House Supervisor Mixing Drips

  1. Dear Nurse Beth,

    I recently started a new job at a small rural hospital that when I was hired was told my title would be Night RN Charge. I quickly found out my actual title was House Supervisor and that I was expected to help out in ER. Well okay I did tell them that I have limited ER experience which was back in the 90's and that I am not competent to know what to do nor how to do it with anything critical. They mix most everything here and I am expected to know how to mix meds such as Drips and take it to the ER and they hang the drip. I feel like I am jeopardizing my license. Should I just look for another job? I feel like I may harm someone with my not knowing what to do in an emergency!


    Dear House Sup,

    In small hospitals it's not unusual for nurses in leadership roles to wear more than one hat but one of the hats you are wearing is Pharmacist if you are mixing and dispensing meds. Back in the day, nurses used to mix many of their drips, but in subsequent years CMS focused on admixtures with increased regulations. In response many hospitals developed training and competencies for nurses who did this during an emergency. Note that reconstituting (such as adding a diluent to a powder) is not the same as admixture (adding medication to an IV infusion).

    Then again, you are a rural hospital, and if you are a designated critical access hospital, rules are different and not as stringent. Critical access or not, mixing meds when you are uncomfortable with the medications and dosages is a personal liability for you.

    This is all to say you must find out your policy's policies on admixture. If they don't have one, that tells you they are naive to regulations and that alone is a red flag. Clearly written polices and job descriptions protect you.

    In the meantime, be very conscientious about labeling. Review your ACLS if you respond to codes. Familiarize yourself with the code sheet so you can take the role of scribe. As House Sup your primary role during a code should be to find an ICU bed and adjust staffing as needed.

    Have a talk with your manager around job expectations, and be specific with your questions. For example, if you are expected to help in the ED, will you be provided orientation and training in the ED? If you cannot reach a satisfactory understanding, you may want to re-consider the position.

    Best wishes,

    Nurse Beth
    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
  2. Visit Nurse Beth profile page

    About Nurse Beth, MSN, RN

    Joined: Mar '07; Posts: 1,480; Likes: 4,353

    5 Comments

  3. by   meanmaryjean
    Having been in your EXACT position- fetch the med from the pharmacy, take the med to the ED and mix it WITH THE ED RN. In critical access facilities, those 'other duties as assigned' take on a very wide scope.
  4. by   NurseDiane
    No, No, No. Mixing meds so that the ER nurses can administer them is practicing beyond the realm of your license since mixing meds is the job of a pharmacist.

    I know all about this because once, many moons ago, as the off-shift house supervisor, I was told to mix up a bag of chemo that the pharmacist had forgotten to mix up before he left for the night. I refused to do it. I called the pharmacist at home & told him that he had to come in to mix up the bag of chemo because I wasn't doing it. Because he lived about an hour away, he tried to convince me that I could do it---he'd talk me through it, blah blah blah. I still refused. I know he was pissed off when he came in, but that was something he should have done before he left & he didn't----not my problem.

    It is not your problem that the hospital is too cheap to hire a 24 hour in-house pharmacist. An RN mixing meds on the unit that they are going to administer themselves is much different than an RN mixing medications that are going to be administered by another nurse. That is against practice laws, and you should let administration know this. If they give you a hard time---or even go as far as terminating you over your refusal to mix medications---just let them know you will file a report with the state Department of Health, Joint Commission and the EEOC for making you perform tasks outside the realm of nursing practice.
  5. by   BeenThere2012
    Quote from NurseDiane
    No, No, No. Mixing meds so that the ER nurses can administer them is practicing beyond the realm of your license since mixing meds is the job of a pharmacist.

    I know all about this because once, many moons ago, as the off-shift house supervisor, I was told to mix up a bag of chemo that the pharmacist had forgotten to mix up before he left for the night. I refused to do it. I called the pharmacist at home & told him that he had to come in to mix up the bag of chemo because I wasn't doing it. Because he lived about an hour away, he tried to convince me that I could do it---he'd talk me through it, blah blah blah. I still refused. I know he was pissed off when he came in, but that was something he should have done before he left & he didn't----not my problem.

    It is not your problem that the hospital is too cheap to hire a 24 hour in-house pharmacist. An RN mixing meds on the unit that they are going to administer themselves is much different than an RN mixing medications that are going to be administered by another nurse. That is against practice laws, and you should let administration know this. If they give you a hard time---or even go as far as terminating you over your refusal to mix medications---just let them know you will file a report with the state Department of Health, Joint Commission and the EEOC for making you perform tasks outside the realm of nursing practice.
    Can't think of one more thing to say. You said it all!
  6. by   Megan1977
    Nurse Diane- you speak the truth!!
  7. by   NurseDiane
    Well, it is true! It's NMFB (not my f****** problem) that the hospital doesn't have a 24 hour pharmacist. I am not going to practice beyond my scope of nursing because the hospital is too cheap to employ someone that can, legally, mix meds. If something happened because a nurse mixed up a medication that another nurse administered, and a patient was injured, you can bet the the hospital would NEVER stand up for the nurse & tell the state that it is their policy for nursing supervisors to mix up medications that other nurses administer. The hospital would throw the nurse under the bus to protect itself, fire the nurse for not following P&P & then fight the nurse's claim for unemployment. When the hospital & nurse got sued, the hospital would try to get out of the lawsuit by saying the nurse didn't follow facility P&P so they have nothing to do with it.

    Unless you can find somewhere in the hospital P&P manual where it states nursing supervisors are to act as pharmacists on evening/night shifts, mixing up medications that other nurses administer, I would stop doing it. (And if the hospital P&P manual says something like that, take a photo of it & send it to the state Department of Health.)

    No matter who or what it is---a rural hospital, long term care facility, home care, etc.---these places expect nurses to take on tasks that are beyond their realm of practice. They'll try to convince the nurse that it's okay because the facility allows it, etc., but the bottom line is that the state draws up what nurses are allowed to do. Don't do it. If the facility tries to threaten you with your job, just let them know you'll be contacting the state to let them know you were fired for refusing to act beyond the realm of nursing practice. There is no place worth putting your nursing license at risk for. Trust me on that one.

close