Ethical question...what would you do?

missmercy · Jul 28, 2004

Mr. X's Tylenol is stronger?! I take it MrX's is ES and your stock box is merely regular? Or does Mr. X have a specialized morphed version of Tylenol that is Super charged?! :rolleyes:

I'm watching carefully because I sure don't want a narcotic error on my shift since the two of us are sharing the same key to the cart

You betcha!!! Keep a journal of it all! specific documentation will be your best defense if anything does end up missing etc. COVER your fanny!! and Keep your eyes open for behavioral chanes, etc. that might indicate further indiscretions. Keep your nose clean and document, document, document!

ksrnstudent · Jul 28, 2004

Thank you for the responses. I feel like the majority of you...I would bring my own NSAIDs before reaching into a patient's drawer. I feel very uncomfortable with the idea of even taking stocked meds like Tylenol even if they are not assigned to a particular patient!

Yes, the patient DOES pay for the medications. The way it is set up here, the pharmacy stocks meds each shift. If we have a med we need to give and is not in the drawer, we document it into the computer as a missed med and pharmacy sends more. I had a missed med last night for a patient at dinner time. Fortunately it was only Coumadin.

By the way, last night I was on my own during dinner time med pass and didn't have to share the key with the other LPN. When the night shift LPN came on duty at 8pm, my drug count was perfect. Next week I will be completely on my own since I will be off orientation. I'm hoping I won't have much to do with the LPN in question. I also took everyones advice and kept my mouth shut for now. If I see a pattern, I will certainly say something in the future.

On a lighter side, there was a different RN that filled in for second shift last night. She most usually works day shift. The two of us hit it off great! She showed me how to do more things that I haven't been taught yet in school. She really took me under her wing and I was so grateful! Anyway, I'm thinking of switching to day shift hours on the weekends during school to be with her. She even suggested it.

Stitchie · Jul 28, 2004

Thank you for the responses. I feel like the majority of you...I would bring my own NSAIDs before reaching into a patient's drawer. I feel very uncomfortable with the idea of even taking stocked meds like Tylenol even if they are not assigned to a particular patient!
Yes, the patient DOES pay for the medications. The way it is set up here, the pharmacy stocks meds each shift. If we have a med we need to give and is not in the drawer, we document it into the computer as a missed med and pharmacy sends more. I had a missed med last night for a patient at dinner time. Fortunately it was only Coumadin.
By the way, last night I was on my own during dinner time med pass and didn't have to share the key with the other LPN. When the night shift LPN came on duty at 8pm, my drug count was perfect. Next week I will be completely on my own since I will be off orientation. I'm hoping I won't have much to do with the LPN in question. I also took everyones advice and kept my mouth shut for now. If I see a pattern, I will certainly say something in the future.
On a lighter side, there was a different RN that filled in for second shift last night. She most usually works day shift. The two of us hit it off great! She showed me how to do more things that I haven't been taught yet in school. She really took me under her wing and I was so grateful! Anyway, I'm thinking of switching to day shift hours on the weekends during school to be with her. She even suggested it.

Yah! Someone not eating her young! Let's clone that nurse.

I work in an ED where their is loose floorstock for Advil, Tylenol, etc. It's given out pretty freely for staff/etc. I still carry my own.

Here, the problem is that there is no control over narcs, etc., and it isn't unusual to medicate a CP patient with 2mg of MSO4 and finish my shift with 8mg still in the vial -- which means I have to make sure I waste before I leave, because what do I do if I bring it home? It happens regularly-- I see those vials in the staff trash. It bothers me and now I'm anal about wasting, because I will do my absolute best to prevent my name from being brought up with the BON.

Makes me feel unsafe to practice in such an environment, though. My first day? 2mg Ativan, 10mg MSO4 and 10mg Valium (holy @rap) on the counter in the nurse's station, and no one paying attention to this.

On another occasion when I noticed a whopping dose of Demerol left in one of our out-of-the-way rooms (in the sink, complete with needles and a huge mess) I said something to the charge nurse and she has since then been just awful to me. I don't understand this place, and my resume is out there, because this hospital is just insane.

BTW -- we have an old, cranky cast-off Pyxis machine. The floors don't have any.

Do your best to cover your gluteals, you will never regret it.

Trauma Columnist · Jul 28, 2004

We have a brand new Pyxis machine this week! We had been using Sure-Med but Pyxis was felt to be more secure.

Jailhouse RN · Jul 28, 2004

You are kidding, right? Employers would rather give up a few APAP, ASA or Ibuprofen than have an employee go home and have to pay sick time. This has been a practice that has gone on for too many years. You will learn as you grow in your profession that we all do things that may on the outside not look kosher but in the end work out for the best for ALL.

Stitchie · Jul 29, 2004

Just wanted to find out how things are going with the OP.

ksrnstudent · Aug 1, 2004

Hi, everyone!

