confused

TheCommuter, BSN, RN · May 18, 2007

The medication aide has the right to refuse to give the medication if the resident is being combative during an 'unsafe' situation. Once the medication aide refuses, it is now your responsibility to ensure that the resident receives his meds. You, the licensed nurse, are legally responsible for everything the medication aide does.

Also, the patient has the right to refuse to take medications.

StormySkies71 · May 18, 2007

well, I was told when I got to work "you might have to give mr. "b" his medications today, In my head I thought it was because the Resident was refusing, so I went to talk to him and he said he didn't have a problem with the med aid it was the other nurse he had a problem with, so I said oh ok, so your ok with "med aide" giving you your meds....he said yes. Well I never heard another word until the end of the day when they started blaming ME for not giving him his meds.......I didn't know it was because the MED AIDE was refusing......I don't see how a med aide can refuse to give meds just because she suspects he did something to her personal property. I learned in school that you can't pick and choose who you care for, if it's your patient, it's your patient....now I could see if he was being physically abusive to her.

Jill

classicdame, MSN, EdD · May 18, 2007

Just do it. The objective is to take care of the patient not argue with the med aide. Then talk to you supervisor to get it cleared up. Sounds like she needs an attitude ajustment.

Daytonite, BSN, RN · May 19, 2007

i wasn't totally understanding your posts. you said "well i never heard another word until the end of the day when they started blaming me for not giving him his meds". who are "they"? did the patient ever get his meds? if so, who gave them to him?

i was seeing another problem here. i was assuming that you delegated the task of giving this patient his medications to your medication aide. am i correct? if so, is that who blamed you for not giving the patient his meds? or did you hear this via other people? i think there's might also be an authority or delegation issue going on here as well, but because you haven't given enough of the facts, i can't figure it all out completely.

StormySkies71 · May 20, 2007

i wasn't totally understanding your posts. you said "well i never heard another word until the end of the day when they started blaming me for not giving him his meds". who are "they"? did the patient ever get his meds? if so, who gave them to him?
i was seeing another problem here. i was assuming that you delegated the task of giving this patient his medications to your medication aide. am i correct? if so, is that who blamed you for not giving the patient his meds? or did you hear this via other people? i think there's might also be an authority or delegation issue going on here as well, but because you haven't given enough of the facts, i can't figure it all out completely.

"they" are the med aide and the other nurse (the one that told me at shift change "oh, you might have to give mr. so and so his meds today").

the resident never got his day time meds, i was unaware that the resident did not get his med's until around shift change, and that's when the unit manager called me at the station and asked me about it.....i said, oh i was unaware that mr. so and so never got his medication because when i was giving him his insulin early this morning, i asked him why i was having to give him his medication and he looked at me kinda funny and said, no, i have no problem with "so and so (the med aide) it's the other nurse i have a problem with (he refuses to get his insulin from her because he's afraid of her)....i said oh ok.......then your ok with (so and so giving you your meds...he said yes). when i found out that she did not give him his med's i knocked on the med room door (she was counting meds with the med aid coming on) and said "how come you didn't give mr. so and so his meds, she said because he "damaged some of my property" and i said well you can't just refuse to give someone their med's because you "suspect" he did something to your property" .

i did not delegate this task to the med aide, that's her job....i only give insulin and g-tube meds.....so i'm not quite understanding your question about delegating this to my med aide??

the bottome line is........there is this nurse that's a trouble making instigator (sp) and she got into it with this resident, so now the nurse has basically turned everyone against this resident and he is literally afraid, there was another nurse on that unit that asked to get transferred to a different station because of all the drama, i was unaware of all the drama because i'm new, i'm new to that facility plus i'm a fairly new nurse.....i think it's ridiculous that a "nurse" is fighting with a resident.....he told me some things that she said to him and i beleive him, and trust me.....this is not how a professional nurse is supposed to act......i just can't beleive that i am getting sucked into this crap......i hate working with immature, unprofessional people.

