BYOB at work?

[Kayauhs]

Need your excellent, expert advice! Recently while at work, it was brought to my attention that another nurse had brought beer FROM HOME and gave it to a vulnerable adult in our Special Care Unit as a 'treat'.

Nurse was on duty at the time and is not a friend or relative of this resident.

Resident has no doctor's order for alcohol whatsoever.

Thoughts? Actions? I was told to ignore it because this nurse has been doing this for years.

(Later I'll tell you what I did).

[kbrn2002, ADN, RN]

General Question: Is alcohol allowed or ever provided in long term care? I understand there are a handful of diseases where ETOH is contraindicated. But, for your average LOL who needs to spend her final years in a SNF, is a glass of wine (not provided by the nurse) out of the question? Genuinely curious.

It's perfectly fine. I work in LTC and an alcoholic drink if not if not contraindicated is in our house orders. Our activity department has "happy hour" one day a week from 5-7 pm where a drink is served to those that want one. The activity department buys and serves the beer and wine. We also have a few residents that are accustomed to a daily drink, their families supply the alcohol of choice and we store it in the med room.

[RNNPICU, BSN, RN]

OP:

I understand that you want to maintain integrity and ensuring patient safety and well being, but you reported second-hand information. Are you 100% certain of the exact account of the CNA. I am not insinuating that the CNA is lying, but you don't know the exact account of what the CNA saw. Additionally, you may not have known the whole story. Also, you stated that you did speak to the nurse who brought the beer, but only after you reported the nurse. Did you ask for clarification about the story? Was there more to the story? Most people are not just going to randomly bring beer just because, there likely is more to the story. Maybe the patient does need an order and no-one has thought about it ye? A nice gentle reminder that, hey, I heard that beer was brought to patient X, don't forget that we really need that MD order as required by our policy or practice standards.

[CrunchRN, ADN, RN]

Super bad judgement by the nurse that brought the beer. However, if the poor resident wants beer then maybe you could do a kindness for the resident and the nurse with poor judgement (but good heart) and advocate for an MD order instead of turning in the nurse. Win for all.

[NutmeggeRN, BSN]

General Question: Is alcohol allowed or ever provided in long term care? I understand there are a handful of diseases where ETOH is contraindicated. But, for your average LOL who needs to spend her final years in a SNF, is a glass of wine (not provided by the nurse) out of the question? Genuinely curious.

Sure!

[JKL33]

Often times when we read something we can infer that there is a 'tone' to what was written.

As I re-read my original post, I don't see anywhere in that text that I have suggested a "Gotcha" mentality, or a "Tattletale" self-appointed hall monitor to the world of nursing title.

I do not have to defend myself or my actions because my board of nursing has already given me very clear directions on what to do when I am in these situations. I will always error on the side of the patient or resident. I will always be a patient advocate, I don't care if I'm friends with someone who is doing this kind of crap. These kind of friends I don't need.

Nurses ARE the gate keepers to this whole thing. We have to monitor ourselves and each other's actions. If not us then who?

As far as "Crossing my fingers and hoping"? Good luck with that in a court of law. This resident has multiple medical issues and is on a ice cream bucket full of pills. There is a reason he doesn't have an order for alcohol. Aside from that, this person is a vulnerable adult. There are laws in place in this state concerning the treatment of vulnerable adults and as long as I take a breath and hold a nursing license I will defend these people no matter what. If I can't do that? then what am I worth?

Maybe next time she decides a little cocaine would be a good thing. Or ? a little something else sprinkled on his cereal. Where does it end?

By the way I did speak with this nurse. You have to be very, very careful when talking to someone about this type of thing. If I ignore it and the the patient has an adverse effect and this heads to court? I'm done.

Okay, here's the thing. Every one of us on this forum could probably list 5-10 ways this could go very bad for either the nurse or the patient.

I know wrong is wrong. And this nurse's actions are wrong. Furthermore, doing what she is doing is a dumb and unthinking thing to do.

But, here is something else for your consideration (written with friendly intention):

The verve with which you're coming at this reminds me of myself 10 years ago. I'm embarrassed when nurses do things like this and hell no I wouldn't do it - and I don't like it. Don't be dumb! People could get hurt! Now you're putting me at risk because I know about it! No nurse should act this way!

I will ask you to forgive me if my perceptions of your writing are off. But, kindly, it reads as someone whom life still has a few very hard lessons to teach.

