What Should A Nursing Supervisor Do?

plumrn, BSN, RN · Feb 28, 2002

I wish the administrators and managers of these facilities could either be a pt or have one of their family members be a pt in

their own facility. Wonder if things would change?

bestblondRN · Feb 28, 2002

It sounds as though your facility is either in dire financial straits or they have digressed to how things were back in the 70s and 80s.

I have been a Nursing Supervisor in several large teaching hospitals as well as a few smaller ones. First of all, nurses are not licensed to dispense medications--this is the realm of the pharmacist. The way most places get around the issue is to have a pharmacist on call to act as a back-up or resource on the offshifts, thus avoiding the need for a 24/7 pharmacist. Back about 15-20 years ago, I was in the role of night supervisor and was responsible for playing "run-and-fetch-it" from the pharmacy. There were a number of issues that I raised about the safety and legality of doing this, and after I was "talked through" mixing chemo for a patient one night by the on-call pharmacist, I went to the VP of Nursing and told her that I would no longer be put in the position of doing this. I pulled the state Nursing Act and cited the statute that specifically related to dispensing of medications. That is when the hospital decided to place a pharmacist and tech on at night. There were also issues of the volume of meds being obtained at night that helped support my position on the matter. I kept careful documentation of how often I was asked to get meds and what I was retrieving. In the end, I was able to be the Nursing Supervisor again, and put the onus where it belonged....on the pharmacy.

Nursing has quite enough to do without being responsible for running other departments. I would address your administration as to the legality and safety of continuing this practice.

debbyed · Feb 28, 2002

In the early 80's I worked at a small "home-town" hospital. I was the house Supervisor, also the ER nurse and had pharmacy keys as well. Of course at that time we also had no ER doctor or house doctor. When a patient came in I had standard orders for most things from each of the 10 town doc's. If it was something I couldn't handle one of the doc's was on call and would have to come in. This was in the mountains and snow storms didn't help much.

By the mid 80's we graduated to "rent a doc's" that worked 24 -48 hour shifts (they slept in the hospital) than by the late 80's we had to have a pharmacy in house.

Back than I didn't think I had it that bad but now I can't believe something "really bad" didn't happen. Couldn't imagine doing it now.

aus nurse · Feb 28, 2002

We must be stuck in the 80's down here. Our night supervisor is the ED nurse and meal reliever for all RN's. She/he holds the keys to the pharmacy also. Needless to say if a case comes into ED overnight then the RN's don't get a break.The EN's go for a break and leave the RN on 22 bed wards alone. If the case in ED involves a multi trauma or similar RN's have to go to help the super then leaving the EN alone on the ward. Dangerous or what? I think the only reason this hasn't turned into something tragic is because of the great work we all do. Do you think the managers appreciate it though? Of course not...we are being told to cut costs.

mother/babyRN, RN · Apr 23, 2002

This, sadly, will always be the situation as long as money talks...Big business is big business. Think any one really cares (besides we nurses, that is), how safe things are? Dream on...

mother/babyRN, RN · Apr 23, 2002

Interview your manager(s)...Usually the costs you cut, or are forced to cut for them, results in big bonuses for them...Wonder how many would admit that to you...You can tell by how badly they blush or evade when you ask the question....

micro, RN · Apr 23, 2002

I would not work there.......period.........

amen.........

**canoehead, BSN, RN** · Apr 23, 2002

I am night sup also maintenance, pharmacy, housekeeping, dietary, social work, and physical therapy during the night at our hospital. Nurses get to do all that because we are multitalented, and multiskilled, although I don't like being all those things I can't think of anyone else that would be as cost effective.

I guess the pharmacy stuff doesn't faze me because I was trained, and did my first job in hospitals without unit dosing, we mixed all the meds ourselves. Things that only a pharmacist would do here. And so long as I prepare a "single dose" for immediate use they say it is not dispensing, I'm just going to a larger "med room" to do my med preparation. So even though I would prefer a pharmacist take over I don't feel it is dangerous practice.

mcl4 · Apr 23, 2002

Originally posted by canoehead
I am night sup also maintenance, pharmacy, housekeeping, dietary, social work, and physical therapy during the night at our hospital. Nurses get to do all that because we are multitalented, and multiskilled, although I don't like being all those things I can't think of anyone else that would be as cost effective.

I guess the pharmacy stuff doesn't faze me because I was trained, and did my first job in hospitals without unit dosing, we mixed all the meds ourselves. Things that only a pharmacist would do here. And so long as I prepare a "single dose" for immediate use they say it is not dispensing, I'm just going to a larger "med room" to do my med preparation. So even though I would prefer a pharmacist take over I don't feel it is dangerous practice.

What type of medication are you mixing and what type of training did you have from your first job in a hospital?

Trauma Columnist · Apr 23, 2002

Yikes!!!!

**canoehead, BSN, RN** · Apr 25, 2002

I've mixed epidurals, IV meds, KCL, and TPN (once)

The epidurals and TPN - I got training on how to use the hood properly at this hospital, add the meds according to a preprinted "recipe". TPN is supposed to be double checked -label vrs orders- on the floor. All other mixing of meds I have been doing since I graduated and RN's in the hospital I trained in did the same amount of mixing so I never came to see it as unusual.

I think over time the average RN on the floor has come to use more unit dosing and may find mixing multiple meds intimidating. However, like any other procedure you must check and triple check. RN's take on tasks that have the same amount of risk as med mixing when they care for pt's with multiple lines or titrate drugs. Some of those functions were unheard of when I trained. So we all probably live with the same level of risk- we're just comfortable with differnt things. For example I'd rather chop off a finger than give chemo.