What would you do?

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I have coworkers who honestly just do not care. A patient who wasn’t mine approached me and requested a PRN and stated they needed it pretty badly. I informed the patient’s nurse, but she said they’d had it already and couldn’t have it again yet. I looked on the mar myself because I don’t trust this coworker, and it had been almost 8 hours since pt last dose when they could have it every 4 hours. Would you let it go since it wasn’t your patient? Would it be overstepping to give the PRN yourself? I honestly wasn’t sure what to do. 

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,438 Posts

I wouldn't give it, as what if they did give it, and forgot to sign it out. You could end up in hot water. Tell the other nurse that the patient approached you again you looked at MAR, and your findings. If nothing done then, go to unit manager or charge nurse

JKL33

6,208 Posts

As above.

"Hey-I checked the MAR cause they are still asking for it--looks like they had it 8 hours ago and they can have it q 4 PRN..."

Edited by JKL33

Bigwave108

Bigwave108, BSN, RN

Specializes in ER RN/House Supervisor. Has 5 years experience. 7 Posts

A few thoughts.  First, I would definitely not give a PRN to a patient that wasn't mine without checking with the patient's nurse first.  You mention trust is an issue, and if one would to do this, trust would be pretty broken.  Also, this nurse may have a reason why it is not charted yet, like they haven't gotten around to charting, or they do their charting in spurts, not as they complete each task.

Be careful assuming this person is not doing their job (without actually knowing this person, I am saying).  There may be more to the story.  Perhaps the order is not updated and to a current plan of care like if the RN and MD have a plan to make PRNs less available, which is not uncommon with addictive medications or medications that yield  a secondary gain.  

 

The nurse may also think that the patient doesn't actually need it (see secondary gain with opioids, benzos, etc.).   Since it's their patient, you should respect their judgement unless they are doing something dangerous or unethical.  

Maybe communicate with this nurse, tell them why you think they need it, and let them know you are concerned.  Communication is really helpful for building trust.

Big picture, and I know this is an idealized statement, but I would not work in an environment where I don't trust the majority of my coworkers.  I try to work in places where I can rely on my fellow staff, because nursing is too much of a team sport to not trust other RNs.  People who work in units where they can't trust their coworkers inevitably get burned out and carry stress home with them.  It ain't worth it in my opinion.  

 

JBMmom, MSN, NP

Specializes in New NP Hospitalist, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,132 Posts

We've all had those coworkers that are truly riding their chairs and shouldn't be doing the job. But I think that fortunately those nurses are in the small minority. In this situation there are a few possibilities other than outright neglect of the patient.

As others have pointed out, it may have been given and not charted. I know that sometimes instructions will be passed in report verbally that aren't reflected in the order (like if a patient has IV pain medications and they're supposed to be working toward discharge, the IV needs to be minimized), it's NOT acceptable for a nurse to decide when a patient gets a medication they have a valid order for- like I can't decide the patient isn't having 10/10 pain if that's what they report. 

I think in this case it would have been reasonable for you to approach the nurse again and ask to clarify, and then as someone else mentioned, if they're not medicating appropriately, you could follow up with charge or your manager. 

TGBrn2022

TGBrn2022

3 Posts

First of all, it was a HIPAA violation for you to log into a patient's chart who was not assigned to you. Second, just because the patient told you he didn't get any pain medicine doesn't mean he's telling the truth. You have no right to overstep the assigned nurse and give any medication without the nurse's request. There is probably a legitimate reason, which you are not privy to because it's NOT your assigned patient, for not giving the pain med when the patient requested it or for making the patient wait. Maybe the nurse was waiting for a new order from the md? Maybe the patient refused the pain meds are the mar and wanted something else? There could be a number of reasons. Your duty was only to inform the assigned nurse of the patient's request and let her handle it. What if you gave the medicine and the patient had an adverse reaction? How would you feel if she reported you to management for doing this? Just because you don't trust this nurse, doesn't mean she's not doing her job.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,020 Posts

1 hour ago, TGBrn2022 said:

First of all, it was a HIPAA violation for you to log into a patient's chart who was not assigned to you. Second, just because the patient told you he didn't get any pain medicine doesn't mean he's telling the truth. You have no right to overstep the assigned nurse and give any medication without the nurse's request. There is probably a legitimate reason, which you are not privy to because it's NOT your assigned patient, for not giving the pain med when the patient requested it or for making the patient wait. Maybe the nurse was waiting for a new order from the md? Maybe the patient refused the pain meds are the mar and wanted something else? There could be a number of reasons. Your duty was only to inform the assigned nurse of the patient's request and let her handle it. What if you gave the medicine and the patient had an adverse reaction? How would you feel if she reported you to management for doing this? Just because you don't trust this nurse, doesn't mean she's not doing her job.

