How would you tell your boss this?

Nurses General Nursing

Published

Here is the situation. I work in a residential facility for kids with psych/behavioral disorders. They currently give all kinds of OTC's with no standing order, just a consent upon admission from parent/guardian. I brought this up with the director twice--- both times she assured me we were covered just with the consent. I know better.....

And another thing that bothers me.... the med "system".

The kids are on lots of psych meds, with lots of changes, naturally. They come on bubble pak cards, from an outside pharmacy. When a kid is d/c, or a med is changed, they keep that med, and we use it to start another kid on it if we get an order or a new admission. They just cross the name out and write the new kids name. There is a closet FULL of meds. So when something new is started, we go to the cabinet, get it out and put that card in the kids binder. Now I know this isnt kosher, but I need something to go to her with, since she is obviously clueless that this cant happen.

How would you approach this with her without sounding confrontational?

Where can I get proof of this to show her?

Specializes in Education, Administration, Magnet.

This is the same practice they do at my local county jail where I had to help out the nurses one day. They have a closet full of unused meds that they give to new inmated until they get a prescription :stone .

Someone called the BON. There was an investigation and my license was publically censured. I'm very embarassed about this and I have never admitted it on this site before, so please don't any of you ream me a new one. I know what I did was wrong, so leave me be.

No reason to ream you out. You learned from your mistake and aren't trying to justify it.

{{{Jill}}}

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
No reason to ream you out. You learned from your mistake and aren't trying to justify it.

{{{Jill}}}

Thank you for your support Tazzi:kiss . It means alot to me. It's hard to come on here and admit that you did something that you knew was wrong, but did it anyway because it was widely accepted as common practice and I REALLY BELIEVED I HAD THE PATIENTS BEST INTEREST in mind. I believe everything happens for a reason, so maybe this happened so I can warn all other nurses:nono: .

Specializes in NICU, ER, OR.
You are right to question such procedures. About the OTC meds, I wouldn't give ANYTHING unless a physician ok'd it. No way. About the bubble packs, let me tell you little story. I had a patient on an antipsychotic, non narcotic. For three days in a row her medication was not there. After calling pharmacy repeated times and charting every time I called, I made a huge mistake. I felt at the time I was doing the right thing for my patient. Her roommate was on the same med, same dose, same doc, and had a bubble pack. I was afraid of what would happen to my patient after three days without her antipsychotic. I borrowed one dose from the roommates bubble pack and gave it to my patient. I circled it on the bubble pack and initialed it, writing next to it that "borrowed for Mr. XX, dated, initials". This is something that is done everyday in many facilities and is accepted practice. I should have known better. Someone called the BON. There was an investigation and my license was publically censured. I'm very embarassed about this and I have never admitted it on this site before, so please don't any of you ream me a new one. I know what I did was wrong, so leave me be. I'm just trying to show the OP how dangerous it is to mess with bubble packs. OP, please learn from my mistake. Check these things out with your BON before you perform any of these actions that are widely accepted, but make you question the action. The fact that you are questioning it shows you that deep down inside you know it may be illegal, so check on it. Good luck.

omg, jill.... thank you for sharing...

we do that all...the....time........I mean, like every day, not even for "emergency"... whenever we can do it, we do it. And I know its wrong. I just cant believe they dont know its wrong.......:uhoh3: I really am not looking forward to having this conversation with my director......

Specializes in NICU, ER, OR.

So, I should call the BON? Or the Board of Pharmacy? Can I do it anonymously, and give the scenario, and see if they agree it isnt right?

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
So, I should call the BON? Or the Board of Pharmacy? Can I do it anonymously, and give the scenario, and see if they agree it isnt right?

I would call the BON. Not the pharmacy one. It's the BON that governs what you do, not the pharmacy one. You may be able to do it anonymously, I'm not sure, but I don't see why not. People make accusations anonymously to the BON all the time, so you should be able to ask questions anon. (I'm getting tired of spelling that out). Let us know what you decide.;)

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
omg, jill.... thank you for sharing...

Your welcome:thankya: . Just remember, it only takes one mean-spirited:nono: person to make that call that will effect your license forever. My public censure will never go away:sniff: . Good luck.

Specializes in NICU, ER, OR.
Your welcome:thankya: . Just remember, it only takes one mean-spirited:nono: person to make that call that will effect your license forever. My public censure will never go away:sniff: . Good luck.

You know, I have been saying that I work with a bunch of dim wits at this place (meaning admin, all the residential staff, etc), and now, in all seriousness, I am glad. Glad they dont have a clue whats going on isnt right. That what they are supposed to rely on OUR department for...

ugggggghhhhhhhhhhhh I will say it again. There is no perfect nursing job. anywhere.

My Gram was just transferred to a nursing home and her meds sis not follow- they said it was okay, they can "borrow" from other residents- I am gonna get her home as fast as i can!!!

Specializes in Psych, Psych and more Psych.
Also, I thought that institutions that accept things like Medicare and Medicaid had to be JACHO inspected? I'd seriously, seriously question both this medication practice AND who your institution reports to.

I don't believe health care facilities are required to purchase JCAHCO accreditation. There are, however, federal Medicare standards that must be adhered to in order to receive Medicare reimbursement.

Specializes in NICU, ER, OR.
I don't believe health care facilities are required to purchase JCAHCO accreditation. There are, however, federal Medicare standards that must be adhered to in order to receive Medicare reimbursement.

Jcaho is a voluntary certification, in fact, the facility has to pay to even be evaluated. But the facility I work in, isnt even considered a "health care facility" it is a residential care facility.

Residential cares can be JCAHO certed too.

Did you decide what to do about this?

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