Med Errors vs being "slow"?

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Specializes in LTC.

there is a nurse who works on the 12 hr day shift who at best, is slow with her work....this is the thing though...every night we come in on nights and she openly tells us that she "Just gave" her pm meds...meaning all the pm's that range from after lunch to 5pm.....we come in at 7p. We have alot of pts that get hs lantus, and other insulins...plus other hs meds like narcotics etc.....which some of it...she just gave when it was due at 2pm...for example someone on scheduled darvocet gets it tid @ 6am, 1pm, & 8pm....she will give that 1pm dose at 630pm..which means we cant give ours....or the insulins because it drops all the blood sugars. We have reported this to the DON with only the response "you know how slow she is". yet...she can stop who knows how many times during the day on med passes to go smoke or flirt with the guys in maint. .....I dont get it..nothing has been said or done....we feel like our licenses are at risk because of the potential of double dosing on certain meds. she only has 3 charts to chart on and 20 residents to medicate. NO txs to do or anything.....none of us on nights want to work behind her because shes not safe, we only halfway know what she gave hours late...and thats b/c we ask her, if not for that shed walk right out and never tell us.....yet at the same time, she goes out to smoke when we come in and we are ready for report...we HAVE to start our hs med pass by 720....it takes over 4 hours to do it because we have 2 halls each on 7p to7a. Days gets a nurse per hall x 4 plus a tx aide and a charge nurse. We are sick of coming in to a mess and instability. I for one absolutely refuse to work behind her but the mgmt is starting to put her on the unit i normally work..I do NOT want to work behind her for I know that if I had to do it night after night Id flip on her. I dont understand why the DON wont do anything about this? its just brushed under the rug..sooooo since the DON doesnt care to address it, how should us nurses handle it ? The last thing I want to do is show how ill tempered I can be but my God, I worked too hard to get my license & if its ever put at risk I want it to be because of my own failure, not someone elses. This is an extremely UNSAFE nurse. None of us are sure of what to do exactly at this point. If we keep reporting it, which we all have several times, its never addressed. We cant force mgmt to take action. Whats our next option here?

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There is generally some latitude provided for when medications are given. In my experience, and depending on the facility and the policies in place, that "wiggle room" is generally 30 minutes, but is never more than 2 hours maximum in either direction (either prior to or after the ordered time) for non-critical medications.

Medications that are being administered so far from the ordered time frames as you describe are considered to be medication errors and require incident reports explaining why they were administered so far outside of the ordered parameters. These incident reports should trigger some sort of investigation into the situation.

In addition to completion of the incident reports, my advice to you would be to document, document, document, including your conversations with your managers voicing your concerns. Personally, I would be going up the chain of command until someone listened, and documenting everything as I went. There is also always the board of nursing and/or the state department of health to whom the situation can be reported.

Good luck. The safety of your patients is at stake.

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Specializes in LTC.

@ the place I work for the policy is that wehave exactly and only 1 hr before/after the time its due in relation to meds. Ive started keeping a log of events that I keep @ home & will continue that. The ADON doesnt want to deal with the nurses or our issues, she mainly deals with the aides. The DON doesnt deal with anything on any spectrum usually, only once in while will she gussy up and handle business, but its rare. the administrator....thats a laugh! She doesnt care one way or the other about anything but a dollar. Staff complaints go in one ear and out the other followed by her sure fire reply to absolutely everything "ill look into it", that of course is always left hanging. I have suggested that all of us night nurses arrange a pow wow with the DON to lay everything out on the table. Only 1 nurse agreed to go...no one else said anything that Ive asked. I told them that the issues cannot come from just one nurse, it has to come from most or all in order to get any real attention. I guess its easier to pretend things dont exist rather than deal with them. I may come out looking like the beast in the end but @ least Ill have my license. I will not let a distasterous nurse put me at risk...If she does my unit like she has the other one shes been on, I will be filling out med errors every time its called for until it stops or gets dealt with.

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Specializes in home health, dialysis, others.

This nurse is jeopardizing patient safety as well as everyone's licenses.

Emphasize pt safety to the management.

