Undermined by administration

[savoytruffle, BSN, RN]

I work in a small SNF (120 beds) as a unit manager. Today one of my LPNs signed for an IV medication delivery. Two hours later the pharmacy called back and said the wrong dose was sent and they were coming back to retrieve it. I was at the NS when the call came through, double checked the med and the order, and then told the LPN that she needed to check doses on delivery and not accept them if they are wrong. The ADON was there as well. As I walked back to my office, I heard her say, "don't worry, it's not your responsibility" to the LPN. I went to the ADON and told her that she completely undermined me and I do think that if a nurse is accepting meds, she needs to take responsibility for the med being right. Has anyone else dealt with this type of thing before? How can a middle manager ever get anywhere with this?

[enchantmentdis, BSN, RN]

Why not just take her aside and explain what you expect from her. It's as simple as that.

[enchantmentdis, BSN, RN]

Wait, she she's in charge of YOU? Tread lightly then

[brownbook]

I understand your being upset but I think you compounded the issue. Telling your boss she undermined you, sure you were upset but you should not try to communicate with co-workers, bosses, even family, when you are feeling upset.

Take a deep breath and think before you talk. You should not be using "you" statements when you are upset. You should be saying "I" as in...."I did not understand why you told the LPN she was not responsible....I would like to discuss the situation....or.....I know the pharmacy sent the wrong dose but the LPN needs to knows she needs to triple check all labels, dosages, etc., when she give a drug."

[classicdame, MSN, EdD]

The BON will probably have a different viewpoint from the ADON. That is the purpose of a license - to have authority, accountability and responsibility for your actions. But be careful how far you pursue this. If you have an opportunity, get a nurse to do CNE on "expectations" regarding BON rules in general.

[kayern]

I can only comment on the ADON comment since I am not familiar with LPN licensure. In order to have a cohesive workplace, Management MUST portray a united front. What she did absolutely undermined your authority. Was she playing good/bad boss? Making herself the safe administrator for the staff? I would have a conversation with the ADON and not make it about "me" but about patient safety, after all that is what the issue is really about.

If the LPN is allowed to sign for medication and hang IV medication then in my opinion, it is ABSOLUTELY her responsibility to insure the dosage is correct before she administers the medication. I would also have a discussion with the LPN about the five rights of medication administration and document the conversation and complete a medication administration error report if the medication was administered. We have a "good catch" policy, i.e., if pharmacy sends up the wrong med, wrong dose, etc we complete a "good catch" form and our CNO sends the staff completing the report a note.

[savoytruffle, BSN, RN]

I resigned the next morning. After speaking with the ADON and letting her know that I feel that she discredits my authority, undermines and micromanaged me I saw no other way. This position was by far the most challenging and frustrating I've ever had. The CNAs said they were sad to see me go. The LPNs said I was the fourth or fifth RN in four years to go through this very same situation with the head LPN and the ADON. I have a 2 week notice and cut ties. I have a reference from the medical director. The last two weeks on the job were horrible. Passive aggression and lateral violence abound here and I was, for all intents and purposes, shunned until my last day. I was not given an exit interview.

I have decided to never work in a nursing home again. I am through. I have a new job lined up working for a fiscal intermediary here that oversees hospital billing for Medicare claims. I am optimistic, and excited to move on. Never looking looking back.

[kayern]

Learn from the experience. Go out and look for another Management job. Good Luck

[savoytruffle, BSN, RN]

Thanks for the suggestion, but I'm finished with management for a while too. I just want to be responsible for myself. Set my own goals and know that my outcomes are my own. For a while, anyway. This whole experience has turned me off managing and nursing homes for a long time. Maybe forever.

[Orca, ADN, ASN, RN]

The last two weeks on the job were horrible. Passive aggression and lateral violence abound here and I was, for all intents and purposes, shunned until my last day. I was not given an exit interview.

I have decided to never work in a nursing home again. I am through. I have a new job lined up working for a fiscal intermediary here that oversees hospital billing for Medicare claims. I am optimistic, and excited to move on. Never looking looking back.

None of this surprises me. My first job in long term care was my last, for many of the same reasons. The facility I worked in paid $2-4 per hour below the area average, consequently they were always understaffed. They were worried to death that a CNA might take one diaper too many during a shift, but apparently not concerned in the least that there were about a third as many CNAs as they needed. Rules were trivial, the workload brutal, and upper nursing management was a revolving door. I worked there for 90 days (long enough to make a connection to get my next job), and I worked under three DONs during that time.

One thing I noticed in both the facility I worked in and similar ones described by other colleagues: The lowest paid employees there tend to be the longest tenured, and ownership tends to side with them. In some respects it is almost an inverted chain of command.

Good luck. You made the right call.

[savoytruffle, BSN, RN]

Thank you Orca. I'm looking forward to my next opportunity. A nice quiet cubical and reviewing charts. I can wear earbuds and listen to music while I work. Monday thru Friday with some OT if I want it!! I haven't had that in years. Hoping to start 9/3!!

[Tampa121]

"When one door closes, another one opens"! You made a great decision-Good luck and you'll be happier!