I work in a nursing home and follow the 8 hour 7-3, 3-11, 11-7 schedule. I work 3-11. I'm also a relatively new nurse. One of the patients that would've been on my assignment discharged on the 7-3 shift. By the time I came on by the 3-11 shift the patient in question was already long gone. However, my supervisor comes to me at 8pm and starts saying we have a problem. I ask why? My supervisor says the patient's wife is freaking out because she doesn't have a full day's medication and the pharmacy is closed. I say what am I expected to do? He left before my shift even started, I wasn't responsible for the discharge.
My supervisor tells me we still need to give her the meds for the patient, and I say well we get it from a Pyxis and he's officially discharged so he's no longer in the system. How can I pull meds for a discharged patient. So my supervisor tells me to pull the meds from patients who share his medication. My supervisor tells me I should be the one searching for his medication since I know him better since he was my patient two nights ago. My supervisor tells me to search the system for patients who share the meds and she watches me as I do so before watching me go to the Pyxis to pull the meds and then I give it to my supervisor. The supervisor tells me to label the envelope where the meds are held in and write down everything in it.
The supervisor then calls the patient's wife and she comes to pick it up. My supervisor then rings me and tells me that the patient's wife came and my supervisor tells the patient's wife that it was me who collected the meds for her husband, and stated my name.
I'm super irritated as I can plainly see that my supervisor is setting me up to be the fall girl in case of any liability or issue arises. I feel dumb for complying. What was the right thing to do in that scenario?
Not trying...you have been set up to suffer the consequences and be made an example of should something go wrong, get questioned, or blame needs to be placed.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I'm going to add that I don't think the sup is diverting and I don't think this counts as dispensing meds. I think the simple explanation is that the patient was discharged without his meds that had already been paid for and should have gone home with him. And the meds were probably destroyed, or can't be found at this point. And now the family is irate and wants his meds. And the sup is trying to make that happen without admitting fault of the facility, so she's dumping the problem on the nurse currently on shift. Which is crappy and wrong. She should take responsibility for taking the meds from wherever she took them, to give to the family. Or she should cover it up her own damn self. Not put it on the nurse working under her. That's why the DON needs to know.
Specializes in OR, Nursing Professional Development.
FolksBtrippin said:
I don't think this counts as dispensing meds.
That may depend on state practice acts. We use bacitracin ointment in our ORs, which used to come in a 30g tube (now in teeny tiny single use "pods”). We were not allowed to send the extra home with the patient because it's considered dispensing medication. And that's something OTC.
I think the simple explanation is that the patient was discharged without his meds that had already been paid for and should have gone home with him.
I am confused with your post....How did the wife know he/she had paid for the medications?
FolksBtrippin said:
I think the simple explanation is that the patient was discharged without his meds that had already been paid for and should have gone home with him. And the meds were probably destroyed, or can't be found at this point.
FolksBtrippin said:
And the meds were probably destroyed, or can't be found at this point.
Have you ever seen a corporation in motion that is NOT at a glassier pace?
WHY did you even consider doing this? SO WRONG on all levels. I am sorry but NO should have been your first thought and then DO NOT ever do that!
But too late now, and you will be paying the price for it. Go and tell your director what that supervisor made you do and that you actually did it. Then you should probably look for another job and consider never doing this again in the future.
I think the simple explanation is that the patient was discharged without his meds that had already been paid for and should have gone home with him.
We never send medications home with the patient; Aren't the patient's daily meds at home still? Didn't the health care facility continue the patient's daily medication? if so, the usual daily doses are at home, waiting for the patient to return.
We do not have any 24 hour pharmacies where I live. I always ENCOURAGE a family member to fill a pain medication, Lovenox, antibiotics, etc on the way home from the hospital. Many rural patients are discharged after rural pharmacies are closed. When you work evenings it is very difficult to ensure the patient will be comfortable until the next morning/afternoon when the patient/caregiver can go to the now open pharmacy.
I would like to add: we need to FEED the patient before discharge. I have seen Nursing home patients receive transportation to their facility after food hours. We send them home without a nutritious meal but say they are protein deficient. But the RN needs to ask for dinner way before discharge time. If that can't be done ask Food or Nutrition services for "a to go box". ALWAYS try to get their food delivered to them an hour before discharge.
You need to report this as soon as possible and you also need to find another place to work. This is all levels of shade and the fact that the supervisor made you do it and gave your name to the patient's wife means that she has no intention of having her fingerprints on any of this. It doesn't show good intention. I'm sorry as a relatively new nurse that you had the be bullied into doing something questionable. The fact that you recognized it as being questionable is good. But this needs to be reported and I would find another place to work. This won't be last time something like this might happen and I would be concerned of potential retaliation.
