Letting CNA pass your meds, bad idea? - page 8

I fill the cups and check for all interactions and whatnot, but anyone have any negative experiences or can think of any possible neg exp with this? Thanks... Read More

  1. by   pagandeva2000
    Quote from goingnuts
    In life there are never any guarentees. I can't go around worrying about everything when working in a nursing home. I do the best I can and take care of what can get me in trouble first and foremost. Hate having to be that way but there just is no other choice. So bottom line is no matter what else is going on there is no way I am letting a CNA give my meds. Not because of the reasons stated on this thread necessarily but because I could get into trouble. Many yrs. ago I worked with an RN that didn't know what to do when she found a resident dead that was full code [the man should have been a DNR trust me on that] anyway I asked her if anything was wrong and when she told me and I tried to tell her what we needed to do she wouldn't listen and then it was such a mess. To make this shorter when I got home I called the board to see if I could get into trouble and the investigator told me it was highly possible. Well I couldn't hardly eat or sleep for three weeks. I asked him what for and he said I should have pushed past the RN and done the right thing. I have since found out I am not reguired to do that. Anyway I told him I will do things different next time and he said hopefully I will do what he said. I said no--- I will know better than to ask if anything is wrong next time. After getting my statement the state did not even report me. The RN board took four months to write me for a statement. By then I had cooled off and wasn't about to give a statement that would cost a RN her livelyhood. She made a mistake and I think she learned from it. Without my statement the BON decided to do nothing. The CNA's word alone would not be enough. Had they asked me right after the incident I was so angry at that RN that I would have gladly given a statement. I have never regretted my decision not to. It does make me sick however to know there are people out there who would salivate at the chance to get someone in trouble. Don't get me wrong---if I see any kind of abuse I wouldn't hesitate. But all of this reporting for mistakes thast anyone could make and are not that big of a deal is just ridiculous. And I might add just plain mean.
    I can attest to what you state about reporting things that are simply too petty to do...there are nurses that have the 'nursier than thou' mentality...very self righteous and annoying....eating and slaughtering the young and all of that. For me, I would never give an aide medication to administer for me simply because there is no guarentee, and if I can't attest to something I didn't witness, then, I should not do it for someone else.
  2. by   lmaldo
    Quote from Marie_LPN
    Because they are sooooooo counted and sooooooo more likely to 'disappear', unlike tylenol or colace.
    HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?
    Any comments or thoughts?
  3. by   Marie_LPN, RN
    Quote from lmaldo
    HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?
    Any comments or thoughts?
    (you quoted me)

    First, never is the pt. less important than the theft of a narcotic to me . Just because i didn't say it on here, doesn't mean my priorities are out of whack TYVW. To me it goes without saying that the pt. and outcome would come first :angryfire .

    Second, caps lock (i.e. yelling) is rude.
  4. by   goingnuts
    [quote=lmaldo]HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. First of all my dear you need to calm down. I have to say if this is the way you react to most things that upset you or don't agree with your way of thinking I am so glad you are not in the nursing profession. Let me assure you that if you or someone you love go into the hospital or nursing home then there are going to be times when you don't get assessed. Well not so much the hosp. because they have the automatic vital sign thing and other neat stuff you are not going to find in a nursing home. Look----for what it is worth I can tell right away if a residents resp. are low like you say. For one thing they will not be able to take their meds. So I will send them out immediately since I don't want to get into any trouble. See how not wanting to get into trouble can automatically make you do the right thing. If I don't see any reason then I don't do an assessment on a resident when I do my med pass. You better wake up and smell the coffee if you think anyone who works in a nursing home does that. Most of the residents that get narcs. have been taking them for yrs. I guarentee you it no longer affects them. At least not so they would notice. ANd there is no Narcan in the nursing home. But EMS will have some when they get to the home.
  5. by   lmaldo
    [quote=goingnuts]
    Quote from lmaldo
    HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. First of all my dear you need to calm down. I have to say if this is the way you react to most things that upset you or don't agree with your way of thinking I am so glad you are not in the nursing profession. Let me assure you that if you or someone you love go into the hospital or nursing home then there are going to be times when you don't get assessed. Well not so much the hosp. because they have the automatic vital sign thing and other neat stuff you are not going to find in a nursing home. Look----for what it is worth I can tell right away if a residents resp. are low like you say. For one thing they will not be able to take their meds. So I will send them out immediately since I don't want to get into any trouble. See how not wanting to get into trouble can automatically make you do the right thing. If I don't see any reason then I don't do an assessment on a resident when I do my med pass. You better wake up and smell the coffee if you think anyone who works in a nursing home does that. Most of the residents that get narcs. have been taking them for yrs. I guarentee you it no longer affects them. At least not so they would notice. ANd there is no Narcan in the nursing home. But EMS will have some when they get to the home.
    Yes, I am in the nursing profession, but, I think you missed the point. You should be glad I am in the nursing profession because I seem to be the only one mentioning the patient as the point of concern. In the hospital I work in and teach in, I see so many new nurses that forget about what the patient is in the hospital for and are too caught up in worrying about their career, and judging from the replies to the email wondering about having the keys to the med drawer, or making sure the MAR is signed for, or that a CNA might take the medication for herself/himself instead of the patient still implies that the best interest of a patient is the last thing considered. And, by the way, I was positing an opinion, not slamming anyone who "disagrees" with me. You do make a very valid point - nursing homes do have a high patient-to-nurse ratio, and you can get absolutely slammed. I know I couldn't work in a nursing home because the loads placed on nurses is beyond safe measures. I applaud you. But, it still concerns me that the first statement you make is that you don't want to get in trouble, not "the patient is in trouble therefore..." It sounds as though the DON may not managing the facility very well. It is still unacceptable that assessments are not made, especially when meds are given. Are you telling me you don't always take a blood pressure before you give a blood pressure medication or having an aide get the blood pressure for you? These are simply reasons that it is not a good idea to let CNA's pass meds. The really neat stuff we use in a hospital is our critical thinking skills that helps us the most. I especially like the stethescope. It is really cool and very helpful.
  6. by   Marie_LPN, RN
    You should be glad I am in the nursing profession because I seem to be the only one mentioning the patient as the point of concern.
    :bowingpur
  7. by   goingnuts
    [quote=lmaldo]
    Quote from goingnuts
    The really neat stuff we use in a hospital is our critical thinking skills that helps us the most. I especially like the stethescope. It is really cool and very helpful.
    :spin: Very funny. But sorry I don't agree with you. The stuff you have in the hospital makes a big difference. ANd no I don't take a blood pressure everytime I give clonidine. Do you think the equipment in the nursing home is accurate? It is not. Do you think the CNA takes the BP. They do not. There is just not enough time. And I hate to have to say this but yes my license comes before the resident. We don't call them pt. in a nursing home. Well we are not supposed to anyway. Unfortunately that is reality. I don't like it and I didn't make the situation what it is but I do accept it. DON's don't care. They are trying to get by also. I see where you have a Master's degree. Very impressive. Be grateful. I wish I had the brains to do what you did so I can get out of direct people care but alas it was not to be.
  8. by   goingnuts
    Quote from Marie_LPN
    :bowingpur
    thanks for the laugh. I really needed it. I think a good sense of humor is just what the Dr. ordered.
  9. by   lmaldo
    [quote=goingnuts]
    Quote from lmaldo
    :spin: Very funny. But sorry I don't agree with you. The stuff you have in the hospital makes a big difference. ANd no I don't take a blood pressure everytime I give clonidine. Do you think the equipment in the nursing home is accurate? It is not. Do you think the CNA takes the BP. They do not. There is just not enough time. And I hate to have to say this but yes my license comes before the resident.
    You are so right! We are very fortunate to have the equipment in the hospitals, as well as the access to doctors and specialists. That is actually one of the main reasons I chose hospital care, as opposed to Nursing Homes. I have to admit that under your situation, your environment forces you to defend your license to the point it does come first.

