Right or wrong? Need some advice

Nurses Medications

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I am currently an RN student doing med-surg clinicals (5th quarter). There is a patient who is to receive Vanc. through a PICC and it is scheduled for 9am. However last week he had an appointment and was gone by 8:30, we were not informed of his impending departure until 8, and by then it was too late to start the infusion as it hadn't been taken out of the fridge yet and is scheduled to run over an hour. The issue I am having is that upon his return at 11:30ish, our instructor said it was OK to give it, even though it was late, and without the Dr.'s approval, although she stated that she had spoken to the NP who was at the facility and that it was approved, no order was written in the chart. Our instructor (who has an MSN) gave it anyways. Another student and I are arguing on whether or not it was an acceptable thing to do, and we can find nothing in the NPA, or the BON websites that will help. Was she wrong for doing this? We are considering going to our nursing chair at school, but obviously do not want to look like idiots if this was acceptable. Any input would be greatly appreciated.

Specializes in Emergency/Cath Lab.

[Devils advocate] Why were you not better prepared for the pt to leave the floor for an appointment? As a student going into clinical you should know just about everything about your pt including impending procedures, appointments etc the next day. Unless this was an emergency, you should have tackled this issue head on [/devil]

Either way though I think you did the right thing by giving it when you did. Ignore the know it all LPN.

Like the other posting said, better late than never. I know of a nurse who didn't give the medication because she thought it was late, and she definitely received a rude call from the doctor. Things happen and its understandable so giving a late medication especially if its once a day is ok.

Specializes in Infusion Nursing, Home Health Infusion.

Absolutely, GIVE the med..for all the reasons already stated.

Specializes in Surgical, quality,management.

The pt is on Vanco for a reason. It is a highly powerful drug that is used with caustion as it has side effects. However the pt obviously needed the Vanco. Give it.

perhaps your LPN fellow student isn't letting go of her LPN scope? Perhaps, as an LPN, in your state, she wouldn't be allowed to do this? That said, I would give the med ASAP. Then, to cover my butt, I would notify the MD.

Specializes in Peds home care...vents,dialysis, transpl.

I am with you. You need to have the patient medicated. We are trained to be critical thinkers...right?

Also, if this was a scheduled appt, third shift should have seen to this.

Specializes in Emergency.

You would give the med. I think it might have helped everyone to have the policy from the area on missed meds gone over. Usually if there is some question if something should be given like that, I just call the pharmacy and ask what they prefer...now or later.

Specializes in OB.

Situations like this are one of the ways student and new nurses learn to change their thinking from "NCLEX world" to real world nursing. In the real world, on a med/surg unit, patients are constantly leaving for tests and procedures, meds are often late from the pharmacy, orders are put in incorrectly, etc. You have to look at the big picture and be flexible.

Big picture in this scenario? The patient needs Vanco, so give it when they get back, and adjust the schedule accordingly. If, as you stated, your professor or you as a nurse ran it by the NP or physician and they know, and you document this, the problem has been solved. Your student colleague is more concerned with the 1-hour window rule than the actual outcome for the patient, and needs to learn to think critically.

This is why I think the LPN is stuck in LPN/LTC land. In LTC, she would have to call doc and get an order to give it late, so that if the state audited that chart, they wouldn't get a "ding".

Situations like this are one of the ways student and new nurses learn to change their thinking from "NCLEX world" to real world nursing. In the real world, on a med/surg unit, patients are constantly leaving for tests and procedures, meds are often late from the pharmacy, orders are put in incorrectly, etc. You have to look at the big picture and be flexible.

Big picture in this scenario? The patient needs Vanco, so give it when they get back, and adjust the schedule accordingly. If, as you stated, your professor or you as a nurse ran it by the NP or physician and they know, and you document this, the problem has been solved. Your student colleague is more concerned with the 1-hour window rule than the actual outcome for the patient, and needs to learn to think critically.

I'm hearing you.

However, I can't come up with the exact legal reason why giving a late med is allowable in this situation.

Talk to your instructor and ask for the rationale and documentation on this issue.

Your LPN fellow student sounds scary!

I think you are not coming up with anything d/t it being expected to do it!...not just "allowable". If third shift had done their job, the day shift wouldn't have been put into this position.

I'm hearing you.

However, I can't come up with the exact legal reason why giving a late med is allowable in this situation.

Talk to your instructor and ask for the rationale and documentation on this issue.

Your LPN fellow student sounds scary!

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