Is It OK for Nurses to Do These Things?

[Plagueis]

I am starting LPN school next week, and as a CNA, I was wondering about some of the things that I have seen nurses do in caring for residents, and curious if they were considered "acceptable." I have also heard some "hearsay" stories from other CNAs and LPNs about some of the things they have witnessed. I just wanted to list 3 of these behaviors, and get feedback about whether these items were common, OK, or justified, since I would like to avoid tasks that would harm people.

1. Dropping meds on the floor, and picking them up and giving them to residents/patients anyway. I know that this should not be acceptable at all, and I would always just get myself another pill if I dropped one. However, when I asked about this, I was told that the nurse would get "in trouble" if they just got another pill, especially a narcotic, because admin would wonder if the nurse kept the dropped pill for herself. This action was also justified because the resident was only prescribed a certain number of pills, and that they could never be wasted, lest it would cost the patient more money for meds to replace dropped pills. Is this practice common?

2. What about nurses who hide meds in food to give to patients, and the patients don't know about it, because the patients would refuse the medicine otherwise? I would think this may not work, one reason being that if the patient doesn't eat all of her food, or doesn't drink the drink with the med in it, she wouldn't get the full dose of the med that she needs. Plus, I thought that people had the right to refuse medicine. Is sneaking medicine in food OK? Also, what if the patient or resident has to be fed his meals, and a family member or CNA feeds the resident with the food with the meds in it? Isn't that considered passing meds by a nonlicensed person?

3. What about borrowing prescription meds in "emergency" situations? I am told that this may happen because of some error on refilling a prescription, and not being able to get the refill in time for the dose, so it's okay to get the pill from another patient who has the same script, since it would hurt a patient more not to get her pill on time, than it would hurt the patient (the one whose pill is getting borrowed) who may not need it right away. (This seems in violation of #1 above, where the nurse claims she would get in trouble if a pill is unaccounted for. )

Thanks in advance. :)

[pagandeva2000, LPN]

I believe that borrowing medications may have to occur occasionally. I have not had to do this myself just yet, because I work in a clinic. However my friends have told me they were left in situations where they had to; usually HTN meds, or once a friend told me that she used dig from a patient's drawer that was discharged. To me, if it is the correct dose, correct expiration date and whatever else and can just contact the powers that be, why not?

This is a good subject to me since I'll be starting to do per diem med-surg next weekend. This is a question I'll have to ask other nurses how they handle this.

[rph3664]

1. "Getting into trouble" is no excuse. If you waste a pill properly, even a narcotic, then there's no cause for suspicion of diversion. I don't know about the certain number of meds or their cost as I've never worked LTC, but I'm sure there has to be a way to replace dropped meds without having the resident run out.

I have packaged LTC meds. If the facility uses those little plastic things, they have 8 compartments with an extra dose for those situations where the patient spits it out or it's dropped on the floor. If they use the sheets, they have extra compartments as well.

[wooh, BSN, RN]

I have packaged LTC meds. If the facility uses those little plastic things, they have 8 compartments with an extra dose for those situations where the patient spits it out or it's dropped on the floor. If they use the sheets, they have extra compartments as well.

Because it's only once a week that they spit out their meds.:)

As for the rest, it's the real world. Not a nursing textbook. Not a nursing class. Of course we all do our best to do everything 100% by the book. But after a few years of experience, it's not that I've gotten too lazy to do it by the book, it's that I've got the experience to weigh everything and do what I've got to do to get my patients (and myself) through the day. And 100% by the book isn't going to get me through the day. So I figure out what I've got to do to keep my patients safe, keep my job, and keep my license. And if I'm lucky, get a couple potty breaks and time to swallow some lunch.

An outside observer usually has no idea all the things I'm weighing in my mind when I make decisions... which is why I try and give my coworkers the same benefit of the doubt when I see them do something that looks a bit odd.

It's easy to see what someone else does and be judgemental and say, "I'd NEVER DO THAT! It's just nasty! There's no excuse!" It's especially easy if you haven't been that nurse yet, in nursing school and as a new grad, I'd have been shocked at a nurse that did some of the things I'll occasionally do now. In reality, it's just another nurse trying to get through the day the best they can and do the best for her patients that she can.

[SuesquatchRN, BSN, RN]

I believe that borrowing medications may have to occur occasionally. I have not had to do this myself just yet, because I work in a clinic. However my friends have told me they were left in situations where they had to; usually HTN meds, or once a friend told me that she used dig from a patient's drawer that was discharged. To me, if it is the correct dose, correct expiration date and whatever else and can just contact the powers that be, why not?

This is a good subject to me since I'll be starting to do per diem med-surg next weekend. This is a question I'll have to ask other nurses how they handle this.

Pagandeva, you won't have to. A med-surg flooor in your facility will have a 24/7 pharmacy, and in mine we have an E-kit," or emergency kit. It's a lock box and the supervising RN and another nurse can remove needed meds.

Meds in med-surg are supplied by the pharmacy basically THE dose at a time.

In LTC, we would rather routinely borrow and remember to replace it. We would also keep d/c'ed meds in the cart for use if needed before the pharmacy could get them to us.

We used to borrow controlled substances but the world has gotten incredibly paranoid about that so it's the e-kit.

[Valerie Salva, BSN, RN]

Because it's only once a week that they spit out their meds.:)

As for the rest, it's the real world. Not a nursing textbook. Not a nursing class. Of course we all do our best to do everything 100% by the book. But after a few years of experience, it's not that I've gotten too lazy to do it by the book, it's that I've got the experience to weigh everything and do what I've got to do to get my patients (and myself) through the day. And 100% by the book isn't going to get me through the day. So I figure out what I've got to do to keep my patients safe, keep my job, and keep my license. And if I'm lucky, get a couple potty breaks and time to swallow some lunch.

It's easy to see what someone else does and be judgemental and say, "I'd NEVER DO THAT! It's just nasty! There's no excuse!" It's especially easy if you haven't been that nurse yet, in nursing school and as a new grad, I'd have been shocked at a nurse that did some of the things I'll occasionally do now. In reality, it's just another nurse trying to get through the day the best they can and do the best for her patients that she can.

:yeah::up::nurse: