Couldn't believe he did this...

Nurses General Nursing

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I work as a nurse delegated CNA in a very small adult family home that is state certified and actually takes place in a big house, not a facility. It's actually a pretty neat set up as it truly feels like you're in a comfortable home and not in an institution. That said, because we are super small and independently operated, there are only two CNA's on staff and that's it. No RN's, no doctors, no anything. However, we do not administer anything beyond oral medications and insulin injections. We don't take anyone in need of acute care, so it's not a place designed where nurses must be present at all times anyway.

So, my schedule recently changed since I'm in school and I now work with someone who has a lot of experience in LTC (20+ years) and has been working for this company from its beginnings (which is still fairly new, less than 5 years in operation). He is a nurse delegated CNA like me. I am a new CNA, but personally? I don't like to work with him. He does things "his" way rather than what is normally expected and it drives me nuts as I am the type of person that likes to follow rules and regulations to the letter, especially when it comes to other people's health. He does a lot of little things that bother me, such as having the diabetic patients already eating before he takes a supposed fasting glucose test, is very vague in chart notes (says someone ate and drank "adequately" instead of giving measurements/ratios), things like that.

To make a long story short, he made a major med error by giving a resident someone elses meds. My heart dropped. I understand people make med errors, but that to me is a HUGE error. I always follow the 5 rights because I am paranoid of this exact scenario potentially happening, so I do everything in my power to not let it happen when I am the one administering. But more disturbing than this is that he didn't make a big deal about it at all. In fact, it was as if nothing happened. I said that I was calling the manager to tell them right away of the incident. He says, "Oh, don't worry about calling her. It's not a big deal. I'll just chart about it later. And anyway, it's not like the medications that this person is taking will effect the other person adversely anyway."

I felt my heart pulsating violently in my chest in anger. Does RN, MD, or PhD follow your name in any way, shape, or form? Are you a pharmacist or pharmacy tech? If the answer is no, you don't know JACK about how that medication well effect that resident! This is the kind of error that could potentially kill someone! And to have no sense of urgency is just...I couldn't believe it. Oh, and he didn't even chart it. This whole thing was just so, so wrong. He should have known better. It shouldn't have even been a hesitation. The fact that he didn't even want me to call and to just keep it quiet...OMG. No. I advocate for my patients, thank you very much, and to hell if I was going to just sit back while a resident has someone elses meds pumping through their system with no one speaking up for them!

I only had a few minutes left on my shift when this all went down, and decided that I was going to call the manager immediately after getting off to tell them what happened and I did. They were shocked and appalled and both the manager and the owner drove to the home that night to address him. They called me while I was home, put me on speaker phone so he could hear me, and I explained the entire thing from beginning to end. The owner asked him if my account was accurate, and to my surprise the CNA said yes, everything I said was true and accurate.

I am not sure what disciplinary action happened, but it's going to be extremely awkward when I have to work with him next shift. Ugh.

:/

I am thinking the state is happy with the lower cost....

Update: this topic is exactly what we talked about in class today, with emphasis on "you cannot under any circumstances delegate someone for anything that requires assessment. As a nurse, that is YOUR responsibility."

So I took the liberty in just talking with her after class privately about my concerns. She said she cannot give me a 100% answer as she is most familiar with the hospital setting/policies/laws, but she was going to speak to a colleague of hers that is familiar with these kinds of places. However, she said she didn't like how it sounded and (as another PP stated) that they sound like they're stretching the law outside of its intended boundaries, especially when administering PRNs and doing wound care. She said she feels that a nurse should always be present for that.

So my confusion is, how is state doing inspections and not seeing that this occurs and is allowing them to operate the way they are? Unless maybe when state comes in they make it a point not to do PRNs/wound care in front of them...? I have never been present at an inspection yet.

Specializes in Oncology; medical specialty website.
Update: this topic is exactly what we talked about in class today, with emphasis on "you cannot under any circumstances delegate someone for anything that requires assessment. As a nurse, that is YOUR responsibility."

So I took the liberty in just talking with her after class privately about my concerns. She said she cannot give me a 100% answer as she is most familiar with the hospital setting/policies/laws, but she was going to speak to a colleague of hers that is familiar with these kinds of places. However, she said she didn't like how it sounded and (as another PP stated) that they sound like they're stretching the law outside of its intended boundaries, especially when administering PRNs and doing wound care. She said she feels that a nurse should always be present for that.

So my confusion is, how is state doing inspections and not seeing that this occurs and is allowing them to operate the way they are? Unless maybe when state comes in they make it a point not to do PRNs/wound care in front of them...? I have never been present at an inspection yet.

Elizabeth: I know you think I was being mean to you, but now that you've spoken to your instructor, do you see why I was being so blunt? I wasn't doing it to be unkind; I wanted you to see what a serious situation you could put yourself in. I don't want you to jeopardize your future career as an RN over this CNA job. The fact that you've listened to what people here and at your school are telling you shows that you are conscientious and care about being a safe practitioner.

When we're talking about adult foster care homes, there's really no nursing delegation going on at all. The caregivers administer medications just like a family member would. It's not a nursing environment.

Specializes in LTC, Psych, M/S.

I googled this topic - having trouble posting the link but it appears these "residential care facilities " are more prevalent in WA/OR but gaining momentum in other states

http://mobile.nytimes.com/blogs/newoldage/2011/12/27/more-on-the-nursing-home-exodus/

Elizabeth: I know you think I was being mean to you, but now that you've spoken to your instructor, do you see why I was being so blunt? I wasn't doing it to be unkind; I wanted you to see what a serious situation you could put yourself in. I don't want you to jeopardize your future career as an RN over this CNA job. The fact that you've listened to what people here and at your school are telling you shows that you are conscientious and care about being a safe practitioner.

Yes, I do understand now. :) Looking back, I appreciate and thank you for your honesty.

I apologize for being sensitive.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Here is the deal.....always KNOW your states specific requirements .........in the stte of WA....in home care......

(b) A registered nurse, working for a home health or hospice agency regulated under chapter 70.127 RCW, may delegate the application, instillation, or insertion of medications to a registered or certified nursing assistant under a plan of care.

RCW 18.79.260: Registered nurse — Activities allowed — Delegation of tasks.

It is each nurses responsibility to know what their state requirements are. Many of thee arguements ensue when one nurse talks about her state requirements and doesn not allow for the laws that vary state to state. Home/residential care is VERY different from any LTC/SUB Acute/Acute care requirments....... for these are these people's homes.

Many people are looking into this....they get reimbursement for minimal out put and resources.

This home is within the law....technically speaking. Would I be the nurse who allowed my name be used for this? NO.

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