Letting CNA pass your meds, bad idea?

[walla189]

I fill the cups and check for all interactions and whatnot, but anyone have any negative experiences or can think of any possible neg exp with this?

Thanks

[Marie_LPN, RN, LPN, RN]

You should be glad I am in the nursing profession because I seem to be the only one mentioning the patient as the point of concern.

:doh: :bowingpur

[goingnuts]

The really neat stuff we use in a hospital is our critical thinking skills that helps us the most. I especially like the stethescope. It is really cool and very helpful.

Very funny. But sorry I don't agree with you. The stuff you have in the hospital makes a big difference. ANd no I don't take a blood pressure everytime I give clonidine. Do you think the equipment in the nursing home is accurate? It is not. Do you think the CNA takes the BP. They do not. There is just not enough time. And I hate to have to say this but yes my license comes before the resident. We don't call them pt. in a nursing home. Well we are not supposed to anyway. Unfortunately that is reality. I don't like it and I didn't make the situation what it is but I do accept it. DON's don't care. They are trying to get by also. I see where you have a Master's degree. Very impressive. Be grateful. I wish I had the brains to do what you did so I can get out of direct people care but alas it was not to be.

[goingnuts]

:doh: :bowingpur

thanks for the laugh. I really needed it. I think a good sense of humor is just what the Dr. ordered.

[lmaldo]

Very funny. But sorry I don't agree with you. The stuff you have in the hospital makes a big difference. ANd no I don't take a blood pressure everytime I give clonidine. Do you think the equipment in the nursing home is accurate? It is not. Do you think the CNA takes the BP. They do not. There is just not enough time. And I hate to have to say this but yes my license comes before the resident.

You are so right! We are very fortunate to have the equipment in the hospitals, as well as the access to doctors and specialists. That is actually one of the main reasons I chose hospital care, as opposed to Nursing Homes. I have to admit that under your situation, your environment forces you to defend your license to the point it does come first.

With the shortage of nurses today, it might be worth it for you to perhaps explore acute care - that way you can be a nurse for the original reason you probably became one. It is well worth it!

[goingnuts]

With the shortage of nurses today, it might be worth it for you to perhaps explore acute care - that way you can be a nurse for the original reason you probably became one. It is well worth it!

Thanks but I have no business being in acute care. I am right where I should be. At least I have become proficient in knowing what is going on with residents in nursing homes. No matter where I go the problems are the same. Only the faces change. I tried hospice. Was thrilled at first. But I did wonder why they hired me since there was no work. I got paid for staying home. They barely had anything for the LVN they had much less me. Then a wife turns me in and accuses me of the most ridiculous actions. Now there is going to be a peer review tomorrow and I will get their answer as to whether they will turn it in to the BON in 10 days. All of what has been going on is just crap. If they really thought I abused a pt. then they should have turned me in immediately. Not take up to three months to decide. I have been sick about the whole thing since over two months ago. If they hadn't fired me before they had the peer review then I probably would have gone. This company is something else. Probably nothing will happen but I will not be able to relax until I know for sure. They even paid me for the day they fired me. Geez. I didn't fill out a pay sheet for that day. I told them I didn't want to get paid for that day and they still paid me. I deliberately went for a few weeks of unemployment just because I was furious with them and I knew their unemployment insurance would go up. After all of this is over I fully intend to report their actions to Medicare. I know they are getting money for nothing and they know it. But I guess they have been gettting away with it for the ten yrs. they have been openned so why worry now. I still can't believe they pay the LVN for staying at home. She told me to put office work down if there was no work. Can you believe it? Other hospices do not promise 40 hours a week. and there is a reason for that. Well anyway I got off track didn't I? But I would like to know your thoughts on this since you seem to at least care and want things to be done right. The sad part about all of this is I really believed they had work for me and that I would be busy and I wanted to work. Not stay at home and put down office work that does not exist.

[dijaqrn]

I am sure I clearly expressed my concern regarding residents not being

assessed appropriately and/or being left in pain. Patients are always first!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:Melody:

[grace90, LPN, LVN]

Any mistakes that were made fall onto the RN.

EXACTLY!

And *that* is the reason so many of us are uncomfortable with a CNA passing meds under us.

