new charge nurse discovering bad practice on the unit

  1. I have recently been named as the full time charge nurse on my unit and I have come to soe unpleasant discoveries. I am not sure exactly what to do.

    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. Apparently the previous charge was very aware but tired of the BS (retired now after 50 years of experience) and never really addressed the issue.

    I asked the nurse why she was giving meds so early and she bold faced lied to me, told me "because the daughter asked me to give her her meds now" SO I couldn't really call her a liar but I audited her other patients med sheets and several of them were the same...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.

    the issue I have is that she wanted the charge position BAD and thay gave it to me, I don't want her to think I am singling her out. I also don't want to make too many big wave my first week on the job but this is really bothering me. How would you handle this situation? Any input would be helpful.
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  2. 29 Comments

  3. by   SCRN1
    IF she was really told by a patient or their family to give it at an unscheduled time, then she should have called the MD for an order to change the time. This sounds like they were scheduled meds. Unless the doctor ordered them PRN, she had no right to give them at a different time. This, along with not changing the times she gave them, are med errors. An incident report for med errors should be written even if you don't want to write her up in addition to that. But, I would be up front with her and explain what you have to do and give a warning that next time, it will be an incident report and writing her up. If you don't write the incident report and have knowledge of it happening, you are just as guilty.
  4. by   shiloh11
    Its pretty tough to prove someone is guilty of something without hard evidence (since she's not charting the early time) even if you know you are right. I would agree that you are probably going to have to do an incident report. I would also discuss it with her privately. Why in the world is she giving the meds so early anyway? How does she justify giving them early (even if it is at the patients request) if they are timed meds?

    I do think its important that you set up the "rules" you expect people to go by while you are charge. By no means do I mean that you be a dictator or anything but if you establish right off that you do expect people to follow hospital policy, they should have no excuse for doing their own thing (possibly to the detriment of the patient and the dept).

    I hope that helps a little. Its a tough situation that you're in!
  5. by   SuesquatchRN
    How does one give HS meds to someone at 2200 when they're sound asleep at 1830? And I had a lot of residents whose HS's were, literally, right after dinner.

    Depending on the med and the importance of timing I'd really let it alone if she has to wake everyone up and try to get the meds down their gullets. It just wasn't possible for a lot of my elderly peeps.
  6. by   mom23RN
    Quote from Suesquatch
    How does one give HS meds to someone at 2200 when they're sound asleep at 1830? And I had a lot of residents whose HS's were, literally, right after dinner.

    Depending on the med and the importance of timing I'd really let it alone if she has to wake everyone up and try to get the meds down their gullets. It just wasn't possible for a lot of my elderly peeps.
    So do you chart them at 1830 or do you go ahead and put that they were given at 2200 when indeed you gave them at 1830? If you say you're giving them at 1830 then that better be charted that way. :uhoh21:

    To the OP, I think you have received some good advice in this post so far. You have to set the tone and letting people slide on med infractions is one you don't want to get "cozy" with.
  7. by   SuesquatchRN
    I never charted meds given unless they were PRNs. Just signed off the MAR. My practice is how everyone dispenses in that particular environment. However, I'm talking LTC, not a hospital.
  8. by   llg
    Unless you are absolutely sure that it is your role as charge nurse to handle this situation by yourself, I would seek advice/assistance from your supervisor. Explain the situation and ask them to give you some advice on how to handle it. I assume you are not the only Charge Nurse who works with this other person. Your boss may want to solicit their help in monitoring the situation. Your boss may even want to hang around to observe the behavior herseld.

    Purposedly covering up such serious malpractice is the type of thing people get fired for and/or lose their license. I don't think it is the type of thing that a new charge nurse should be handling on her own. Your employer should be assisting you in this situation. If not, you got bigger problems than you know.

