You are night shift supervisor and there’s a problem with insulin dosing

You are making your last rounds for the night on a busy medical unit. Night shift nurses are responsible for administering AM insulin on this unit. A relatively new nurse who has worked night shift on this floor for 9 months asks you to check insulin with her prior to administration. This nurse is regularly responsible for giving insulin, and has been on this shift and this unit the entire time she has worked here. She shows you an MD order for 3 units of insulin, and tells you she will give 3 units of insulin. You ask to see the syringe, and she shows you a syringe with 3 cc of insulin. Shocked, you point out to her that she has the wrong syringe, and show her an insulin syringe. She seems surprised that there is a special syringe for insulin. When you question her further, you learn at she hasn’t actually shown the syringe to anyone before, and they have never asked to see it. She says “Someone should have told me if it was wrong! is it wrong?”Ã??

You excuse the nurse from work for 3 days to investigate. The head nurse of this unit just started a 6 week vacation and you are covering for her.

This nurse has shown up reliably, but has always had a tough time completing work and has had some problems following up appropriately on patient problems. You discuss the situation with risk management, who was already investigating an unusual rate of sudden death among young diabetic patients. The clinical nurse specialist and the risk manager investigate further, and conclude that although insulin has not been properly checked, all other nurses on the floor demonstrate understanding of insulin dosing and proper syringe use. Upon further investigation, there is some concern that the unexpected deaths among diabetic patients have occurred during shifts she worked, although the findings are preliminary.

Three days later, you have to make a decision about this nurse.

What are the ethical and legal problems you see here?

Should the nurse be fired, or just disciplined?

If you choose to fire the nurse, why did you choose that?
If you choose to discipline but retain the nurse, why did you choose that?

Assume that your facility policy solidly supports any disciplinary action, up to and including immediate terminationÃ?¢â?¬Ã?¦the choice is up to you.

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