Rn not giving scheduled meds

Daytonite, BSN, RN · Aug 14, 2006

Does anyone have an answer for me? I have a new RN that was just hired a week ago. She works only on the week-end. Pharmacy audited the med-carts and books. She was not giving the residents their scheduled narcotics. Narcotic cards were full. But the Mar was signed that she gave them. What do you do in your facility? tinkle

I am curious to know what happened with this nurse? I worked at a LTC where this was going on. Two of us were harping at the DON about it and they finally had the pharmacy come in and audit the med cart before and after a shift this nurse worked where they found all the meds she wasn't giving, including the blood sugars she was making up (they audited the glucometers as well). The facility needs the objective audit of the pharmacy as documented proof of the wrongdoing of these nurses.

Do you know if your DON or the pharmacy reported this nurse to your state board of nursing? She was falsifying the records, you know? Is she still working there? What has happened with this?

goats'r'us, ASN, RN · Aug 14, 2006

i've been trying to think of how someone could accidentally do this, and i've come up with a scenario. it is, may i point out, based on australian practice, so if this isn't how things are done, forgive me..

ok.. what i think could have happened..

i used to work in a nursing home where the rn came around with a big cart, and each patient had a page with their medications listed to be signed off, and a webster pack with their week's medications split into breakfast, lunch dinner and bedtime meds. the idea was, the rn would pop out the meds, and ideally would identify them as they signed them off by checking the info printed on the back of the pack (it'd say, for example, frusemide 20mg: half white tablet. omeprazole 40mg: pink, oval tablet...) i say ideally because usually they just popped everything out, then went down the chart and signed everything that was meant to be given without checking it properly.

but, when the patient had narcotics, they would not be in the same pack as the other meds, because narcotics have to be kept in a double-locked cupboard (a cupboard in a cupboard).

maybe this nurse is from the pop-them-out-and-don't-check-them camp, and didn't realise that the narcotics were kept seperate.

it'd be suspicious if the meds were being taken from the cart but not given, but the fact that they were still on the cart makes me think it was probably accidental. maybe she was so worried about getting everything done in time that she rushed and made a mistake.

Daytonite, BSN, RN · Aug 14, 2006

Here in the United States Federal Laws require that all narcotics must be accounted for. Almost all facilities have a system in place where each nurse must sign out each dose of narcotic that they remove, whether it is from a blister pack or some other way it is stored. It also has to be signed off as being given on the individual patient's medication administration record (MAR). So, in the particular case the OP is talking about, the nurse never took out the narcotic and just signed it off as being given on the patient's MAR. It was probably easy to find this since the narcotics were noted as never being signed out.

In the case we had, some patients were telling us they weren't being given their medications. And, because we had unit doses that were just individually packaged pills all contained in boxes, we noted when we were getting down to one or two pills that were left that new boxes weren't getting opened and placed in the patient's spot in the medication cart (by the way, we have huge medication carts in the nursing homes here, too!) alerting us to the fact that the nurse in question wasn't giving medications. I started counting the number of pills in the pill boxes before I went on my days off and started finding the same number of medications in the pill boxes when I returned to work. I also found two new bottles of liquid medications for tube feeding patients that should have been opened up and used, never opened up by the nurse who wasn't giving medications when I returned from my days off. When aides were questioned it was found that this particular RN was disappearing for hours at a time while on duty and that treatments and dressing changes weren't getting done either. Had she been smarter, she could have covered her tracks better, I suppose, but who knows what was going on in her mind? The bottom line was that she got found out and she quit. The only regret is that I wish the DON or the pharmacy had reported her to the state board of nursing (I still don't know if they did or not because of confidentiality reasons) because for all any of us know, she is in another nursing home pulling the same crap.

LauraF, RN, ASN, CNA, LPN, RN · Aug 14, 2006

I am a new RN in a LTC. I was an LPN in another facility 6 years ago. I just started a new job. I only work weekends. I had two nights of "orientation" which the person I was suppose to be learning from slept. She had the attitude of "what are they going to do fire me". I am now on my own. I am fumbling through the best I can. The med cart is the most disorganized mess I have ever seen. But I am lucky enough that most of my residents will point out an over site on my part. Mostly it is people who want their PRN's but it is not scheduled. I think your DON owes it to this new nurse to point out what was found. Perhaps give her some orientation. LTC's work so short. It's hard to be responsible for so many people in so little time. I think if her skills are there an effort should be made to help her out, rather then gossip behind her back.

