Medication nurse vs. Charge Nurse

[Earthgrlrn]

There’s quite a debate at my work regarding the responsibilities of the RN charge nurse vs. LVN medication nurses. When any change of condition happens (falls, vomiting, new pain onset, falls etc) the medication nurses immediately call on the charge nurse to attend to the patients. Their argument is that they have too many meds to pass and they don’t have time for anything else. The charge nurses say while they don’t have meds to pass (besides the occasional IV) they also have a full plate, and the medication nurse should at least take some kind of action to help the patients. Often times, if something happens to a patient, the medication nurse will chart “informed charge nurse” or “charge nurse aware” and then nothing gets done for the patient.

For example, we had a patient that was alert x 4, for angry at another patient (confused) and began yelling at the confused patient. The medication nurse saw this, but was in the middle of passing meds and told a staff member to tell the charge nurse.

Now this can of worms has been opened, medication nurse vs charge.

What are your thoughts? I know every facility is different, but generally shouldn’t medication nurses take some kind of action with changes in condition? It’s seems a prudent nurse would do something to help patients, not just expect the charge nurse to do everything.

[garciadiego]

The hospital should have a policy designating roles and responsibilities of med. Nurse and CN. The charge nurse should deal with changes in condition if the med nurse still has to pass a thousand more pills for 25 more patients.

[Golden_RN, MSN]

I agree that this is a question that management should address. It depends on the staffing set up, # of residents each nurse has, and where other tasks fall.

Calling a nurse a "med nurse" contributes to the problem. The implication is that all she has to do is meds, which sometimes is not the case.

Sometimes it just has to do with teamwork..."I will handle the immediate problem with the resident and chart on the incident. You update care plan and XYZ" but as we all know sometimes people need clear lines in the sand of what they have to do.

[Tenebrae, BSN, RN]

I agree that the person doing the meds if they are first on the scene should be doing something to help and start the assessment process

I've had it happen before, encountering a patient who I discovered first on the AM med round that had become incredibly unstable and it appeared that they had moved into end stage. I needed to stay with that patient. So I rang my manager, explained what was happening and advised that I needed someone to help pass the rest of my meds.

Speaking as a charge nurse, there is often alot i have to do that the nurse on the floor isnt able to do, that said, when the chips are down and there is patient need, the paper work and charge nurse duties will always be defered.

[ComeTogether, LPN]

If the patient is assigned to me I do everything. If they fall, I deal with it as well as pass out the rest of my meds.

[mander]

They are nurses. I know they did more than study the art of medication passing in school. They need to practice to the fullest extent of their licenses. Yes, they need to report things to the charge nurse but they also need to do their best to take care of situations within the scope of their practice.

The charge nurses need to empower their staff and hold them accountable. End of story. We are all busy but if they weren’t needed to practice as nurses we could just be using medication aides.