Accused of "Cheating her out of medicine"

[LightCommaStix]

This is 50% rant, 50% request for advice.

First, background info: I'm an LPN for a large company providing in-home services to MR/DD clients. (I have serious doubts regarding the company's ethics, Medicaid billing etc., but that's for another post.)

Like I mentioned, all our clients are MR or DD. They live 2 or 3 to a house/apartment, with 24 hour staff to assist with ADLs, cooking, cleaning, driving to a part-time job, etc. Staff in the home has no medical/nursing training or accredation. Above the home staff are Home Surpervisors, who deal with staff in the houses, make sure bills are paid, bill Medicaid for services, etc. Home Supervisors also have no medical/nursing training. I pass medication at 5 different homes. Our district office employs 4 LPNs including myself, and our supervisor, an RN.

Now onto the issue: We have a particular client who is 3 days post-op cataract removal. She's doing really well with the 'don't touch the eye, don't bend over, etc.' stuff. Yesterday the doc said everything looked great, and decreased her Vigamox and Predisolone to one drop each to right left eye Q3-4h while awake. My supervisor (RN) took the order from the MD over the phone and transcribed to the MAR. Times to be given: 8am (when she wakes), 12 noon, 4pm, 8pm. Client goes to bed between 8pm and 9:30 pm, so the 8pm does is last one of the day. I take the MAR to the house and begin administration.

When I come back to house at 3:30 pm to administer meds, the house staff asks me, "So who is going to give her 6pm eye drops?" I tell staff she doesn't have eye drops due until 8pm. Staff says "No, Home Supervisor told us to have her drops given at 6pm. She said she really needs as much medicine as possible right now. -" and yes, this is a direct quote - "Home Supervisor told us the nurses are cheating her out of her medicine. She could have them every 3 hours, but is getting them every 4 hours." The Home Supervisor had arranged for staff to bring her to a state-certified Medication Aide at 6pm and give an additional dose of her eye drops.

I immediately call my supervisor, who immediately calls her supervisor. The only action taken by management at this time was to tell staff not to let the client receive the additional medication. I scheduled a meeting with my boss' boss Monday morning, and plan on bringing a written statement.

To summarize, Home Supervisor:

A) Told her staff to administer medication not scheduled at that time, which amounts to

B) Practicing medicine without a license and

C) Told her staff "The nurses are cheating her out of her medicine"!

I can't emphasize how humiliated I felt. Three layperson, house staffers with no medical/nursing training questioned my ethics and told me how/when I should administer medication. Stating something like I'm "cheating her out of her medicine" opens me up for accusations of theft and malpractice. Can you imagine the jeopardy my nursing license would be in if the wrong person had heard that statement? (It may already be in jeopardy as we speak!) What if the staff continues to say this about the nurses? This is COMPLETELY unacceptable behavior. Not that this should affect my decision, by this particular Home Supervisor is open hostile to the nursing dept. She's been overheard (by both myself and other nurses) making anti-nurse remarks such as "They get paid the most and work the least" and "If I had the power, I'd fire them all."

So...thoughts? Advice? Again, I have a meeting with my boss' boss Monday morning. Am bringing a written statement of the events. I'm also considering going to my union rep over this. Should I press the 'Home Supervisor is practicing medicine without a license' issue? What would you do?

[mamason]

Stick to your guns. You are doing the right thing. Rn's follow medication instructions written by a doc. Not verbal orders from a house supervisor. Just document. No job is worth losing your license over. Sounds to me that she/he is over stepping their boundaries. Document any remarks made by this person. Very unproffesional if you ask me, on her part that is.

[santhony44, MSN, RN, NP]

I have to wonder what exactly she thinks you're doing with the "extra" meds the patient isn't getting.

I think this woman does have a major chip on her shoulder in regards to nurses, and yes she's way out of line. I think you're handling it fine and have also had some really good suggestions from others. Good luck!

