[abooker]

I’ve been an LPN less than a year, and have just been assigned my own hall doing 3-11 in long-term care, after previously floating all over the place. Trouble is, the previous evening shift nurse on my hall is now the night shift nurse, and she is extremely proprietary about the residents we share.

I have an 8pm med pass, but one of our A&O x 3 residents on refuses his meds until his chosen bedtime. He’s on Ambien routinely, and doesn’t want to get knocked out too soon.

The other evening, I offered him his meds and he refused because he was watching the news in another room, and asked me to give them at 11pm. I placed his med cup in the med cart, went ahead with my treatments, and completely forgot about them until after I got home. I called the night shift nurse, apologized, and told her about my forgetting the meds in the cart.

Last evening, I’m reading the nurse’s notes for our nightowl resident, and see she has charted she found the meds on the nightstand. I am certain I locked them in the med cart, because when I called she said she found them in the med cart, and I certainly wouldn’t leave Ambien out as it is a controlled substance. I have observed her popping her 6am meds in advance, which seems to me to be a more serious infraction than saving one resident’s meds to offer later when he refuses.

So, what is a professional way to handle this? I’m tempted to do a late entry in the resident’s chart explaining the reason why the meds weren’t given, or weren’t given on time. (The chart doesn’t say what she did about finding the meds). I don’t want to start a chart war. I’m afraid to talk to her directly, since she has libeled me, exaggerating my mistake, and she is going to continue to follow me and catch any more errors that I make. I’m afraid I might lose my temper and say the wrong thing and make things harder for me. I don’t know how to avoid this in the future - should I compel this nightowl to take his meds on time? Should I tell the supervisor what I know about the night shift nurse’s breaches in policy? Should I run screaming back to libraries, where I used to work? *SIGH*

[Macedonia the Great]

The most professional way to solve the problem by talking to her FIRST...and not to the supervisor.You have to gather lots of selfconfidence and professional attitude before you aproach. Don't judge her about what she is doing,but ask her what she can advice you.People usualy like when the aproach is with asking for advice rather than pinpointing on them. Definately avoid chart fight and supervisors. She might dragg you in different direction in conversation (out of being aware about herself) but try to keep your head on the real motiv of the conversation and that will be"asking her to help".If she is not willing to talk...than give her few days...if not...talk to your supervisor and tell your part of the story.

[abooker]

Thanks, Macedonia. I will work on my self confidience and professional attitude. I need to be a bit braver; talking to the supervisor or charting seems easier, but a lasting solution isn't going to be easy.

[dekatn]

If this pt. consistently refuses to take meds during your normal med pass, I wouldn't pull those meds up, I would ask the pt. if he/she wants their meds now or later, if later, just don't pull them up and leave a note for oncoming nurse. Just circle the med and state "refused at this time", if this happens a lot, the times on the meds can be changed if need be, after all, hs is hour of sleep and this can be different for different people. If it is a prn med, you won't have to chart anything on the mar, did the pt. just not want the ambien, or did they refuse all hs meds? I really wouldn't want to start a war over this, as for the other nurse pulling 6a meds, I worked in a nursing home for years, and honestly, if I hadn't pulled my meds up early, I would never get all of them passed in a timely manner. I counted the pills on one of my shifts one time, 523 pills, in one med pass. So, I would take the advice of the previous poster and just talk to the nurse in a non threatening way, try to work this out in a positive way, and, it is possible that the other nurse gave the pt. the meds and the pt. left the meds on the bedside table after the other nurse gave them!!! Sounds like you both want what is best for the pt., just talk to the other nurse and ask for suggestions in a positive way, this too shall pass, who knows, you may end up being best friends with the oncoming nurse!! This pt. may want to wait and take meds after the night shift nurse comes on duty.

[medsurgnurse]

Call the doctor, tell the doctor that the patient routinely refuses meds until 11pm. Get an order for these meds to be given at 11pm. Then do it. I assume you are 3-11 shift. It will make life easier. And forget about Miss Chart Queen, it was inappropriate for her to chart a lie.

[abooker]

Yes - I see the other options available. I love the option of changing the times on my resident's meds, at least the Ambien. It hadn't even occurred to me to wait to pop the meds until after talking to him.

My "mentor" is the day shift nurse I follow. When she sees something I've missed or need further training on, she always pulls me aside and offers help and advice. I've got to be brave and talk to her, though, about my wanting liquid Carbamazepine for a resident with a g-tube. The stuff isn't water soluble; it floats on top, and when I got it changed to liquid she did an "order clarification" and got it changed back.

At least my co-workers show up for work. On other halls we get a lot of call-ins, so my previous job was as a filler for gaps in the schedule.

[morte]

Originally Posted by abooker

Yes - I see the other options available. I love the option of changing the times on my resident's meds, at least the Ambien. It hadn't even occurred to me to wait to pop the meds until after talking to him.

My "mentor" is the day shift nurse I follow. When she sees something I've missed or need further training on, she always pulls me aside and offers help and advice. I've got to be brave and talk to her, though, about my wanting liquid Carbamazepine for a resident with a g-tube. The stuff isn't water soluble; it floats on top, and when I got it changed to liquid she did an "order clarification" and got it changed back.

i have been told that you need a doctors order to change the form of a med....also the liquid may be more expensive.....and may be less accurate

[kiszi]

When there's something I know I may forget about later, I write it right on my report sheet, circle it, etc. That way, even if I totally forget, I'll at least see it when giving report and therefore avoid leaving the building with something important left undone.

Regarding the carbamazepine, did the other nurse know you had gotten the order to change it to liquid? She may have thought pharmacy screwed up, since it came in capsules before.

[abooker]

For the carbamazepine, we sent the patient out to the hospital last week and he came back with it as a liquid and also a dosage increase. When I did the re-admit, I told his doctor about the change, and she approved. The other nurse called the doctor the next day and got it changed back to pill form. She said, "we always want meds in pill form" but I can't give it without coating the inside of my envelope or syringe with the crushed med, because it floats. I even tried adding it dry to the bottom of my syringe and pouring water over it, but the syringe clogged. I'm concerned my resident isn't getting the prescribed dose because I'm losing this med inside the cup or tube or envelope. I need to do something, like explain this to the other nurse before I talk to the doctor again.

My discomfort is r/t this day shift nurse giving the med too, so she's gotta know and maybe just doesn't care because it is easier to pop it with the other pills then pour it out and deliver it separately. I'm afraid I'll come across as criticizing her, but I have to do what is in the best interest of the resident.

I'll maybe ask her for help; find out if she has a more effective delivery system for this med. If she doesn't, though, the conversation may be awkward for both of us. I don't want to come across as "not a team player"

[TheCommuter]

I have observed that the nurses who do things such as look for errors in other peoples' work, report coworkers to management, document inaccurate statements on the medical record, and lie also tend to be the most sloppy nurses ever. They'll become horrendously offended if you mention something that they didn't do (or shouldn't be doing), but will report you in a heartbeat.

You cannot win with these types of people.