What did I do wrong?

Red Kryptonite · Jan 14, 2015

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?

Yep, you kinda have to. I've had to go toe to toe with my own boss on this issue. Bottom line, I am responsible for knowing my scope and protecting my certification, and no one else. The nurses know better, but as demonstrated by this case, some just don't care. They'll push you outside your scope to make their lives easier. This risk is especially prevalent in home care situations and I remember being warned about that in my training.

I wish there were a way to provide some ramifications to nurses who push CNAs like this, but I'm not aware of any. Just take responsibility for yourself and your choices.

When I pushed back, I was afraid of losing my job, but at least if I lost my job, I'd still have my certification to find another one with. If crap hits the fan and you get your cert pulled, then you can't work as a CNA anymore and it might impact your ability to go to nursing school if you want to. Not worth it.

toomuchbaloney · Jan 14, 2015

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.

1) you work at a retirement center as a nursing assistant or similar and you must follow THEIR rules and state guidelines for interaction with medications.

2) You indicate that you were assigned to "sit" with him which suggests to me that the fellow is confused, agitated, or is otherwise a safety risk to himself or others.

3) It is appropriate to call hospice triage when there is a change in the condition of the patient. Further, it is typical for the hospice triage nurse to decide, over the phone, if a prn medication might relieve the symptoms without requiring a nursing visit. Good agencies will want to follow up over the phone 45-60 minutes later to discover the results of the planned medication dosing.

4) The hospice triage nurse should have access to the medication plan of care and should have known that there was ativan AND haldol in the residence available for use.

5) If the family knew that the very elderly patient experienced paradoxical affects from benzos then the triage nurse should have known that too, it should have been clear in the record. That med should have been removed by the case manager.

6) If you did not administer the medication you did nothing wrong, in my opinion.

7) It sounds like the very elderly wife is not competent to manage the medications of this hospice patient and other arrangements should be made by the son and the hospice agency.

8) A significant change in mentation for this guy could be indicative of a number of things; UTI, a transition toward the phase of active dying, other infection, unrelieved pain, etc. I hope his hospice RN visited him the next day.

Be careful about making comments referencing your status as a "nurse", you are not until you graduate and successfully pass the test and intimating as much can also get you into hot water.

good luck

RN2serve · Jan 14, 2015

We all make mistakes. I put a pt in the ED giving an enema. They bucked and came down on it and my fist causing a tear and bleed, but boy did I feel awful and have not done an enema since. When the state did our annual survey I was interview by them for the incident. Fortunately I charted well and the state did not write me up or the facility for it.

On the part of delegating; like everyone said the triage nurse should not have given orders to you. I had a CNA who was in school and I had a pt who did not like me. I asked her where she was at in her schooling, had her review the meds that the pt was getting and why and then still witnessed her give the meds. The pt wouldn't take them from me. I even wasted the meds I pulled and had her pull fresh meds so she knew what she was giving. I charted meds given by and witnessed by in my notes. I did not turn over the care or delegate the care, I used the resources that were available to help care for my pt. Once their meds where on board they were compliant the rest of the day to me taking care of them. He just likes young blondes over the old grey haired lady.

ktwlpn, LPN · Jan 15, 2015

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.

Please read the posts again and more carefully this time.-this CNA works in ASSISTED LIVING. She did not PASS the med. She was well within her job duties.She has no idea what the rights of med admin are,she is a CNA.

The son is experiencing complicated grieving,that's why he is "upset".The OP wells knows her duties in her AL.

taggart84 · Jan 15, 2015

Ksrn20- how? I see no way to do it on my iPhone. When I brought the topic up in the site suggestions section I was told it was eliminated to save clutter.

Touch the quote once lightly. Quote is an option.

mzsuccess · Jan 15, 2015

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.

Heather thanks for you're opinion. But you obviously have no idea about AL. I know my scope of practice and its an insult to say I don't. Please don't feel like you know me as a Cna. Have a great day.

mzsuccess · Jan 15, 2015

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.

