Rn not giving scheduled meds

achot chavi · Aug 16, 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.

1. I worked 5 years in NY in SNF's- 1 year as a staff nurse, 2 years as a Head Nurse for 40 pts and 2 years as a PCC for 80+ patients. I guess my place was pretty good but when I started working the place was horrible and after a few months I quit and found a better place (Thank G-d). The DON was very involved as was the owners! It made all the difference

2. Good for you I am proud that you work by the book- too many nurses get sloppy and give us all a bad name

It sounds like you're the kind of nurse I would love working with- I hope the conditions get better for you- You deserve to work in a place that you enjoy and gain satisfaction etc.

buddy5630 · Aug 18, 2006

At the LTC facility where I work, this kind of omission is par for the course. I don't know what to do anymore. No one seems to care about anything except whether or not their relief shows up. I have been in a quandry about this for some time: I have patients who are ordered 10 and 12 mg Coumadin each evening, get a PT/INR back of 1.3 and 10. What?? I have brought this to the attention of Administration and invariably nothing is done. I have changed jobs already twice just this year alone because I keep dreaming that somewhere things are the way they're supposed to be. I am at the point where I give up. Must decide if I am going to play the game and ethically live with myself or starve (nursing is all I know) because the BS that goes on is making me wonder about my OWN intergrity..thanks for the thread and thanks for listening.

CapeCodMermaid, RN · Aug 19, 2006

This whole discussion is VERY disheartening...there are rules and standard for a reason. If nurse made that many errors in my facility she/he would be counseled and then written up and if it continued and we thought residents weren't getting their meds, that nurse would be fired. After weeks of my going on and on about expectations, things are finally being done. One nurse neglected to call a doc to tell him of a very abnormal xray and she was fired for it. Being short staffed is not an excuse for shoddy nursing care.

banditrn · Aug 20, 2006

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.

Achot - I definately understand a lot of what is being said. I worked in LTC in the late 80's, then went to the hospital. Recently I started in another LTCF, and I am amazed at how things have changed.

I am tired of hearing "It's just a nursing home." as an excuse for not taking proper care of someone.

I appreciated the LTC where I used to work, and I knew that they would take good care of my MIL when we admitted her there a few years ago. We moved and it's too far away for me to work at now. I can tell you that I would NOT want a family member of mine in the place where I work now. Some people there care, others don't, and everyone is treated the same.

achot chavi · Aug 21, 2006

Achot - I definately understand a lot of what is being said. I worked in LTC in the late 80's, then went to the hospital. Recently I started in another LTCF, and I am amazed at how things have changed.
I am tired of hearing "It's just a nursing home." as an excuse for not taking proper care of someone.
I appreciated the LTC where I used to work, and I knew that they would take good care of my MIL when we admitted her there a few years ago. We moved and it's too far away for me to work at now. I can tell you that I would NOT want a family member of mine in the place where I work now. Some people there care, others don't, and everyone is treated the same.

OK I understand I have been out of the country and Thank G-D here in Israel the LTC's are heavily audited and generally do a good job (or lose their license and patients).

But what happened to inspections and quality assurance etc.?If nothing else isn't there a standard that the facility MUST live up to?

I don't care if the staff doesn't "care", You do your job if you want one!!

Can CNA's be sued or lose their licenses?(just curious)

chris_at_lucas_RN, RN · Aug 21, 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

Fire her.

She is either totally clueless or a liar or both. She is clearly incompetent, and her patients' pain has been effectively ignored.

Her only redeeming value in this circumstance is that she did not take the meds.

BTW, there was a physician in California sued for malpractice because he did not respond in a reasonable manner to the pain of a nursing home patient. (I just presented an inservice on pain management to a local nursing home.)

A facility that keeps a nurse on, knowing that she deprives the patients of their pain meds is probably courting legal disaster.

JMHO

banditrn · Aug 21, 2006

OK I understand I have been out of the country and Thank G-D here in Israel the LTC's are heavily audited and generally do a good job (or lose their license and patients).
But what happened to inspections and quality assurance etc.?If nothing else isn't there a standard that the facility MUST live up to?
I don't care if the staff doesn't "care", You do your job if you want one!!
Can CNA's be sued or lose their licenses?(just curious)

Achot - well, like most places, if the KNOW an inspection is coming, they get busy, but as long as they meet a certain criteria - which seems to have more to do with paperwork than actually taking proper care of people - they pass.

I called the state inspection agency when I first started there to ask some general questions, and they told me that there are no guidelines that are specific to the number of staff to residents. The lady told me that it doesn't matter how many residents are in a facility, there must be two staff members on duty. And they have to have an RN in house for 8 of 24 hours.

And if all our residents were at least partial self-care it wouldn't be so bad - but they take almost anyone, and we have a LOT of total care residents.

As for the CNA's, I haven't been there long enough to know all the regulations.

CapeCodMermaid, RN · Aug 21, 2006

In Massachusetts, CNAs aren't licensed - they are certified. They can lose the certification for proven abuse but not just for doing a 'bad' job. And, if I fire one today, I can almost guarantee that by tomorrow they'll have a new job in another facility. Any one can sue anyone else for anything, but why sue the CNA who is the most overworked, least paid member of the staff? The facility can be sued and the nurses and docs can be as well. Last article I read said that ER nurses are sued the most frequently and LTC nurses the least and (the article mentioned) it has nothing to do with the difficulty or complexity of the tasks done. You see your ER nurse for probably less than 1 hour. Your LTC nurse ...you see her every day for weeks, months,...etc. People with whom you've established a relationship with are less likely to sue....

