What to do, what to do.

[needtoknowbasis]

I am an LPN in an LTC/rehab facility in south Florida and have been doing this for about four years now. Where I currently work, I do not have my own "assigned" hall but rather on nights [11p-7a] I work, I am put on a hall where I am needed to be that night. I have run into a stupid and needless situation on one particular hall I have to work anywhere from one to two times a week.

My situation is this: The 7a-3p nurse, we will call her A., loves to get new orders for meds and patches and figures it is just okay to put these on 11-7 and sets them for 6a or if it's anything else, she puts it on 3-11 and sets it at 6p on the MARs and TARs. If the orders says "QD" or "daily," it should automatically go to 9a but she continually ignores this and does whatever she wants.

Our DON is rather spineless and has told me that she knows about the issue and that it has been going on for quite some time yet she has never done a single thing about it. If anyone, such as my ballsy self, tries to set it for the correct time unless otherwise indicated, she throws a fit and writes a fake order WITHOUT calling the MD/DO first to have it 'set' at whatever time she feels like it. She also never starts an antibiotic on her shift but rather leaves it for 3-11 to do by setting it at 6p or 8p even though she is the one who wrote the order for it at 10 or 11 in the morning and that really irks me.

This is only "her hall" that has this going on and everyone agrees that it's ridiculous and stupid and very lazy of her to keep doing so but no one is doing anything about it.

I have been butting heads with her for the year or more that I have worked at this facility to no avail and I feel as if my only other option is to report her. Am I taking it too far? What should I do? Even if I were to follow through and report her, how do I go about doing that? Please advise, fellow nurses/healthcare professionals.

-- J.

[morte, LPN, LVN]

It would seem that you are boxed in. Perhaps photocopying the P+P and attach to the Incident report, send to DON and administrator? If you are corporate the next step would be risk management, I would think.....I basically have the opposite problem in one place I work (I work agency) that nurses don't use any critical thinking and put once a day meds at 0800 whether that is appropriate or not. I think were she is commiting her biggest error, is writing the "fake" order, this could be considered practicing medicine without the requisite license.

[Forever Sunshine, ASN, RN]

1) Being busy is now excuse for allowing a patient to wait for a med.

2) Three-eleven should check charts and call docs to get the orders changed.

3) Check your P+P, it may cover this issue, and you can tell miss slug to "look it up" after you change it to appropriate times.

7-3 can check charts and call MDs to get orders changed just as much as 3-11.

I've done all shifts. 3-11 is just as busy as 7-3 so I'm not even going to get into a shift war. Its not a battle I like to pursue because all shifts are busy.

OP- The time the med should be given is time stated per your facility's policy for daily meds. Ours is 8:30am. So all daily meds (unless otherwise stated in the MD order or facility policy such as digoxin, coumadin, remeron, senna, lantus, ambien etc. ) should be given at that time. This should be in the policy and procedures book if not ask your DON for further clarification.

Its not up to the nurse what time a daily med is. If this was me, I'd change them back to her shift.

[horrorxgirl]

Wow she sounds pretty obnoxious. Where I work, everything is computerized, so the pharmacy picks the times since they are the ones that put everything into the computer system. Also, if someone got an order for an ATB and didn't start it on their shift and it's available from the E-Box, they would get a warning/lecture from our unit manager, and maybe even written up for a med error.