We took report and I started my rounds with the medicine cart. As soon as I finished we prepared for supper trays, putting in the necessary nurse’s notes etc. By evening rounds it was time to pass the meds again. When I got to the patient’s room, the sitter who was hired by the cousin to watch over the patient when we, the nurses and aides, were helping with other patients, asked for the patient’s evening narcotic along with her other medicines. We had had a meeting the week before when the new Director of Nursing had taken over the duties of Scotty, the former and now retired director. She had laid out the new rules for sitters. They would no longer be giving the meds to the patients anymore unless they were a qualified Med Tech or LPN. We had to give the meds directly to the patients now and the Doctor had said this particular patient was receiving too many narcotics and her liver would start to fail. We had to only give those narcotics when she said she was in a lot of pain and nothing else seemed to work. I went into the room and asked the patient herself if she was in a lot of pain and she sat straight up and said, “Not really”. The sitter was so insistent that I knew she had Tylenol ordered, and had it on her MAR page for several years so I gave her a couple of Tylenol. The sitter was so angry that I did not give her, the sitter, and the drugs to give the patient that she said she wasn’t giving the rest of her medicines again and that I could just give them from now on. I told her about the meeting and reminded her that she would not be allowed to give the medicines to the patient anymore due to the rules set up by the new Director. I gave the meds and continued my med pass to the rest of the patients. She had called the Cousin of the patient and angrily told her that I would not give the narcotic to the patient as she, the sitter, had asked for and the cousin went ballistic. She said she was going to report me to the new Director of Nursing. I didn’t know this that night and didn’t find out about it until the next day when I was getting ready to go to work. I received a call from the Director’s office to come to her office before reporting for work. I had no idea why. When I went to her office I knocked on the door and pasted a smile on my face, knowing this couldn’t be good. She said to “Come in and sit down.” I nervously waited to hear what could possibly be wrong; after all I had done nothing I knew of to require such a meeting. She said she had received a call from the cousin, guardian for the patient, and wondered why I hadn’t given the prescribed narcotic to the patient when the sitter had asked for it? I reminded her of the orders she herself had given only a week before and what the Doctor of the patient had said about not giving the PRN drug unless she absolutely needed it. I told her that the patient herself had said she wasn’t in that much pain and I also told her LPN that sits with her in the daytime had said she hardly gives her any narcotics when she works. I told her of the many instances when the evening sitter had asked for the patients narcotic only to find out she had been given the narcotic only an hour and a half before that by the daytime nurse. She was only ordered the drug PRN, as needed, and the order was for every 4-6 hours between them. I also told her of the suspicions that we, the nurses, had that the sitter herself was taking the medication or selling it on the street. Every nurse that worked with that sitter had said that. Nonetheless, she said I was suspended for four days without pay. I didn’t know what I was going to do for the missed money since I could barely miss one day without it causing a hardship unless it was a sick day that was paid.
On the day I was scheduled to go back to work the Director called me again and told me to come into the office before my scheduled shift. I thought “What now?” I hadn’t been there for four days what could I have possibly done this time? I was scheduled to go to the conference room on the first floor where the business offices were. There I saw a long table and other administrators sitting around it passing papers and talking amongst them. I nervously looked around at everybody who smiled at me as I sat down. The nursing director, whom did not smile came out and said I was discharged for giving the Tylenol to that particular patient and another patient, whose husband was a doctor and was present at the time of the incident and who told me to give the drug along with her other medicines to help her sleep better since he was staying the night in her room, otherwise she screamed all night and he was a busy Doctor and had to get up early the next morning to make rounds. Her actual Doctor had given us orders to do what ever her husband wanted and had an order in the nurse’s notes to that effect. I even called him to verify that it was, “Okay”, made all the notes in the chart to that effect but “They still didn’t think it was right”. The extra drug, which she had in her list of PRN’s on the MAR they felt, was contradictory to her scheduled drugs that were also given. I explained that her husband whom was authorized by her general Doctor to be able to add extra medications if he felt the need was in her best interest, said it was “okay” and that he just wanted her to be comfortable. He knew she was dying. Nothing I said seemed to matter. I started to cry and plead for my job that I had had there for almost six years. It was February eighth and on April 16th 1996 I would have been there for 6 years. I was coming up for evaluation and a raise. They had told us for the last six months that they didn’t know how the change from West to East hospital was going to affect the staff since there were 16 LPN’s and only 12 LPN jobs available. We had to reapply for the jobs we already had and we knew something was going to have to give. Many RN’s who had offices on the first floor and had been there for over 25 years had lost their jobs as well as their jobs had been done away with. These were Registered Nurses who were looking to retire in five years after 30 years of service. They were left with no benefits, no pension plans and no credit union where they had their savings invested. They needed to lose some nurses for the “Heartland in the 21st Century” plan that didn’t include certain jobs that were done away with; kitchen staff and housekeeping all took the cuts. We didn’t really believe the nurses’ would be cut as well. It was rumored any errors charted in the MAR would be dealt with harshly.
I went home crying so hard I couldn’t see to drive. Kelvin was sitting the couch and wondering what happened. “Why was I back?” One look at my face told him what had happened. We both wondered what we were going to do. The mark on my nursing record would simply say “discharged for medication errors” not “gave 2 Tylenol while following orders given previously by the Director of Nursing herself” or “while following Dr’s orders etc…etc..”
I didn’t know how I was going to be able to find another nursing job with that on my record and I knew I would have to list them as a reference. I applied for Caregivers, a Home Care service that hired out nurses on a PRN, as needed, basis to go into the homes of the elderly that wanted to be at home for their care and not live the rest of their lives in a nursing home. I also applied to a nursing home in Wathena Kansas, I had applied there when I first graduated from Nursing school but they were rude and didn’t pay as much as the Citadel where I had worked until April of 1990. My Kansas License was a temporary one for three months. After that I would have to go to In-service meetings for my credits every year. I would have to go as far away as Topeka, Falls City, pay for it myself, it was expensive, and be able to take the time off from work without pay. I decided I could use the temporary license until I could find a nursing job in Missouri, where all of that was not required.
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