Pheebz777, BSN, RN · Aug 21, 2006

I wonder... if she's not giving narcotics, how about the patients regular medications??

In a LTC facility that I had worked in, there was a nurse that was all talk and no walk. When you talked to her she seemed like a smart and well experienced nurse. But in the long run patients were complaining about meds not being given. Out of curiosity I looked at the narcotics cards and none of her signatures in the MARS correlated with the narcotics cards. She signed them off but actually never gave them. I told this to our DON and we had her on observation for 3 days. During those 3 days, she still never have them their medications. The nurse had a meeting with the DON and she stated that she never signs meds unless they are given. Well, she was investigated and it turned out that she wasn't giving anything. No inhalers, no regular medications, no heart pills. She was just acting busy while on duty. Talking to staff and residents.

achot chavi · Aug 22, 2006

:yeahthat:

I would agree but that would be an emotional response. An investigation has to be carried out to determine if the nurse got the meds from another source etc. and give the nurse a warning that she could lose her license etc.

Good to see that there are still places that value quality nursing care!!

Re the Pain Management- it is a bit issue here in Israel- We have to do an assessment for pain with every vital signs and a 3 page form on admission asking about the patients Pain History, previous treatments, alternative treatments (massages, oils etc.) etc.

We use a scale that is drawn so the patient who cant communicate verbally can be assessed as well.

I think we should be focusing on improving our professionalism instead of throwing in the towel and allowing poor nursing care to become the norm.

Where are the Pt advocates?

SilentfadesRPA · Aug 22, 2006

Fire her.
She is either totally clueless or a liar or both. She is clearly incompetent, and her patients' pain has been effectively ignored.
Her only redeeming value in this circumstance is that she did not take the meds.
BTW, there was a physician in California sued for malpractice because he did not respond in a reasonable manner to the pain of a nursing home patient. (I just presented an inservice on pain management to a local nursing home.)
A facility that keeps a nurse on, knowing that she deprives the patients of their pain meds is probably courting legal disaster.
JMHO

if this "nurse" did not report her not giving narcotic meds and left them in cups that means that patients in pain were not medicated -- we are not talking about Vitamins or MOM here. If that was my grandmother or my grandfather not getting meds for pain I would be livid.

I totally agree with the above poster she is a disaster and needs to be terminated with no excuse.

I am not ususally this judgemental but lets get real here.

Marc

speckleddove · Sep 5, 2006

Simply ask her about it!

Don't be a back stabber!

I am certain she will appreciate your direct question rather than speculation behind her back that may wrongfully discredit her.

I had been working on a new job a few months.

There was one nurse that simply did not like the fact they hired me and paid me more.

She never considered all my certifications and 10 years of LTC experience.

She had one year of LTC experience.

A severe snow and Ice storm was scheduled to hit us on a holiday weekend.

Meds were fairly well stocked, however one patient would have run low on Coumadin because the Dr. had just written the new order to increse the dose after pharmacy had already ran.

Knowing this storm Could prevent medication delivery by 2 to 3 days, IF IT DID IN FACT HIT.

And that the pharmacy was on the other side of the state combined with a holiday weekend on top of that.

I ordered a stat order of Coumadin just to be safe since this patient was unstable and the fact his son was his doctor.

When it arrived in a clear packet containing blister packets ( because it was only 4 tablets) not a sleeved card, I simply opened the packet and placed the pills in the pre-existing sleeved box.

I put the empty delivery packet in the med room.

I thought nothing about it.

I was off for the next 3 days.

When I returned to work everyone acted a tad odd.

I blew it off as they were just having a rough day.

Later in the evening, another Nurse that worked midnights called me on the phone to warn me and informed me that the nurse that didn't like me was spreading the rumor that I had not been administering that patient his Coumadin.

Why, because there were extra pills in the sleeved box Compared to the number of Original tablets written on the sleeved box.

So of course it seemed like pills had not been given compared to the number of original pills delivered in that box with the number of days since that specific box had been ordered.

I can see the concern on even her part.

However, she saw this as her chance to get me fired and spread a totally Un-true rumor about me.

I was also informed that that nurse went to my DON and accused me of patient neglect over this matter.

The DON Ordered a stat PTT, etc. to see if the patient was in any danger.

The DON got into trouble because she ordered a PTT that was not covered by medicaide/ medicare and without a Dr.s order.

It came back perfect!

I was furious that my DON of all people had not bothered to call me at home and ask for an explaination.

I was so mad, that I contacted the pharmacy and obtained a copy of my statement of delivery reciept to prove my innocence and to protect my reputation.

If such a situation ever happens like that to me or another fellow nurse, I will advise them and if it is said about me; I will file a lawsuit against the person for defamation of character.

Be fair, Ask her.

Just say I don't understand somthing here, can you explain this so I can understand it.

Do it in a fair, open minded way. Not an accusing way.

She will respect you.

If your just trying to get her fired YOU JUST MIGHT END UP WITH EGG ON YOUR FACE.