First day on psych...Nightmare! Advice needed

[MacyismyBaby]

I started a job on a locked psych unit this week, i was given a great preceptor; she is very good at her job. On Tuesday I was learning the basics of med nursing since that is my primary job. I am the only LPN on the whole unit, the rest are RNs. The nurse that was orienting me decided one of the pts needed a prn as she was becoming more agitated. We walked into the room with med cup and a glass of water. The patient them became physically abusive and attacked the RN. We left to get meds drawn up to do an IM but then we realized the pill was gone. After the whole thing was over, I was very upset as the pill was taken out under my name. I spent at least 30mn tearing the room apart and found nothing. I asked my preceptor how to document the incident, and she told me that was not necessary. She wouldn't even call the dr

There were a few other incidents that concerned me as we'll. I've always been taught how to properly dispose of narcotic meds. However, here, they have been having me waste in the sharps container with no documentation. I went to my nurse manager the next day to discuss the problems and find out exact policies on the issues.

There is one problem I'm facing though, what are some of these psych RNs going to think of me. I didn't want to "tattle" but I had to list everyone present

[Psychopath, MSN, RN, CNS]

I'm guessing the drug of choice you signed out as PRN was an accountable one. Every facility should have a protocol and policy dealing with the handling, administration and storage of these types of medications.

You did the right thing in reporting the incident. Not only does it mean that you have legally documented a required aspect of your practice, but most importantly you are highlight safety concerns for your patients under your care.

When reporting, it is important that you are supported through this by your manager. It is about raising awareness of the potential for situations like this to reoccur and to reduce the rate of the same situation to occur again and what strategies that can be put in place to manage standards of health care expected by your national body regulating nursing.

Different people have different reasons for not reporting these types of incidents. In fact the majority of medication 'errors' are often undocumented or not formally recognised. One can speculate reasons for this: eg fear of disciplinary action, having to do extra paperwork, we've always done it this way etc. but remember the risks of an an adverse reaction to occur in which that particular dropped medication may be at a later date found and taken by that client may have potentiated the IMI that he had or worse may have been contraindicated if taken concurrently.

Thus it is important that safety concerns are always addressed in appropriate, prompt and non judgemental way whether its addressed by your manager in a staff meeting etc. no one wants to tattle on their colleagues, so its good that it is clarified to your manager and it can be addressed.

Besides the CYA principle is always a good one to follow! everybody no matter what their role is, is responsible for their own actions.