It's not a HIPAA violation to access the patient's chart for reasons related to their care.  There is no expectation that the nurse assigned as their primary RN will be the only nurse that will be providing them care.

JKL33

6,208 Posts

On 6/15/2022 at 11:36 PM, TGBrn2022 said:

First of all, it was a HIPAA violation for you to log into a patient's chart who was not assigned to you.

Agreeing with poster above me. The action in the OP is certainly not a HIPAA violation. It's hard to understand how an RN would have come to that conclusion.

TGBrn2022

TGBrn2022

3 Posts

At my facility this is considered a violation. Patients' right to privacy is a priority. Patient information has to be protected at all times - no open computers unattended, no discussion in public areas, etc. We are not allowed to open our own medical records.

It is standard practice at my facility that only the assigned bedside nurse and charge nurse have the right to access a patient's medical record. No other nurse is supposed to access this information. If so, it must be for a valid reason - code, auditing. If you are caught violating this policy, you will be written up. We have auditors that monitor this.

One time we had a legal matter with a psych patient in which every nurse and doctor from the er to the floor who came in contact with that patient and/or opened the chart had to give a written statement on why they opened the chart. If you had unauthorized access to the record, you got in trouble for this. I know one nurse who got fired. 

If the OP had a problem with her coworker whom she doesn't trust, she should either discuss with that nurse or escalate to the charge nurse and not overstep. If she had looked into the patient's chart and given the medicine at my hospital, she would be in a lot of trouble.

JKL33

6,208 Posts

8 hours ago, TGBrn2022 said:

It is standard practice at my facility that only the assigned bedside nurse and charge nurse have the right to access a patient's medical record. No other nurse is supposed to access this information. If so, it must be for a valid reason - code, auditing.

So you are never expected to help provide care to patients not assigned to you? Codes and auditing, etc., are not the only scenarios that present valid reasons to access a patient's chart.

In any case, this is your facility's take on the matter--it is not what HIPAA says. It is not a HIPAA violation.

 

8 hours ago, TGBrn2022 said:

Patients' right to privacy is a priority.

Yes, but in this context that comment implies that accessing a patient's chart to provide care that they requested is a violation of their privacy.

 

8 hours ago, TGBrn2022 said:

One time we had a legal matter with a psych patient in which every nurse and doctor from the er to the floor who came in contact with that patient and/or opened the chart had to give a written statement on why they opened the chart. If you had unauthorized access to the record, you got in trouble for this. I know one nurse who got fired. 

Yep. That is standard procedure. I bet the person who got fired was not in the chart to provide care. Providing care is the valid reason to be in the chart. Being nosy is not a valid reason. Charts involving legal matters are always scrutinized.

 

8 hours ago, TGBrn2022 said:

If she had looked into the patient's chart and given the medicine at my hospital, she would be in a lot of trouble. 

That is crazy. I believe you, but just want you to know that is not what HIPAA is about, it isn't what HIPAA says.

When you work for hospital corporations long enough you'll notice that idiotic takes like this tend to go out with yesterday's trash as soon as the hospital decides one thing or another is getting changed for their own purposes/benefits. Then you realize it was never about HIPAA, JC, or whoever to begin with. Just like for years we were told we couldn't have water while on the floor because it was some violation. It never was. It was never a violation of anything, in and of itself.

Your hospital does things the way they do for THEIR purposes, and their purposes likely include the desire to control employees with fear and threats constantly.

I would not work at that place.

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

On 6/18/2022 at 10:28 PM, TGBrn2022 said:

At my facility this is considered a violation. Patients' right to privacy is a priority. Patient information has to be protected at all times - no open computers unattended, no discussion in public areas, etc. We are not allowed to open our own medical records.

It is standard practice at my facility that only the assigned bedside nurse and charge nurse have the right to access a patient's medical record. No other nurse is supposed to access this information. If so, it must be for a valid reason - code, auditing. If you are caught violating this policy, you will be written up. We have auditors that monitor this.

One time we had a legal matter with a psych patient in which every nurse and doctor from the er to the floor who came in contact with that patient and/or opened the chart had to give a written statement on why they opened the chart. If you had unauthorized access to the record, you got in trouble for this. I know one nurse who got fired. 

If the OP had a problem with her coworker whom she doesn't trust, she should either discuss with that nurse or escalate to the charge nurse and not overstep. If she had looked into the patient's chart and given the medicine at my hospital, she would be in a lot of trouble.

At the facilities I’ve been this IS a HIPAA  violation, I mean even if you’re on the same floor. If it’s not your patient you Cannot access the chart.  And if you accidentally open the  chart you have to write a note with the day and time and how or why you accidentally opened the chart

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

I think you should have stayed in your lane. Trust works both ways. I would have told the patients nurse and moved on.