Recently terminated

MrChicagoRN, RN · Dec 21, 2014

I am sorry that you lost your job. This could have been a teaching opportunity, but....

Medications Should never be left at the bedside for later. This is an unsafe practice, as you don't know if or when any, or all, of the meds were taken. What if the patient drops a pill or two? Or someone decides the "green one isn't needed?" Or, it's one for you, one for me, from the family.

perhaps during days the wife helped by giving the pills under the direct observation of, and assistance from, the RN.

Anytime a patient doesn't want to take their meds, you take them with you, and come back later. Never leave meds at bedside unless you have a specific order.

PacoUSA, BSN, RN · Dec 21, 2014

As a general rule, I never document meds as given until I physically see the patient take them or I administer them via PEG or injection or IV. Also, I would never leave meds at the bedside for patients to take "later" ... If they are not ready to take them when I am there, I leave the room with them and come back later. This also applies to something as simple as simethicone, and it goes without saying that it applies to narcotics as well. While I can see their point about false documentation with respect to meds given in this manner, I do believe this should have been a re-education opportunity as opposed to a flat out termination. I know this is hard to grasp right now, but consider this their loss and a chance to pursue work with an employer that values you more. Also go into your next gig embracing the same rule I follow above: never document until the meds are actually administered.

Oh by the way, if a patient refuses a medication ... I no longer stay at the bedside begging for them to take it like I did when I was a new grad. Ain't nobody got time for that with 5 patients. One NO is enough for me to document Patient Refused and alert the doctor accordingly. Patients have a right to refuse medication, any medication, it is outlined in the bill of patient rights they get upon admission. The best thing we can do is educate them on what the medication is for and why it's important for them to take it. If they refuse again, that's on them, and documenting that you educated them despite refusal and alerted the MD protects you.

Pangea Reunited, ASN, RN · Dec 21, 2014

With the exception of those giant bottles of bowel prep solution, I never leave medication at the bedside. There are just too many variables ....

The patient could take it hours later, or not at all. It could end up on the floor, picked up and taken by the patient's roommate's child. In some bizarre cases, the patient's family might want to take it or even sell it. Some hospital medications have street value.

I do appreciate families who assist with difficult patients, but I never leave them to accomplish the task, alone.

If a patient refuses and I feel the medication is important, I'll leave and re-approach the patient after a while. If it's a relatively unimportant medication, I just chart it as refused and discard it.

Termination does seem harsh for a first time offense with no bad outcome. I'm sorry...

TheCommuter, BSN, RN · Dec 21, 2014

Per most board of nursing statutes, if the nurse did not administer the medication or physically witness the medications actually being taken, then no proof exists that the medication was ever given. Therefore, in the eyes of the law, the medication was never administered.

If a patient is not ready to take the medicine, I will lock the medication in my med cart and return in about an hour to try again. However, I never leave medication at the bedside, even if the patient or family insists on it. I also would not hand pills over to a spouse to administer unless I stood in the room to see for myself that they were swallowed by the patient.

When you leave pills at the bedside, you have no proof that they were taken by the patient for whom they were intended (other than the patient's word).

JustBeachyNurse, LPN · Dec 21, 2014

You are always wrong to leave medication at bedside and chart that you administered. You can observe a family member, within facility policy, administer medications I know this some times happens in pediatrics and difficult patients. But to leave at bedside for self-administration or family administration will leave you in the same scenario you are in now--terminated for false documentation and risk being reported to the BoN for failure to follow the standard of care. Very difficult lesson to learn.

OrganizedChaos, LVN · Dec 21, 2014

As others have stated, you can never leave the medications in the room with the patient. You have no way of truly knowing if the patient took his meds. It would have been one things to have handed the meds to his wife & he took the meds while you were in the room. But to leave them there to take later is a no no. As one poster said, you could've taken them with you & tried again later. If he still did not want his meds then you would mark it down as refused.

I think it's a bit much to terminate you over this, if you don't have two other strikes. But learn from this & start applying to new jobs. Good luck.

roser13, ASN, RN · Dec 21, 2014

OP, are you a QMA or LPN? I am honestly surprised that your training did not include this very basic safety precaution. Since you have been doing it for 2 years and no one has corrected your practice, I can understand your surprise at being terminated. I do think that termination is harsh if you otherwise have a clean slate.

BuckyBadgerRN, ASN, RN · Dec 21, 2014

Great replies so far, I won't bother repeating any of it! I am curious however, if this seemed to be standard procedure with this patient, why was it YOU that caught heck for doing it? Who turned you in and decided that you would be the almighty example of what not to do?

roser13, ASN, RN · Dec 21, 2014

Great replies so far, I won't bother repeating any of it! I am curious however, if this seemed to be standard procedure with this patient, why was it YOU that caught heck for doing it? Who turned you in and decided that you would be the almighty example of what not to do?

Someone else speculated that the RN who endorsed the practice might have neglected to mention that he/she also stayed in the room to observe the patient take the pills.

imintrouble, BSN, RN · Dec 21, 2014

I never leave a med at the bedside. It's one of those things I learned that's actually stuck in my brain all these years after school.

While I might have learned that in school, as a seasoned nurse I can give you a dozen different reasons why it's a bad idea. Even if you leave it with a family member.

I wouldn't have been fired if I had done the same. Written up and reprimanded maybe. But not fired. Is it possible you'd been warned before about leaving meds? That's a really basic, universal no-no as far as nursing goes.

Gooselady, BSN, RN · Dec 22, 2014

I'm surprised you were fired.

We had little cubbies in the patient's room that had locks on them. We encouraged participation by family members, and I was FINE with allowing family to give medications for me. I'd lock them up in the cubbie and have the family call up front to let me know they were going to give the pills. Then I'd go scan them as administered.

Apparently if the state comes in and does a surprise survey, finding meds in the patient room is a whopper. The reasons you left the meds in the room were benign, even understandable. But the whole hospital will get smacked over it, and this can put their accreditation in jeopardy.

I agree that a reprimand and some follow up would seem more appropriate . . . I'm sorry this happened, what you INTENDED was no harm at all, though let's underscore how much that doesn't matter. I'm always amazed at what people get fired over, but I think my one and only hospital job, lasting six and half years, was administrated by a 'forgiving' bunch. People got educated, put on 'behavior plans' for serious issues, and finally let go if none of the previous interventions worked.