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 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...

This is still going on, on her shift anyway. From my understanding she's not signing the morephine out of the book - so I've heard there's nothing anyone can do. I plan on finding employment elsewhere very soon.. I just think that this is so...disturbing. I've been an aide for 3 years now, since I finished HS and I've never seen anything like this :chair:

[sacralciara]

Are you and the others also charting each time the pt. requests pain meds and that you reported it to the nurse? Avoid the risk of any of this garbage falling back on you when/if the pt's unaddressed pain becomes a facility problem.

Also, have you noticed whether the med nurse is accurately charting the cranberry juice(or charting at all) as her implementation of care in response to the pt reporting pain? I'm curious.

Ciara

[nurse_wannabe]

I am fairly new to LTC, but I can't imagine a standing order for morphine for respirations > 24.

In any event, if this resident is on hospice, she more than likely does have morphine ordered for pain management. But I do have some questions:

1) If PRN, are you positive that it wasn't given by a different nurse on the prior shift and therefore too early to give again?

2) If routine, do you know the dosing schedule?

3) Is it possible your nurse had already given it to her and you didn't know about it?

4) Did she keep complaining of pain after the cranberry juice was given? Did you recheck her respirations?

The only reason I bring this up is b/c I once had a resident who was taking Morphine, Valium, and Vicodin for his back pain r/t paralysis from the waist down. He was not on hospice, but all of these meds were PRN. You could give this man a Morphine & Valium at 10pm, a Vicodin at 11pm, and by midnight he'd be on his light asking for more, so out of it that you could barely understand his slurred speech. If I didn't have full, open communication with my CNAs, they wouldn't know that I'd already given him all of those things. They may run to the other CNAs or DON and accuse me of being some kind of monster who enjoys inflicting punishment on those who can't fend for themselves.

However, if you know for a fact that it is time for this resident's morphine, that she needs it and has not had it, then you absolutely did the right thing by going to your DON. Maybe you should follow up with her and see what has been done. She may tell you it is none of your business, and if she did I would report it as others have suggested.

You sound caring and intelligent. I think you'll make a very good patient advocate! Good luck.

[Redlady]

I know in Canada a nurse cannot also administer a placebo without informing a patient that they are receiving a placebo

:chuckle Sorry. This situation certainly isn't funny, but the fact that someone would give a Placebo after telling someone that they were receiving a placebo :trout: I mean...doesn't that kind of defeat the purpose?

[Bala Shark]

To the orginal poster, You have to understand, is that the CNA is not considered professional so the nurse can over ride what you say..A nurse has a lot of education and experience and you do not..You cannot be above the nurse in terms of what you think what is right and so fourth in terms of patient care..

[Todd SPN]

When I was an NAC, I saw something similar. I called and talked with the Hospice nurse saying I was concerned the pt wasn't getting the pain med needed and why I thought that. She came out and without mentioning the call decided to make the med routine. I hate to see pts in unnecessary pain.

[vloho]

So now one has asked how is the PT reacting to the pain med?

[Marie_LPN, RN, LPN, RN]

SHOULD she be fired????

[Tweety, BSN, RN]

So now one has asked how is the PT reacting to the pain med?

What pain med? You mean the cranberry juice?

[Marie_LPN, RN, LPN, RN]

So now one has asked how is the PT reacting to the pain med?

No, because she has yet to receive it. :stone

[leslie :-D]

To the orginal poster, You have to understand, is that the CNA is not considered professional so the nurse can over ride what you say..A nurse has a lot of education and experience and you do not..You cannot be above the nurse in terms of what you think what is right and so fourth in terms of patient care..

anyone has the right to advocate for a pt.

there are also too many nurses who hesitate in giving mso4.

whether its' intent is placebo or otherwise, it's still illegal and grounds for revocation of a nsg license.

there should be a number for the ombudsman, on the wall, out in public view.

i urge you to call this number. their response will be the quickest.

God bless.

leslie

[JSRN81]

I know in Canada a nurse cannot also administer a placebo without informing a patient that they are receiving a placebo

:chuckle Sorry. This situation certainly isn't funny, but the fact that someone would give a Placebo after telling someone that they were receiving a placebo :trout: I mean...doesn't that kind of defeat the purpose?

I believe that a person must consent before having a placebo, which means that they could sign a general consent for a treatment that says that may, or may not receive a placebo instead of the actual drug or treatment. They don't necessarily have to be told that they are getting the placebo, but they do need to consent to the possibility of that happening.

JS

[vloho]

That's a big asumption. that the nurse didn' sign out for the med. If she didn't give the med would the PT be relieved? Pesonally ifthe order is there no nurse has the right to deny the PT something the Dr. has OK'd