Larry in Florida · Aug 14, 2006

Here in the United States Federal Laws require that all narcotics must be accounted for. Almost all facilities have a system in place where each nurse must sign out each dose of narcotic that they remove, whether it is from a blister pack or some other way it is stored. It also has to be signed off as being given on the individual patient's medication administration record (MAR). So, in the particular case the OP is talking about, the nurse never took out the narcotic and just signed it off as being given on the patient's MAR. It was probably easy to find this since the narcotics were noted as never being signed out.
In the case we had, some patients were telling us they weren't being given their medications. And, because we had unit doses that were just individually packaged pills all contained in boxes, we noted when we were getting down to one or two pills that were left that new boxes weren't getting opened and placed in the patient's spot in the medication cart (by the way, we have huge medication carts in the nursing homes here, too!) alerting us to the fact that the nurse in question wasn't giving medications. I started counting the number of pills in the pill boxes before I went on my days off and started finding the same number of medications in the pill boxes when I returned to work. I also found two new bottles of liquid medications for tube feeding patients that should have been opened up and used, never opened up by the nurse who wasn't giving medications when I returned from my days off. When aides were questioned it was found that this particular RN was disappearing for hours at a time while on duty and that treatments and dressing changes weren't getting done either. Had she been smarter, she could have covered her tracks better, I suppose, but who knows what was going on in her mind? The bottom line was that she got found out and she quit. The only regret is that I wish the DON or the pharmacy had reported her to the state board of nursing (I still don't know if they did or not because of confidentiality reasons) because for all any of us know, she is in another nursing home pulling the same crap.

Hey lets not judge until all the facts are in!!!

achot chavi · Aug 14, 2006

It is important to know if this is a one time "mistake" or a chronic case of not not administering meds as per dr's orders (she could lose her license for that). Are narcotics missing... Is she neglectful in other areas? Are her wound care treatments done? You arent clear on how you know that she is to blame for these omissions.

Bottom line is that it sounds like it really isn't your problem, and it wouldn't be right to discuss without knowing all the facts etc. She has her own supervisor- but you can let it be known that you wouldn't (and shouldn't) tolerate such shenanigans assuming them to be true ( we still live in the country where a person is inocent till proven guilty- right)

SO Don't rush to beleive all that you hear!

achot chavi · Aug 14, 2006

i am a new rn in a ltc. i was an lpn in another facility 6 years ago. i just started a new job. i only work weekends. i had two nights of "orientation" which the person i was suppose to be learning from slept. she had the attitude of "what are they going to do fire me".
i am shocked and think this should not be tolerated- if i were you i would demand a proper orientation!!
i am now on my own. i am fumbling through the best i can. the med cart is the most disorganized mess i have ever seen.
so clean it up and organize it with the head nurses approval of course
but i am lucky enough that most of my residents will point out an over site on my part.
how will they learn to trust you? - you really need a proper orientation- for their sakes!!!
mostly it is people who want their prn's but it is not scheduled.
why not???????
i think your don owes it to this new nurse to point out what was found. perhaps give her some orientation.
take your own advice!!!
ltc's work so short. it's hard to be responsible for so many people in so little time. i think if her skills are there an effort should be made to help her out, rather then gossip behind her back.

i agree about the gossiping but y'all in glass houses shouldnt throw... well you know!

supernurse65 · Aug 14, 2006

it's probably a long-term care facility such as a nursing home or rehabilitation.
at the nursing home where i am employed, occasionally a nurse will initial on the mar that she gave a scheduled narcotic; however, she never signed it out or ever took it from the locked narcotic drawer.

no meds should be signed until they are given (at least in indiana that's the law) :no:

LauraF, RN, ASN, CNA, LPN, RN · Aug 14, 2006

I agree about the gossiping but y'all in glass houses shouldnt throw... well you know!

