The Board of Nursing

CCM, is this a one day occurence or is this happening every day the nurse comes to work? I guess I would probably go the discipline route. But, check out your BON website and it should be specific as to what you need to report.

I have reported nurses before. Two nurses stated they had given the (tube fed) resident her medication when in fact, the punch cards for two weeks had been initialed by other nurses and there were no doses left for these two nurses to have possibly given any. It amounted to 7 missed doses. The BON did nothing to them. Then again at other times, when I have reported the license was suspended or revoked.

I think you need to go with your gut. If the BON does nothing, at least you have did your part in protecting your residents. I also always tell the nurse that i am reporting them.... no surprises here.

WOW, you've never had an off day? if it is just one day and usually you are happy with her work you can point it out to her so she doesn't think that it is acceptable BUT to report to BON...??? THe med errors are a serious problem and she obviously needs instruction as to that- you can even decide that she is too high maintenance and replace her, but I'd investigate why this happened (are the orders clear?etc.) is she the only one making this mistake? Is she going through some rough patch and needs a vacation to clear her head? Does she work too many double shifts? Has her work changed recently?

In this case I'd document all of the work you are not happy with- call her to a meeting and keep the minutes make it clear what is expected of her and what the consequences of not shaping up will be. Try to start with a complement- an example of why she is or could be an asset to the facility- and then get to the hard stuff- if you don't deal with this- you could be personally responsible...

personally I'd rather see you try to save a nurse and get her to improve than call the BON- use that for last resort.

She is an agency nurse and it was reported she was falling asleep at the med cart. She didn't document medications for 12 residents and gave the wrong doses to 5 others. No this is not a usual problem with my nurses. Yes, the orders were perfectly clear. Something is wrong with her and if I don't report it she will go on to the next place and maybe cause some harm. I asked my pharmacy consultant and he said he thought it should be reported.

I agree, if nothing else just to cover your own tail. I would also report my concerns to the agency.

As far as having an "off day", I completely agree with trying to educate nurses, giving second chances, trying to "save" a nurse, BUT... in my many years of experience, I have witnessed some horrible, horrible nurses. Nurses that someone should have taken out of service long ago and you've got to wonder just how many people suffered of even died because of to many second chances.

She is an agency nurse and it was reported she was falling asleep at the med cart. She didn't document medications for 12 residents and gave the wrong doses to 5 others. No this is not a usual problem with my nurses. Yes, the orders were perfectly clear. Something is wrong with her and if I don't report it she will go on to the next place and maybe cause some harm. I asked my pharmacy consultant and he said he thought it should be reported.

Thats a horse of a different color- I definitely agree that you must report it immediately. Thanks for the clarification. Messing up the dose on 5 patients meds is very dangerous. Besides reporting I would document and send a copy to the agency that sponsors her. I know we sometimes fill a shift (usually after a call off) with any licensed nurse as long as she or he has a pulse but thats just dangerous. I wouldn't mind if she worked slowly- but shes got to be careful- otherwise she puts too much in jeopardy.

Be prepared to defend your actions. There doesn't have to be patient harm for you to report her to the BON- if your facility has a legal consultant you might want advice on the best way to phrase your complaint. Free legal advice for nurses has to be available somewhere as well, I'd look that up.

Thats fine- as long as you did your part- hopefully it will serve as a wake up notice to her...and if there is a next time it will help as well.

The meds not being signed off are not as concerning as meds not given, for me anyways. If you use paper MARS it can be pretty easy to miss a spot to sign. Don't get me wrong, if the med isn't signed out, I would definately call her to ask if the med was given and request she comes to the facility to sign them out. I would contact the agency. If she has worked for you in the past, I might audit the MARS to see if a pattern is there. I would feel more comfortable reporting to the BON if a pattern is evident.

Let us know what you decide to do.

I wish to amend my post. :)

I had something like this happen recently. We didn't contact the BON but did contact the Department of Quality Assurance....aka State (for us) They came in and investigated. Gave us a citation and they will report their findings to the BON. But again, it would depend on how many meds she missed.

Good for you, but why would she be ill? since when is laziness, carelessness, and sloppiness an illness?

Can we research a drug to alleviate these symptoms?

Sounds like you did your homework,

My only question is did you sit with this nurse, show her (or tell her) what she did wrong and hear her side? - AGAIN I am not condoning it.

I once had a nurse wait next to my office when I arrived to admit that she gave the wrong pills to a patient (including a Xatral to a female). She was in tears with remorse, did not wait for me to find out myself, She had alreasy reported it to the MD and stayed to follow V.S. She agreed to study and pass a new med test and be more careful. We wrote up the incident - again no real patient harm, she took a 6- hour course at a local hospital and passed and is now back in the game.

I am not comparing as the situation is totally different, but I feel that the nurse has a right to know that she is being reported - probably by the agency that sponsors her- I would also investigate this agencies policy on continuing ed and if they ask their nurses to pass a med test before sending them out in the field (I don't know if that is required in your state)

Keep us posted.