    Good luck. Let us know how it all works out.

    llg
  9. by   augigi
    In order to avoid making waves your first week, while covering the liability issue, I would arrange for an inservice on medication administration which is compulsory for all staff. Included in it should be:
    - facility policies and procedures
    - licensed personnel state requirements
    - example of med administration times, and how to get an order changed if it's inconvenient or incorrect
    - policy with regard to infringements of the above 2 (incident reports, warnings, write ups etc).

    This will let staff know in no uncertain terms where and what the applicable policies are, and what will happen if they do not adhere. After that, write them up to your heart's content.
  10. by   pagandeva2000
    I think that the reason this nurse adapted this practice is because she may have worked in places where there was never time to do all of the assignments correctly. Is your unit busy? What is the nurse to patient ratio? I know for a fact that this happens more than we care to admit...I saw it myself as an aide, so, I know that it goes on as a nurse. Speak to her privately and tell her that you are uncomfortable and this isn't the correct way to do this. Only thing is that next time, she may do this when you are not around.
  11. by   nursindaz
    Yes our unit is busy, but she is a relatively newer RN <4years experience. So I don't think she learned it at a previous job, and she had her orientation with the same Rn that I had two years prior so I don't think she picked it up from her. Honestly I think she is just being lazy and grouping all of her meds together to save her from having to get off her butt and actually do her job (the correct way). The thing that bugs me is that I always go to the staff I am woking with and ask if they need assistance and she always seems so calm and put together. The reason is of course because she knows that all of her meds are passed and she can just enjoy watching every one else run around.

    Yes, we are a fairly busy floor, although small. We are an acute care/ orthopedic specialty unit. on any given night (3-11pm) we will recieve 5-6 post-op total joints. We generally have three RN's, 2 CNA's and a unit clerk.

    Thanks everyone for your input.
  12. by   P_RN
    Are they once a day? Did the pharmacy arbitrarily choose 2200? I can see not giving a TID at 1700 when it was just given at 1400, but once a day things why not just ask the pharmacy to change it on the MAR?

    I know of plenty RA patients on prednisone who wanted it at 5 AM with an early breakfast so they could be able to move when they got up.

    I take all my daily meds at 6PM because I would forget to take them in the AM. Instead of confronting, why not have a group meeting to see if anyone has similar ideas. Nursing is flexible and 2200 is not necessarily set in stone.
  13. by   Spidey's mom
    Quote from P_RN
    Are they once a day? Did the pharmacy arbitrarily choose 2200? I can see not giving a TID at 1700 when it was just given at 1400, but once a day things why not just ask the pharmacy to change it on the MAR?

    I know of plenty RA patients on prednisone who wanted it at 5 AM with an early breakfast so they could be able to move when they got up.

    I take all my daily meds at 6PM because I would forget to take them in the AM. Instead of confronting, why not have a group meeting to see if anyone has similar ideas. Nursing is flexible and 2200 is not necessarily set in stone.
    I like this idea and the one about an inservice about med administration.

    It should be easy to change the timing, legally, of a medication if the resident is asleep by the time the med is due.

    Skirting the legal rules for time-saving is wrong. If you are short-staffed, then that needs to be addressed. The staff shouldn't be giving meds prior to stated times, and they shouldn't pre-pour.

    There were times I had to fill in at our LTC and I would not pre-pour and if the med was late, then I just charted it late and gave the reason why - "not enough staff"

    steph
  14. by   nursindaz
    theses meds were things like Cipro, which the patient recieved at 10am, then she gave it at 1600. also coumadin, which is specifically ordered for 2200 (for ortho pateints) , which she gave at 1600. I checked the accudose and it showed that she pulled the meds at 1553,but she left the times on the MAR at 2200. so unless she forgot to change the times (on three MARS) she knows that the meds should be given at specifically designated time.

    I think I will talk to my manager, the pharmacy should be able to audit her charts for pulling medications and falsely documenting the administration times. All of our meds are stored and dispensed from a computerized system.

    I think I should write it up as a med error. Then it is out of my hands as to what disciplinary action our manager takes. (And how many offenses the pharmacy finds.)

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