Its the way the son And hospice set it up. We open the box and the wife give the meds. All we do is remind and open the box. They have sticky notes on all the meds and the wife chose for agitation since the triage nurse said Ativan was for agitation..the wife got confused there. She's not all the way incompetent but her memory isn't that great. But its the son wishes to have his Mom give meds if he's not there. But that med was dc'ed and wasn't pulled from his med box. But my supervisor said things were blew out of proportion and I was in my scope that the med doesn't or didn't cause Dad to act crazy he's just declining. But if the son didn't want him on, the hospice nurse was suppose to pull the meds. It wasn't even in his charts that it was suppose to be pulled.

mzsuccess · Jan 15, 2015

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. :)

Yeah my supervisor said the same the son is looking for everyone and anything to blame. Thanks for your advice, honesty and encouragement. It means a lot . I will remember everything you said when I become a nurse.

mzsuccess · Jan 15, 2015

1) you work at a retirement center as a nursing assistant or similar and you must follow THEIR rules and state guidelines for interaction with medications.
2) You indicate that you were assigned to "sit" with him which suggests to me that the fellow is confused, agitated, or is otherwise a safety risk to himself or others.
3) It is appropriate to call hospice triage when there is a change in the condition of the patient. Further, it is typical for the hospice triage nurse to decide, over the phone, if a prn medication might relieve the symptoms without requiring a nursing visit. Good agencies will want to follow up over the phone 45-60 minutes later to discover the results of the planned medication dosing.
4) The hospice triage nurse should have access to the medication plan of care and should have known that there was ativan AND haldol in the residence available for use.
5) If the family knew that the very elderly patient experienced paradoxical affects from benzos then the triage nurse should have known that too, it should have been clear in the record. That med should have been removed by the case manager.
6) If you did not administer the medication you did nothing wrong, in my opinion.
7) It sounds like the very elderly wife is not competent to manage the medications of this hospice patient and other arrangements should be made by the son and the hospice agency.
8) A significant change in mentation for this guy could be indicative of a number of things; UTI, a transition toward the phase of active dying, other infection, unrelieved pain, etc. I hope his hospice RN visited him the next day.
Be careful about making comments referencing your status as a "nurse", you are not until you graduate and successfully pass the test and intimating as much can also get you into hot water.
good luck

You're right but I never claimed to be a nurse. In Cna training we were taught to never present or introduce our self as a nurse. I only said I was in nursing school. But yeah thanks

ktwlpn, LPN · Jan 15, 2015

This thread is so annoying.People are jumping ALL OVER the OP without even reading her posts,assuming they know what they are talking about.It's a fine example of how witchy and snotty we nurses can be.And it exposes these people,their ignorance and low self esteem is what causes them to try to take someone else down,it's a darned shame.

nurseprnRN, BSN, RN · Jan 15, 2015

OK the med that was given was called
Cp HALOPERIDOL it said to be given for agitation. But people call it ativan and I don't think its the same. That's the name I charted for the med.

No, it sure as heck is not the same. "Ativan" isn't a code word or something for "makes people quiet down."

I know that standards are different in home hospice and in AL, and I know that you now know you greatly exceeded your legal scope of practice by even touching it. I believe that if you are a CNA, you get that designation from the state, and it comes with legal limitations regardless of what is allowed or common practice in AL. I mean, just because an AL says it's ok for LPNs to do initial assessments doesn't mean it's OK by the state nurse practice act, which is in force no matter where you work. If you are not a CNA, but an unlicensed and uncertified helper, then you would have no reason to know CNA standard of care or scope of practice, and your employer is responsible for what you do, even if it's bad practice, if it's not specifically prohibited in your milieu.

Now we hear that you charted it too, and inaccurately to boot. Hot mess, indeed. But your employer's mess to clean up.

nurseprnRN, BSN, RN · Jan 15, 2015

Thanks a lot and for your positivity. I so appreciate it. It just make me want to give up like I'm not good enough to be a nurse now.

You might not be good enough to be a nurse now but you could be good enough to be a nurse after you go to nursing school and learn how.