

[TazziRN, RN]

I'm going through a very similar situation. All you can do is be honest. Ask your union rep what he/she thinks might happen.

[UM Review RN, ASN, RN]

I've done that before. I don't see how that was wrong. So let me see if I've got this right:

Mrs. X is demented and fights the BP cuff. Therefore, you were hitting the manual button to take her BP's.

They should've recorded, but the time intervals would not be as exact as if she was on a timed interval BP. Did they or did they not record? If they did not record, I'm guessing that is why your manager says you did not take the BPs.

In comes Nurse 2. Nurse 2 doesn't notice or doesn't care that Mrs. X is fighting the cuff and therefore causing inaccurate results. Her results could very well have been skewed due to Mrs. X's movements while the cuff was inflating, and therefore Nurse 2 was treating something that potentially did not need treatment.

I'm guessing Nurse 2 got a very high BP as opposed to a very low BP.

Reason is, if the BP was a very low one, it might indicate that Mrs. X had been in AFib with RVR for awhile and was not hemodynamically stable. Then the patient needed immediate treatment. But I've seen chronic Paroxysmal A-fibbers pop in and out of Afib and their BP is Ok, so we just do the standard stuff we always do for A-fib -- dig, lopressor, cardizem, coumadin, whatever, depending on the doc and the patient's hx.

I hope all that made sense. What you need to do is prove that your actions were timely and appropriate for the patient. This is not to say that Nurse 2's actions were not, mind you, because Afibbers are notorious for being fine one minute and then spontaneously going haywire the next.

I wouldn't worry about it too much; as the others said, just tell the truth.

[Furoffire]

The more I think of all this, the more of a blurr it becomes. Wheather the machine cycled on its own or someone pushed the button, I wrote down the BP's that were on the monitor while I was checking out her RVR.

I only remember doing a BP when I did my morning assestment and it was low, maybe another one that was O.K. At some point I gave her Dig. and I'm sure I documented the BP also.

Somewhere in between, while popping in her room to look at the monitor, I wrote down her HR (that is what we were treating her for) and I think 2 times there were BP's on the monitor that I wrote down. I did not do those manually becasue of her getting wild but I saw the cuff was on, I kept getting distracted from my crazy isolation down and accross the hall and it just never entered my mind as to "who pressed the button" or maybe I left the cycling feature on...................the strange thing is that those BP's I wrote down did not stay in the memory, I said I used the hard wire and not the other Dinamaps etc. we have on the floor. So it makes me a lier???? Could I loose my job for this? I am having a hard time getting hold of the Union Rep, but what is she going to do for me, she does not know me. I feeled attacked, funds are being removed from my banking account from insurance that we purchased but they took way more, they will fix but no one knows how it happened, a complete mysterey, I was just told I will get my refund, but here, now with nursing...........would this be considered benign or is my head on the choping block. I've never done anything wrong like wrong meds or whatever to make me suspicous etc. So why is this getting so formal?

[TazziRN, RN]

Fur, give me a few minutes and check your PM

[Ruby Vee, BSN]

could i loose my job for this? i am having a hard time getting hold of the union rep, but what is she going to do for me, she does not know me. i feeled attacked, funds are being removed from my banking account from insurance that we purchased but they took way more, they will fix but no one knows how it happened, a complete mysterey, i was just told i will get my refund, but here, now with nursing...........would this be considered benign or is my head on the choping block. i've never done anything wrong like wrong meds or whatever to make me suspicous etc. so why is this getting so formal?

the union representative can do a lot for you -- just be as honest with her as you can be and follow her lead. she can help you organize your thoughts and your story, and she can remain calm, cool and collected no matter how emotional you get. that's a big plus right there. she's your advocate, and she's been through these meetings before. she knows what to expect and can help prepare you. she probably knows your manager and the hr department and can work with them to negotiate the best possible outcome for you. (which may or may not end up being the outcome you desire at this moment.)

being told to appear at a meeting with a union representative is formal and it is serious. your job may very well be on the line. ask your union rep what she thinks and be sure to follow any and all advice she gives you. good luck with your meeting and let us know how things go.

[Ariesbsn]

What equipment should do, and what it actually does are 3 different things.

Our Alaris pumps should deliver a piggy back at the rate that we set them for. However, they don't. It happens so frequently that we have to run our Vanc, K+, and anything else that is really time sensitive as a primary. It has taken 4 hours to infuse a 50 ml bag of K+ that was programmed to infuse at a rate of 50 mls an hour. The roller was unclamped, and it was infusing into an IJ TLC that flushed freely. They have also delivered a drug too fast on a primary line. It wasn't my pt, and thank God they were vented because 1000 mcg of fentanyl was infused in less than an hour.

I recently had a pt become tachycardic on dopamine. I was in the room for the better part of 30 minutes, watching the monitor. The pts heart rate would dip to the low 100s every so often, but for the most part stayed in the 120s-130s. Apical hr correlated with the monitor. There was another nurse with me to verify this. When I went to import the vital signs using a 1 minute time increment, there were only 2 heart rates that were above 105.

