LPN's Who Sign Off Med Passes But Dont Give Meds

TheCommuter, BSN, RN · Dec 4, 2006

There's a nurse with 20+ years of experience at my workplace who is too lazy to pass meds to 'difficult patients'; therefore, she pops the pills directly into the trash can. I am going to be honest: it happens frequently, especially in nursing homes.

Fiona59 · Dec 4, 2006

I remember getting hauled on the carpet for having too many "refused" on my MARS. Three refusals=no meds. I'm not stuffing them down a difficult patient, not did we have time to try and give the meds more times.

jamangel · Dec 5, 2006

This definitely happens alot esp in nursing homes. Sometimes you notice it even when you'r enot trying to. At a nursing home job I had in the past I worked nights and was responsible for ordering the refills for the carts on my ward. Well I had a pretty good system so we didn't end up with too much overflow (the pharmacy would get pretty ticked if meds were put in the cart out of order because the labels are sequential) or run out of meds. Well part of my system was to balnce how many meds were left in the drawer with how often they took the meds so I only orderd what we needed. Often I found that I may have counted pills and there should have been 3 pills left and there were 5.

It happens alot!

The only place I have noticed it doesn't ever happen is at the jail here. Those guys get their pills. The problem there is that sometimes we don't have them.

jjjoy, LPN · Dec 5, 2006

I'm pretty sure this was happening at a LTC facility I was at for a short time. There was simply no way the nurses could have been giving all the meds and actually finishing anywhere close to on time. I can only speculate because no one would admit to routinely doing it and given the poor work environment I didn't stick around long to find out more. I think the majority of the cases were "neglible" things like routine multivits and stool softeners and that the nurses would plan to give them later when it was less hectic, but they'd chart them as given during the specified time frame and just toss them if they couldn't get to them later with the rationalization that the patient did get it most days. And I'm sure there were also many "refusals" when it just would've taken too much time to work with the patient to take the med.

mel1977 · Dec 5, 2006

it is sad bc they are hurting the patients. Sometimes I would rather be short on nursing than have plenty of nurses who don't care.

Fiona59 · Dec 5, 2006

When you say nurses who don't care what do you mean?

LTC nurses just don't pass meds. Woundcare, personal care, charting, chest therapy, the list goes on and on.

We all start out willing to coax the difficult patient take her senekot, colace or whatever, but when we find it's taking 3 hours to do a med pass at 1700 hours some decisions have to be made. Most nurses have talked to pharmacy to see if some of the pills could be rescheduled, some nurses have even managed to have meds discontinued. (Premarin for a 90yo?, four laxatives for a patient with no narcotics and daily bm?).

The problem is there but don't say its negligence without knowing all the details.

mel1977 · Dec 6, 2006

Our job is to not do harm and give meds as ordered. the nurses who just don't give them are hurting the patients as they are on them for very specific reasons. It is one thing to not be able to give the med-but if you have a hard time giving it, then document that. don't just sign it off and not give it. These patients also pay for the medications and I am sure they aren't cheap. So, the nurses who don't care don't bother to give the med and just sign it off like they did.

pagandeva2000, LPN · Dec 6, 2006

I see this practice done daily over the years when I was not a nurse, and now, I see it very often.

I can't say all the time that the nurse that is not giving the medications is negligent. What I see happening is many of what Fiona mentioned...you have some supervisors who really do not want to see refusals...whether they are true or not. This can leave people to make decisions such as these. And, there can be bad nights when there are really 10 patients out of about 30 that are being difficult....for whatever reasons. And the textbook suggestions to encourage and hear what the patient has to say does not always apply when the phones are ringing, and emergency has happened, families are visiting with their demands and then the aides come and report that there is something unusual. I had a situation in my clinic yesterday where I didn't get to chart something that happened to a patient until 3 hours later. And, had to guess because I lost the original note to remind me of what to chart. It's easier said than done.

MsLady06 · Dec 6, 2006

yeah an LPN's job can be quite hectic and cause for forgetfulness. Maybe they should consider adding another person to assist because CNA is swamped as well...we need another middle man.

Kashia, ASN, LVN · Dec 6, 2006

Experienced acute care, recently started agency work and go to many skilled nursing homes, my take:

There is no way in h... that a nurse, even if she/he knows every patient and their meds can pass on 30 patients and still have time to take regular cigarette breaks or sit around the nursing station.

I kept inquiring " what is the routine you follow in SNF, I am needing some hints".

I never once have goten an answer.

One night it occurred to me what was happening.

I said to the staff nurse...I just figured out how you all do this and have time for so many breaks...you do not do everything you sign.

She just smiled and walked away.

So, the system is a fraud. And nurses are hungry so tey are doing what they have to do, isn't right, it just is.

There is a bill up to congress H.R.4293 another nurse posted information on.

It will change ratio in nursing home 1:15. This bill has been sitting around the desks of this sleepy congress but perhaps after first of yr and new congress we can show our support to move this bill forward.

Nurses are on the front line lets advocate for innocent people in nursing homes.

Index of /congress

See 109th U.S. Congress (2005-2006)

H.R. 4293: Nursing Home Staffing Act of 2005

To amend titles XVIII and XIX of the Social Security Act to establish minimum requirements for nurse staffing in nursing facilities receiving payments under the Medicare or Medicaid Program.

Status: Introduced

This bill is in the first step in the legislative process. Introduced bills go first to committees that deliberate, investigate, and revise bills before they go to general debate. The majority of bills never make it out of committee.

linzz · Dec 8, 2006

I wish we had ratios for nurse to patient here in Canadian LTC"s. It is really crazy and getting worse. The average pt. ratio is one nurse to 40 - 60 patients and in retirement it is one nurse to about 80 - 90 patients. It almost makes me want to die before I get old.:angryfire