Thanks again for the comments. I kept my mouth shut about the other LPN. However, I have an even BIGGER problem now! A couple of nights ago I was working second shift. When I walked in, I was told that I was the only LPN scheduled to do med passes until 8pm. I freaked out! I am still on orientation and don't feel comfortable passing meds to over 40 patients. I discused this with the RN on the shift, and she told me the charge said that 5pm med pass wasn't a big deal and that I could do it on my own and that only insulins she would need to help me with. Anyway, the shift progressively got worse! I found out that I was only paid $9.30/hr instead of $11.05/hr I was quoted. (The student nurse techs get $11.50/hr and I was told when I was hired that they didn't have anymore student nurse tech positions, which was a lie.) Anyway, I was breaking up tylenol in the generic drawer when the RN came into the med room and dumped a pile of pills on top of my cart and told me to put them up. I did, but what happened is that I accidently put the Lortab 5's in the Tylenol drawer! At the end of the shift I was doing a count on the narcotics, and noticed 30 Lortabs were missing. The RN freaked out, as I did too. Only when I got home did I remember my steps during the evening and immediately called them on the phone. I asked if they would check the Tylenol drawer. They were there! BUT...5 were given out as Tylenol. I have been so upset this weekend I haven't been able to sleep. I've done nothing but cry over the past couple of days. Yes I agree I made a HORRIBLE mistake, but I was trying to hurry and get all the meds in the cart so I could start my 5pm med pass. Also, this was the first time I have ever filled a cart with narcotics. I don't want to go back out on the floor next week as an LPN because I don't think I am safe to do so yet. Can I get into trouble with the state over this? I certainly don't want to lose my license as an LPN because I still have 9 months before I become an RN. This would be horrible!! I feel like the VA has lied to me every turn. I plan on going in on Monday to speak with the director about this. I really think I would be better off in a SNT position, not an LPN position while I'm finishing school. But part of me wants to get as far away from that place as possible...

cannoli · Aug 1, 2004

Who was it that gave the lortab instead of tylenol, you or someone else who wasn't reading the label on the med? That's a med error right there, not reading the label and therefore not giving the right med.

My first thought as I started reading this was, and you were worried about somebody else taking tylenol for their own use. Maybe there's more than one lesson to be learned here.

Good luck and be sure and let us know what happens.

Nurse Ratched, RN · Aug 1, 2004

I'm confused - you're working as an LPN, or a tech? If you're hired as a tech, why do they have you passing meds and accounting for narcs? If an LPN, why are you making less money than a tech? Just wanting to make sure I understand the situation :).

ksrnstudent · Aug 1, 2004

Nurse Ratched,

Sorry for the confusion. I am an LPN. When I called the VA and asked about student nurse tech positions, they told me they didn't have anymore openings. I opened my big mouth and said I was elligible to take NCLEX-PN during the scope of the conversation. The recruiter told me that they only had an LPN position in the nursing home area. She told me it would be great experience and that I would get to float to different departments, so I took the position. When the lady from Leavenworth called to offer me the job, she quoted me $23,002/yr, which is roughly $11.05/hr.

When I started in the nursing home area, I was told I would not get to start IV's, etc. like the nurse techs do because I was an LPN even though I'm still a nursing student. So basically I do some dressing changes and pass meds. The only time I have administered meds was during my first two semesters of nursing school with my clinical instructors watching. I don't even chart like the nurse techs do, so I feel like I'm getting no experience and I'm putting my license in danger. And there's no way I will get to go to another floor because the nursing home is so understaffed! I told the recruiter in the interview that my goal was to get critical care experience; after I started, I found out they won't put LPN's in that department.

What I have found out is SNT get paid $11.50/hr plus shift differential plus 1 1/2 times pay for working over 8 hours during a shift. When I went to HR and asked about my status last week, the manager said I wasn't eligible for OT or benefits because I was classified as Intermittent (PRN). Well, the nurse techs are intermittent as well! So, you can imagine what a blow it was to look in the computer the end of this week and see I was only paid $9.30/hr. Oh, and by the way, SNT's are STILL needed in our unit! That's why I said I feel like I have been lied to at every turn.

But the most upsetting is the error I made last week. I don't know what will happen to me over this. I fear I will not be able to return to school if a complaint is submitted with the state. I'm by no means dumb, either. I am the top student in my class! I'm just very depressed over all that has happened and really question if nursing is what I should be doing. My husband tells me maybe I should look at a real hospital position as a nurse tech instead of working at the VA nursing home. I don't know yet what I will do.

ksrnstudent · Aug 1, 2004

cannoli,

To answer your question, I gave at least 2 Tylenol (or what I thought was Tylenol) and the new RN on second shift gave a couple herself. So, we both did!

leslie :-D · Aug 1, 2004

sigh.............what a horrible 'orientation' for you.

to answer your question, YES, that was a huge med error.

but i don't think that you will be the only one responsible for it.

who was supposed to be your supervisor?

and aren't narcotics signed in by 2 nurses?