As a psychologist, I can’t prescribe. What I can do, and what I’d recommend, is to encourage the patient and her family members to call the patient advocate immediately if there are any concerns about pain medication. This adheres to scope of practice considerations, attends to the patient’s distress, and may sidestep some of the issues that go along with questioning a prescriber’s decisions during treatment (i.e., you are not being insubordinate).
What you did was not a mistake. A mistake is accidentally giving a patient the wrong drug, or misreading the dose on a prescription. What you did was willfully disregard the rules in a manner that put your patient at grave risk of death. That, to me, is an unforgivable sin. As I said earlier, you should thank your lucky stars that you didn’t kill this girl and move on.
One more thing, what you wrote on your website, posting only positive comments in the comments section, and this “fired for caring too much” junk is a load of shit. You aren’t ethically correct, and what you did wasn’t right. Publicizing this incident any more just draws attention to the fact that you really shouldn’t be a nurse.
Keeping this in mind, my suggestion for what you do next is to begin looking for a new job. If asked about the incident, tell the truth, which is not that you “Cared too much” but that you gave medication without an order for it. As others have recommended, your chances of getting another job increase if you say that you wouldn’t do it again.
Your chances of keeping your new job will improve if you actually don’t do that again.
Having worked in a hospital for a number of years I can sympathize with you entirely. Most of the time nurses are more in tune with the patient than the doctor. I have seen doctors refuse to stop eating to attend a coded patient, adding “let them die.” I have seen doctors throw things at nurses and curse them out for the smallest things. There is a shortage of nurses now because they become disillusioned with the treatment they receive in hospitals and quit or find desk jobs. Sure, not all doctors are abusive, there were some at the hospital that really did care about their patients and treated their nurses with respect.
I suggest you work out of a nurses temporary agency. They are paid more money and work in many different environments. Usually the temporary job leads to a permanent one. Don’t be bitter, hospitals are running scared of malpractice law suits and were covering their ass when they fired you. That doesn’t make you a bad person. Forgive and forget, and get on with your life. We need people like you.
This is the first time that I knowingly stepped out of policy and as I mentioned, I’ll never do it again. Your right; Nurses are the eyes and ears for the doctors, when they don’t listen - there is a problem. One that I’m not qualified to fix, but I tried!
treis - Your not qualified to tell me I shouldn’t be a Nurse. You’re judging me on one mistake. I’ve been a Nurse for 18 years and worked in the ER for 12. I have saved countless lives and made more people happier than I could ever begin to explain here. I realize this doesn’t excuse what I did - but sharing it sure helps.
treis doesn’t seem to be juding you on one mistake. It’s a litany of mistakes: the original one, the website you posted in the OP, the comments you’ve made in that website, and your comments here.
It seems to me that you have a serious problem with accepting the fact that you could’ve killed the patient because you “cared too much” and thought you knew how to practice medicine better than those actually qualified.
Maybe one reason you’ll never do that again is because you won’t be working as a nurse again. I don’t know. But, I would think that taking down that website and really accepting personal blame for your personal failure to work within both policy and the law would be positive steps in getting you back into the nursing field.
Asked a doctor I’m married to. She says this is legally a pretty clear cut case and the hospital is not going to lose this one: they have every right, legally, to fire you for practicing outside scope. It isn’t something that you should have to lose your career over, especially if the BoN isn’t going to take action, but it certainly is well within the rights of the hospital to have a policy that, to insure themselves against any potential liability, requires firing you with cause.
She’s very sympathetic to the case: doctors can indeed be negligent assholes, especially when it comes to pain and discomfort and their own laziness in letting it go. On the other hand, the only person qualified to make decisions like the one you made is a doctor. Not because nurses are without knowledge in this area: heck nurses often end up being a lot more on the ball with meds than doctors (catching their mistakes and so forth). But still, especially for insuring the hospital against lawsuits, only doctors can make those sorts of decisions, like it or not. That doesn’t mean that doctors shouldn’t be fought when they are in the wrong, but ultimately they have to be fought by bringing in other doctors to countermand or argue with them.
