Working with a nurse who does things her own special way...

JBMmom, MSN, NP · May 23, 2014

While I can see your concern I think you partially answered your own question. If management is likely aware of how she operates, they've clearly made the decision that the benefit outweighs the risk. Until she has a med error or incident of some sort that requires action, they're likely to be happy with a nurse that comes in, picks up and must at least pass as competent in her job. You're unlikely to change her habits by bringing it to anyone's attention, and it could come back and bite you if you're perceived as "not a team player". You have to do what you feel is right, though, and if you see something that you think will cause serious problems, you might speak up. I'm surprised that none of the family members have mentioned anything to a supervisor about being asked to administer their loved ones medications.

Nola009 · May 23, 2014

Thank-you, JBMommy. One of the family members asked (I would take it as a nice way of info gathering/complaining) 'if it is okay that I give my mom these medications, or does a nurse have to give them?' --- the resident's nurse (you know who) crushed the meds up, put em in applesauce, and then put them on the residen'ts tray for the family member to give along with meal. I told her that I could not administer a medication(s) that another nurse had prepared, but I would be happy to go and get the nurse who did prepare/left those meds. She KNEW who set them there, and yet didn't say anything (not her job to, anyways). I felt very bad for the visiting family member as well as the patient! Guest declined that I ask the other nurse to administer...

systoly · May 23, 2014

you guys have PPD?

i'd wanna draw it up ahead of times and look at it for a while myself :)

ktwlpn, LPN · May 23, 2014

While I can see your concern I think you partially answered your own question. If management is likely aware of how she operates, they've clearly made the decision that the benefit outweighs the risk. Until she has a med error or incident of some sort that requires action, they're likely to be happy with a nurse that comes in, picks up and must at least pass as competent in her job. You're unlikely to change her habits by bringing it to anyone's attention, and it could come back and bite you if you're perceived as "not a team player". You have to do what you feel is right, though, and if you see something that you think will cause serious problems, you might speak up. I'm surprised that none of the family members have mentioned anything to a supervisor about being asked to administer their loved ones medications.

I have had several family members in LTC take the med cup out of my hands and give their loved ones the meds themselves while they were feeding them.I observed and made sure the meds were completely consumed before I walked away so it was not a time saver. I don't see a problem with that but just putting them on the tray for the family to give is poor nursing practice.

If I discover a bandaid that was not changed on the previous shift day on a little skin tear I'll take care of it and move on. Others will put that bandaid in a baggie and give it to the supervisor. If I find a cup of meds in my med cart in the morning I will give the person I followed a "head's up" when I see them next. If it happens repeatedly then I will bring it someone's attention.

Even though pre-pouring is now against regulations and no-one would do it in front of a surveyor I do believe it can be done in a safe manner. I don't do it but I have worked in the past in settings where it was accepted. The meds were in a marked cup and covered with another cup. No spillage happening, no mixing up of the residents.

There are two kinds of people in the world-the kind who get through the day by trying to do good and the ones who worry too much about what others are doing .They seem to take a particular kind of pride in stirring up crap and in my experience Karma ALWAYS gets them in the end. Who do you want to be?

Nola009 · May 24, 2014

^ Thanks for your comments ktwlpn. Like I said, this nurse left the pills and it was obvious that the family members didn't grab pills out of her hand. I would think that the "bad karma" would likely follow bad nursing practice. Not merely noticing the bad practice. Or, noticing bad practice and not saying a word about it! Anyways, I am not one to pick apart my coworkers' behaviors. I was just rather surprised and wanting to know if that was really unusual behavior.

HappyWife77, BSN, RN · May 24, 2014

Everyone has their own little routines that work for them.

In LTC, believe me you have to get good at your your game to be efficient and on your game. There are some short cuts that are better for time management, and there are some that are straight-up dangerous. (Pre-drawing insulin is one that could be really dangerous).

She is practicing by her licensure, which is a relief your are responsible for yourself. I would mostly worry about your assignment unless you feel residents are in jeopardy. We have to pick our battles wisely because energy is valuable and really, she's been there a while and management is aware of her work history right?

At least you know it's wrong, the horrible thing about not practicing lawfully is when state comes in then the shoddy nurses sweat to try to do things right, and BELIEVE ME state recognizes when nurses do things properly naturally or they are just doing (trying to anyways) them properly when being observed.

As a newer nurse Nola, keep your standards and don't compromise your practice, use them to be the best nurse you can be. It is great you readily recognize what is wrong and are concerned, however pointing out other workers discrepancies and issues at times can make going to work a pain. I would keep focused on your residents and assignments unless she is dangerous or harming her residents.

Good luck!! :up:

Ruby Vee, BSN · May 25, 2014

You're best off just worrying about your own practice and not trying to monitor someone else's. (Unless, of course, your job is monitoring the practice of others.) Pre-pouring meds used to be an acceptable practice, and as long as management knows about it and has decided to let it pass, there's little you can do about it except make yourself part of the problem. It may come back on you as being "less than a team player." You already know how YOU want to practice, so be the nurse you want to be and let the other nurse be the nurse she wants to be. As long as she doesn't make a serious medication error, it's unlikely to become a problem for you.

Besides, she'll be gone in about a year, and when the new nurses come to replace her, you can train them in the right way to do things!