Thursday, February 25, 2010

That 24 hour chart check

I'm growing increasingly tired of the antics of other nurses.

This morning, one of the LPNs who has yet to write a correct order, once again went off on me for flagging her orders. Her usual errors include: omitting the route of administration ("everyone knows it's oral unless you write something else"); writing one frequency on the order sheet and another on the medication administration record; writing the order on the wrong patient's chart; writing blanket discontinue orders and then specifically carrying them out on the medication administration order ("you know what I meant.")

She said, "You must have nothing better to do than go through all of the charts and find mistakes."

I told her she was exactly correct. It's called the 24 hour chart check and is performed at night by the night nurse, i.e., me. I asked her how she wanted me to handle the errors in the future.

She replied, "Just leave them there and the next nurse can sign off on them."

I told her that it didn't work that way, that I was responsible for the orders on the particular day that I worked, and that I could not ignore erroneous orders, nor could I sign off on them.

She still didn't get it.

But in a way, she's right. She has never been spoken to by administration about these daily errors, so it looks as if I am the only one with a problem.

I can't just sign off on all of these errors. If a patient suffers a medication error, I can also be blamed because I checked the order and signed that it was correct. If I orally inform the nurse of the error with her written order and she does not correct it, I have no proof that I caught the error; rather, it looks as if I didn't do the chart check, and that the error could have been prevented had I bothered to do chart check.

The director of nursing considers this to be womanly cattiness, so approaching him is useless.

Another nurse discontinued a few orders that never existed in the first place. I can't sign off on their being carried out correctly because they are, by definition, impossible to carry out. On the 24 hour report, I asked for clarifications. She said, "That's the most important thing of your shift? You're kidding, right? I'm not clarifying anything. Who cares? You make mistakes, too."

I told her that she can do as she wishes with the orders, as my name is not associated with them, hers is.

She said, "You don't support your coworkers."

I told her that I let her know that orders she wrote are incorrect so that she may correct them, but I cannot guess what she meant and do it myself, if that's what she means by "support."

She declined elaborate on how she expected me to handle such phantom orders.

I also documented that certain patients refused medications. She replied, "So? Why would other people care that you can't handle a med pass?"

I think that she lost sight of the resident and instead focused on slamming me. The result is that we now have several residents with current orders that maybe should have been discontinued; and we have several that are not taking their meds and their doctors will not be told. Perhaps she is content, though, thinking that she proved, at least to herself, that I am the jerk for raising such issues.


  1. I know this type. I've dealt with them. Sometimes the urge to slap them is as strong as the need to breathe.

    They're like a time bomb, just waiting for the day when they make one gigantic mistake that gets a patient killed.

  2. My question is, how does administration know that she has made these errors?

  3. I am running into more and more nurses with this same type mentality. It's just a mistake on paper, no big deal. These are the same nurses that pass medications based on what meds are in the drawer and not the MAR. It makes me so crazy! I don't understand how such nurses made it through nursing school. I try to remind myself that as a seasoned nurse it is my job to try to teach and guide them, but when they refuse to understand... Frustrating to say the least.

  4. I use PCC how can I chart check in PCC instead of individual sign offs in each chart?? All orders are entered in PCC

    1. Hi Aisha! Wow. Seven years later and I still have not worked in a place with electronic medical records. So I do not know the answer to your question!
      Anyone want to weigh in?

  5. I go through this often. Has anything been done yet?