How should this have been handled by facility?

[LuckyLibraLPN]

Ok, I'm an LPN at an LTC facility. A few days ago a res. family member was questioning another nurse about pain mgmt for res.(this res. was a hospice pt.) Nurse was overheard stating they had already given res. pain meds and unless they were in excruciating pain there nothing that the nurse could do. Long story short fam member went berserk, yelling, threatening to call state, saying nurse was a liar and was lying about narcs and they were going to call the police, punching walls, etc...so said nurse was very shaken and scared and this was heard by other residents and other staff who were equally frightened. I was not around for the beginning of the explosion and only caught the tail end of the situation. When I made it to the unit the aides and nurse were hiding out in residents rooms. Once the family member stormed out they returned to the floor. The nurse stated that the police had been called and the admissions director was in the facility as well and escorted the police to the unit. It was then discovered that the nurse had in fact given res. pain med, but not all pain meds that were available to a hospice pt. There was an order in place for Morphine, Ativan, and Tramadol, and APAP, but only the Tramadol had been given two hours prior.

When the nurse had to report the incident to the officer I offered to help with the med pass, that had not been completed. (I work all units and am very familiar with the residents.) After 15 minutes passed and the officer had left, the nurse never returned to the unit. Upon calling the other nurse in the facility I was informed that the other nurse had left the facility completely. I was confused as to how that had happened since no report was given to me nor was there a narc count done. When we called the nurse's cell there was no answer. The Administrator, DON and ADON on call were all informed of everything. They stated they would handle the matter. The 3rd nurse for the second half of the shift came in and I was stuck trying to give report and do the narc count even though I was not the nurse working that unit.

I was scheduled off the next day but the nurse who left was scheduled to work, we were all speculating on if they would show up...they did.

With all this being said my question is should this nurse have been fired immediately and reported to the board for abandonment? Or some other type of disciplinary action?

Thanks, all feedback is appreciated

[llg, PhD, RN]

I think that a decision cannot be made in a situation such as this until after the facility has completed an investigation. There may be a lot that happened that we don't know about. We need to hear the RN's side of story ... we need to know if someone gave her permission to leave ... why she didn't give all the meds available ... etc.

Until all of the information has been gathered, it would be inappropriate to jump to any conclusions.

[BuckyBadgerRN, ASN, RN]

My honest feedback? Mind your own business on this one

[dudette10, MSN, RN]

Was the narc count after the nurse left correct? That is truly bizarre behavior on the part of the nurse.

[LuckyLibraLPN]

No, count was correct

[ktwlpn, LPN]

It's rare when someone leaves like that due to a crisis but not unheard of,she was probably too " upset" to continue her shift.BUT is it possible the other nurse knew she was as not coming back and had forgotten or not had the chance to call and inform you?

[Emergent, RN]

It sounds like this nurse was not a very good nurse. She lied to the family about the pain meds available, and even worse, she under medicated a hospice patient. What was she worried about, that a hospice pt was a drug seeker?

Yes, the family overreacted. But, they are very sad and stressed and dealing with a heartless nurse, if what you say is true.

[LuckyLibraLPN]

Yes the other nurse saw her leave but did not know that she had not given me report or counted the cart out with me. I offered to help her not do her job and she just left w/o a word.

[kbrn2002, ADN, RN]

My first impression is to say give that poor nurse some slack in this situation. It sounds like the family member was over the top aggressive, both verbally and physically if he/she was punching walls. I am sure the nurse was terrified. Hopefully she told management if she felt unable to complete the shift before she left, but even if she didn't it's really none of your business.

[LadyFree28, BSN, LPN, RN]

The answer to your title is...

The facility is handling it; yes, the narc count should've been done prior to her leaving; however, if might have been prudent for her to leave immediately for her safety; since the ADON, DON, and Administrator were involved, and you weren't there for the WHOLE event-let THEM handle it.

If you have ever experienced familial aggression where there was potential immediate violence, I think you would want someone to be able to "pick up the slack" while you are able to leave safely and unharmed...

[ktwlpn, LPN]

The nurse may not have lied purposely either.I had a family call me a liar when they uestioned a nurse about their loved ones "order for morphine.The nurse informed them there was no order for it and proceeded to document exactly what the family said about me.Without reviewing the orders,without realizing I got an order for a fentanyl patch due to this residents refusal of meds and without bothering to review my notes which included ALL the info and the fact that I had explained it in painstaking detail to THIS FAMILY MEMBER...Nuts,they are all nuts

[HeySis, BSN, RN]

I worked LTC and then hospice for years. It is hospice's job to educate the nurses in LTC about the patients pain management since it is so different then any other pain management we do in LTC.

I find most nurses have not received this education and truly don't know the proper way to administer the ordered medications... they are super worried about OD'ing the patient. So as far as the fact there were more meds ordered... she needs to be educated on that, not judged.

As far as he departure that night, I'd stay the heck out of that..... let her supervisors that have a fuller picture of what was going on take care of it.