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If a QHS med is due at 2100 and the patient refuses THEN comes back and asks for it around 10:30, do I need an order for the late med administration? For example, if it was a once a day anxiolytic. Our EHR system prompts you if you give a med outside the one hour window, and you select a reason. Our policy is one hour before or after, but there are no specifics on this special circumstance. What is the LAW on this? I hate to pester on-call people in the wee hours of the night for something like this.

If one of your newly hired (i.e. fresh out of training and generally overwhelmed) staff members had a hectic shift and left a sharp in a patients room, but then put it away immediately when they noticed it upon their return, would you have expected them to write up a self report? Is that reasonable? Or would you fire them? Thoughts?

I have only worked in a non-medical nursing specialty for about 5-10 years. I have started working for a company that provides home care and other things. I have been asked to care for a patient with a trach. They use a ventilator at night. I have only done a trach dressing change in a lab at school. I have suctioned patients before, and am fairly comfortable with this. I have never done a trach change. The primary caregiver of this patient has a medical background and needs relief at times. They stated they can go over everything with me just one day. My question is IF I read up on trach care/watch videos for 3-4 hours and have this one hour overview of the dressing change, suctioning, and trach change...will this be enough? Or, should I tell the company I am not comfortable doing this? Not all job assignments the company provides are this medically involved, so I should have other options in the future. However, I don't want to seem incompetent or like a non-team player that leaves all the harder assignments for their other nurse. HELP!