I've wanted to be a nurse forever, do to the long lottery waits I decided to start as an LVN. Long story short I became employed at a snf- initially I was supposed to do admissions but got forced to work the floor.
A few days ago a family stopped me walking out the bathroom- they know me- and asked that I give the pt pain medication I let them know I was on break. The family became upset, stepping in my face. I walked away. I endorsed to the other floor nurse that patient wanted a pain medication (family requested not pt). The patient ended up not getting the medication until after my break -30 minutes. As soon as I clocked back in a had a call from the MD regarding a temperature of 103.5 and lethargy of another patient, I took the to and explained to the family that I had no emergency and to give me 5 minutes at most.
This particular pt is on a great deal of pain medications and she is hardly ever awake- mostly always sedated. On oxycodone 40 MG bid, dilaudid q3hrs as needed. Anyway I proceeded to give the 2100 meds as it was close to that time. The FAMILY said, but we requested you give her a dilaudid, I said excuse me she is her own rp- patient sat there saying nothing. I asked the patient if she was OK with her medications she said YES. then he family proceeds to take my picture, yes my picture on their phone.
Fast forward to today, this same patient made a complaint on a cna a few days ago. The administrator told me it's a possibility for her reporting me also if state speaks with her so be aware that this can be considered neglect.
I'm so disappointed and seriously considering quitting. I dislike snfs. We are over worked and have zero support. He began to tell me that they can take my picture without issue 🤔.
I'm upset because the Nurse that was not on break could have pulled the medication easily or her husband who is the RN supervisor. This place employs family members only. You have to be family to get help or support.
What should I do? Is my license at risk..how can I learn from this and protect myself?
Specializes in Psych (25 years), Medical (15 years).
A situation occurred on my last shift that was somewhat similar to this one.
Here's a recall of my documentation:
States, "I want my PRNs". Enquired of specific sx. Stated, "I'm having lower back pain and want my dicyclomine". Informed dicyclomine is for GI distress and not for structural pain. Sates, "Then I want my Tylenol". Reminded Percocet which contains acetaminophen (Tylenol) previously administered. Requests denied.
Stated, "I want your full name". Informed I am only required to give my first name and title. Stated, "Then I want to talk with your supervisor". Request fulfilled.
Yes I've definitely got to get better at documentation. This happened on Wednesday . I won't let one bad seed break me down. Thank You so much for your input. I've had a headache all day worrying about possible license troubles.
Specializes in Psych (25 years), Medical (15 years).
Once upon a time, while working at the state hospital, I was charged with patient neglect/abuse and was suspended for 15 days.
It was silly, really. Patients would come up to the nurses station window and request, as in this instance, Tylenol. I believe many approached me, as in this circumstance, just to get attention from me. I can be entertaining, so I spoke like a TV preacher, laid my hand on the patient's head and said, "Be healed!" The patient went on their way, smiling.
An administrator was investigating another complaint toward me by a doc when a Tech informed him of this situation.
So, I was suspended for accusations the doc made toward me. The notice also listed the patient neglect/abuse claim. I filed for unemployment benefits and won the case; I received pay reimbursement for the time suspended.
I filed a countercharge with the INA to have the patient neglect/abuse charges dropped. It took a year and a half, but the charges were finally dropped. And I was reimbursed by the state for the suspended time off.
So, in essence, I was off for 15 days and received reimbursement from unemployment ​and the state; I was paid twice for the suspended time!
The writer was approached at 1915 by residents family- while attending to a COC of another resident- requesting pain medication. Resident found lying in bed and stated to be in no distress. Once other resident was stabilized the writer administered pain medications. Family stated that they requested another type of pain medication. Residents medications were explained to resident whom is alert/ oriented ×4. Resident verbally conveyed contentment. Family upset verbally angry, stepping in writers face. Will endorse.
End Note
I would include the part where you specifically asked the resident if she needed the prn Dilaudid, and she said no. And more detailed assessment findings, rather than simply "in no distress." Also include any re-assessments, if any. I would name the meds "scheduled Percocet (?)" and "prn Dilaudid" vs "administered pain meds," "family requested another type of med."
More factual details, but never judgmental details "daughter said xyz when meds and assessment explained, took picture of writer without consent," vs "daughter started to act bat guano crazy."
Hugs!! I'm sorry you're going through this. You acted appropriately! The one little thing I might suggest is if someone makes a request as you are leaving for break, is tell the family who is covering/who they can go to with concerns while you are off the floor.
Edited to add: thorough documentation will show that you acted prudently. Neglect =/= failure to comply with family's every demand.
I also work in a SNF doing admissions, but started out as a floor nurse and what I've learned is documentation is everything. Luckily it sounds like my DON is a lot better at backing us up then yours is, but either way, we still get family members trying to create havok at our facility all the time.
Remember that to prove neglect, there has to be actual harm done to the patient. In this instance, you assessed the patient, the patient did not complain of pain, you stated she was lethargic, which is already a red flag when administering pain meds, so you didn't feel it was appropriate to administer the med at that time. You did exactly what you were supposed to do. Having said that, families can...and will always complain, but usually these complaints are sent to the ombudsman and are dealt with diplomatically. Only actual cases of neglect would ever make it to the board.
I am not sure if "I'm on break" was the best response. "I'm presently off the clock" sounds better and add that you'll find another nurse on the floor to assist.
The writer was approached at 1915 by residents family- while attending to a COC of another resident- requesting pain medication. Resident found lying in bed and stated to be in no distress. Once other resident was stabilized the writer administered pain medications. Family stated that they requested another type of pain medication. Residents medications were explained to resident whom is alert/ oriented ×4. Resident verbally conveyed contentment. Family upset verbally angry, stepping in writers face. Will endorse.
End Note
I started my nursing career in a psych hospital, so became pretty adept at documenting "exciting" events very factually. Unless two patients/residents had an encounter/altercation, mentioning another resident, and his/her situation in the charting is not generally appropriate--though for your private records, it's perfectly fine.
It is technically not within our scope to attribute a specific emotion to another person--you can say that "daughter appeared to be angry" but not "daughter was angry," then follow that up with observable facts: stepping very close to this writer while speaking in a raised voice, taking a photo of this writer without this writer's consent." Something like that, anyway. You want to keep your charting as free of your emotions and frustrations as possible--this tends to demonstrate your level of professionalism. It can be hard to divorce yourself of your frustration/angst sometimes, but it's an excellent skill to develop.
They may have taken your picture but they are not able to use it as evidence against you because it was without your permission. These family members are clearly bullies and use picture taking as a scare tactic. It sounds like you get no support from Administration. There are many good SNF's out there, please don't hate all of us for the poor judgement of one building. Polish up your resume, do some research on Nursing Home Compare on the CMS website, and find yourself a good place who will appreciate your efforts and give you support.
. I won't let one bad seed break me down. Thank You so much for your input. I've had a headache all day worrying about possible license troubles.
Davey Do
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