Need help

[JenRN2011]

I am currently working in an independent/assisted living facility in SoCal as an LVN. I work the NOC shift. I am there in case of an emergency but also to pre-pour the meds for the 30 or so people that we assist with their meds. I am also required to pre-pour and sign for the narcotics for the following day. I have been there for about 3 weeks and as of last night I refused to sign for the narcotics because I had no control of them after I my shift. The nurse that relieves me understood and agreed with me and the nurse I relieve also agreed with me. We are all the part time empoyees. The last couple of times I have gone to work I have been sick to my stomach worring about the narcotics. I also worry about the other meds.

The facility has asked me to work on the day shift in a couple of weeks and I went in to get the routine down and became very worried over the fact that I will giving meds that I have no idea what they are because I did not put them in the med cups.

We have a staff meeting next week and I want to bring it up about my concerns but I need some documentation. I was told to ask the question, "If the state walks in, will we pre-pour the meds/narcotics?" I was talking to a friend that has been an RN for over 10 years and she told me I did the right thing with the narcotics and I really need to be careful withe the other meds also.

If anyone can help me I would appreciate the comments.

[NickiLaughs, ADN, BSN, RN]

I'm going to tell you right now that pre-pouring is going to get you in trouble. There is no way to possibly do the double check of right med/right patient/right time/ etc this way. That is what state is checking for when they visit a facility. This could possibly cost you your nursing license that you worked so hard for.

I would inform all the nurses that this must be discussed in the meeting. That it is firmly taught in nursing school to never give a medication another has prepared. Be prepared to not only all stand up for yourselves, but make them aware that you are going to report this practice to the board if they insist that it is allowed within the scope of practice.

I worked at an assisted living, it is scary because where I worked, medication aides administered medications under my license. I know that many facilities try to skip around the rules to save money and time.

Good luck!

[JenRN2011]

Thank you for your response. I an going to talk to the Director of Health Services and let him know that I can not give a medication that someone else has poured and I feel that the day and evening nurses sould not trust what I have put in a cup. He has said many times that it is different because they are an assised living facility. I have been trying to find something in writing that says this.

[caliotter3]

That may be an assisted living facility but you hold a very real license that you are jeopardizing each time you sign for a controlled substance then leave it unattended. I can't believe you have been doing this. I would have tendered my resignation the first time I was told to jeopardize my license.

[JenRN2011]

I have learned a huge lesson. I knew it was wrong. I feel so much better. I am giving notice tonight and letting them know that I will give two weeks but I will not pre-pour.

[JenRN2011]

I did not pre-pour the narcotics and I thought the day shift nurse was going to come unglued. At first he was not going to do the narc count until I signed out the 2 residents narcotics. I refused. We will see if I still have a job. If not, it really is not a place I want to work anyway.