In this case there is also a very real question with Toradol, which is a drug you generally want to be careful with in patients that have any sort of kidney problem (though perhaps stones were the only problem in this case, I don’t know and maybe you did know, but…) It’s not a risk-free drug. I’m of course assuming that you were 100% sure that in this case that it would be safe… but that’s not the point: the point is that they can’t have nurses taking that iniative. Again, as policy, hospitals are not going to want to hear that you’d do something that could put them at greater liability should something go wrong (and remember, lawsuits can be filed even when it ISN’T really your fault and you didn’t do anything wrong: the mere fact that standing policy was violated can be a major point of extra damages!)
The best route is to not treat this as a crusade to prove yourself right. As you look for a new job, it’s best to explain it as something you did because you were moved out of concern for a patient (understandable and laudable), frustrated with doctors and wanting to be a real advocate for a patients needs (both laudable and in many services (though not all, depending on who is doing the hiring), a desired quality), but acted in a way that went outside of the system which you shouldn’t have done (a mistake you’ve learned from and are not likely to make again: you WOULD fight for the patients’ needs again, but because of what you went through, you’d be especially careful to play within the rules: perhaps more careful than another nurse who hasn’t necessarily gone through what you have).
I don’t personally blame the hospital for firing me, I would have probably done the same if I were them. Mainly I’m angry with the Admitting Physician for ignoring my requests and my chain of command for not helping. I shouldn’t have been in a position to make that mistake.
Nicely put Apos.
As I said before, it wasn’t a mistake. It was a conscious decision that endangered the life of a patient. That is pretty much inexcusable. The fact that you continue to act in a manner that shows you think you did nothing wrong just seals the deal. Nurses aren’t the only ones that have to deal with ethics. If I did what you did I’d have violated three of the seven fundamental ASME Canons namely:
You violated #1 because you didn’t hold paramount the safety of your patient. You made a decision that you aren’t qualified to do endangering her life, which leads into #2. Prescribing medication to a patient is outside of your competence, and obviously you shouldn’t be performing tasks that you are not competent in. Lastly, number 7 states that you should only issue public statements in an objective and truthful manner. Stating that you were fired for “caring too much” is neither objective nor truthful. You were fired for willful disregard of the rules, performing a task you aren’t qualified to do, and endangering a patients life.
OK, obvious you acted beyond the scope of orders – been pointed out, acknowledged, duked around a bit more than necessary. But let’s start with that issue.
ESC gets “misconduct” justifications from employers all the time. In the absence of contrary information, they’re bound to go by it – but they’re quite willing to be skeptical of a world in which employers never make mistakes and employees get canned for them.
I know whereof I speak – it happened to me once, in NC, and in the course of job searches I overheard short snatches about any number of cases, some in professional positions, where it was the initial employer allegation.
Put together the precise circumstances – you acted without orders to give a dose of a controlled pain medication which you knew the patient, in severe pain, had been administered in the past, after attempting in vain to get pain medication authorized. That puts a far different picture on what they deal with – if Guilford County’s State EMC offices operate anything like Wake County’s, which I’m relatively sure they do, you stand a good chance of making a case for unemployment compensation.
Second, the need for experienced RNs is enormous. I can point you to a number of hospitals in two states where my best guess is that they would hire you on the spot, presumably after getting your side of this story in lieu of a reference.
The advice to take down the website, and admit error, partially justified by your sense of proper care, is excellent. We get the fact that you were outraged by the callous indifference to a girl’s pain. As Qadgop (whose medical credentials are well known here) notes, there were possible good reasons for avoiding that medication – ones you happened to be aware were not necessarily valid in this particular case, but distancing yourself from the case, I’m sure you can see where it is in general unwise to disregard a R.N.'s administering of a medication with potentially irreversible effects. Think that through, accept that it’s a good reason in general, though perhaps only tangentially valid in your particular case, and construct the attitude that you’ll approach dealing with the incident in future from that basis.