Does the nurse document the times meds are given or the time they were supposed to be given? Please take a good look at that. Anything more than an hour late (occassionally 2 ) needs to be documented. Demand it. And don't let her take a smoke break before you get report.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

It is so unfortunate that your co-workers opted out of a "pow wow" with your DON, as there is strength in numbers. If they do not want to be a part of the solution, then they play a role in the problem. I honestly don't know of any solution short of circulating your resume!

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20 residents, 3 charts to do, and NO treatments?

Wow. She ought to be breezing thru her day. Unbelievable that she can't get her work done and then do her flirting and smoking.

I had a supervisor once tell me I was going to have to go give part of another nurse's medications because she couldn't get finished. I said, "Well, if she didn't stop and smoke in between the areas she was to give medications she could get finished just like I do." I never did have to go give any of her meds. No one else seemed to have any trouble getting finished. Just this one smoking nurse was all.

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Several thoughts:

1. talk to her directly. tell her to please give report before smoking, as you need to start your work by 1920. She's waited that long to smoke, she can wait another few minutes.

2. think about how serious or not serious what she's doing really is. Not saying it's ok or not wrong, but no one has suffered adverse reactions yet, right? Why is that, do you think? Your colleagues think, apparetly, that it's not so bad, since they won't go with you.

3. I guess you can talk to the DON's boss.

4. refuse to follow her.

5. find a new job.

I wish you well.

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Specializes in Hospital Education Coordinator.

no excuse for this being done routinely. Talk to DON or appropriate supervisor. There should be a policy about medication administration.

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Specializes in MED/SURG.

If you try everything and get nowhere in the matter, report it to the state.It's anonymous and there is no action they can take against you even if they suspect it was you. This person so far has no reason to change infact she is being enabled to be lax,late, and unsafe. It is hard enough to be a nurse you shouldn't have to constantly clean up after someone else or have to worry about pt safety in her wake!

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1) I agree, call the state. #1 rule of healthcare- first do no harm. The nurse is welcoming harm to your patients and it doesn't even seem to be that's she's trying to do well and just can't handle it. She is blatantly blowing off her responsibilities, someone must do something.

2) Also, CYA- document, document, document and even if you feel you are being excessive.

3) Get yourself some professional .

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There may also be what is called an ombudsman you can call, that information should be posted somewhere in your facility where residents can easily access it. The ombudsman's sole purpose is to basically be a representative for the residents when they (or anyone else) feels they are not receiving appropriate care or have other issues with the facility. I'm assuming you could do this anonymously, but at this point, it needs to be addressed, anonymous or not.

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Specializes in LTC.

wonderful input & I appreciate it all so much. I had a class at work this am and saw that I have to follow this nurse on my next shift..needless to say my stomach is already in knots about it. I did get a small chance to talk to the DON about it, I told her I didnt feel she was safe to follow & if she isnt done w/ meds when I come in I will not take keys nor will I follow her again & if they insist on rotating her, I want to be rotated too....so I dont have to come behind her. I didnt get a real response from her. Just a look...as for the ? about does she doc the time meds were given actually vs when due....she signs them all out as if she gave them on time....ex: insulins that were due at 4pm/5pm whether its on a set schedule (ex novolin 7030 20 units) or SSI Nov. R ....she doesnt give it til about 6pm to 645...we have caught her lying about this before..reported it and Nothing done. now...mind you the same pt that was due the 70/30 @ 4 also gets say...80 un of lantus at hs which may be 8 or 9 pm....which we have to hold to keep them from crashing in the night and early am since the 70 30 and or SSI wasnt given til well after they ate supper. I am keeping a log of events & conversations. I will see how it goes @ my next shift, make my notes, keep track, & go from there. If she pulls the same stunts w/ me I will fill out med errors also as to why I couldnt give xyz meds on my pass & see how they like that. I also plan to cut it short and to the point if she does me like the others I cannot wait for an hour on her to sign out meds that should have been 1. given on time 2. signed out as they were given....she waits til 7 to sign the MARS...completely STUPID!! I will nicely tell her she can do that the next day, it will be waiting on her. I just...have a bad feeling all together.

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