new charge nurse discovering bad practice on the unit

gitterbug · Dec 10, 2006

P.S. Any meds given so far off a normal schedule needs a physicians order and a note explaining why, like"family states patient takes med at 1630 x years."

Mulan · Dec 10, 2006

Most times are set by the pharmacy. Once a day is once a day. No need to get a doctor's order for most things.

Pharmacy will have meds scheduled for 1600, 1630, 1700, 1730, 1800, 1830, 1900, etc. all on the same patient. It's a little ridiculous. Do people take their meds at home like that? I think not.

I agree meds should be charted for the actual time they are being given, but as far as the times being written in stone, as based upon some pharmacy computer program, sometimes you need to use a little common sense, or nursing judgment.

salseranurse · Dec 10, 2006

Hi, This sounds like a long term setting but that shouldn' excuse the fact that this RN has developed bad habits over the years. She is obviously used to getting over on other supervisors therefore unless you do something about it her deceptiveness wil continue. Follow your companies protocol re: issuing discipline. This will not only safeguard your job but it will also show the rest of the staff that you won't tolerate that kind of nursing practice.

outcomesfirst, BSN, RN · Dec 10, 2006

i
i found out that another rn on my unit has been giving her patients their bedtime meds at 4,5,or 6 pm, instead of 2200 as ordered.
...now the thing is, she didn't change the tmes to accurately reflect when she gave the meds, so i know she knows what she is doing is wrong.
another post mentions computer documentation on when meds were pulled - this is enough circumstantial evidence. i am sure you have hospital p&p that dictates when meds are pulled.
hello - your license is at risk !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
you must immediately stop this practice, report and document this. please go to the deleware brn site, print out the info, write it up, keep a copy and hand it to your direct supervisor. delaware professional regulation - board of nursing
specifically:
10.4.1 nurses whose behavior fails to conform to legal standards and accepted standards of the nursing profession and who thus
may adversely affect the health and welfare of the public may be found guilty of unprofessional conduct.
10.4.2.1 performing acts beyond the authorized scope of the level of nursing practice for which the individual is licensed.
10.4.2.4 inaccurately recording, falsifying or altering a patient or agency record.
10.4.2.8 failing to supervise persons to whom nursing practice or advanced nursing practice has been delegated.
10.4.2.12 failing to take appropriate action to safeguard a patient from incompetent, unethical or illegal health care practice.
10.4.2.15 diverting, possessing, obtaining, supplying or administering prescription drugs to any person, including self, except as directed
by a person authorized by law to prescribe drugs.
10.4.2.21 aiding, abetting and/or assisting an individual to violate or circumvent any law or duly promulgated rule and regulation intended
to guide the conduct of a nurse or other health care provider.
10.4.2.24 failing to report unprofessional conduct by another licensee.
10.4.2.27 failing to take appropriate action or to follow policies and procedures in the practice situation designed to safeguard the
patient.
this is going to be a huge problem for you and your institution. i am sorry this has happened to you. i urge you to address this situation immediately, and save your license. you must immediately cease supervising this individual to protect yourself, you must work with hospital administration, if they choose not to address it, you must report directly to the board and unfortuanately this is going to be the end of your employment at this organization - get a lawyer first in this situation, but do not supervise the individual. document, document, document. please let us know how this turns out.

outcomesfirst, BSN, RN · Dec 10, 2006

I have been thinking about this post all day. I must apologize, I painted worst case scenario and did not give you a positive option. In the real world, the situation you find yourself in is more common then you might think. If these situations were always reported, we would probably have a great many less nurses, and the nursing board could not function. In the improved culture of today, a blameless culture, we work together to resolve issues positively. Hopefully your situation will be handled as follows:

You gather your concerns, document them and meet with your manager. You explain - I am concerned about nurse X. I am concerned about patients safety and our organization. I believe this is happening. You describe your facts. You ask how you can work with nurse x and management to resolve the situation. Together you develop a learning and mentoring plan for nurse x with specific objectives. Now the tough part. You all meet together - maybe you have access to a moderator/EAP/arbitrator to participate. You, not the manager, give the facts:: _____ on Friday the 14th you withdrew 2200 medications for Mr.Jones and I saw you administer them at 1830. ______ you documented the Coumadin and Lasix as being given at 2200 on the MAR. I am very concerned that the early administration of medications may harm Mr. Jones. Can you help me understand this situation. Let nurse X talk. Avoid blame, show compassion. "I am sorry this is happening, I want to help you and our patients" will go along way to defusing. Etc. Then together you discuss the requirements, safe practices, hospital policy and if necessary the law. Together you review the draft plan and seek nurse x input. Everyone signs off and you implement, with follow up etc. In the meantime your manager works with education/administration and develops a plan to address the issue facility wide because you were not the first person to be aware of it, you are the first person taking action. Regulation and law are a topic covered in basic nursing education and a refresher never hurts anyone. It is important that nurse X continues to be treated with respect and dignity while being given the opportunity to imrove her practice. - there must be no gossip. I think in this way we grow, learn and mentor each other - while protecting patients. Truly I hope this is the result you have. If on the other hand things do not go this way - your manager puts you off etc - I would quietly seek new employment and keep documentation. I would not take this to the BRN unless I was planning on leaving healthcare. Sad but realistic. Going to the BRN is a last action to protect patients, if nurse X cannot/willnot change, then the obligation to report is clear and should be undertaken by hospital administration, not you. I hope this is better help than a rant about laws. Take care of your self and best wishes.

crb613, BSN, RN · Dec 11, 2006

I can tell you as a new nurse I have seen this first hand. I did go to my NM & she did an audit of the pyxis...don't know the outcome. Since this I have seen it several times by different nurses. These are not qd, or bid but scheduled meds.....these nurses give all their meds at one time, & then they are done for the night. The MAR times are not changed to reflect time actually given. It really irks me that I am running around trying my best to give them as scheduled & change times to reflect any given late. Then their charting is done, Mar checked, chart checks done, & they have time to take breaks, eat, visit ect....while I try to do it right & some nights run myself to death! What about pt safety & their rights? I wonder what happens if a pt dies at 2100 & MAR reflects a med given at 0000.