nursing home injustice? need advice!

I think that tee admin. acted in the way they needed to to apease the family.
Aside from that, they also followed the regulations for the facility and the state you live in. Yes, it stinks.

If you are still not satisfied, I HIGHLY recommend you take the high road. Request a meeting with your manager or DON, and offer a proactive approach to preventing this from happening to others.
Let her know that you are interested in the well being of other nurses. Research some information on this type of med error and things facilities did to change the potential error. Recommend a small (15 minute) inservice to CNA's. They can be taught the importance of relating this information, because meds have to be given within a certain time as per physicians order. Even if it were reported at the end of the shift, you are out of the 'range' for administration as per federal guidelines. Make sure they bring the pill with them, for visual confirmation.
This will change the perspective of you in her eyes. You will not be the victim, or the 'negligent' nurse. Instead you will come out looking like a person actively interested in their career and the advancement of nursing.

Nothing smells sweeter than success from failure.

It seems as though the administration wanted this family member off their backs, and so you were the "fall guy" who was punished in order to appease them and to give the appearance that "something was done". In my opinion, the CNA should bear at least some of the blame here, particularly since she actually witnessed the resident removing the pill from her mouth and did nothing about it.

I agree with the previous poster about taking the high road and perhaps inservicing the CNA's on this subject. In the long run, you will be improving the care your patients receive, and it will also serve as a cue to the administration that this was a systemic error rather than the fault of one nurse.

Being suspended for such a thing is way over the top, in my opinion. I do believe you should ask a patient to open his or her mouth so you can make sure pills are swallowed, though, especially if a patient is confused. I like the idea of a new policy for what CNAs do if they find a runaway pill...

I think you should go to your manager, too, and talk about it. They surely need a good nurse like you.

Wonderful advice from the other posters. In the end, you need to decide how you will handle problems like this in the future. Believe me, this type of thing happens frequently in LTC facilities. I do not think it was fair to throw you under the bus like this administration did but it is their usual way of handling problems. Blessings and take this time off to think of ways to improve your practice and protect your license.

Most likely it was obvious from the appearance of the pill that it had been in someone's mouth, but that didn't seem to matter. Someone got to slam their fist on the table, but nothing was resolved. Some residents are masters of pocketing and you may or may not be able to ensure the resident actually swallowed the pill. What if the resident does not want to open the mouth after placing the pill in it? You would have to remain with the resident. What really concerns me here is the severity of disciplinary action combined with a complete lack of action to avoid repeat episodes. Based on my experience, and everything else being equal, I would expect a verbal with a written being unusually harsh, but suspension - never. Again, in the presence of the drastic action without any consideration given to prevention I suggest you get malpractice insurance (if you don't have it), forget about talking to the DON or admin - they won't hear you. And figure out a way to address the issue for yourself. And, of course, document any extra effort you make when medicating this resident.

The best way to prevent that situation is to always ...first ask the pt if she swallowed the pills ...Secondly ask the pt to open her mouth and you look inside to make sure she has swallowed the pills. I hope this suggestion is benificial.


TuTonka

As probably the majority of resident's in nursing homes have some form of dementia, it is always a good idea to check their mouths for cheeking or pocketing before leaving them, especially when they're in bed. Having too often found pts hoarding, cheeking or pocketing meds after administration, especially at night, I make it my policy that unless they have no history of dementia, their pills are crushed, I provide a full cup of H2o and make sure med is swallowed completely before leaving the bedside. If a pt is too sleepy and can not be awakened, I return later or waste the med. Charting in MAR why med was not given and that med was wasted. Also have a 2nd nurse (if possible) sign with me if any med was narcotic/opiate. If no 2nd nurse, place med in safe place (locked in cart) and wait for on-coming shift to destroy. If it becomes a pattern of behavior that resident is not taking meds or hiding them, I place a note in the MD review book for him to go over on his rounds. I also discuss with other nurses on my unit if perhaps changing times of administration would solve the issue. Many elderly pts w/ dementia have some degree of paranoia, usually related to some unknown fear. They may tell you or others they think you are poisoning them. Or, they believe they are being held there against their will and the meds are keeping them from leaving. Whatever their particular fear, to the patient it is real. As a night nurse, I realize my pts don't necessarily recognize me on sight. In their confusion they might believe I'm trying to harm them. So, if possible I try to work with other shifts to solve the issue of hiding meds first.
You might want to discuss some alternatives with management to avoid this happening in the future. And, I think having a discussion with CNAs on the importance of reporting these types of issues directly and immediately is also important. However, although you may feel you were somehow wronged in this situation, it is your responsibility (6 rights of medication) to complete the process. I'm not saying I'm perfect, I too make mistakes, but own up to it and do what you can to solve the probelm.

If you gave the meds at the beginning of the shift, they would criticize you for not entering the room again to check on your resident and finding the pill on the table. The admonition to look in on your residents at least once every two hours covers a lot of ground when looking for something to criticize nurses and/or CNAs for. I was once accused of leaving meds on a side table when I knew I had done no such thing. It would not have been out of character for the person making the accusation to have planted the "evidence" as that was the way she operated. Nothing I could do about it since she counted for more at that facility. I left eventually. Toxic atmosphere.

I have worked in LTC for over 7 yrs and I can tell you that administrators unfortunately will do ANYTHING to get the families off their backs, even if it means unjustly blaming YOU!!