Medication Mishap

[Amethya]

Got a student who has ADHD badly and she tends not want to take her medication and I was told in the beginning that she's a liar and that we need to keep an eye on her to take her medication. I wanted to trust her and help her, but sadly it didn't work out.

Today she came to take her medication. I gave it to her like always, and she proceded to go to the water fountain to take her meds. The secretary called out to me and told me she threw away the medication. I then proceded to give her another one, which this time I saw her take it.

My AP called me and asked me if she took her medication or not, and I told her she threw away the first pill and I gave her another one. She got upset because she said we didn't see her take the medication and gave her one, and the child told her she took it, but opened the capsule and took the contents. She never has done that with me, she always took the pill whole. Then the child changed the story to that she didn't take it.

My AP was upset with me because she said that I'm not doing my end of the bargain which was watching her take her medication and that yesterday was the second time I didn't give it to her on time.

I explained to her that yes, it was my mistake I didn't check before I gave her another dose, but I can't do anything if she doesn't take her medication.

She is upset, and wants to talk to my principal, which I did before her, explaining that I'm not sure how we can do this with this child, she is difficult and I now know why we can't trust her.

I wanted to give her trust but obviously she can't be trusted. It was my mistake and I am trying to fix this situation by finding a solution, but I'm not sure how I can defend myself when I talk to my AP.

I know this will be another written warning and I will write a rebuttal but I'm not sure how I can defend myself on this.

Yes, it was my fault, and I made a mistake and I'm willing to fix the situation, but what I do I tell her.

[JenTheSchoolRN, BSN, RN]

I agree, and she has supported that. And it does stink. I just get my feathers ruffled when my profession is disregarded. It also makes me apprehensive about entering nursing school, because I do not want my teachers, peers, and preceptors to assume that my experience has no value.

I actually think you will find the opposite - I have several friends in nursing school with CMA and MA experience that was valued. They also had great connections, which helped in the job search after.

[NutmeggeRN, BSN]

I am being harsher towards Amethya as her many previous posts have alarmed me and I am trying to convince her that her reputation is on the line and student safety. For the student/patient/client safety I will stick my neck out to be a bad guy. She is inadequately supervised at this charter school. There are other MA's who do a fantastic job and I am guessing they have adequate support. There is a history with this OP being overwhelmed and definitely not supported by her office or Lead Nurse. I believe she would be valuable in a different kind of position with children.

This.

[ohiobobcat]

The reason I'm upset with the child because my trust with her is gone and it was my fault for trying to trust her.

Before she came here I was told by her files and such that she's a compulsive liar and manipulative, very hard to reason and very defiant. I was warned on this behavior, but I wanted to give her a chance. As someone with ADD, I kind of understood her difficulties and wanted to help.

Before I gave her the first dose, I explained to her that I want to trust her and work with her on this. But as time went on I saw and been told if things happening, both students and staff. She's violent and aggressive , constantly fighting and acting out. I tried to talk to her, our counselor and AP tried to work with her and her mother asked me basically to do the tongue check because she will not take her medication at home. It's a struggle for us here with her and she refuses to cooperate! I understand why she's like this because of my research on psychology and personal experience.

If mom told you to do a tongue check on the student, then you do the tongue check EVERY TIME. You do not allow the student to leave the room to take her medication unsupervised when mom has specifically asked you to visually assess whether the student has taken her medication or not. Medication administration is NOT the time to try to establish trust with a student who has the history you are describing.

It sounds to me like you wanted to be "the one" who this student could come to, and that you are empathetic to her situation. I can appreciate that, but you were told by multiple people/her files that she is defiant and a compulsive liar, yet you trusted her to leave your office and your supervision, to take a controlled medication on her own. And even though you have some personal experience and have read some stuff, you are not trained or qualified to be the person who helps this student overcome her issues, unfortunately.

I have to agree with other posters here. Based on this and the multiple other issues you are having at this place of employment, it might be time to consider another career option. And maybe do some soul searching. A lot of the issues you seem to have are with your coworkers. In my opinion (for what it's worth anyways), I can see having an issue with 1 or maybe 2 coworkers. You seem to have issues with everyone, from your secretaries to your AP, to your direct supervisor. You talk about reporting people for real (or perceived) things they have done to you. Have you considered that the common denominator for all of these people you have issues with is.....well, you? Things to think about: do you come off as abrasive? Are you polite (even if you are super irritated inside)? Do you ask questions when you are unsure of something? Do you talk down to people? Do you smile? Do you engage in small talk... like "Your son was sick the other day, is he feeling better?" What do you think you can do to improve your relationship with your coworkers?

I am not saying you do or don't do any of these things. Just some food for thought for you.

I know you have been struggling a while in this position. And I truly believe you do have the best interest of your students at heart. But you have to be SAFE about it. And what you did with this student was not safe (I think you know that now).

[SchoolNurseTXstyle]

I have to agree, my medication kids take their medication right in front of me - no ifs, ands, or buts. I also would NEVER give a second dose unless I had that first does in hand (or in sight at least). I would rather have the student miss a dose than get double dosed. This means a call to the parent to explain everything.

In fact, I have a few kids that take ADHD meds at home but have a few extra at school just in case. The parent has to e-mail me (so I have something in writing) that student did not take at home and parent is requesting. This is how I cover myself. I don't want someone coming back later saying their kid had all these bad side effects because I double dosed.

