LVN "teamate" not doing meds properly-advice wanted

seamang2, BSN, MSN · May 28, 2011

Just a simple bit of advice, it's your license, so you need to do what your career can handle.

Anna Flaxis, BSN, RN · May 28, 2011

This is a serious patient safety issue that, in my opinion, you cannot ignore. I completely understand not wanting whatever drama and/or backlash that could come of your interference, but I don't think you can ethically turn a blind eye.

You've already discussed it with the LVN, and the behavior continues. The next step is to follow the chain of command. It sounds like the charge nurse isn't likely to be receptive since they are friends, and the manager of the unit is already aware of at least one instance. I would still give the unit manager the benefit of the doubt, and give her the opportunity to handle it, so I would suggest talking to her. If that proves to be ineffective in curtailing the behavior, then keep following the chain of command.

Another option is if your facility has a hotline for reporting patient safety issues. Some facilities have this; it allows staff members to report their concerns anonymously without fear of retribution. Maybe this is an option?

Either way, depending on the culture of this unit, it's possible that you will make things harder for yourself by confronting this. You may want to start formulating an escape plan just in case things get ugly.

NurseLoveJoy88, ASN, RN · May 28, 2011

I agree with the above posters. I don't know that you can lose your license due to something she did, but she can definitely loose hers due to her own actions. She works under her license not yours.

I would talk to her and then go up the chain of command, her practice is un-acceptable.

drmorton2b · May 28, 2011

In my state MA the RN can legally have authority over the RN (Supervisor). But if the LPN messes up its the LPNs license. Unless the LPN and RN were doing a procedure or something together and messed up causing harm.

canesdukegirl, BSN, RN · May 28, 2011

How awful is it that we as professional nurses must fear retribution and backlash for simply doing our jobs and keeping our patients safe? It is akin to middle school hallway antics if we call out the Reigning Miss Popularity for picking on the class nerd. Nothing changes, it seems.

Look at this thread carefully, y'all. Do you know how many other nurses feel this way on a daily basis? It is RAMPANT. I see it all the time myself. Can't you just imagine this scenario playing out:

LVN: "Hey BFF Charge Nurse! I got pulled into the manager's office today for not giving a med as charted. I just know it was Nurse S. She was riding my tail about this last week and I EXPLAINED to her that I was GOING to give the meds, but the stupid pharmacy was late with the meds AGAIN! I mean, what gives? Why am I being nailed just because of THEIR stupid mistake? I'm not going to get in trouble over this. What does it matter if I give the stupid Zantac two hours late? She is just out to get me. Little Nurse Goody Two Shoes had better watch her back."

BFF Charge Nurse: "Don't worry sugar, I got your back. Watch how many new admissions I give her! She isn't going to know what to do! Pass it along and tell everyone not to help her. She is going to regret talking to the manager!" *insert cackling like witches stirring the brew pot here.

Y'all, this happens all too frequently. Why? I never have understood it. I have no easy answer. Why is it that the nurses that stick to their guns about SAFETY issues of all things continue to be blackballed by the slackers? Why does management not do anything about it? They must know about it.

The easy answer is to report it, because it is the right thing to do. However, the backlash is very real. Nobody wants to work in a toxic environment like that.

OP, I have no concrete answer for you. Report it, of course. Then what? You are between a rock and a hard place, but the safety of your patients trumps everything. Perhaps things will work out, and the LVN will actually start passing meds the proper way...or not. It is a hard position to be in.

BabyLady, BSN, RN · May 28, 2011

I am getting assignments as a team w/me as the RN and an LVN. I caught her not giving a med on time (which she then gave me attitude when I brought it to her attention as she's talking w/the charge nurse-her best buddy). I've caught her marking meds as given when she gave them later and blamed pharmacy for bringing them late.(I can understand pharmacy bringing them late, but don't mark it as done at 0900 if it didn't get to the pt until 2 hrs later). This person seems pretty lazy as she is gone off the floor frequently to joke w/ the charge in the nurses station.
I don't want to cause problems, but I don't want to lose my license over this either. The hard part is that she has a lot of friends at work and I've been there less than 2 years and tend to stay "out of the loop" and avoid the politics/gossip. Should I talk to the manager (who saw firsthand that she didn't give the med until later, but yet it wad marked and brought it to the LVNs attention and suggested she mark the actual time she gave it). I feel like I have to double check that she gave the meds b/c I don't trust her. I'm not trying to cause this person trouble, but want yo voice my opinion that I refuse to be assigned w/her as a team. I get floated to her unit frequently, so not sure if they'll just try and ignore
my request.
Any advice? I want to handle this as a professional, but afraid it will turn catty and be to my detriment.

The LVN works under her own license and if you pull up the disciplinary actions of your BON, I have never even seen a nurse that had their license suspended or revoked for a med error or giving a medication late.

What SHE (not you...SHE) is doing is false charting. You cannot force another healthcare professional to chart differently.

I would give her one last opportunity to correct it by telling her directly that you will have to report her for false charting if she does it again...and don't feel guilty about doing it.

Mrs. SnowStormRN, RN · May 28, 2011

Because it's team nursing are you both held responsible? I'm curious about this because it changes things. When we did team nursing, the team leader ultimately got dinged if someone on the team screwed up (well, they both did, but the team leader would be dinged also even if the fault wasn't directly hers). Is this the policy in your facility as well?

KayRN910 · May 28, 2011

The LVN works under her own license and if you pull up the disciplinary actions of your BON, I have never even seen a nurse that had their license suspended or revoked for a med error or giving a medication late.
.

True, but I respectfully disagree with the fact that the RN isn't held accountable to some degree. They are her patient's too. And forget the BON, what if meds aren't given on time and somebody codes? Even if it isn't caused by the med error, can't you just see the RN on the stand and them asking,"Did you ever witness Ms. LVN give medications late? Did you ever witness her chart incorrect times for medications? How can you be sure at Ms. LVN gave your medications at all? Why did you never report her?"

I realize it's a small chance, but it's a real one. Report it. At least you will not be eaten up with guilt and feel you are sacrificing patient safety.

Katie5 · May 28, 2011

Any advice? I want to handle this as a professional, but afraid it will turn catty and be to my detriment.

Forgone conclusion.

Is picking another teammate an option? Otherwise dissolve the team-who needs a team like that, when they only pull you backwards.

JerudC · May 28, 2011

Two points:

1 Karma will eventually catch up with this LPN. In a hospital near here an RN was marking the meds as given before they were actually given. Unfortunately for her the patient died before the next medications....the doctors had quite the question as to how a dead person could take their medications.

2 As one of the other poster said, you are liable if you see a problem that could result in patient harm and do nothing to stop it.

demylenated, BSN, RN · May 28, 2011

At a facility I worked in, if the mar said 0900, we had a 2 hour (before and after) window in which the medication is given "on time" (because we may have 30 patients to pass meds on). We simply put our initials on the MAR as it being passed. Every facility is different... but, in the facility I used to work at, when I did pass meds, giving it at 1100 (when the mar said 0900) is actually on time.

Another facility was a strict 1 hour (before and after) window... so you had from 8-10 to pass 09 meds and be "on time."

I loved it when they went to passing meds via scanning with the cart... it was great.. told you when there was an exception, and there was no way to "cheat" the system. That got a lot of nurses (both RNs and LPNs) to give the meds on time. That was always a pet peeve of mine.

Check with your facility what "on time" entails.