WHY did you even consider doing this? SO WRONG on all levels. I am sorry but NO should have been your first thought and then DO NOT ever do that!
But too late now, and you will be paying the price for it. Go and tell your director what that supervisor made you do and that you actually did it. Then you should probably look for another job and consider never doing this again in the future.
Jeepers! this is way too harsh to someone just trying to navigate this thing we call a "helping profession". Haven't you done anything you wish you could have help with (before, during and NOT after) in our job?
Truly to the OP I do not hope you will pay the price for this. Yes, being a professional means making difficult decisions every day....I am glad you are questioning this on our forum. It will help many a nurse (new and old) know what is encountered in the work place even if it is a school like you SCUBA,
I've been silent so far....'cause can't help but turning this over and thinking that, aside from the fact that other patients' medications were used, I'm just not as incredulous about this as some.
I keep thinking that, in the OP's favor, we ultimately aim to make sure we "just take care of the patient." This used to be standard guidance and a standard measuring stick (for our actions) back when we had to (or were allowed to) make more independent decisions without so many entities weighing in on what was or wasn't considered acceptable. And so many MMQ's (Monday morning quarterbacks) hypercritical about what should have been done when they weren't there to help with the problem.
At the end of the day, the OP did not do this because they are a recklessly practicing RN or had a pathological desire to steal drugs, but in attempt to accomplish something appropriate for the patient.
I would NOT expect a new grad to have a full set of trouble shooting options that would have sprung immediately to mind upon being drug into this. That sort of thing comes with experience.
I am not saying what happened is right, but stuff like this falls strongly into the 'teachable moment' category as far as I'm concerned. I certainly hope that the OP is counseled and supported at his/her workplace. The supervisor who concocted this should be held to a higher standard. Agree with reporting to the DON.
I would say that the medications were not already paid for. The OP stated that the resident's name had been removed from the PYXIS. The PYXIS system tracks removals for patient safety AND accurate billing. This tells us that every resident's name that the OP pulled a medication under was double charged for the medication pulled. Some systems provide explanation selections for pulling an additional dose: dropped on floor, refused earlier, new order, etc..
The supervisor clearly took full advantage of his or her authority while taking advantage of the innocence of a new grad. The problem with this as well is that the new grad DID and DOES know better, as evidenced by this post.
Unfortunately in today's nursing climate at many organizations, it's brazenly clear that to walk through the door safely, that T-shirt that reads "Today ain't the day, and tomorrow's not looking too good, either" should be worn....and MEAN IT.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
londonflo said:
We never send medications home with the patient; Aren't the patient's daily meds at home still? Didn't the health care facility continue the patient's daily medication? if so, the usual daily doses are at home, waiting for the patient to return.
We do not have any 24 hour pharmacies where I live. I always ENCOURAGE a family member to fill a pain medication, Lovenox, antibiotics, etc on the way home from the hospital. Many rural patients are discharged after rural pharmacies are closed. When you work evenings it is very difficult to ensure the patient will be comfortable until the next morning/afternoon when the patient/caregiver can go to the now open pharmacy.
I would like to add: we need to FEED the patient before discharge. I have seen Nursing home patients receive transportation to their facility after food hours. We send them home without a nutritious meal but say they are protein deficient. But the RN needs to ask for dinner way before discharge time. If that can't be done ask Food or Nutrition services for "a to go box". ALWAYS try to get their food delivered to them an hour before discharge.
Do you work in a hospital? Because if so, medications will be dispensed as they are used. A nursing home is the patients home. And medications are dispensed monthly, similar to how you would pick up your monthly meds from the cvs. As an example, If you picked up all your meds for October on October 1 from one CVS and then tried to go to another cvs and get the same meds on October 15, your insurance would likely deny it, because they already paid. In a hospital, the medication is not pre charged to the patients insurance, so it's not an issue and you go home on new meds or the ones you have at home.
In a nursing home, the medication in the med cart normally belongs to the patient and has already been billed to the patient, and should be sent home with the patient as part of their belongings. This is not dispensing medication because the medication has already been dispensed by a pharmacist.
Of course you should not send home pills that aren't labeled and packaged.
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FolksBtrippin, BSN, RN
2,322 Posts
That is an abuse of power. I agree that you should go over the sup head and tell the DON what happened.