[pagandeva2000, LPN]

HELLLLLOOOOO ARE THERE ANY NURSES OUT THERE WHO ARE FOCUSED ON THE PATIENTS, NOT ON THEFT OF NARCOTIC????????!!!!!!!!!!!!!!!! My God, people, wake up! Not one response to this email, as well as the other saying they don't know what the big deal is, says anything about the patient, with whom we are ultimately responsible. Here is the big deal: If you don't have time to assess your patient before giving a narcotic medication, let me know what hospital or nursing home you work at because I will not have my family or myself subjected to such horrendous practice. Let's look at what the adverse reactions are to narcotics, specifically the opioid analgesics. RESPIRATORY DEPRESSION. Opioids depress the medulla's respiratory center. If your patient has respirations of 10, and you failed to do a quick assessment of respiratory rate, and you give them their scheduled/prn dose of narcotic, break out the Narcan, and hope you have IV access. Now since I do not work in a nursing home, I am only making the assumption that the patient more than likely will not have ready IV-access if they are in a long-term facility. "Death from an opioid overdose is commonly caused by respiratory arrest; the victim stops breathing...Accumulated doses, especially in patients with liver or renal failure and in the older adult, can cause an overdose." K. Gutierrez & S. Queener (2003). Pharmacology for nursing practice (p. 175). St. Louis: Mosby, Inc. Older adults have a reduced clearance and medication doses can accumulate in their tissues, thereby effectively causing an overdose. The reason for this pharmacology lesson is two-fold: 1) Is it possible for a CNA to learn and know what will happen or how it happens physiologically in a two week course? I don't know - I was pretty astute as a CNA but it still took me an entire graduate semester of Pharmacology to understand and beaucoup hours on the floor to comprehend the responsibility. 2) Why aren't more of you concerned about what the outcome for the patient will be if we don't have time to assess or we delegate this important responsibility to one with fewer credentials?

Any comments or thoughts?

I agree with what you are saying, but I do believe that people stated this in varying degrees without the actual statement of 'patient first'. Posters in this thread have stated that there is no guarentee that the patient would receive their medications, the proper assessments and such. What was prominent in this thread is that once medications leave the sight of the nurse, that anything goes, and because we are licensed, we are ultimately responsible for the outcome; even moreso than the CNA.

[pagandeva2000, LPN]

You are so right! We are very fortunate to have the equipment in the hospitals, as well as the access to doctors and specialists. That is actually one of the main reasons I chose hospital care, as opposed to Nursing Homes. I have to admit that under your situation, your environment forces you to defend your license to the point it does come first.

With the shortage of nurses today, it might be worth it for you to perhaps explore acute care - that way you can be a nurse for the original reason you probably became one. It is well worth it!

It is a shame that many nursing homes do create this atmosphere. I am a new LPN working in a hospital, and one of my friends told me that when she first became a nurse, she worked for an agency that sent her to a nursing home. She went there and found that she had to medicate 40 patients by herself. Most of the patients were demented and didn't have ID bands on, no photo ID on the MAR, and she said that by 5:00 pm, she was still administering morning meds (she was supposed to leave by 3:00). She went to the RN and asked her what to do and she stated that the RN told her "Do what you have to do". By the end of such a horrendous day, while she was trying to assure patient safety, she realized that she had to then resort to first protecting her license, so, according to her, she wasted the narcartics, signed for them as well as the other medications, went home, and never returned to any nursing home again in her career. Was she wrong? Maybe yes, but this was an impossible assignment, especially for a new LPN. This made the decision to me not to ever work at a nursing home. I didn't judge her. She, or others in such a situation may have resulted to getting anyone...even a housekeeper to administer medications. Based on knowing that many (not all), but MANY nursing homes do things like this to nurses and if the facility is not assuring that their patients are safe, it is hard for the nurse to do the continue to advocate. Nurses leave, because we did work hard to become LPN/RNs and to possibly lose a license because of a facility that is asking for literal blood would be insane. I was fortunate to be employeed at a hospital, they seem safer in many aspects, and I am glad that I heard the story from this particular LPN so that I don't walk into the same path of destruction. I guess what I am stating is that I am avoiding at all costs places that would even tempt me to risk my license by asking a CNA, dietary aide or housekeeper to adminster my meds or anything else for me.

[txspadequeenRN, BSN, RN]

This is the main reason that a nurse has no buisness working for agency unless they are experienced in the area in which they are working in.

It is a shame that many nursing homes do create this atmosphere. I am a new LPN working in a hospital, and one of my friends told me that when she first became a nurse, she worked for an agency that sent her to a nursing home. She went there and found that she had to medicate 40 patients by herself. Most of the patients were demented and didn't have ID bands on, no photo ID on the MAR, and she said that by 5:00 pm, she was still administering morning meds (she was supposed to leave by 3:00).

[goingnuts]

I guess what I am stating is that I am avoiding at all costs places that would even tempt me to risk my license by asking a CNA, dietary aide or housekeeper to adminster my meds or anything else for me.

I guess that is the difference in me and you. I would never be tempted to ask anyone to help me that was not considered qualified. I would have done and have done exactly what the other nurse did. Someone has to work in the nursing home. So I do the best I can. Document whether it happened or not since that is the most important thing. Ridiculous I know but not my doing. Since I have gotten in trouble for not documenting but never for documenting whether or not I really did the job----I think it is pretty obvious what has to be done.

[txspadequeenRN, BSN, RN]

I have been following this thread since the beginning and as anyone else noticed that when you respond to a quote that it is all wrong when you save and post it. Like I responeded to a post by pagandeva2000 but when it posted it says it is quoted by lmaldo....