Finally, consider going into R.N.P. training – from the sounds of your personal caring and medical awareness, you have what it takes. And I’m sure you’re aware how much they are needed.
Good luck.
I am not a doctor or a nurse or currently even a patient. I’m completely outside the medical field.
You have been given some extraordinarily good advice from people who don’t know you enough to try to cushion a decent response because they know you.
I hope you can take the criticism, even if you did not want it, because you might just be throwing out the baby with the bath water.
I’m on final warning at work because I tried to make a decision that would benefit my customers. Granted, the cocktail waitresses were the only ones medicating anyone, but although my heart was in the right place, I was in violation of company policy and procedure.
One of the hardest lessons in life to learn is that a tremendous amount of the time, we are actually in bad situations because we did something bad. No one else is responsible for the actions that you took. Not the patient, not the hospital and not the doctors. Just you. You may know more than the doctors, care more than the doctors, but you are pretty low on the totem pole of people that would be sued by the actions that you took.
Please repeat after many of the people in this thread. “I fucked up, I was wrong. I’ve learned that having a heart isn’t enough if I am not going to engage my brain and learn from my mistakes honestly, openly and forthrightly.”
I severely doubt you will have a problem finding a job. I have great hope that you can take what the people here have said and move on.
The people who’s opinion counts judged you and found in your favor. Stop responding to people who aren’t qualified to discuss something that’s already settled by people who know what they’re talking about. Seriously.
Since you still have your license then I would suggest you free-lance as a nurse. The pay is way higher per hour and you can eventually work your way back into a position that you want.
I’ve been in the emergency room with kidney stones and 7 hrs without functional pain medication is not acceptable. I had to go back serveral times to change medication and never had to wait more than an hour. Each time a doctor walked in, looked at my chart, got out a pen and I was on my way 2 minutes after the exchange. Why this wasn’t done in this situation should be explained by the hospital to the satisfaction of the patient involved.
Take the lesson you learned and move on. 18 years is a lot of solid experience to waste. I would rather have you attending me with your background.
I would however, lose the website. You’re branding yourself as someone who rocks the boat.
If you posted that website with all your personal identifying information in some sort of expectation that the medical community would rally to your defense you’re sadly mistaken. You want real world advice? Take down the website that says “I talk about what goes on at my workplace to anyone who will listen”, pray Google hasn’t cached it, and start looking for another job.
Um, how long does it take to take a webpage down?
You cannot work in an Emergency Room and be thinned skinned. Some of your comments, although painful were very much needed. I have learned alot and will be a better Nurse because of it. Believe me when I tell you - I’m not a rogue or a rule breaker; just someone with alot of compassion that wants to help.
Web site down. Thank you EVERYONE.
Original link to his website.
Male_RN, I hope you have good luck finding your new job. If you have enough saved up, why not take advantage of your newly found free time and treat yourself to a nice quick vacation.
I talked to my mother who is a retired nursery nurse, with NICU experience. She had her share of working with difficult physicians and correcting doctor mistakes.
Among other reasons, she finally retired from nursing because she didn’t like the liability issues of nurses following physicians’ orders but being held responsible.
She said that without knowing more about how the structure of the hospital it would be hard to tell exactly what to do in this case, but it seemed to her that the OP was wrong to act on his own. She wonders if the chain of command was really exhasted.
Another option would have been to have suggested to the parents that they take their daughter to another hospital. That’s sort of a drastic step, but it beats doing something as dangerous and illegal as a nurse proscribing medication.
It a sane and just world this person would still have a job and all the others who ignored the patient’s pain because they couldn’t be bothered to help should have been severely reprimanded.
And all the people chastising the person for making the right move because it was out of procedure should stay far away from the medical profession. We need fewer people like you around, both in general, but especially in medicine.