    With the shortage of nurses today, it might be worth it for you to perhaps explore acute care - that way you can be a nurse for the original reason you probably became one. It is well worth it!
  10. by   goingnuts
    [quote=lmaldo]
    Quote from goingnuts



    With the shortage of nurses today, it might be worth it for you to perhaps explore acute care - that way you can be a nurse for the original reason you probably became one. It is well worth it!
    Thanks but I have no business being in acute care. I am right where I should be. At least I have become proficient in knowing what is going on with residents in nursing homes. No matter where I go the problems are the same. Only the faces change. I tried hospice. Was thrilled at first. But I did wonder why they hired me since there was no work. I got paid for staying home. They barely had anything for the LVN they had much less me. Then a wife turns me in and accuses me of the most ridiculous actions. Now there is going to be a peer review tomorrow and I will get their answer as to whether they will turn it in to the BON in 10 days. All of what has been going on is just crap. If they really thought I abused a pt. then they should have turned me in immediately. Not take up to three months to decide. I have been sick about the whole thing since over two months ago. If they hadn't fired me before they had the peer review then I probably would have gone. This company is something else. Probably nothing will happen but I will not be able to relax until I know for sure. They even paid me for the day they fired me. Geez. I didn't fill out a pay sheet for that day. I told them I didn't want to get paid for that day and they still paid me. I deliberately went for a few weeks of unemployment just because I was furious with them and I knew their unemployment insurance would go up. After all of this is over I fully intend to report their actions to Medicare. I know they are getting money for nothing and they know it. But I guess they have been gettting away with it for the ten yrs. they have been openned so why worry now. I still can't believe they pay the LVN for staying at home. She told me to put office work down if there was no work. Can you believe it? Other hospices do not promise 40 hours a week. and there is a reason for that. Well anyway I got off track didn't I? But I would like to know your thoughts on this since you seem to at least care and want things to be done right. The sad part about all of this is I really believed they had work for me and that I would be busy and I wanted to work. Not stay at home and put down office work that does not exist.
  11. by   dijaqrn
    I am sure I clearly expressed my concern regarding residents not being

    assessed appropriately and/or being left in pain. Patients are always first!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:Melody:
  12. by   grace90
    Quote from FutureNurse2005
    Any mistakes that were made fall onto the RN.
    EXACTLY!

    And *that* is the reason so many of us are uncomfortable with a CNA passing meds under us.
  13. by   pagandeva2000
    Quote from lmaldo
    HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?
    Any comments or thoughts?
    I agree with what you are saying, but I do believe that people stated this in varying degrees without the actual statement of 'patient first'. Posters in this thread have stated that there is no guarentee that the patient would receive their medications, the proper assessments and such. What was prominent in this thread is that once medications leave the sight of the nurse, that anything goes, and because we are licensed, we are ultimately responsible for the outcome; even moreso than the CNA.

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