Since I can not get your purple responses to quote I will do it this way.

1. They don't have the staff to give me proper orientation.

2. I cleaned up the work area alone and the weekly day shift girls had a fit. I also do not feel that I as a new person that only works two night a week, have no right to go change everything to "my way". I do plan to address it if there is a nurses meeting. Which I hear they do have on occasion.

3. The meds that were missed were the PRN's easily fixed. I just wrote them down for me to remember they request this. This also goes onto #4 they are not scheduled because they do not always take them during the week. But after excitement of visitors or being up more then during the week. They need their sleeping pills or pain pills.

5. See number 1.

I don't understand why you feel you need to be so harsh. Or maybe I'm just misunderstanding you. I do my best not to gossip. I stay as far away from getting in the middle of the banter. I do my 12 hours and do my best to get out of there.

Daytonite, BSN, RN · Aug 15, 2006

Hey lets not judge until all the facts are in!!!

What in heaven's name are you referring to? I gave, and was referring to, all the facts (that were in) of a case that was similar to the OPs. Did you not read my posts? Where did you jump to the conclusion that I was judging anybody? The nurse I knew was falsifying records and CAUGHT doing it. She was failing to give medications and CAUGHT doing it. She was making up blood sugars and CAUGHT doing it. Those are facts! In many states there is mandatory reporting of these facts to the state board of nursing by the finders of these facts. I don't think you were reading what I wrote very carefully. Maybe you ought to look up the definition of the word "judge".

achot chavi · Aug 15, 2006

Since I can not get your purple responses to quote I will do it this way.
1. They don't have the staff to give me proper orientation.
2. I cleaned up the work area alone and the weekly day shift girls had a fit. I also do not feel that I as a new person that only works two night a week, have no right to go change everything to "my way". I do plan to address it if there is a nurses meeting. Which I hear they do have on occasion.
3. The meds that were missed were the PRN's easily fixed. I just wrote them down for me to remember they request this. This also goes onto #4 they are not scheduled because they do not always take them during the week. But after excitement of visitors or being up more then during the week. They need their sleeping pills or pain pills.
5. See number 1.
I don't understand why you feel you need to be so harsh. Or maybe I'm just misunderstanding you. I do my best not to gossip. I stay as far away from getting in the middle of the banter. I do my 12 hours and do my best to get out of there.

I do not accept your contention that the facility that you work for does not have the staff to give you a proper orientation, I do not accept sloppy med carts (it leads to mistakes and other big problems- remember the first rule of nursing- DO NO HARM)

I do not understand why the day staff has a fit when you clean up- in my facility it is unheard of to leave the unit unless you have cleaned up first!!

It is a good thing to write things down, but dont depend on your old notes from shift to shift because the doctor might have changed the orders. Since you don't work full time it is a good idea to always check doctors orders when you come in to avoid making mistakes.

My comment on gossiping was intended to point out that we are all guilty of it from time to time and not to be too harsh on yourself.

As to avoiding socializing with your fellow staff- I think you SHOULD join in but avoid gossiping or commenting on gossip.

I reread my note and don't think I was being harsh but if it came across that way to you than I apologize. Where I work we are accustom to constructive criticism and welcome it knowing that it comes from a loving heart.

As a sister nurse, I love you and hear your situation. I wish you luck in finding a way to work effectively and safely in the environment that you describe.

If it were me I would ask for a couple of more days of orientation with the head nurse (working WITH her not asking her to take off time for you) and I would see how she deals with the problems you described. You might want to take notes and ask questions in a nonjudgemental form .

I applaud your initiative.

LauraF, RN, ASN, CNA, LPN, RN · Aug 15, 2006

Have you worked in the states at LTC? It is a very sad situation here. It seems very few people want to work in the LTC facilities. I am the "head nurse". The DON does not work the floor nor does she know the little in's and out's of the floors.

And I would of course never just go by my notes alone. I have my notebook and my MAR together. And as far as socializing I never said I don't socialize, I do not engage in the gossip. We talk about our kids or something. We do not discuss other employees.