What did I do wrong?

Published

OK. So I'm a Cna while in nursing school. I work at a retirement center. And I was assigned to sit with this gentlement who had a stroke. One evening while sitting with him he gets really agitated and starts yelling, screaming at his wife. Kept getting up saying things were out the window that wasn't there, asking was he going to doe and couldn't sit still. I thought he was honestly going to hit his wife..I never seen him so upset. Now I'm not suppose to give meds we give them to his wife and she gives them to him. Every other day, the mangers are changing the "what to do" forums and who to call and his son also. He's on hospice. I called the triage nurse because it was late. I explained to her what was going on and I told her he had ativan and she told me to give it to him. ThT was two days ago and now. I get to work and I hear I'm in big trouble and the son is so upset yelling. Saying it was the wrong medicine, but it had his name on it and he's now messed up. Anyway I'm suppose to have a meeting tomorrow and don't know what to expect. I feel bad and everyone is looking at me crazy like its my fault and I don't know what to tell my boss. I feel embarrassed and it makes me not want to be a nurse anymore. Plus the wife is fabricating the story and she isn't all the way in her right mind. How can I handle this or should've handle this? I charted everything, like I was suppose to and other girls gave it to him and didn't chart anything.

Specializes in hospice.
I'm confused, what is it that the son thinks the medication did to his dad?

As I stated earlier, I suspect Dad is declining through disease process and Son is in denial and looking for people and things to blame. We see that a lot in hospice.

That's not to say Dad doesn't react badly to Ativan, Haldol, or any other drug. He very well may.

And I agree that whatever hospice this is completely screwed up at least twice: first, when the dc'ed med was not removed from the patient's med box, and second, hiring lazy-ass triage nurses who can't be bothered to get off their desk chairs and actually go do their jobs. Since I work hospice I find this agency's incompetence and disregard for their patients offensive. That's not who we're supposed to be.

I'm very happy for you, mzsuccess, that your bosses seem to have their heads on straight and aren't eager to punish you. Value that, because employers who will actually stand by a good employee through something unfortunate like this are rare birds indeed. :)

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Specializes in Mental Health, Gerontology, Palliative.
Thanks and like I said I feel terrible. It just said to give for agitation. We're told we're not allowed to administer and let the wife take what she needs. This happened Saturday night.

I still have the guilts over my error..... Again its about learning from your mistake and moving on.

Dont give up on nursing...

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Is there any kind of repercussions for nurses or physicians pushing CNAs to break scope of practice? Or is it one of those things where they can coerce you and make you feel like its a hostile work environment and it's tough sh*t for you?

I'm in CNA classes right now and yesterday my LPN instructor was telling us "NEVER EVER EVER give meds even if the nurses are pressuring you." Do you pull the "It's against the law!" card?

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You need to realize that as a CNA YOU DON'T HAVE IN YOUR SCOPE OF PRACTICE TO GIVE MEDICATIONS. NEVER.

An error occurs if someone went out of line and this is an example of that.

Learn from it and move on. It's very hard to accept that we make mistakes but we do. Go shopping or work out to get your mind away from thinking too much about this error.

WE ARE NOT PERFECT, WE MAKE MISTAKES. LEARN FROM IT and DON'T DO IT AGAIN.

I too made mistakes and have blamed myself about it.

This is not correct. In most assisted living facilities, it is part of a CNA's practice to ASSIST in giving meds (assist being a really broad term). They open prepour med cases, take from blister packs, and otherwise assist in what is supposed to be a pretty independent resident to take their medication. Any number of residents are not really suited for assisted living, and should be at a higher level of care, however, they are kept for the money they pay long after they should be. However, the key is a prepour or locked medication box that is done up by a nurse, that a CNA helps pull from. Doesn't mean it is right or necessarily safe, however, it is done every day.

In this instance, the OP is a CNA at home for a hospice patient. When a hospice patient is at home, again, family (or if able, the patient) has the prepoured/lock box medication they need. Again, and all of this depends on POLICY of the individual agency--they can and do "assist" in administration of medications.

