Am I in the wrong Nursing home?

Specialties Geriatric

Published

My facility expects me to "borrow" medications. Should I leave? We are currently under new management and new DON/ADON but we have the same immediate supervisors. No one else cares about whether they borrow or not. I used to write " unavailable" but I received notes directly stating I should have borrowed from another nurse(this is from my current supervisor). Our pharmacy is not able to provide the medications in time. My coworkers are no help because they just borrow themselves. Medications are missing for a week, no one calls pharmacy. Can I get into any trouble by just circling the medication? Just a scenario, a lady is missing her trazadone, call placed to pharmacy at 9:30pm. On call pharmacy returns phone call by 10:30pm. They state it will come in on the" night run" which for us means 5am. Its not in the e box, it wont be there on my shift. What should I do? Call the MD at say 11pm to ask for an order to hold? Our MD can take up to 5 hours to call us back. Is the whole system flawed? Am I spinning my wheels for nothing? Would another facility be better? I am unsure and do not have supportive co-workers. Should I just continue doing all I can and stay employed or would another facility be more helpful?

Thanks guys,

Specializes in LTC,Hospice/palliative care,acute care.

CapeCod-DONs like you are un-common.My DON has "much bigger fish to fry right now"-our concerns on the unit are "petty" That's a direct quote. That is,until the DOH comes back and spanks us for something we have complained to her about-over and over.Then she claims to have never heard of the thing. Even though being the squeeky wheel is often the right thing to do it does not endear you to anyone.

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Specializes in Gerontology, Med surg, Home Health.

Bigger fish to fry than getting a tag for delay of treatment? In Massachusetts that's a big deal. Sorry to hear your DON isn't responsive to your concerns. Maybe she's never worked as a staff nurse and doesn't have a clue about how hard all y'all work.

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Specializes in LTC, Memory loss, PDN.

It's not borrowing, it's theft. There are many ways to prevent outages in by far most of the situations. I will not commit an unethical, possibly criminal act because someone else failed to do their job. If it really is an isolated emergency, then the supervisor, DON or admin can run to the pharmacy. If they're not willing to do this then it's not an emergency in my book. At any rate, it's a slippery slope and only enables the slacking off on proper procedures. Yes, documenting N/A without proper cause is a deficiency, but that fact alone should be a clue to the need for adressing the underlying problem.

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Specializes in Home health was tops, 2nd was L&D.
Windibird-not all nursing homes are the same. We had problems with our pharmacy not delivering meds on time. The nurses would be on hold for close to an hour.....then I got involved. I called the person highest up the ladder at the pharmacy and complained to him. I asked him his supervisor's name and phone number. We have many fewer problems now.

The pharmacy should be able to customize an ekit to suit your needs. We have a psych med ekit since most of our admissions are on high doses of antipsychotics. The pharmacy even added a few drugs because my consultant knows what the docs prescribe most.

You can't really borrow meds. I know everyone does it but that doesn't make it right. Surely no one is going to die from a missed multivite or trazodone. Circle it, call the pharmacy and reorder, call the doc and notify that the dose has been missed.

The docs don't have any more pull with the pharmacy than we do.

I agree with all of this...... Except if you are my nurse and decide I do not need ordered Trazadone for sleep and I do not sleep and then have a rotten next day...you are as guilty as it you charted and did not give the drug or borrowed it...You are not licensed to decide if someone needs an ordered med or not!

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In my experience, most issues with meds involve the pharmacy not sending refills in time, even if they are ordered. Just yesterday, for instance, two meds I pulled the refill label for last Thursday were still not in. (I was off the days in between.) Thankfully, the resident still had a few days supply left, and I called the pharmacy about the meds. Of course, the response was the standard we-didn't-get-the-fax. :mad: However, at least this facility has an e-box with plenty of the most commonly ordered meds in it.

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Specializes in Telemetry, Case Management.

"Borrowing" meds is commonplace in nursing homes. Wrong? Yeah. Does it deter anyone from doing it? No.

I've worked in many a nursing home in my day, four of them as a regular employee, heaven only knows how many I worked in as agency. Out of all of them only ONE wasn't this way, and it was all private pay and pretty ritzy.

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Specializes in Gerontology, Med surg, Home Health.
I agree with all of this...... Except if you are my nurse and decide I do not need ordered Trazadone for sleep and I do not sleep and then have a rotten next day...you are as guilty as it you charted and did not give the drug or borrowed it...You are not licensed to decide if someone needs an ordered med or not!

I didn't imply I was licensed to decide if someone needs an ordered med or not....simply saying not all meds are a matter of life or death (your crankiness/rotten day aside). PS. A bit off topic, but as far as sleeping meds go, the DPH and Joint Commission want documentation of NON CHEMICAL ways to induce sleep.

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Specializes in LTC.
You are not licensed to decide if someone needs an ordered med or not!

Suppose a resident has loose stools x1. Holding senna and colace.

Suppose a resident has a blood sugar of lets say.. 64. Holding anti-diabetics.

Digoxin is held for an apical pulse of below 60.

B/P meds have parameters also. If you took a b/p and it was 90/60 and the resident runs around 115/70.. even if theres no orders to hold it.. I'm going to hold it and leave a message with the doctor saying I'm holding it.

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Specializes in Home health was tops, 2nd was L&D.
I didn't imply I was licensed to decide if someone needs an ordered med or not....simply saying not all meds are a matter of life or death (your crankiness/rotten day aside). PS. A bit off topic, but as far as sleeping meds go, the DPH and Joint Commission want documentation of NON CHEMICAL ways to induce sleep.

Crakiness..maybe it has to do with NOT sleeping

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Specializes in LTC,Hospice/palliative care,acute care.

If a med like trazadone is unavailable we are to call the physician and he/she may order a one time dose of whatever we have in our e-kit or not order anything. The doc makes the decision-not the nurse. It may not be pleasant for the resident but no-one ever died for lack of one xanax or a sleeper. People often miss meds at home for many reasons-not that this makes the situation in LTC acceptable. No system is perfect-unless you have a comprehensive 24 hr on site pharm it's going to happen..

As for holding a med due to parameters that is nursing judgement-you don't write an order to hold a dose of a routine stool softener,lax,b/p med or digoxin-you just hold it and document on the MAR. I'd put it in a nurse's note if it was something like loose stools. That also goes on our 24 report (infection control) When the doc makes rounds whomever is rounding with him needs to make him aware of anything like this that is occuring frequently so it can be addressed. THis a completely different issue then the original topic.

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Specializes in Home health was tops, 2nd was L&D.

Goodness sake..you all need a vacation. I was joking!!! You do not borrow meds legally in a nursing home..of course it is done. Speeding is illegal too and who has not hurried their way along to work!!! This site is just for people to offer opinions, comments.. The idea is NOT to lose it because someone has a difference of opinion.

I respectfully withdraw any comments made that not acceptable.

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