Trying to learn from mistakes

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

That's just flat illegal, not a scope of practice issue. Why did you mislabel it?

I reported it to managers. They were taking care of the issue. It is illegal yes. My apologizes for mislabeling it. That act they did made it extremely difficult to trust them, since it should be common sense to NOT do that.

I reported it to managers. They were taking care of the issue. It is illegal yes. My apologizes for mislabeling it. That act they did made it extremely difficult to trust them, since it should be common sense to NOT do that.

So, you were let go and your preceptor still has a job? Something does not seem right.

In this case, yes, my preceptor would have a corrective action as they saw fit (whatever that may be), but retained her job. I was still within my 90 days, and they had overstaffed making it easier to let me go.

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

So Yes, I am CERTAIN the preceptor went outside her scope.

In some settings and under some circumstances, medication administration can be delegated to a PCA.

"Borrowing" medication from another patient is common practice in some settings.

also it was not prescribed yet either.

Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

So Yes, I am CERTAIN the preceptor went outside her scope.

It's not really as clear cut as all of that. In some situations, delegation to a PCA is allowed. And there are degrees of delegation. If the PCA is feeding the patient and I have a pill to give, crushed up in pudding it is reasonable to hand the PCA the pill mixed with pudding and have her feed it to the patient. That is not delegation of medication administration. I pulled the med, identified the patient, crushed the pill and ensured that the patient received it, and then I charted it as given. All the PCA did was hold the spoon. *I* gave the medication.

Also, in some situations it is not only appropriate but desirable to take a medication from Mr. Jone's drawer to give to Mrs. Smith. The physician gave me a verbal order to give it because the patient needs it right now. He'll put in the order as soon as he contacts IT so they can remind him of his current password for the order entry system. I cannot get the pill for Mrs. Smith from the pharmacy until two hours after he orders it, and Mr. Jones won't need the pill for another four hours. As soon as I get Mrs. Smith's pill from the pharmacy I'll put it back in Mr. Jone's drawer. That has been common practice for years, although the practice is gradually fading away as medication administration systems change.

There is the 5 rights in medication administration to. You wouldn't be able to go through the 5 rights if the names do not match. Completely unacceptable.

And as mentioned previously, the hospital has rules against it, and in this case, managers agreed it was never allowed.

And some states does allow the PCA to aid a pt in administering meds, however, with babies, I strongly am not okay with them administering meds. Other than "handing the meds" to the pt, while I stay in the room and see that they hand the meds to them. I am not comfortable with that under my license if I would have left the room. In addition, I need to be able to assess the patient before administering and might as well administer myself. I am very uncomfortable with the practice of having UAPs give medications, and will not under my license. As mentioned above, it is a moot point, because as previously stated, hospitals had rules against it, and managers already stated it was out of scope, at least at this hospital.

Geeze, I thought you were referring to patient controlled anesthesia and narcotics. And then I was confused by posters calling this common or acceptable practice.

I still wouldn't call that outside of scope but rather outside of usual protocol. Whether it should have been enough to throw you off center I'm not sure. I think it's more of the need to develope discernment and judgment gauged to the situation. Some come by that inherently, for others it's more challenging. Your communication style might be inflexible to the personalities you're working with and will face in future jobs. So perhaps that's the first step, learning how to work with different and challenging personalities.

Nevermind! I can tell this is useless!

The wonders of PIXIS allows those kinds of meds to be given without under someones elses names in emergencies. :) And a verbal order is still an order :)

Also, hadn't had problems with other nurses. I was a PCA myself also, not a problem there either. Always had high ratings in work performance.

And again, Hospital has policies and rules & regulations against it, and managers agreed it was not okay.

Thank you. As mentioned way early in the posts, I originally didn't want to talk about the out of scope part since it was dealt with under where I worked, and managers said it was out of scope (at least at this hospital), and not okay to take from other patients medications. In this case, that is all that matters, moving on.

Thank you. As mentioned way early in the posts, I originally didn't want to talk about the out of scope part since it was dealt with under where I worked, and managers said it was out of scope (at least at this hospital), and not okay to take from other patients medications. In this case, that is all that matters, moving on.

I will say it again--there is a difference between nursing school nursing and real world nursing. You have not been around long enough to realize that. That's not an insult. That's just reality. I agree there are some things that cannot be compromised. But you will find out that nursing is not always black and white. It is usually various shades of grey.

I erased my previous post because you seem very rigid in your thinking--unwilling to even consider any other point of view and I thought it futile to even try to communicate with you. I'm not even sure why I'm trying again to reach out other than you said you were trying to learn from your mistakes. So, call me an eternal optimist but I'll try again.

There will be times in your nursing career when the text book way of doing things will not work. Hospitals are full of system failures and those failures will keep you from effectively doing your job and providing the best care for your patients. You will have to learn ways around those system failures. And yes sometimes that may mean temporarily borrowing medication from one patient's supply to give to another patient. Same medication. Same dose. Your other option is to be written up for a medication error for a missed dose. And/or allow your patient to needlessly suffer uncomfortable symptoms or side effects from not receiving their medication as ordered. Sure you can fax a zillion missing med forms to pharmacy and call them umpteen times--like you have all day to do that? You can fill out incident report after incident report but eventually you figure out it's not going to change anything. (By the way, I'm not talking about the particular incident at the hospital you were fired from. I'm talking about your blanket statement that it is never okay under any circumstances to take medication from another patient's supply.) When I was just out of school I thought the same thing. I'm a rule follower too. But sometimes following the rules doesn't work. Sometimes you have to think creatively outside the box. Should it be this way? No. Is it this way? Unfortunately, yes.

You can continue to try to prove to everyone here how right you were in your actions and how wrong they were to fire you (and that may very well be the case) or you can listen to wealth of knowledge that comes from years and years of real world experience from the nurses here who are taking the time to try and help you. Your choice.