[VegRN]

ooops

[VegRN]

In reality though, this is besides the point, he has no business nosing into the pts medical concerns.

Actually, this person is supposed to keep an eye on the patients very closely and there is nothing wrong with her being very much aware of the clients' medical situations. In fact, there is everything right with it, since she is on-site and the nurses are generally not. This staff member is the nurses' eyes and ears in this residential care facility.

The problem is what she said and the nasty way she said it. She needs to be reprimanded and counseled to be courteous and mature and professional, and, if she has concerns, to contact the RN or whoever is on call for such concerns, instead of badmouthing the nurses.

Just wondering - how come she wasn't concerned that the client wasn't getting the drops q3 throughtout the 12-hr period?

Or ATC q3? Personally, I think 12 hours without the drops is too long but if the surgeon is happy with it, I guess it's ok.

OP - how come you're meeting with your boss' boss and not with your boss?

Trudy, what about HIPPA? It seems to me that a non medical person having access to a persons med list would be a violation. Keeping a close eye on them is all fine and good but having access to med list? Seems like HIPPA would not like that.

[TazziRN, RN]

Veg, non-medical personnel responsible for the medical care of others are allowed access to information.

[MrChicagoRN, RN]

When I come back to house at 3:30 pm to administer meds, the house staff asks me, "So who is going to give her 6pm eye drops?" I tell staff she doesn't have eye drops due until 8pm. Staff says "No, Home Supervisor told us to have her drops given at 6pm. She said she really needs as much medicine as possible right now. -" and yes, this is a direct quote - "Home Supervisor told us the nurses are cheating her out of her medicine. She could have them every 3 hours, but is getting them every 4 hours." The Home Supervisor had arranged for staff to bring her to a state-certified Medication Aide at 6pm and give an additional dose of her eye drops.

To summarize, Home Supervisor:

A) Told her staff to administer medication not scheduled at that time, which amounts to

B) Practicing medicine without a license and

C) Told her staff "The nurses are cheating her out of her medicine"!

I can't emphasize how humiliated I felt. Three layperson, house staffers with no medical/nursing training questioned my ethics and told me how/when I should administer medication. Stating something like I'm "cheating her out of her medicine" opens me up for accusations of theft and malpractice. Can you imagine the jeopardy my nursing license would be in if the wrong person had heard that statement? (It may already be in jeopardy as we speak!) What if the staff continues to say this about the nurses? This is COMPLETELY unacceptable behavior. Not that this should affect my decision, by this particular Home Supervisor is open hostile to the nursing dept. She's been overheard (by both myself and other nurses) making anti-nurse remarks such as "They get paid the most and work the least" and "If I had the power, I'd fire them all."

Should I press the 'Home Supervisor is practicing medicine without a license' issue? What would you do?

Absolutley no need for you to feel humiliated. If someone else acts like a fool, that's their issue.

You are following MD orders to the letter. When there was a dispute over the plan, you reported it appropriately.

You did not nothing wrong. Don't feel defensive, don't feel you need to respond emotionally to her false statements

If it's appropriate to the conversation, it'd be ok to mention her openly hostile attitude towards nursing, but basically keep a cool head.

I'd probably say something like, "I'm confused as to why the home supervisor is attempting to change medication orders. Does she have the authority to do so?"

We all know the answer, but it sets her up without it being a direct accusation

[LydiaNN]

I honestly don't believe your license is in any danger whatsoever, but if it gives you peace of mind, perhaps schedule a consult with an attorney.

As for the vent portion of your post... I work with a number of both families of individuals with DD and professionals who care for them and all I can say is that I truly wish this story surprised me. I've not heard these exact details before, but I hear similar sagas all the time. I also wish I believed filing a report or complaint with the state agency that licensed the home would make any difference, but I don't believe it will. These sorts of things just never seem to raise any flags and then along will come a tragedy when one of these rogue staff members ends up causing harm to a patient and everyone throws their hands up as if to say 'Who knew?"