nursing home injustice? need advice!

[babybumblebee]

I was recently got written up and suspended for an incident. I feel that I was innocent though for some reasons. I need some advice, as to know if this is really my fault, and if i deserve the punishment. So this is my story. The daughter of a resident was very upset that she found a pill in her mom's room. She complained to the supervisor and wrote a letter to the administrator because she was very upset. I was the nurse who gave her the night meds while a CNA was present. I gave the pillls to her, INTO her mouth and gave her water before i left, all of this while a CNA was present in the room (I know that the resident is confused). The letter the administrator wrote to the family stated that they are sorry for the inconvenience and traced back to the nurse who passed out the night meds and did not wait for the resident to finished her pills therefore will be subject to consequences for violating the facility policies. When I read that, I was like what?? I know what happened and I have a witness. That was a lie. I was present in the room with the pills into her mouth and did not leave until she drank enough water. I later had a talk with the CNA who revealed that she saw the resident taking a pill out of her mouth after i left. The CNA placed the pill on the table and was going to let me know but she forgot. That explains how the daughter found the pill. Anyways, the CNA never mentioned to me about anything until I asked her about it. If she had told me, I would certainly have done something about it. I just felt that the nursing home was trying to put the blame on me without listening to my point of the story. Well, my point of the story didn't matter somebody had to get in trouble and so it was me. Even though, I felt I already did the best I can in that situation. So do I really deserve this? Is this injustice or what?

[SitcomNurse, BSN, MSN, EdD, RN]

I think that tee admin. acted in the way they needed to to apease the family.

Aside from that, they also followed the regulations for the facility and the state you live in. Yes, it stinks.

If you are still not satisfied, I HIGHLY recommend you take the high road. Request a meeting with your manager or DON, and offer a proactive approach to preventing this from happening to others.

Let her know that you are interested in the well being of other nurses. Research some information on this type of med error and things facilities did to change the potential error. Recommend a small (15 minute) inservice to CNA's. They can be taught the importance of relating this information, because meds have to be given within a certain time as per physicians order. Even if it were reported at the end of the shift, you are out of the 'range' for administration as per federal guidelines. Make sure they bring the pill with them, for visual confirmation.

This will change the perspective of you in her eyes. You will not be the victim, or the 'negligent' nurse. Instead you will come out looking like a person actively interested in their career and the advancement of nursing.

Nothing smells sweeter than success from failure.

[David13, MSN, RN]

It seems as though the administration wanted this family member off their backs, and so you were the "fall guy" who was punished in order to appease them and to give the appearance that "something was done". In my opinion, the CNA should bear at least some of the blame here, particularly since she actually witnessed the resident removing the pill from her mouth and did nothing about it.

I agree with the previous poster about taking the high road and perhaps inservicing the CNA's on this subject. In the long run, you will be improving the care your patients receive, and it will also serve as a cue to the administration that this was a systemic error rather than the fault of one nurse.

[Whispera, MSN, RN]

Being suspended for such a thing is way over the top, in my opinion. I do believe you should ask a patient to open his or her mouth so you can make sure pills are swallowed, though, especially if a patient is confused. I like the idea of a new policy for what CNAs do if they find a runaway pill...

I think you should go to your manager, too, and talk about it. They surely need a good nurse like you.

[barefootlady, ADN, RN]

Wonderful advice from the other posters. In the end, you need to decide how you will handle problems like this in the future. Believe me, this type of thing happens frequently in LTC facilities. I do not think it was fair to throw you under the bus like this administration did but it is their usual way of handling problems. Blessings and take this time off to think of ways to improve your practice and protect your license.

[systoly]

Most likely it was obvious from the appearance of the pill that it had been in someone's mouth, but that didn't seem to matter. Someone got to slam their fist on the table, but nothing was resolved. Some residents are masters of pocketing and you may or may not be able to ensure the resident actually swallowed the pill. What if the resident does not want to open the mouth after placing the pill in it? You would have to remain with the resident. What really concerns me here is the severity of disciplinary action combined with a complete lack of action to avoid repeat episodes. Based on my experience, and everything else being equal, I would expect a verbal with a written being unusually harsh, but suspension - never. Again, in the presence of the drastic action without any consideration given to prevention I suggest you get malpractice insurance (if you don't have it), forget about talking to the DON or admin - they won't hear you. And figure out a way to address the issue for yourself. And, of course, document any extra effort you make when medicating this resident.

[TuTonka]

The best way to prevent that situation is to always ...first ask the pt if she swallowed the pills ...Secondly ask the pt to open her mouth and you look inside to make sure she has swallowed the pills. I hope this suggestion is benificial.

