gypsywind

Borrowing is NEVER the answer because it sets up a cycle of borrowing. It is however part of the nursing culture. How often does admin borrow from Peter to pay Paul, then Paul works short because Peter is collapsed at home. Same thing except now instead of staff, we are talking about meds. Meds get out of ordering sequence when Peter and Paul borrow. Peter is out of meds and Paul's will not arrive until tomorrow. It is every nurses responsibility to document and notify when a med is not on hand. If the med is not there, it cannot be given. Period. Borrowing is illegal, it is up to every nurse to protect their license. Big pharma does not care about your nursing license. They only care about their business model, which makes them lots & lots of money! If the meds are not on hand d/t borrowing then the system is broken. My guess is the borrowing all started when a med was not delivered even with many pharmacy notification attempts. After many years of medication tracking, I found this to be the root cause in most cases. Nurses MUST advocate, not passively bow to big pharma & admin. It is NOT your fault that a med is not there for your med pass. REFUSE TO ACCEPT BLAME or enable the problem. Part of advocating is a detailed paper trail of admin & pharmacy notification when a med in not on hand. It is not the staff nurse who is in charge of fixing the system, it is administration. This is a system error and should be documented as such on your medication error incident report. If a med is not on hand d/t pharm error, reflect that on your report. Person committing the error... name your pharmacy. You are the one who is reporting the error. When you call the doc, cover your butt and get an order to hold, stat, or replace the omission. Now you have not made a med error... and you show clear documentation to the powers that be, they will know all about a missing med.

Medication Error Incident Report - d/t omission r/t pharmacy.. How do we give a med that is not on hand? This is common problem in sub-acute with no onsite pharmacy; medications change frequently and the MAR must reflect that the nurse gave the right med at the right time... we know the drill. When the meds were not on-hand, where I worked at one the "best" sub-acute facilities, we were told we would get a write-up for borrowing and/or omission, even when we circle & write not available notified PCP! Most of the time it was traced back to pharmacy not communicating with nursing. Time & energy is spent tracking the medication, calling the doctor, and calling the pharmacy because faxing 3 times hasn't worked. After the new "memo" that we must give these invisible meds or risk a write-up, I decided to fire back at the pharmacy. Put blame where blame is due. Why in the world should I or my peers risk a write up, a job loss, or a visit to the BON because pharmacy stated they never got the order but did order the rest of the meds on the same order or the classic, you never ordered the med (most often not true with documentation to back up the pharmacy lie)! The list is way too long for this post of the reasons why we don't have the med, but somehow nursing is always blamed for not giving it, even if it was ordered 3 times in the last 24 hours. In my anger with the new policy, I actually got a bunch of nurses at the facility to join forces with me and we went on a medication error rampage writing up the pharmacy every time a med was ordered and not sent. Even the supervisor smiled when I told her I will write up the pharmacy. In less than a week, 5-20 medication error reports were filed each shift on all 4 units. Now administration was caught in their own policy! It played out perfect. Pharmacy called administration and stated that we needed to stop writing medication errors by omission on them, administration rolled it down to nursing, nursing refused to stop because it was our legal right and responsibility to write a medication error incident report for d/t omission r/t the pharmacy. A medication error incident report requires PCP notification, the doc always knew when the pt did not get their meds. Sometimes a stock med was used in replacement. Also,critical meds were then ordered stat by the PCP, adding $$$ to pharmacy's bottom line. By no means did our pt.'s suffer. Administration quickly realized that they finally lost a battle with nursing. We work short, we get mandated, we get verbally abused by pts & families, we can't stay on the clock to chart (I did anyway) but do NOT threaten us with disciplinary measures when pharmacy is not doing their job! We wrote lots and lots of medication error incident reports, they were not going away just because "they" said to stop. By the end of the second week administration had no other recourse but to go back to the pharmacy and tell them they will communicate with nursing when a medication was not sent - for any reason. That if they missed an order, they will delivery the medication within 2 hours, no matter the time of day or night. If they are out of stock for a critical med, they will sub contract with a drug store pharmacy and the facility will have the med on hand. And of course they will not send us expired meds. Yes, we had immunosuppressants sent that were expired for a transplant pt. At the end of the day nursing won this round with administration and pharmacy. Administration called breach of contract and threatened to terminate. Pharmacy stepped up and we started getting all of our meds in a timely manner. Nursing was not blamed for circling the med and writing omission, med not on hand, see medication error incident report on the back of the MAR. Medication error incident reports took a lot of time out of our already too busy of a day. However I have to admit, it felt empowering to write up the pharmacy for a medication error that admin wanted to blame on nursing!

I remember the day when we would all walk off the hospital or rehab floor together. We truly worked as a team. We were not done until everyone was done. Nursing has become hostile and abusive, it seems to be a national trend.. Those of you who chose nursing for the money or the job security and don't like being a nurse. Go Away. You do not belong here. Is that why nursing had changed so much in the past 5 years? Because of all those people who flooded the market and who are not cut out to be a nurse? All you new grads... all of you who became a nurse because it is your passion, if you are not given the proper orientation, DEMAND IT..!! It is not your fault when you make a mistake without a good orientation. And find a nurse who will take you under their wing. Find that nurse if you want to survive. Retention is a thing of the past, now they just fire you when you hit the pay ceiling. Just about everyone I know has been fired in the past 5 years. It is so common that employers expect it these days. At my present job, I told the truth and was hired the next day. I learned my lesson though.. where I live, it has become common practice to hold two jobs now. It is a way to protect oneself from unemployment. One job is your regular job, the other is causal, pool, contingent or whatever your region calls it. I just finished my BSN, time for me to start looking for that 2nd job now : )

The Canadian's think much different than the people in the US. Canadian Human Rights Commission Policy on Alcohol and Drug Testing Executive Summary (2002). In the Commission's view, drug testing is generally not acceptable, because it does not assess the effect of drug use on performance. Available drug tests do not measure impairment, how much was used or when it was used. They can only accurately determine past drug exposure. Therefore, a drug test is not a reliable means of determining whether a person is — or is not — capable of performing the essential requirements or duties of their position. That said, alcohol testing may be acceptable in some cases, because a properly administered breathalyser is a minimally intrusive and. accurate measure of both consumption of alcohol and actual impairment... Canadian trucking and bus companies wishing to do business in the U.S. may be required to develop drug- and alcohol-testing programs to comply with U.S. regulations (See Appendix). Nevertheless, these programs must respect Canadian human rights law. Canadian human rights law takes a different approach to the U.S. on the issue drug testing — not because protecting the rights of those who abuse drugs or alcohol is considered more important than public safety, but because drug testing has not been shown to be effective in reducing drug use, work accidents or work performance problems. In my opinion it seems that Canada does not buy into the lobbyist from the insurance agencies who are out to make a lot of money drug testing. Also University of Michigan did a research study on drug testing and found similar results. Last I heard, a few years back now, they do not do new hire drug testing or random testing either. For more information about the Canadian Human Rights Commission Policy on Alcohol and Drug Testing Executive Summary (2002). http://www.chrc-ccdp.ca/pdf/poldrgalceng.pdf