Ehtical Dilemma

[pharmgirl]

I'm in kind of a dilemma and was hoping to get some advice. We just graduated from LPN and are waiting for our ATT for the NCLEX. A bunch of us have gotten jobs that work us under a provisional license until we pass the NCLEX. I met with 2 of my friends the other day for lunch and to catch up with how things are going and was absolutely flabbergasted at the stories my one friend was telling us about where she is working. She is employed at a LTC facility 120 beds. She said she typically has 69 pts under her charge. She pulled out her sheets to show us all her pts (hello!! HIPPA!!) She will be "charge nurse" once she gets her perm license (which is scarey in itself since she is a new LPN grad). She takes care of 18 GTubes (aside from 2 flushings its tube changes for all), 36 accu-checks, 10 trachs etc.,etc.,. Aside from this alone seeming like an astronomical amount of pts, she informed us that when she works nights the previous shift nurse pulls her meds for her and signs the mar, so all she has to do is admin the meds. That scared the crap out of me. My other friend and I were concerned and told her she seems to be putting herself and her pts at risk. Then she told us the big one.....on the floor downstairs, they don't admin the night meds, they just sign them off on the mar. This panicked us on sooooo many levels, but my friend just seemed to take it in stride. I'm just so disappointed in her, I just keep hoping and praying that these are just "stories" but she has never been one to embellish the truth in the past and we've been friends for awhile.

We have been taught over and over again that we are the advocate for the pt. and I am appalled that my friend is putting up with this. She said that she didnt want to "rock the boat" because she is new but as soon as she is officially on her own she will not be "that nurse". Well, we certainly hope so, however, I'm really scared for these pts and my friend. License or no license I really feel that she IS being "that nurse" by not doing something. Am I overreacting and is this none of my business? Should I do something or keep my big nose out of it? Aren't I just as guilty if I dont do something and I know about all of this? This is just so wrong on so many levels. what should i do?

[hopesgramcracker]

Wow, sounds like someone should really give her a reality check and make her aware that she too may lose her license if she gets invovled in this. It only takes one phone call for the state to get invovled. At least you are concerned about her. What about talking to an instructor. Will any of the students and yourself be in contact with any of the instructors one last time for anything? Maybe an instructor can give her a call if not. Unreal. What is the point of going to nursing school just to set yourself up for failure and possibly losing your license? Congrats on your graduation!!

[Daytonite, BSN, RN]

i worked in ltc and i have no doubt that this is going on. i saw a lot in ltc over the years. you have to put yourself in your friend's shoes. if this was your first job and you had no license, what would you do? when i first started in ltc over 30 years ago we pre-poured all our meds for our 50 patients. it was illegal then too and we knew it. we did it because it was the only way we could get all our work done. the thing is that these medication orders never change and you memorize what each patient is getting. we did check the mar (at least i did) before i gave any pills to a patient and i kept them locked up at all times. not all the nurses did that. what do you see being different between another nurse pouring meds as opposed to a pharmacist pouring out your meds (they do that now). you still need to check the pills that you are giving to the patient before you give them. at the end of the month the don checked the mars to make sure that there were no blanks left unsigned. if there were she would initial them. that's illegal too, but if the state surveyors come in and find blank spaces in the mars with no explanations as to why and the facility can get huge fines levied against them. chances are that the patient got the med, but the space just got overlooked. if you've ever seen these mars they are a sight to see and the end of the month and it is easy to skip signing a space.

you say "this is just so wrong on so many levels" but you really don't state your case. as i have been there, i understand what is going on and how this can be corrected. in the same vein, how does your friend expect to change her practice after she gets her license? i did. i know how i did it. it can be done. how is she going to do it?

you can always make an anonymous call to your state department of health that licenses these facilities and report what you know. it's hard to predict what they will do with the information. it's possible your friend could lose her job or be reported to the board of nursing if the surveyors make a surprise visit and all the illegal stuff is going on. she could also be determined to be the one who did the anonymous reporting and that wouldn't go too well for her.

[pharmgirl]

By stating that it is "wrong on so many levels" I was trying to make my post as brief as possible without specifically going into the obvious welfare of the pts etc.,etc., I could make several cases why this is wrong but that was also not the tone of my post. My question was......what should i do? So, with that said, I thank you for your suggestion. Just because it is done does not make it right, and I find it very scarey that meds are drawn by another nurse and signed off on and then that nurse leaves.......what if there was a med error and that pt crashed? You would have no idea what was given....at least in this situation because they are not double checked, they are simply passed. Secondly, it is also scarey that other pts are not receiving meds at all and the mar is simply signed and pills are "wasted" (of course, not logged as wasted).

So thank you for your input and maybe I do need to talk to an instructor as hopes suggested and see if they can give my friend some direction that I am not able to. It is very sad for the pts that this sort of thing happens and its deemed "ok" because that's the way its always been done. I don't believe I can change the world but I surely can be the pt advocate I pledged to be.

[NurseLoveJoy88, ASN, RN]

Pharmgirl maybe you can report the agency. I'm sorry but what your friend and the other nurses are doing is illegal and you are right to feel the way you feel. I do believe there are short cuts here and there however, when you are putting pts and your license at risk thats a whole other story. I'll be new grad soon and I won't work at a place that does these types of things and if I did I would report those nurses. Sometimes we have to be the change we want to see.