Accused of "Cheating her out of medicine"

Nurses General Nursing

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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?

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Specializes in Med/Surg, Ortho.

Although i never had the same instances as you as far as being questioned about "cheating meds" i did have someone have a problem with what my job was when i worked with MR/DD groups. They were upset because they thought since they had military training as a medic they could do MY job and they didnt need me.

My comment to them was "when you get a license to practice in this state and sign these MARs, ill step aside and you CAN do this job, but until then the STATE says I have to be here to do it and thats it." They didnt like it but sometimes the truth hurts. They didnt have any response and if there were any comments afterward, I sure didnt hear it.

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I don't think you need to worry about your license, since you did no do anything to jeopardize it. The house supervisor would have to back up her allegations with proof. I think you did the right thing informing your supervisor and allowing her to take control of the situation. I also think that meeting with your supervisor and providing a written account of the incident is also prudent on your part. I also think that perhaps when receiving doctor's orders, if possible, avoid using ranges for time or doses.

Definately the home supervisor's remarks were out of line, especially since she lacks the knowledge as to why the patient is receiving these drops in the first place. I think the bigger issue is the fact that this house manager has an attitude towards nurses in general. I think it's time the nursing staff along with your supervisor discussed this issue, as her attitude and remarks create a hostile working environment for the nursing staff.

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In your shoes I would welcome a BON investigation because the home supervisor is the one who would end up under the microscope. You did nothing wrong. You followed doc's orders, while the H.S. is making up her own, basically practicing medicine without a license. Might wanna point that little factoid out.

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Well, I'd be steamed :angryfire

First off, why is the house supervisor even getting involved? Obviously, I bet you were in shock and p.o.'d that a non medical person is questioning your medical cares. I would have asked him where he got the idea that the pt was supposed to receive these drops. Maybe he wasn't aware that the orders were changed. Then since he/she apparently has a poor opinion of nurses in general he maybe thought you were lying to cover yourself since "nurses work the least and get paid the most" geez.

Also, I would ask him to explain what he meant by "the pt really needs these drops". Was he noticing things in the pt that concerned him? Ask him to explain this. Many times non medical people can misinterpret things and it can get blown out of proportion. Would it have helped if you would have told him to notify your supervisor, the RN, if he had concerns about the meds? In reality though, this is besides the point, he has no business nosing into the pts medical concerns. Maybe he needs an updated copy of the HIPPA policy.

And even if there is an error in the order, it isn't your fault since the Md gave the RN the verbal order which was transcribed to the chart. Your job is to follow these orders for when and how much med to give. Doesn't sound like this is the case though.

Will the accusers be there during the meeting? If so, I would casually mention that they legally don't need to concern themselves with the pts medication schedule because they are not medical caregivers (HIPPA!) I would also mention that there false accusations can be considered slander which may earn them some legal repercussions if it happens again.

And yes, I would contact my union rep to report this. That way if it happens again you will have documentation of past incidents.

And "if she had the power, she's fire them all" ???!!! Oh really? and who does she think would do the assessments, pass the meds, moniter pts and the like. I bet she would change her tune if she walked a mile in your shoes. People that aren't nurses think nurses "do the easy work" because when they see us we are charting, waiting for Md to call us back, following up on labs i.e. "just sitting around". Then when we are providing care, the door to the pts room is often closed. They may interpret that as "wow, they aren't doing anything" especially if they are jealous of your job which sounds like could be the case.

I can't see that you will be getting punished for this. First off, doesn't your union provide some protection in matters like these? I hope you have your union rep present Monday. And then, where is the documentation to support the accusers claims?? That's right, there is none! I would be careful though that you focus on the facts during the meeting. These people you work with sound like real pieces of work that may try to misrepresent the facts and get you into trouble.

Good luck!

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This happens all the time. Lay people act as if they know a lot about the stuff we are supposed to be taking care of. Sometimes they do.

I don't see where you did anything wrong or how your license would be in jeopardy. The person complaining is guilty of big mouthosis but that's about it.

Get used to it, I'd say. This is pretty common.

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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?

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Specializes in Med-Surg,BH,Geriatric,Cardiac/Tele.

Hi

I am an LPN yes I was in the same situation as you... only with Narcs and suppositories (long story) pt was so gorked out she didnt remember when she was taking it and well so on and so forth

Meeting yes, written statement yes, watch your reaction to what the admin has to say to you in fact dont react.. mention the "practicing w/o a license as well as prescribing with out a license, because who is she to say "she needs all the meds she can get right now" those meds dont work that way and she does not understand that dee dee dee.. (sorry)

Watch your reaction they could possibley blame it on you and I dont mean to scare you but yes worry about your license make sure you are clear

I have gone thru just this thing and I thought my Lic was okay

then if things dont go in the manner in which they should email me and we

can chat later State Board so on and so forth

Good luck

SwtNrs

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Thanks for the support, everyone. I'm getting all my documentation ready for tomorrow morning.

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Best of luck, and keep us posted. :)

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Specializes in Geriatrics, Cardiac, ICU.

I don't think you have to worry about your license. If you are following the order, then there is no malpractice.

If you gave an extra dose to appease them then I'd be worried.

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At least you are being heard out on this matter and not just ignored by your managers. Best of luck in coming to some positive resolution to this problem. Make certain that you act professionally in the meeting and address this from the standpoint of what is best for the patients and your employers. I see no reason why you should be concerned about your behavior to date. Just hang in there.

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