TuTonka

[LilPeonNo1]

As probably the majority of resident's in nursing homes have some form of dementia, it is always a good idea to check their mouths for cheeking or pocketing before leaving them, especially when they're in bed. Having too often found pts hoarding, cheeking or pocketing meds after administration, especially at night, I make it my policy that unless they have no history of dementia, their pills are crushed, I provide a full cup of H2o and make sure med is swallowed completely before leaving the bedside. If a pt is too sleepy and can not be awakened, I return later or waste the med. Charting in MAR why med was not given and that med was wasted. Also have a 2nd nurse (if possible) sign with me if any med was narcotic/opiate. If no 2nd nurse, place med in safe place (locked in cart) and wait for on-coming shift to destroy. If it becomes a pattern of behavior that resident is not taking meds or hiding them, I place a note in the MD review book for him to go over on his rounds. I also discuss with other nurses on my unit if perhaps changing times of administration would solve the issue. Many elderly pts w/ dementia have some degree of paranoia, usually related to some unknown fear. They may tell you or others they think you are poisoning them. Or, they believe they are being held there against their will and the meds are keeping them from leaving. Whatever their particular fear, to the patient it is real. As a night nurse, I realize my pts don't necessarily recognize me on sight. In their confusion they might believe I'm trying to harm them. So, if possible I try to work with other shifts to solve the issue of hiding meds first.

You might want to discuss some alternatives with management to avoid this happening in the future. And, I think having a discussion with CNAs on the importance of reporting these types of issues directly and immediately is also important. However, although you may feel you were somehow wronged in this situation, it is your responsibility (6 rights of medication) to complete the process. I'm not saying I'm perfect, I too make mistakes, but own up to it and do what you can to solve the probelm.

[caliotter3]

If you gave the meds at the beginning of the shift, they would criticize you for not entering the room again to check on your resident and finding the pill on the table. The admonition to look in on your residents at least once every two hours covers a lot of ground when looking for something to criticize nurses and/or CNAs for. I was once accused of leaving meds on a side table when I knew I had done no such thing. It would not have been out of character for the person making the accusation to have planted the "evidence" as that was the way she operated. Nothing I could do about it since she counted for more at that facility. I left eventually. Toxic atmosphere.

[snowyRN]

I have worked in LTC for over 7 yrs and I can tell you that administrators unfortunately will do ANYTHING to get the families off their backs, even if it means unjustly blaming YOU!!

[CapeCodMermaid, RN]

How about an order to CRUSH the pills which can be crushed...easier for the resident to swallow. I've always had residents do the Fear Factor Prove You've Swallowed The Whole Thing maneuver if I think they've not swallowed something.

Personally, I think your punishment was over the top. Perhaps a verbal counseling would have been more in line with what you did or didn't do.

And...for the record, not all administrators throw their staff under the bus when a family member complains. I had a family meeting yesterday and the resident's POA started complaining. She said if the resident had been anywhere else, she would have found out what was wrong. I suggested to her that if my facility was so 'horrible' and she was so unhappy having her person there, I'd be happy to help her transfer to a different facility. The look on MY nurse's face was priceless. Apparently they're not used to having a DNS stick up for them.

[babybumblebee]

I would like to thank each one of you for taking the time to read and reply to my post. It was just a way of venting out my disappointment. I do feel the sentence was harsh, if it was just a verbal then it wouldn't have been as bad. I would like to add in some details to my previous post. Don't get me wrong, I do check to see if the resident's mouth after meds administration when I am not familiar with the resident and believes the resident to be confused. However, in this case, she does not have trouble swallowing nor has given anyone (including me) any problems with pills in the past. It just happens that this was the case, just my luck. The letter made it seem like they did some investigation and found me to be guilty but I believe that is a lie because I have a witness who was present with me during meds administration. When the DON showed me the letter of what the adminstrator wrote to the family member, I told her straight up this is a lie. She didnt say anything. She told me that not to take it personal, she was just following the administrator's orders and that this will not go into my records or anything. She also advises me not to tell the administrator that I saw the letter as it was confidential materials. I mean, if there's nothing for them to hide, if they did not accuse me, why can't i mention the letter? You see what i am saying? Of course, at the end of all that drama, I realized it was no use to defend myself and talk to the administrator because he was the one who accused me in the first place. This is not the first time I have been in trouble at this facility. I feel that they will do anything to divert the fault on them (that is, systemic error) and to please the family members. I do feel I need to get out of this place because if they can not even support a nurse in something little, I can not imagine how they will stand behind a nurse when a big problem arises like a lawsuit.