Got a new nurse in trouble

[TwoLayi, ADN, BSN, RN]

I work in a SNF with many post acute rehab patients, so we have a lot of new admits, with the majority arriving on PM shift. We do not have a pharmacy or ADU onsite, so meds for new admits are not delivered until after midnight, on NOC shift. We have an Ekit, but it only contains antibiotics and narcs.

During a meeting we were told to "Hold" the meds that weren't available and document

" waiting on pharmacy for delivery" and endorse the administration to NOC shift. The major hospital we contract with didn't want to change the orders to administer when available, basically saying it was our problem.

Well many of the nurses "borrow" the first dose from other patients. I feel uncomfortable doing this especially since we have a clear written policy against it, so I always hold the meds. I was orienting a new grad and taught the new admit medication procedure to her. When she was on her own, she got a verbal warning for not administering a medication we didn't have. I feel personally responsible and not sure if I should speak up or let it go.

[Silly_Sally_RN]

I would speak up. If holding a med is what is in policy, that is what you need to do. If a surveyor came and saw you "borrowing" meds, they would have a cow. Especially if they asked you what the policy was and discovered you were not following it. You should not be "borrowing" against another patient's meds to cover. We had a nurse who was fired because of a similar situation - hung the right antibiotic at the right time, but had the wrong patient's name on it.

[NuGuyNurse2b]

Why would you feel morally obligated to say anything? if I'm reading correctly, you had a meeting where you were told to hold medications that you simply don't have on premise. I'm assuming this is the policy if it was spoken about during this meeting? The borrowing of medication from other residents' medication bins is an unofficial way of going around that. So why would she get in trouble for NOT doing that and doing what is (supposedly) the facility's policy...which is to document and hold any medications that are not supplied.

[macawake, MSN]

We do not have a pharmacy or ADU onsite, so meds for new admits are not delivered until after midnight, on NOC shift.

During a meeting we were told to "Hold" the meds that weren't available and document "waiting on pharmacy for delivery" and endorse the administration to NOC shift.

Well many of the nurses "borrow" the first dose from other patients. I feel uncomfortable doing this especially since we have a clear written policy against it, so I always hold the meds.

I think the parts I've bolded is the problem. Am I correct in understanding that what you were told in the meeting, isn't an existing written policy? I should be, if that's how management wants you to deal with these types of situations. If there is a clear written policy that states that a nurse can't borrow meds, then there should also be a clear written policy that states what the nurse should be doing to solve the situation.

I was orienting a new grad and taught the new admit medication procedure to her. When she was on her own, she got a verbal warning for not administering a medication we didn't have.

That's sounds absurd. What does the written policy say that a nurse should do when the medication isn't available? Where, according to the person who gave the new nurse a verbal warning, was the new nurse supposed to have found the medication?

I feel personally responsible and not sure if I should speak up or let it go.

I don't see how you're responsible unless you've given your new coworker inaccurate information. If the written policies are incomplete, I guess you could have informed her, just as a friendly heads up, about the policy being a bit vague on how you're supposed to solve a problem if you don't have the medications a patient needs.

Personally, I expect my employer to have clear written policies and if they weren't in place, I would bring it to their attention.

[TriciaJ, RN]

You didn't get her into trouble. You told her what the policy is. The trouble is that your facility has a written policy that they expect you to circumvent. That's bad news for all of you.

Yes, you should speak up in order to clarify the policy. If you've been teaching it wrong and doing it wrong yourself, you want to know. So should everyone else.

[NuGuyNurse2b]

You didn't get her into trouble. You told her what the policy is. The trouble is that your facility has a written policy that they expect you to circumvent. That's bad news for all of you.

Yes, you should speak up in order to clarify the policy. If you've been teaching it wrong and doing it wrong yourself, you want to know. So should everyone else.

Exactly. OP didn't do anything wrong. This facility sounds awful. How does one get in trouble for following policy...

[TwoLayi, ADN, BSN, RN]

Unfortunately, it is not an official written policy. Actually the DON was unaware that the medications were not delivered until after midnight AND we didn't have most common medications in our Ekit until I brought it to her attention. The only thing written policy states that if a med is refused/ or given at a different time to intial and circle, indicating it was held, which the nurse did. But the DON told her to leave the MAR blank because it " looks bad" to hold the particular med

[Glycerine82, LPN]

You just have to go by what your facility policy is. Our facility policy is that if the medication isn't available we have to get an order for a different med or an order to hold that dose, we are not supposed to ever chart that it wasn't given because we didn't have it. Thats delay of treatment, I believe.

[TriciaJ, RN]

Unfortunately, it is not an official written policy. Actually the DON was unaware that the medications were not delivered until after midnight AND we didn't have most common medications in our Ekit until I brought it to her attention. The only thing written policy states that if a med is refused/ or given at a different time to intial and circle, indicating it was held, which the nurse did. But the DON told her to leave the MAR blank because it " looks bad" to hold the particular med

Leave the MAR blank? That's a big no-no in many facilities. They want every square filled in, no matter what.

[neuron]

I'd be gone out of that place. No official policies, DON doesn't know when meds are delivered, I'd be out of there.

[Nurse SMS, MSN, RN]

The DON advising a nurse to not document what was done is just......frankly......BS. Any time a facility alters what should legally take place because it "looks bad" is a facility that needs to be reported because they have things to hide.

[Ruby Vee, BSN]

You didn't get her into trouble. You told her what the policy is. The trouble is that your facility has a written policy that they expect you to circumvent. That's bad news for all of you.

Yes, you should speak up in order to clarify the policy. If you've been teaching it wrong and doing it wrong yourself, you want to know. So should everyone else.

Make sure you know exactly what the written policy says, and that's how you do things. That's also what you teach the new employees. As long as you're going by the written policy, you cannot get into trouble. The written policy is your defense.