Someday you will look around you and see many things worse than this in both risk and intent. Worse by multiples. You will be very sure that your employer must not be aware of these, because certainly they want to take good care of people and mitigate their own risks too. Well....joke's on you! It turns out they do know. It turns out that doing things this way or that way is what is "required" to meet the bottom line or somehow help their numbers or support the facade required for their business model. And they will look at you like you're the devil incarnate for bringing these safety/ethical issues to anyone's attention. They will "encourage" you to focus on the things you can fix and "do the best you can" with all of the other things that are downright wrong on a much more serious ethical level than giving someone a beer [from home!].

You might even experience instances where you tried to warn, you said patients were going to get hurt, and within a matter of months the only reason someone wasn't hurt by the exact manner anyone with a brain would have predicted was because you or one of your coworkers were in the right place at the right instant and used your solid skills to quickly intervene. And when it is eventually discussed, you'll all be told "atta boy" and "we need to keep doing it this way."

And you might wonder what world you're living in that, uh, no one with the power to change this or that, CARES unless they stand to lose far, far more than just a patient here and there.

Back to your situation. I would bet money that at some point in your life, other risks and "situations" in our world will start to bother you much more than a nurse who does something dumb in the course of trying to make someone's life just a little better. And you may find yourself asking whether this gal needs to be strung up and pilloried and labeled as someone who "drugs/abuses vulnerable adults."

You might notice that someone who does something dumb but well-intentioned is the very least of our problems in this world. You might begin to focus more on those who do things that are evil and then do even more evil things to cover them up.

Generally-speaking (very generally) my observation is that most nurses actively involved in taking care of patients are trying to do the best they/we can. It might not be my idea of best, but it is what it is. My goals are re-focused with regard to problems I observe: I'd much rather just have it stop, have the risky/unethical thing be changed (in situations where nothing untoward was ever intended) than to participate in the current charades.

My first reply represented my first reaction. I would strongly encourage my coworker. Yeah, I would probably come around to saying 'make this right or else I will, because now all of us are on the line for it.' But, if no one was being hurt, I sure wouldn't be happy about having us all be bothered with it.

[Kayauhs]

Okay, here's the thing. Every one of us on this forum could probably list 5-10 ways this could go very bad for either the nurse or the patient.

I know wrong is wrong. And this nurse's actions are wrong. Furthermore, doing what she is doing is a dumb and unthinking thing to do.

But, here is something else for your consideration (written with friendly intention):

The verve with which you're coming at this reminds me of myself 10 years ago. I'm embarrassed when nurses do things like this and hell no I wouldn't do it - and I don't like it. Don't be dumb! People could get hurt! Now you're putting me at risk because I know about it! No nurse should act this way!

I will ask you to forgive me if my perceptions of your writing are off. But, kindly, it reads as someone whom life still has a few very hard lessons to teach.

Someday you will look around you and see many things worse than this in both risk and intent. Worse by multiples. You will be very sure that your employer must not be aware of these, because certainly they want to take good care of people and mitigate their own risks too. Well....joke's on you! It turns out they do know. It turns out that doing things this way or that way is what is "required" to meet the bottom line or somehow help their numbers or support the facade required for their business model. And they will look at you like you're the devil incarnate for bringing these safety/ethical issues to anyone's attention. They will "encourage" you to focus on the things you can fix and "do the best you can" with all of the other things that are downright wrong on a much more serious ethical level than giving someone a beer [from home!].

You might even experience instances where you tried to warn, you said patients were going to get hurt, and within a matter of months the only reason someone wasn't hurt by the exact manner anyone with a brain would have predicted was because you or one of your coworkers were in the right place at the right instant and used your solid skills to quickly intervene. And when it is eventually discussed, you'll all be told "atta boy" and "we need to keep doing it this way."

And you might wonder what world you're living in that, uh, no one with the power to change this or that, CARES unless they stand to lose far, far more than just a patient here and there.

Back to your situation. I would bet money that at some point in your life, other risks and "situations" in our world will start to bother you much more than a nurse who does something dumb in the course of trying to make someone's life just a little better. And you may find yourself asking whether this gal needs to be strung up and pilloried and labeled as someone who "drugs/abuses vulnerable adults."

You might notice that someone who does something dumb but well-intentioned is the very least of our problems in this world. You might begin to focus more on those who do things that are evil and then do even more evil things to cover them up.

Generally-speaking (very generally) my observation is that most nurses actively involved in taking care of patients are trying to do the best they/we can. It might not be my idea of best, but it is what it is. My goals are re-focused with regard to problems I observe: I'd much rather just have it stop, have the risky/unethical thing be changed (in situations where nothing untoward was ever intended) than to participate in the current charades.