I did an accucheck on a pt on CRRT. I drew the sample at the same time as I drew the 10 pm labs from the Prisma. The BS came back as 37. I did an immediate recheck with new blood from the Prisma and got a BS of 12. I immediately did a finger stick with the same accucheck and got a BS of 282. Treated the BS of 12. BS from the Chem 7 came back with a BS of 102.

I had a pt that would get hypotensive (SBP of 76 mmhg) when lying on their left side. I repositioned the pt to their back and took a pressure. SBP was 105 mmhg. I waited 5 minutes and took another pressure. It was 101 mmhg systolic. There were 2 nurses with me who saw it. I moved on to my other pt. When I went to import vitals, I had to reduce the time increment to 1 minute to find the pressure with the SBP of 105 mmhg. However, it showed a pressure taken 1 minute after that and the systolic was 74 mmhg. There was no pressure with a systolic of 101 mmhg. The cuff did not recycle while I was in the room.

At least once a shift, after I click save on an assessment, the screen will turn blue, and I will click exit. When I go to chart my next assessment, one of the prior ones will be missing.

We use a bar scanner for meds. Frequently we will scan the pt, the med, save and confirm everything, and log off. When we log back on, a previously scanned and administered med is showing as overdue. When you look at the meds admin review screen, the med that is showing as overdue is also shown as having been scanned and given.

We also have problems with checking the "to do" section when it comes to meds. We check, nothing shows as due. When we get back on to chart an assessment or med administration, there will be overdue meds that weren't there before.

Another nurse had a Prisma pull off 3 times more fluid from a pt than it was programmed to.

My all time favorite is the spontaneous wedging of a swan, which by the way, they didn't cover in my class about waveforms. I learned that could happen when I was doing my chart check at the beginning of a shift and another nurse came to me and said "I think your swan has spontaneously wedged."

I hope things work out for you and that someone apologizes to you. It amazes me how quickly people forget that computerized things can malfunction too.

Oh, as far as the dynamap goes, did anyone bother to check the battery or run a diagnostic on it before they started slinging mud?

[Furoffire]

We have dinamaps and couple of those 1950 rolling one's but the patient was hooked up to a hard wire and since not all rooms have hard wire, we are told not to use the dinamap if you have the monitor so that is what I did. Its not a matter of having an eye witness but the memory of monitor. In this case, it would of been so simple to have really lied and said "yeah I used the dinamap, it got turned off so all the info is gone" BUT I couldn't.

If I get the axe, meaning fired, can I get unemployment? AND worse, who is going to hire a falsifier?

If I am put on some sort of leave can also unemployment benefits be used? I have no PTO, I have really had a tough year with illnesses etc. I was off about 2 years caring for my older parents in another location and coming back to nursing hospital work has really done a number on my health. Plus I happen to be sick now with a middle ear infection, went to Urgent Care got ABX and am calling in sick, the director said I could work, but not feeling well I do not think I could bare the wibes at work until this meeting takes place and I know where I stand. People are supportive but I feel so shamed into being classified as a liar or something going on with me. I see so many sitting on thier butts and I really work hard and go the x-tra mile, it kind of hurts but whatever happens I am willing to accept as what life has for me, hopefully something better but I'll settle with the same with some teaching and pointers well taken. Little Kitty

[EmerNurse, BSN, RN]

In our ER, all our monitors are hardwired. Sometimes you can't see stuff in memory unless you decrease the time increment and some of them STILL won't show up on the memory. Drives me batty.

Often, I'll run an EKG from the monitor, which shows the current HR, and that HR (and nothing near it) is in memory on the trends.

These machines are NOT failsafe. We were told that printed trend reports were NOT to be part of the chart. That our nursing documentation - what WE document - is the be-all and end-all of what happened with a patient, because machines are fallable.

Just be honest in the meeting, that's all you can do. If you DO lose your job, and I pray you don't, make sure you have copies of all your good evals from years past, so you can show other employers your *reputation* as opposed to some one-off incident. Any decent HR person is well aware that machines make mistakes.

That said, is there any other reason these folks might be frowning on you? Could they be making this a big issue for other reasons?

Good luck! I'll be rooting for you!

[sissiesmama, ASN, RN]

Hey -- I really hate to hear the way you re being done. Been there, done that!!! Something similar happned to me not too long ago. I'll say a prayer for you, and good luck with your meeting. The NM I had been working for I had known for almost 3 years and I had NO idea what kind of crap I was in for. Please let me know how everything turns out, and pm me if you would like to talk. I'll be glad to!! I wish that we had the benefit of union reps, maybe that would have helped in my situation. All I had to allegedly help me was a HR rep, and he(who I'd never laid eyes on) and the NM along with the ''big director'' played bad cop/bad cop/bad cop. To make matter worse, I went in without my attorney. Lets just say it did not turn oit well.

Anne, RNC

[Furoffire]

Well now that you put it into perspective, what machine is reliable? Thanks, shows that we put too much emphasis into them.

Maybe there are other underlying issues like no love connection in that unit, I have sensed that but push under the rug. Healthcare has changed so much that every department is feeling the crunch.

I don't want to, but there are several doctors that adore me with my clinical skills and I would hate to impose. My other evals are old but good.

I just can't believe this is all happening, like a bad dream and hopefully I will wake up and it will be over and the meeting goes smooth. However with the manager insisting the rep be there I sense doom. Kitty