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Is it normal that some nurses won't give out meds to their patients?

Geriatric   (821 Views 9 Comments)

The0Walrus is a ASN, RN and specializes in Psych.

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I remember when being oriented some nurses would click on the EMR they gave meds. They would then say "I gave these earlier." I don't remember seeing them give it to the patients though. They would just return and just click "Yes" to the options. Then they would click off "yes" to the nursing aid jobs saying "We can click that the CNA's did these." Is it normal that some LPN's just don't give out certain meds? Also sometimes you'll see the same vitals as if they just copied the vitals from the other nurse. Is this normal in a nursing home?

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Yes, in some cases it is normal, illegal, and the fault of the doctor ordering the medication and not the nurse; if the doctor ordered to give non-serious medications (Tylenol crushed prn), for a patient without pain, who has dysphasia and the medication must be crushed (Tylenol tastes bad when crushed), and given in bed with the head all the way up, causing pressure on the patient’s abdomen (discomfort), and resulting in pneumonia (due to aspiration r/t dysphasia), and the doctor refuses to change the schedule of the medication for office politics reasons (the family so threatening to sue and making demands without medical knowledge of common sense).. you get the picture. But really what should be done is on your part:

1. Is the medication not administered causing harm?

2. What is the reason the nurse is doing this.

3. Has actions been taken to prevent this situation from happening and what was the response of the ordering provider?

4. If you are not administering a heart medication, there will be patient harm. If you are not administering a medication the family pressured the doctor to prescribe but the patient doesn’t want or seem to need it, then it’s legallg clear but ethically tricky. 

5. Both situations should be addressed, but how you address it depends if the medication is serious and necessary on the first place and appropriately prescribed.

The same with vital signs: if the vital signs frequency is inappropriately prescribed and causing unnecessary harm to the patient, then changing the frequency of the vital signs can be discussed with the prescriber. 

Sometimes, vital signs had to be discontinued, but the provider has not gotten around to doing it yet. 

 

In all cases, if it has not been done, it should be documented that it had not been done. 

 

 

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Glycerine82 has 3 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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So, the way I look at the orders in my MAR/TAR is that I am signing off that the task was performed.  Whether or not I did it myself doesn't matter as long as it's done.  

Sometimes I will give apap or other non-critical meds early/late  if they are ordered at odd times. This can occasionally cause me to have to sign off a medication after i've given it.  For me, I don't stress out about it as long as the person is getting their medications. Usually I just change the order, though.  

Then there are nurses who skip the OTC drugs. This is a bad habit and not something you should do.  If there are a lot of needless vitamins etc. ordered its easier to just talk to the MD and get them discontinued when indicated. Also, many times there are good reasons OTC drugs are prescribed.  Probiotics, folic acid, Vitamin D, are all examples of meds that the patients really need to be getting. 

Eventually you will get a feel for which corners you can cut and which you can't. Until then you just do everything by the book and never do anything you're not comfortable with. In order to get to the place where you're comfortable you have to go through the first year or two. 

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I once worked with a coworker who would not give meds, or do treatments, or get off her rear to answer a call bell or otherwise see to a resident's needs, because she was inherently lazy and came to her night shift job in order to sleep.  She was the exception, and not the rule.

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On 11/19/2019 at 1:00 PM, The0Walrus said:

I remember when being oriented some nurses would click on the EMR they gave meds. They would then say "I gave these earlier." I don't remember seeing them give it to the patients though. They would just return and just click "Yes" to the options. Then they would click off "yes" to the nursing aid jobs saying "We can click that the CNA's did these." Is it normal that some LPN's just don't give out certain meds? Also sometimes you'll see the same vitals as if they just copied the vitals from the other nurse. Is this normal in a nursing home?

I will answer as if you are certain that the meds were being charted but not given (which is how I read your OP):

You're asking the wrong question; it doesn't matter if it's normal (common) or not.

It is illegal, unethical, fraudulent, and could probably be considered abuse/neglect of the residents in question.

If, as suggested by the previous poster, there is a particular reason why the med is not being given, there is a proper way to document that and a proper way to follow through seeking resolution of the problem. But in no instance is the correct answer to chart that something was done when it wasn't.

Edited by JKL33

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KadesUmma2011 specializes in ICU Stepdown.

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I am completely floored by some of these answers.  It is NEVER ok to chart that you gave something when you didn't.  It is NEVER ok to just summarily change a DOCTOR'S ORDER on your own.  We are NURSES. We take care of HUMAN BEINGS.  We chart on a medical record that is also a LEGAL DOCUMENT.  We don't just "CUT CORNERS" because we are too lazy to do our job.   Every single person that does these things should reevaluate why they even wanted to be a nurse in the first place. And also examine their clear lack of ethics. Those people should stay in the SNF environment because that would never fly in a hospital. 

Edited by KadesUmma2011

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WLD is a BSN, RN and specializes in GEROPSYCH.

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Is it normal? DEFINITELY NO! Is it happening? Yes. Will it constitute neglect? YES! is it illegal? YES, it is literally a “lie” and MAY constitute a forged document (in extreme cases when presented as an evidence),   it being part of a medical record. Will you be liable? hmmm... if some one saw it and reports it and you could be charged, criminally and administratively. Is it ethical? Definitely NO under the principle of non maleficense and utmost Goodfaith. Something happens? You will always be accountable and if proven would be liable. Lesson? Do what is right based on standards of nursing practice. 

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It shocks me that this question is being asked by an RN.

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Sadly, some nurses don't give out certain meds. Some nurses seem to think for example, that it is OK to skip the Metamucil. It's wrong but it does indeed happen in nursing homes. I have seen other nurses copy other nurses vital signs too.

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