What I believe is the issue is that there was an acute change, and the licensed nurse triaged this change over the phone. And directed to a lock box that was outdated, and unclear on which med was to be given by the cognitively impaired wife--the CNA did the best that was available. Again, I say it was on the licensed nurse who delegated to a CNA to assist in giving a med that was discontinued, still in a lock box.....it would have been no different if the wife called, and the triage nurse directed HER to give a med that should not have been there, used the incorrect name of the med, whatever.

There are also many, many CNA's who take a course on medication administration and are able to give residents meds in long term care. These are stable residents who live at a facility that assists in many ways. Much like there's CNA's who take a course on physical therapy and become restorative aides, focusing on physical function. Does that increase the risk of falls?

Assisted living, long term care, and palliative care at home are very different than an acute care setting.

And thevez, if in fact an error occurs and the documentation is such that the RN/LPN delegated incorrect medication administration to the CNA, it is on the licensed person. The CNA is tasked to give meds that the nurse is responsible for making sure is correct.

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Sounds like there is some family dynamic issues here that are not being addressed. Is the Ativan listed in the allergy list or as a drug that the patient is sensitive to? The son and the wife sound like they are on different pages with each their own viewpoint of what is going on. Ativan would have been the appropriate medication to give someone who is agitated unless they are sensitive to it. Ativan can make some patients worse and this could have been the case here. The son may not want his father to receive these psych type of medications because they tend to make some patients worse and affect their cognitive abilities. It is true you should not be handling medications at all unless you are certified as a CNA and a Medication Aide, the medication aide is a separate certification from the CNA. You cannot legally distribute medications of any kind, therefore, your facility needs to clarify your duties as allowed by your practice act in your state.

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Specializes in Oncology.
On my phone anyway, I hit the "reply" button then when that box opens I hit the "reply" button a second time and then the quote/post I am responding to appears.

Figured it out kind of by trial and error. Hope that helps :)

How about that! Thanks so much! I'm thrilled to be able to quote again!

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Specializes in Oncology.

3. We all make mistakes. Any nurse who says otherwise is IMO telling fibs. I had a fairly monumental mistake just before Christmas. Made the mistake of working with a temperature and totally managed to give the wrong meds to the wrong patient. The patient was ok, however I've done alot of beating myself up over it. I got asked to explain what happened and have had to redo my med competency however certainly learned not work febrile.

Or they're oblivious to their mistakes, which is even more terrifying.

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Specializes in Pediatrics, Emergency, Trauma.
It must---I don't have a quote option on my iphone

You can do what ICURN3020 has been doing :up::

On my phone anyway, I hit the "reply" button then when that box opens I hit the "reply" button a second time and then the quote/post I am responding to appears.

Figured it out kind of by trial and error. Hope that helps :)

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Specializes in Tele, ICU, Staff Development.

So sorry you were put in that position! The regulating body in your state (example, Department of Public Health) has higher authority than the triage nurse re: your scope of practice.

In this kind of situation, you really have to know the scope of practice as well as your facility's policies.

Best- Beth

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Why wasn't there a cognitively intact caregiver with this hospice patient? Our local Hospice would not have admitted a patient without a competent caregiver.

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Specializes in HH, Peds, Rehab, Clinical.

Yes, I see that now.

You can do what ICURN3020 has been doing :up::
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Specializes in ICU.

I'm sorry but I am going to be harsh here. You should not be passing meds at all. You had no idea what you were giving and you obviously did not do the 6 rights of medications. You don't even seem to know your scope of practice. I can see why the son would be upset. You cannot rely on a 98 year old cognitively impaired woman to give an accurate statement. It does not matter whether the other aides charted or not. This is you and your situation. I realize we are in different states but here CNAs do not touch meds. QMAs are allowed to pass meds but they take a course on it and understand how to pass a med. To me you are extremely lucky nothing happened to this patient and you did not get fired here. Yes, people make mistakes, but the OP to me does not seem to understand her job. And what if she kills a patient next time with a medication she doesn't know but it's an innocent mistake. I disagree with most of the people here.

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