[Flare, ASN, BSN]

agree -i had a student on liquid methylphenidate last year who took a dose then vomitted shortly thereafter (spinning too fast on a playground toy - not even a reason to go home). The teacher expected me to simply dose him again. Nope - little body, fast absorption for all I know - I'm not a biochemist. I called mom -these things happen.

[dd_txrn, ASN, BSN]

I figured out what happened. I'm not sure how in the hell this brat did this, but she didn't even take my second pill.

Both pills were empty, she emptied the contents somewhere, and I don't know how.

^^^ This makes me very concerned. You're placing blame on the student. YOU let her leave without verifying she took the pill. Then, you let her leave a second time, again, without verifying. It's not her fault and you know how this happened. If the cheek check would have been done, like you told Mom it would, none of this would be happening.

If the contents of the capsule are gone....this opens up a whole new can of worms; like who got those contents? (remember I'm in high school, so my spidey senses are firing off).

I know that some of the posts on here are harsh, but you cannot EVER blame a student/patient/client/resident for a mistake that you made. Always be accountable. THAT establishes trust. With co-workers and students.

[audreysmagic, RN]

I have a policy with medication - trust no child. It's my background as a pediatric psych nurse. I'm back doing that, but when I worked in the schools (three glorious years

To Amethya - you seem like a very nice person who genuinely cares. And, believe me, I understand needing a job...see also the time I spent canvassing for an environmental agency while waiting on my state license after a move several years ago. But you are definitely in over your head, which I see that you realize. I just don't want to see you end up in a place you can't come back from. There's so much potential for error in school nursing that no one realizes until they do it.

[OyWithThePoodles, RN]

I'm not caught up on all the comments yet and it may have been said but for those asking why she is posting here or why she is giving medicine if she isn't a nurse: in most schools, medication administration can be delegated to unlicensed personnel. Meaning secretaries, teachers, MA's. Some schools don't hire nurses, but MA's, dangerous but it saves money. This person usually becomes the scapegoat.

Also, let's not insult MA's or CMA's just because they don't have RN behind. She name doesn't mean they aren't competent. Yes, there are many things they cannot do that a nurse can, but administering medication in a school is well within their scope.

[Cattz, ADN]

Amethya- I am just now catching up on your thread. I am so sorry that this has happened. You are part

of our Group here. We all have the same goal in mind-- at the end of the day that we have done the best

we can for our students. Somedays are just crap and throw us a curve ball that we didn't see coming. There is not one of us here that hasn't done something that we wish we hadn't have when we looked back on the situation. We are all human.

Please, don't lose heart with yourself. You have owned your mistake, pick youself up and dust off your

your britches. You obviously have a great heart for kids. Please let us know that

you are ok. I hope that you can find something quickly and move on where you have the support

and the training that you deserve so that you will be enabled to be successful. There are many kids that need you and your heart.

Hugggs to you my Friend.

[Been there,done that, ASN, RN]

I figured out what happened. I'm not sure how in the hell this brat did this, but she didn't even take my second pill.

She was acting out a lot today, which is one clue, giving issues to all and even the person testing her today. She came to harass me for another pill but I didn't give her any because I was under direct orders from my AP just in case of overdose.

Then another clue is today she hasn't come to cry about her stomach hurting or vomiting because her medication causes her to have sever stomach pains and vomiting. Same with eating, she doesn't eat and she ate today.

So I wrote my statement and explained yes I made a mistake and I will make sure not to do it again but she did not take any medications today. Both pills were empty, she emptied the contents somewhere, and I don't know how.

Never working in health care again, would be best for all.

Referring to kids as brat's .. indicates you should not be anywhere near them. If you knew the medication caused loss of appetite, stomach pains and vomiting, you should have held it and discussed those complications with her doctor and parents.

Being a health care giver is NOT about you.

[WineRN]

Amethya- I am just now catching up on your thread. I am so sorry that this has happened. You are part

of our Group here. We all have the same goal in mind-- at the end of the day that we have done the best

we can for our students. Somedays are just crap and throw us a curve ball that we didn't see coming. There is not one of us here that hasn't done something that we wish we hadn't have when we looked back on the situation. We are all human.

Please, don't lose heart with yourself. You have owned your mistake, pick youself up and dust off your

your britches. You obviously have a great heart for kids. Please let us know that

you are ok. I hope that you can find something quickly and move on where you have the support

and the training that you deserve so that you will be enabled to be successful. There are many kids that need you and your heart.

Hugggs to you my Friend.

This.

Please know that the regulars on this board do welcome and encourage you to post. Even when it is tough stuff like a med error. We are all here for you and want to support you.

[OldDude]

Amethya and thousands of other unsuspecting, yet genuine individuals, have fallen for the con and have been taken advantage of by school districts who have knowingly placed them in "fall guy" positions which they are unqualified to hold just to save a few measly bucks. Districts who operate under such circumstances are "consciously negligent" of student health and safety concerns when they structure their district in such a manner; simply to "cut cost." It's an outright shame and I feel for the poor individuals, like Amethya, who have been lured into such positions, and bring with them the best intentions and capacities and then don't get the support to adequately perform tasks for which they haven't the training or experience for. And I feel for the students which have been slighted and neglected because of such "cheap skate" and indifferent circumstances. It is a sad sad shameful situation how these district's admin sit around and pat each other on the backs and think they are so smart; makes me wanna wretch.