jill

Daytonite, BSN, RN · May 20, 2007

Oh, wow. That's sad. I would make it a personal mission to watch over this patient because this nurse sounds like a bully. I'd volunteer to take over the management of this man's medications. With the approval of the DON, I would change the times on his MAR so as many of his medications as possible were given on my shift, including the insulin. There's nothing wrong with doing that. I wouldn't address any comments anyone makes to you about catering to the whims of this charge nurse either. Justify it by saying you like the patient and don't mind giving him his insulin. I would do this for the patient's safety. I'd also keep a close eye on this particular charge nurse. If she's able to cause this much trouble with one patient, she's capable of more shenanigans. And, I have to say this, if others have turned against the resident based on things this charge nurse has said about him without making their own assessments, what does that say about them? I hate working with immature, unprofessional people too, but sometimes you have to draw the line, dig your heels in and do something. I don't know how many times I've said in other posts how destructive gossip is in a work place. Little Napoleons like this can rise to power in LTC facilities much easier than in an acute hospital where there are too many big cheeses to step on them like the cockroaches they are. All I can tell you is to do your best to stay neutral and offer positive solutions that are patient centered because this will keep you in everyone's good graces. But, keep your eye on this charge nurse. People who get crazy with their own imagined power eventually cross the line of right and wrong and make mistakes. You want to be alert when she makes a big one so you can get all the facts and documentation correct in order to help the DON get her OTD (out the door). The DON may very well be aware of what this charge nurse is capable of pulling, but just has no documented proof to back up disciplining or firing her.

StormySkies71 · May 20, 2007

You hit the nail on the head....she's a BULLY, and yes, I believe it is a personal mission to watch over this patient, I do make an extra effort to check on him and see how he is doing. I have not seen the Med Aide for the last 2 days at work....so I'm not sure if it's because she's in trouble or just had those day's off....I'm still to new to know everyone's schedule.

Trust me, I watch my back with this nurse because she is CONSTANTLY trying to "catch" me doing something or "NOT" doing something, she goes in the charts and reads all my documentations, etc. I told the scheduling person Friday that I want OFF that station.....it's a scary place to be.

My question is this: when I'm at work I stay busy from the time I hit the floor to the time I leave, I don't have time to be sitting at the desk talking and playing all day like she's seems to be able to do. I just wonder if she is doing her work? I mean she has accuchecks, a couple of G-tube meds, some treatments and I only saw her "on the cart" for a short period of time.....also, her glucometer (sp) was missing so she asked to use mine so she could check this patients BS, but then she gave it back......did she not check the other patients BS? Is she just marking down that she's doing these things but really she's not? I wonder how I could catch her....I know she's a bad nurse and they need to get rid of her. She's scary.

Jill

Daytonite, BSN, RN · May 20, 2007

Oh, Geez! I was the same as you. Always on the go. Never took a break. This almost sounds like deja vu with an RN I used to work with only she was not as outgoing and always trying to hide. I and another LPN caught and nailed her but good for documenting false glucometer readings and not giving medications. We were pretty sure she was sleeping for a couple hours a night on the job, but no one could ever find where she was hiding out to do this. Here's what we did.

The glucometer has a memory and retains old readings. If you find the directions (or they may be on the manufacturer's website) you can find out how to access the memory. We started checking the blood sugars our nurse was documenting on the MARs against the blood sugars in the memory on the glucometer. We couldn't find the blood sugars that she was documenting on the MARs in the memory of the glucometer. We found every other nurses, but not hers. We documented this, dates, patient names and blood sugars, and sent a memo that we signed to the DON. I also documented a statement made to me by one of the patients. The patient asked me why I was the only nurse who stuck her finger. This lady was on sliding scale insulin and while she was a bit confused, she wasn't totally in left field! I think it was her statement that started me checking the glucometer.

Because I was real anal about the medication cart being neat and orderly and the meds ordered, I became aware that a lot of the meds that were only given during the night shift, which is the shift this nurse worked, in our Alzheimer's wing did not need to be re-ordered at their regular 30 day intervals. Then, I noticed a new bottle of liquid vitamins for a tube feeding patient that should have been opened by this nurse and given by her had remained untouched for a week! I started counting the pills in some of the Alzheimer patient's containers and sure enough, I was coming up with the same count every day indicating that this nurse was not giving these patients their medications. I hounded the DON about this. Finally, the pharmacy service arrived a hour before one of her scheduled shifts and completely inventoried the medicine cart she would be using as well as checked the memory of the glucometer without her knowledge. They came back and did another inventory as she was leaving the next morning and boy! did they find all kinds of discrepancies! The pharmacy was able to give an official documented report to the facility of their findings. The nurse was asked to come in and meet with the DON. She resigned and we never saw her again.

I still get angry over the whole thing. She should have been reported to the state board and for all I know maybe she was. Technically, she was falsifying medical records when she made up blood sugars and wrote them on MARs. Not giving medications is failing to follow medical orders.