My first reply represented my first reaction. I would strongly encourage my coworker. Yeah, I would probably come around to saying 'make this right or else I will, because now all of us are on the line for it.' But, if no one was being hurt, I sure wouldn't be happy about having us all be bothered with it.

I can only laugh out loud as I read this, especially the part where you write: "It reads as someone who life has a few hard lessons to teach".

haaaahahahaaahhahaha HAAAAAAAHAHAHAHA HAAAAAAAHAHAHA Oh and HAAAAAHAHA!!!!!

Excuse me while I laugh just a little bit more.

First rule in nursing? Don't assume anything. Waaaayyyyyyy off base here on your 'assessment' of me.

You think life needs to teach me a few hard lessons? Oh there I go laughing again. HAAHAHA. You have absolutely no clue who I am or what I've been through.

I've been in this business since we shoveled coal in the stoves in the morning. I've been in nursing so long I remember BEFORE there was mercury in the thermometers. I've been in nursing so long the starch on my nurse's hat could cut your bangs if you leaned in too close and the polish on my white shoes would blind people who couldn't look away.

I've been in nursing SO long that I worked as a wet nurse in the morning and wrapped bandages in the evening.

Don't assume that because I currently work in LTC that I've always been here or that I'm a new nurse just flying in with a cape and a mission.

Wrong is wrong and in my state if you don't report it, you are just as guilty as the person committing the wrong doing.

I come at things with a 'verve' as you say because I have a zest for life that will not die, because I'm sick and tired of stupid people, because if someone doesn't step forward to stop it who will? because someday it might be me they are taking care of and want BETTER CARE than what is currently available.

No one was hurt? "Best intentions"? How about knowing that this nurse gave this resident this beer so the nurse wouldn't have to deal with the resident's behaviors for the next 8 hours?

Yeah. Well I have to go now so life can teach me some more hard lessons.

Good gawd.

[Kayauhs]

Really? You don't think that's a ridiculous, hyperbolic leap?

Davey, can you do a cartoon on beer being a gateway drug to cocaine?

Beer is cheap. Cocaine is not (from what I've been told). Who's going to waste perfectly good cocaine on a patient?

Wait, though - what kind of beer was it? Was it PBR or, like, Fat Tire or Dale's Pale Ale? Because that will definitely factor into my level of outrage.

You really should get a job doing stand up at a club somewhere. It will give you a break from nursing.

[Kayauhs]

Sorry for misinterpreting, but how else was I suppose to take this comment other than you were talking to coworkers about the situation:

"The idea by some of my co-workers that, "Well it was JUST a beer, don't get so excited" really saddens me"?

Also, you did state that you were taking the CNAs account of how the nurse brought a beer to the resident. You did not witness it, yet you reported. That is basically the definition of secondhand.

I WAS talking to my co-workers about the situation. You assume that I was talking to them about the nurse that was involved.

I did not witness it. But I asked the nurse involved how it happened and she admitted it.

Thanks for picking through the details though.

[Kayauhs]

Plus, I though we we talking about legal drugs. Next thing you know, the Nazi's are going to be brining in the beer. Mr. (Dr?) Godwin on line 1.

Seriously? You're going down the Nazi road? Is there a high turn over of nurses who work with you?

[JKL33]

Thank you for the additional information! I'm sorry my experiences can not be of use to you.

I like to know where people are coming from.

Mission accomplished.

[Have Nurse, ADN, RN]

Report that immediately. Alcohol can be deadly with some medications. It is also not what a careful and prudent nurse would do. You need to get an order for that. Alcohol is considered a drug.

[Kayauhs]

I must really be missing something here. I'm assuming this is in LTC with the usage of the term resident. I am a DON in LTC with 30+ years experience in LTC. If a resident wants a beer - get a physician order, get the family OK if resident not cognitive enough to make that decision, put it on the careplan & let them have a beer. The chances are high that if a resident is requesting a beer it's because they've been drinking a beer for 50+ years - this is their home - who am I to decide (within reason of course).

I'm missing the outrage over someone bringing it from home. It's not like you can order it thru pharmacy. Certainly no one should be "sneaking" it in to a resident from home but rather than wasting a bunch of time being outraged and ready to get someone in trouble for this, wouldn't it be more productive to just work on getting the OK from the Dr. and family?

If you are missing the outrage at a nurse bringing alcohol from home and giving it to a vulnerable adult without a doctor's order? Then I have no words for you especially as a DON with 30+ years of experience.