Recently terminated

[beausilk74]

Hello all,

I need some advice from nurses who have been in my shoes in the past or any constructive advice that can help me move forward from this ordeal. I was terminated from my job after according to my employer's statement, I falsified documentation by scanning medications but physically I did not witness or give PO medications to a patient with expressive aphasia, instead I left medications to his wife to administer.

So this is my side of story.

After scanning all the medications, as I attempted to administer them, however, he (he is a MD) was not cooperative which it could be due to his medical condition or just he didn't want to. I am not sure exactly why he was not cooperative. So I asked his wife (according to a day RN during shift report, she administers medications for the patient) if she wouldn't mind giving them to him. She agreed to it and I left the room. He was not on aspiration precautions so I was not worried about him aspirating, it just takes time for him to swallow PO meds.

I didn't clarify with my employer whether that day RN did the same thing or not but I knew my employer would not have disclosed that info anyway.

I have been working on that floor close to 2 years and sometimes patients are not ready to take their medications right away for whatever reasons, then I would leave them at bedside until they are ready to take. Was this wrong? Was I supposed to chart as "refused" if they didn't want to take them at the time medications were due?

Please help, I think my head is going to explode and thank you for reading my post.

[AnnieOaklyRN, BSN, RN, EMT-P]

Medication safety is lacking. You cannot document something you do not see, which means that would be falsifying documentation since you documented you administered the medications.

Scary as this is this is the second time in a week I have had to say this- PATIENT'S HAVE VISITORS, VISITORS CAN INCLUDE CHILDREN THAT WILL PUT WHATEVER THEY FIND, ESPECIALLY SOMETHING THAT THEY THINK IS FOOD OR CANDY IN THEIR MOUTH, WHETHER ITS ON THE TABLE OR FLOOR, WHICH MEANS WE NEED TO PRACTICE SAFETY WITH MEDICATIONS AND KEEP THEM AWAY FROM CHILDREN JUST LIKE WE WOULD AT HOME! There are several medications given to elderly people that are on the "one pill to kill" list for children, look it up when you have time!

HPRN

[beausilk74]

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...

I must say, I am still giggling after you mentioned "with the exception of those giant bottles of bowel prep solution" and thank you for making me laugh. I definitely needed that.

[beausilk74]

It was my fault that I didn't clarify whether the day RN statyed in the room to observe the patietnt take the pills or not. We hardly ever talk to each other (and I am intimidated by him). Now that this happened, it would have been better off if he didn't mention anything about his wife "assists" with the pills. I thought it was "ok" to do it because it sounded that was what they "do". And thank you so much for questioning that.

[beausilk74]

I was written up before but not for the same reason. I was never warned and I have witnessed others doing the same/similiar things (yes, I know, it still doesn't make it right to do it) ...(like leaving meds at the bedside or leaving "extra" meds that patient takes at the computer, etc...). So I really thought it was okay. After reading everyone's comments, I understand it now. It sucks that I lost my job but I am glad that noone was hurt and I learned a valuable lesson. However, I will have to elaborate on how my floor is like later. Thanks for your comment.

[beausilk74]

First of all, THANK YOU so much for taking your time to read my concerns/questions and giving me such helpful comments. I am a RN, and it was my first job right after nursing school. I worked at the Oncology floor and it wasn't my first choice but I thought some experience would be better than none, especially when it was tough getting any nursing positions at that time. (I am sure it still is). Anyway, it was my first time EVER to ask a family member to give medications to the patient for me and I physically have given PO meds to the patients except a few times when a patient said "I will take them later".

I know (now) that it's NEVER ok to leave meds either at the bedside or with patients to take "later", it was just a bad night for all of us because we had so many heavy patients. We usually take care of 3-4 patients and on the first night, I only had 3 patients, and one of them was a total. So I spent a lot of time taking care of him compared to my other "stable" patients. Then the next night, when I came back, the 4th patient was added to my assignment. So having two patients who both had expressive aphasia, it was a challenging night for me so I did ask a charge nurse after my shift was over that I would like to take over someone else's heavy patient so I can at least communicate with them to provide a better care.

Then of course, I was asked not to come in that following night and the next thing you know, I was fired.

So this is how my floor is like. If you are in their circle of trust/friends, you can't do anything wrong. They cover for you for everything and anything but someone like me misses one thing, you get write ups. I never have gotten annual evaluations for 2 years I was there. Actually I was on my maternity leave when my manager was doing evals, then when I returned in Sept, he didn't say anything until 2 weeks ago which he cancelled on me but I was never contacted to be rescheduled. So, I feel like I never had a guidance/direction.

Is this something I will lose my license over? Gosh, I really hope not. I read it somewhere that by law, hospital has to report me to BoN that I got fired. Besides those mistakes I have made, I was alway punctual (I was NEVER late) and never called in sick in the first year. I did a few times after having my baby.

Anyway, thanks for caring!! It means a lot to me.

[caliotter3]

My initial reaction is that I think you didn't cover yourself. I was taught that meds are never to be left at the bedside unless there is a valid order. I would not ask a family member to flip the light switch in the room unless I knew there was some policy, order, or precedent to do so. Family members, especially the savvy ones, have a tendency to smell out situations where they can throw a staff member under the bus.

[beausilk74]

I am learning how to cover myself better but I just didn't see this coming. I am not sure if I am just that naive or too trusting or something, I tend to believe what people say. I know it sounds bad. I used to be in the military for 10 years and I never had to deal with this he said/she said BS but now that I am in this field, I started to realize that it doesn't matter what he/she said, I need to find out on my own for sure. And the patient was a MD.

[beausilk74]

I keep thinking that I should have resigned instead of letting my employer to fire me. I know it's too late. sigh~

[imintrouble, BSN, RN]

My initial reaction is that I think you didn't cover yourself. I was taught that meds are never to be left at the bedside unless there is a valid order. I would not ask a family member to flip the light switch in the room unless I knew there was some policy, order, or precedent to do so. Family members, especially the savvy ones, have a tendency to smell out situations where they can throw a staff member under the bus.

I have witnessed this same thing countless times, and can never figure out how those family members benefit by deliberately sabotaging the nurse.

The really bad ones are the families that are on the unit for weeks. The ones we know well. The ones that depend on our kindness the most. I just don't get it.

[MPKH, BSN, RN]

And the patient was a MD.

It doesn't matter who the patient is or what the patient's profession is.

You, as the nurse, is responsible for administering medication in a safe, competent manner. The onus is on the nurse to make sure that the patient has received the correct dose of the correct medication at the correct time via the correct route. By leaving the meds out for the wife to administer, you can not verify that the patient has taken the medication at all. So it was an unsafe scenario that you set up. It also doesn't matter what previous nurses have done--it is YOUR licence and YOUR practice.

Learn from this and best of luck in the future!

[zombienurse13]

That was the first thing they taught us in Nursing School about meds, always watch the patient take them, and never let anyone else give them, especially a CNA or anyone else because you could lose your license. Wasn't you taught this is Nursing School?

[LadyFree28, BSN, LPN, RN]

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.

FYI, LPNs learn NOT to leave meds at the beside of ANY pts; that is a part of Nursing Fundamentals, whether it be a PN, ADN, or BSN program.

Now, OP, the lesson of being terminated, is to move on and improve your practice; hope to heck that they don't report you to the BON either; and ensure YOUR (not another nurse's) actions are within your BON practice; you can never go wrong with it. IF, a pt rather have a family member give the meds, then staying at the bedside is a MUST; otherwise, mark it as a refusal and notify the MD, as others have expressed.

Best wishes.