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Hello,
I caught one of the night nurses at our psych unit using the Pyxis as a resource and dispensing medications to patients as she sees fit. This nurse primarily works as the only RN on the unit. The nurse in question charted in MAK that she gave two IM injections to a patient. I watched the nurse and she did not give this particular patient any medication. I then woke him up and asked if he had gotten an injection and he said no, he's been sleeping all night.
This nurse then went to another patients room told the patient she was going to give him something for the voices. I checked what she had charted, and what was charted was ambien and vistaril. She then went back into the room an hour later and checked on the patient. A mental health counselor asked the nurse what she gave him. The nurse's response was, "the cocktail". This particular patient just got back from the ICU with a very high cpk and in addition to not having "the cocktail" ordered, he didn't have any IMs ordered.
It has been suspected for some time that this nurse has been doing this, as evidenced by patients coming to the nurses station asking for medications that are not ordered for them, then saying well the nurse on night shift gives them to me.
I wrote her up, told supervisor and my manager, but it seems this is getting swept under the rug. The nurse has not been suspended and continues to work as the only RN on the unit at night.
Need advice here.
He clarified that he was witnessing a waste, not cosigning an admin. And it sounds like she's pulling and charting the meds under patients to whom they are assigned, but then administering them instead to other patients to whom they are not. He reports that the patient on whom the med was charted denied receiving it, and patients who don't have those meds ordered are telling other staff that this nurse gives them those meds anyway/he witnessed her give something to a patient who didn't have a med ordered for that route and tell the patient it would have an effect that none of her ordered meds would have.
That is correct.
"I caught..." Really? Nurses are just cruel to each other. Making speculations about another professional's actions that can affect their livelihood. And what if you're wrong?
Yes, I caught her. What's cruel is what she's doing to the patients.
No speculations, I'm 100% certain the patient she charted the medications for did not receive them. The security tape can verify the patient didn't come out of him room during our shift and she never entered his room. By her own admission, she gave "the cocktail" to a patient who did not have the cocktail ordered. And the patient was taken off IMs after he returned from the ICU with the high cpk.
Do not EVER cosign for anything until you look at the order, the patient, the dose, the waste....do NOT let this nurse pull you into her whatever-ness. Be direct about it. "Ativan is not ordered for this patient, until I see an order, I will not co-sign for you"Know that the pyxis is a wonder machine which records and sees all. As is the camera attached to most ceilings above said pyxis. And if she is overriding to get meds that have no order---don't witness them.
I am unclear on how this is all happening, however, uninvolve yourself to tying your name on it.
There is parent company websites that have areas for ethical complaints. Use it. Each time a patient makes a statement regarding this stuff, do an incident report. Every time. CYA.
Finally, just to throw it out there, is there standing orders/protocol that a cocktail can be given for agitation, etc? This may be what is happening--she is using those standing orders or protocol for the wrong reasons. Regardless, her documentation needs to match the pyxis.
Investigations can take a long time, as this may mean her license as opposed to just her job.
This patient was taken off standard protocol orders because of his high cpk. And IMs are not standard protocol, (PO Ativan and PO Benadryl are however). Before he returned from the ICU, this patient did have those medications ordered, but they were removed when he returned to the unit.
She doesnt override meds to get the order. The way our Pyxis is set up, when you select a patient, only the ordered meds will populate on the screen. So, she needed to select a patient that had those medications ordered.
So if you were there, and her actions caused you to be concerned enough for patient welfare that you actually woke up a sleeping patient to interrogate them, why wouldn't you simply ask the nurse "Hey, what's going on?".You seem hell bent on getting this nurse suspended or fired. I don't understand that, especially when you were on the spot and had an opportunity to seek clarifications for actions you perceived at the time were detrimental to patient care, not to mention criminal. If you were so concerned, why did you allow this to happen? You seem to be more concerned with documenting it than resolving it. Makes me wonder whether this isn't a personal "thing" you have with this nurse. I certainly wouldn't stand by and watch something like this happen, on multiple occasions, and not challenge what was going on and seek clarification/explanation. You chose to just passively observe patients being endangered and I think that is why people are having a hard time with this. I cannot imagine watching all this and not intervening at the time to protect the patients on that unit.
Sometimes when we see something boggling, especially if new and unexpected, we don't always react as promptly as we wish. I am willing to cut the OP some slack on that basis. However...
Now, OP, you must act. When (not if) this is found out and the nurse in question is asked who might have known she was doing this, if your name is mentioned you will be seen as complicit. A baaaaad place to find yourself in.
At very least you should report to the Board of Nursing and the state board that oversees this facility, anonymously if you like, because this is a very, very serious patient safety issue. Let your management know you have done so, knowing that you will probably lose your job but if they do make a move to discipline you, you can and will let the known universe in on why.
It's late, but in this case, better late than never.
Sometimes when we see something boggling, especially if new and unexpected, we don't always react as promptly as we wish. I am willing to cut the OP some slack on that basis. However...Now, OP, you must act. When (not if) this is found out and the nurse in question is asked who might have known she was doing this, if your name is mentioned you will be seen as complicit. A baaaaad place to find yourself in.
At very least you should report to the Board of Nursing and the state board that oversees this facility, anonymously if you like, because this is a very, very serious patient safety issue. Let your management know you have done so, knowing that you will probably lose your job but if they do make a move to discipline you, you can and will let the known universe in on why.
It's late, but in this case, better late than never.
Why would I lose my job?
Why would I lose my job?
Sometimes people who do things like report unethical behavior are seen as troublemakers, and if management doesn't like troublemakers, you will not do so well at that facility. You can't get fired for being a whistleblower directly, but sometimes they will find stupid little things that nobody would care about normally (like being one minute late clocking in or giving a med two minutes late), document them, and use them as an excuse to get rid of you.
It doesn't even matter that you'd be right in filing a report with the BON if the nurse really is doing what it looks like she's doing. You'd be making waves, and making the facility look bad.
...GrnTea is fast! Beat me to it.
Code of Ethics for Nurses, American Nurses Association.
1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimal patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality healthcare and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
This is not some artsy-fartsy gobbledygook. This is a standard of ethical practice to which every nurse in the US is held, regardless of individual state nurse practice acts.
Which one(s) of the above applies to you in this situation? There's your answer.
Big-RN;
I just want to say I'm sorry you're going through this. I have been through something a bit similar, twice, and it absolutely sucks. Also very hard to prove even when you know in your gut that this person is unethical. (There's often a reason why people like this find jobs where they work nights alone on the unit.....)
Hugs to you.
Since your facility has not done anything to discipline this nurse, perhaps you should take it up a notch and report her to the DON of your facility, and if again nothing is done, report this RN to your state's Board of Nursing. Before you do this, make sure that you have all your ducks in a row. eg; the occurrences that you have witnessed, with dates and times, a copy of your write up of this person, who you have discussed this with (Charge RN, Department Manager, and DON). This RN sounds dangerous and something must be done before she seriously injures a patient or a death occurs.
gigi_bsn_rn, BSN, RN
17 Posts
"I caught..." Really? Nurses are just cruel to each other. Making speculations about another professional's actions that can affect their livelihood. And what if you're wrong?