Maybe that will give you some ideas. A word of caution though. Keep quiet about what you are doing if you decide to "monitor" this lady. These people can be smart. If she's falsifying blood sugars she's probably smart enough to know which patients she thinks she can safely ignore and which patients she absolutely has to do a real fingerstick on. She'll also be smart enough and experienced enough to know how to make you look like you've done something wrong if she suspects you are watching her and she wants to retaliate. I had 25 years of experience behind me and could go toe to toe with my nurse, but you're a newbie and still wet behind the ears. So, if you do this, collect good evidence and make it one big bang that will hang her sorry butt. One thing I did do before talking to my DON was make copies of patient MARs with the false blood sugars. I also kept xeroxed copies of all the memos before I sent them to the DON. I was prepared to send all this evidence to the state board of nursing if the DON wasn't going to do anything.

Something else that I started doing very early in my career, I can't tell you why, I think I heard it mentioned at a legal seminar, was to develop a unique way of signing off doctor's orders and of making my initials which makes it very difficult for them to be falsified by anyone else. In LTC I also initialed the tape I applied to any dressing changes I did. My two initials of my name only take me a second to scribble, I know exactly what I'm writing, but to most people it looks like scribble and they can only kind of make out the initial of my first name. I draw specific lines on top an under doctor's orders so no one can add more orders to make it look like I forgot to transcribe any additional ones when I sign off doctor's orders.

If your nurse is doing anything like what I've described above she needs to be run out of the business. A patient "damaged some of my property". What a load of crap. I don't know what kind of "property" she brings with her to work, but all I ever brought with me was what was in my pockets and a digital blood pressure cuff which I let the CNAs use and fully expected to get knocked around. What did he do? Grab a pencil out of her hand and break it in half? Stick his hand in her pocket and bend her bandage scissors in half? :lol2: What a horse's orifice.

nightmare, RN · May 20, 2007

I did exactly what Daytonite did a few years ago to catch a nurse like that.Our drug rounds take quite a while and if someone is doing them faster then you can bet your life they are not doing them properly!I count tabs regularly for drug ordering and I quickly became aware that there were too many tabs left over.I had my eye on one nurse so I counted tabs before her shift and then after ,documented number and then reported this to manager,turned out the manager also had noticed the speed at which this nurse did the drugs.She was OTD the next day!!

banditrn · May 21, 2007

Daytonite - are there bullies everywhere? Geez! I've noticed a real problem with the rehab nurse at our facility. I think she she should stay within the bounds of what she is there for, but she is, in my opinion, nasty and bullying to the residents in ALL areas.

A family recently removed their mother because of her - as was reported to me - the lady was about to take some pills at breakfast with a sip of coffee, and this person ripped the coffee out of her hand, told her she couldn't do that, and went on and on at her. This resulted in the resident, who was new, and depressed to be there to begin with, in refusing to take the remainder of her meds, or to eat her meal. This rehab nurse had pulled a chair over to sit and 'watch' her. It wasn't until she left that the resident would finally take her meds from the nurse.

In my opinion, the nurse on duty should have politely asked the rehab person to back off and leave the residents alone. I know I'd have had difficulty not picking her up by the seat of her pants and removing her.

It angered me to hear that this lady was treated like a 2 year-old child! I don't blame her family a bit. I've heard lots of complaints from residents about this particular person. I know that in rehab you have to be tough - but I don't think you have to be an ass about it! And she had NO business getting involved in the breakfast situation.

Daytonite, BSN, RN · May 21, 2007

daytonite - are there bullies everywhere?

oh, yeah. it's just particularly sad when you see it in a licensed nurse. makes you wonder how they slipped through the cracks. if it were me, i would treat a situation like you described above by just writing up the facts as i observed them on a memo and give it to the don. that gives the don some written documentation to work with. you can only hope that eventually someone else will have the guts to do the same and that the don will do the right thing. the facility could get into a lot of trouble if a patient's family complains to the agency that licenses the ltc facilities in your state or to an agency that take complaints of elderly abuse. if it comes out that everyone was aware that this nurse was like this and nothing was ever done about her behavior, look out.

when i was working at a ltc in another state we had a patient's family complain to the state department of health about an incident that occurred when their father had been roughly handled by a couple of aides. they left bruises on him. there were state investigators in the facility that very same day to follow up on the complaint. the aides, as i recall, were fired but not right away. i believe the state really turned the heat on the facility at the insistence of the family and threat of a lawsuit from the family. why a facility would keep on employee who had done something like that to a patient is beyond me. i'd have no problems firing people like this.