Running head: REFLECTIVE LEARNING ESPERIENCE 1

REFLECTIVE LEARNING EXPERIENCE 2

The experience that I encountered was when the charge nurse medicated my patient for

me. The situation was; the doctor was being very impatient, I was with another patient in

another room and the charge nurse was tired of the doctor asking when the patient would be

medicated. Working the night shift, the pharmacy does not always process orders quickly. I

routinely will not override narcotics unless it is an emergent situation. The doctor order dilaudid

for my patient, and I had been checking in pyxis every few minutes. The charge nurse overrode

the medication, medicated my patient and when the medication was profiled I pulled the

medication and medicated my patient. The charge nurse informed me that he medicated my

patient after I had also medicated my patient.

I was angry and annoyed with this whole situation. I was angry with the doctor for being

impatient, and a little annoyed with the charge nurse. The charge nurse and I then approached

the doctor and informed him of the situation. I informed the doctor that I had checked the order

time and the time that the medication was profiled and that only fifteen minutes had transpired,

and that I do not override narcotics for nonemergency situations. The doctor’s response was to

order the additional dose that was administered. I was annoyed with this situation and felt a bit

incompetent and disappointed in myself. While I appreciate the thought behind my charge

nurses effort, I feel as though I should not have to ask other nurses if they have medicated my

patient before I pull the medications.

While I was mostly annoyed in this situation, I also had a great deal of frustration. This

whole situation is the reason safety measures have been put in place for medication

administration. I do not like to override any medication, whether it is Tylenol or Motrin, and

especially narcotics. I have worked too hard to obtain my nursing degree and would be

devastated if I put that in jeopardy over a missing narcotic. After discussing the situation with

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my charge nurse we both felt that the doctor had become too impatient in this situation as the

patient was not in any crisis or life threatening emergency. When discussed with fellow

coworkers they felt as though the doctor should not have gone to the charge nurse and instead

found the assigned nurse to inquire as to why the medication was not administered. Many nurses

felt as though I did nothing wrong by waiting for the medication to be profiled from the

pharmacy rather than overriding the medication.

The consequences of my response to this situation were an understanding that fail safe

measures are in place for medication administration and that these should not be breeched due to

a doctor’s impatience, rather on the individual situation itself. The patient was not impacted, he

was quite happy to get more dilaudid (1mg IV charge nurse dose, and 1mg IV assigned nurse

dose). The patient did not require any additional monitoring or interventions. Other nurses felt

as I did and that I did nothing wrong.

There was not much that I could have done differently other than to override a narcotic.

Even if I had overridden the medication this situation could have had the same result, and the

charge nurse could have given the profile pyxis medication. The results would have been the

same. I feel as though waiting for the medication to be profiled was and remains the proper and

right way to administer medications.

The knowledge I should have had was about this doctor. He is known to be very

impatient and wants things done immediately if not sooner. He tends to be very short with the

nurses as well as the patients. Many nurses have had situations with this same doctor in both

emergent and non-emergent situations. Knowing this information from others and encountering

situations myself with this doctor, I have learned to steer clear of him and to make it a point to

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complete orders on his patients as quickly as possible. I have learned that he will through you

under the bus without regard to how it makes him look.

I have not changed my practice with regard to medication administration as a result of

this situation. What I have done is to become more aware of the timing of when medications are

ordered and when they are available in pyxis. Even as a result of this situation I still do not

override medications in non-emergency situations. This is a practice that I believe is in place for

a reason, patient safety.

As a result of this situation I feel as though my communication skills as well as some

assessment and intervention skills were tasked. Nurses must be as proficient in communication

skills as they are in clinical skills (American Nurses Association, 2010). This situation combines

these states skills as I needed to communicate with the other nurse as well as the doctor about the

situation and any repercussion that could occur. I needed to assess my patient for the potential of

a narcotic overdose and monitor for any signs or symptoms of such. If an overdose was

suspected then I would need to take appropriate actions to treat the overdose.

This is a situation that I hope to never encounter again. The potential for serious harm to

the patient was present. I have learned that I should maintain my practice of medication

administration by not overriding medications, and that safety nets are put in place for a good

reason. I have also learned that although I have a disliking for this doctor, I must learn to

communicate and work with this doctor in any situation.

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References

American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver

Spring, MD: Nursebooks.org.