nurse not giving her meds...should she be fired?

[cant_not]

Hello,

I've visited this site for quiet awhile but recently decided to join. Anyway, I'm an aide (hope to start nursing school really soon..) I work in a long-term care facility in Bath County, Kentucky. We're a rather small facility, housing only 57-60 residents (60 = max). One of our patients there is hospice, and has been for some time (from my understanding, I've recently moved here from WV, and started working there in Feb). A popular thing there is that if you have a resp. over 24 there's like a standing order for morphine? Or something to that effect. Anyway - To get to my point, I'm basically new there - This poor, dying resident, whom is obviously in pain and has a resp of 28 ask for her morphine. I told the nurse promptly, like I'm supposed to do- she said that the lady has a history of drug abuse - she "knew" because she was friends with her daughter, so instead of giving the morphine, like she's legally entitled to do - she gave the lady cranberry juice.. Passing it off as morphine. I reported this to the ADON - and she said she'd take care of it. Well, 4 days later - the same nurse did the same thing. I brought it to the ADON's attention once more - and still, they haven't done anything about it. Several of the other aides have reported this as well. Should she be fired? I think so...

[UM Review RN, ASN, RN]

Fired? She, the DON, and the facility, could all lose their licenses!

You're saying that the nurse:

Is undermedicating a patient in pain.

Is misrepresenting a medication--in effect, giving a placebo instead of a narcotic. Unethical and illegal.

You're saying that the facility (through the DON):

Investigated and lied about the situation instead of correcting the problem and reporting the nurse to the State. Again, very illegal for all involved.

If you are sure that you saw a nurse giving cranberry juice instead of morphine and telling the patient that it's morphine, yes, that's wrong. Doesn't matter what state you're in, there's still a chain of command, and the next step is for you to call the State. They will investigate the allegations.

[cant_not]

Yes, the nurse is undermedicationg a patient in pain, in extreme pain at that. She did use the cranberry juice as a "placebo" and I know that for a fact, because I witnessed it with my own eyes more than once.

I was in nursing school before I moved here, but had to quiet for financial reasons. I know this lady was in pain. And I know that this is very unlegal and unethical. I just don't see how someone could call themself a nurse and...trick? someone so badly. Sad thing is the last time she did it (that I know of) another nurse was about to come on shift - this lady was in extreme pain, and her daughter asked if she could have some morphine - but, she couldnt because the previous nurse had told her she had just gave it. She actually even told the nurse on the on-coming shift that she gave cranberry juice instead of morphine. I confronted this nurse about reporting her - and she said she didnt want in the middle of anything.

When I asked the ADON about all this, after reporting it twice - she called me in her office and told me to keep my "eyes" shut at times. She said that there's absolutely nothing that can be done because she's not signing the meds out of the book.

[BBFRN, BSN, PhD]

Your ADON lied to you. Call the KBON and report these nurses. Ky is a mandatory reporting state. You are required to report this. I believe this nurse would fall under "A licensee or applicant who has negligently or willfully acting in a manner inconsistent with the practice of nursing, " at the least.

Here is the KBON info page on this:

http://kbn.ky.gov/conprotect/investdiscp/

You should probably fill out the "facility complaint form" on the website. All complaints are investigated, and the complaint is confidential until resolved. They may know it was you that made the complaint, because you have been vocal about this.

You know, this pt having a hx of drug abuse has no bearing of whether or not to give pain meds as prescribed, unless they are at risk for being overdosed, etc. You said the pt is dying? I really hope this isn't a hospice floor.

Let us know what happens.

[serenity19649]

yes, yes, and yes to all comments made.

you are those patients advocate, you are basically their last line of defense. and god bless you, i hope i have someone like you as i age. that will stand up for me..... i applaude you.

you report them, and stand up to them, they are wrong, wrong... number one as a nurse we have no right to say who is or isn't a drug abuser, we do not do those types of diagnosis, it is our responsibility's as nurses to relieve our patient pain, especially a terminal patient. it is called pallitive care, inquire as if your nurse knows and understands what that is.

i sincerely appreciate individuals such as yourself, who try to make a difference... i wish there were a whole bunch like you...:bowingpur:bowingpur:yeah:

smiles,

[elkpark]

You also have the option of calling your state agency that licenses/regulates LTC facilities and making a complaint. When I worked for that agency in my state, we allowed people to make complaints anonymously, and we investigated every complaint (every complaint that involved a regulatory issue, that is -- if people complain that the food doesn't taste good or the beds aren't comfortable, there's not really anything to be done about that because there's no applicable regulation).

Every state has an agency like that, but the name is different in every state -- they are usually a division of your state Dept. of Health and Human Services (or whatever that's called in your state! :)), so that department's main website would be a good place to start looking for who to contact ...

Many states also have an ombudsman program specifically for residents in LTC facilities -- that is another option ...

Best wishes; what you're describing, if it's really happening as you describe, is illegal, unethical, and immoral. It should not be allowed to continue, and the licensed professionals who are involved should be held accountable.

[psalm, RN]

...it's also neglect AND abuse, imo.

[RN BSN 2009]

...it's also neglect AND abuse, imo.

yeah that!

[NurseCard, ADN]

Yes, you can call the Long Term Care Ombudsman and report this. When I did my clinical at a nursing home in Frankfort, the Ombudsman's phone number was posted on a large framed poster right near the front door of the place. (My father in law was the ombudsman at the time, ha! =)). But seriously, someone needs to get on this.

[behensley]

She isn't signing out the medication, passing a juice as a placebo and the DON is turning her head???? By all means you need to report to the governing bodies. Just because you have previous knowledge of a persons past doesn't mean that it is a current situation. If she was worried about abusing the morphine, IF there was a non-narcotic alternative that was available she could have tried that first to see if there was any effect. If not, then certainly go on and issue the medication. Doing this addresses the issue of pain the pt is complaining about. I have always tried to start small and work my way up with pain medications, (unless it is after a serious trauma). But never is it acceptable to lie to a patient. :)