Hello fellow nurses. I have something to get off my chest, and I cannot discuss this with coworkers so I sought out all of your opinions. FYI: I am a new grad RN, currently working in LTC for about 7 months.
A few months ago, during a med pass at 5 pm (supper), I left a pill in the pill cup next to a resident who normally will take the pill, if not, the aide will help her take it (it was senokot). When I left it there, I acknowledged to the resident that I am leaving a pill beside her and would like her to take it. A family member of another resident sitting at the same table, saw this and commented "She won't remember to take that," in a very rude manner. In response to her hostile personality, I was firm and told her "She usually does take the pill, if she does not, I will follow up and be back to make sure she does". I left saying this and administered pills to the other residents at this time. I came back to the same table while giving a pill to another resident sitting on the same table as this family member and the original person I left the pill beside, I asked the aide "did A.I. take the pill?". The aide responded and said yes. I then proceeded to administer the crushed pills to another resident while waiting for her to finish IN FRONT OF this family member.
This family member then went to my director and reported me for inappropriate medication administration. I was written up for something that did not even result in harm or distress for a resident. I was disciplined for "leaving a medication beside a resident that has dementia," instead of waiting 5 minutes to help her take it, I proceeded to admin meds to the other 30 residents before time runs out.
I honestly feel like this is unfair. Also, my director was very strict and had a look of no mercy when telling me that this is just "unacceptable practice". Also, the family member who reported me has a history of issues with many co-workers, and the management team knows that.
So, tell me, give me your honest feedback. Would you write me up for this? I feel a sense of indignation towards my director.
I think that's fine as long as you're right there to witness administration and you "prepared" the medication. I had a patient who refused to take her PO blood pressure medication unless the CNA gave it to her. The patient's SBP was over 210.
...same thing with family. If I prepare it and I'm standing by, the family can hand it to the patient. Ive never heard of that being a problem.
If the medication were IV, I wouldn't dare.
I would also agree that in some circumstances, this would be OK to do, especially with demented/paranoid patients who may respond better to a particular staff member or family member over the nurse. Nursing in SNFs/LTCs is its own unique environment, and that's where I see this practice more likely to slide.
But in no way does that mean the nurse can hand the CNA/family the med, say "OK, give it, I'll be back in 5" and leave the scene.
I would also agree that in some circumstances, this would be OK to do, especially with demented/paranoid patients who may respond better to a particular staff member or family member over the nurse. Nursing in SNFs/LTCs is its own unique environment, and that's where I see this practice more likely to slide.
But in no way does that mean the nurse can hand the CNA/family the med, say "OK, give it, I'll be back in 5" and leave the scene.
Absolutely! Ya gotta do what ya gotta do and when I mix a med with food, for instance, I'm still standing at the CNAs side while that food is fed to the resident.
It's the risk/benefit balance, again - which is it's more likely that I'll break the time-frame rule and maybe give that senekot with hs meds instead of the 1700 meds (after all, some ltc's are already experimenting with giving non-time-sensitive meds in a 4-6 window) than the right-patient rule, which is what you're breaking when you leave meds at the bedside or dinner table.
I believe she needs to follow the rules. #1 if you charted you gave it. You better have.
#2 A CNA is not a nurse and it is not in a CNA's scope of practice to "supervise" medications being taken by a resident...it is the nurse's responsibility.
#3 As a nurse , we all should keep in the back of our minds that no medication is "harmless".
#4 I'd rather get a med error for not having my meds passed by 0900, then chance losing my nursing license because I was in such a hurry, I couldn't take a few minutes to make sure my patient safely took the medication I administered to them.
If I saw this going on with my loved one, I'd go to the state about it.
You were not supposed to leave meds unattended. How do you know she even took it. You cannot say just because she normally does. Remember if you did not give it to her OR watch her take it OR if you did not document it, then it was not given.
I noticed so many nurses do things that my school said was a no no. I've heard of nurses leaving high risk pts alone in home health before the next nurse or pcg comes leaving the pt in danger, I've noticed other nurses not signing the mar, too much to continue mentioning but you were wrong in this case and i don't blame the other person for reporting you. Let this be a learning moment.
You have to " visually" see that the meds were "ingested" otherwise how do you know she actually took it or what if someone else took it or stole it, what if there was a child near there who could have taken the cup, what you did leaves room for many things to happen
[COLOR=#000000]my director was very strict and had a look of no mercy when telling me that this is just "unacceptable practice". Also, the family member who reported me has a history of issues with many co-workers, and the management team knows that[/COLOR]
[COLOR=#000000]OF course because this is very unacceptable and the fact that this family member has issues with many co workers and mgt I don't blame this person since many nurses are doing things they shouldn't be doing and that has no bearing on what you did. Accept responsibility and be accountable for your mistakes.[/COLOR]
Wrong guys....Obviously, some people forgot what it is like to be a new nurse. Anyway, cupquake, I know you are appreciative by some comments and startled by some that why you are absent, but its gonna be ok. Learn from this mistake and be the best nurse you can be. If you can accept your current mistake and future mistakes then I know you will be awesome nurse in the near future. But pls dont go online to ask for this type of advice, because some people can be unreasonable.Ask a close peer at your facility that you know will tell you the truth and be reasonable at the same time. Thats what I do and my peers do when they ask me for advice.I know sometimes its hard to take crititism. But know that every supervisor/or DON is different. Some give a verbal for first time offenses and other just write you up. Learn my friend, and wish you the best in your nursing career. Have a good day.
New nurse? That's just an excuse. What she did was clearly wrong and what's worse is her attitude thinking she did nothing wrong and want to blame the DON and the concerned family member. The OP clearly doesn't like to take accountability for her actions and instead want to hide on the new nurse excuse. New nurses do lose their license and trust you cannot hide on the new nurse excuse.
What the OP did was something unacceptable because in my nursing school this was basic, I've seen other nurses do things that were clearly wrong and not sure what school they went or maybe it's just them.
Sure if one is a new nurse of course they will make mistakes but not something as basic as this, she obviously doesn't have basic concepts on certain duties. If she messed up on something as basic as this who knows what else she will mess up in.
As I understood it, it was ANOTHER resident's family, not the resident in question's family.... Which, no matter how well intended, it is frankly not her business...
It's everyone business, what if this nurse also takes care of their family member or may need to in in the future? That's the problem these days, people do not like to stick up for others and have that attitude if it doesn't affect me then it doesn't matter, sure it doesn't matter until it happens to you.
That other family member prevented other worse things from happening so this was a good thing, Too many sloppy nurses these days, sloppy work can contribute to patient deaths.
I had a res once who would not under any circumstances take her meds for me and several other nurses. The only way we could get her to take her meds was to let her favorite cna give them to her. I was there in the room trying to get her to take her medicine and she would spit them out at me. The cna asked to try and the res opened her mouth like a little bird and swallowed ever pill. From that moment on I would take the cna with me to give her her meds. I know its not right but sometimes you just have to pray you dont get caught.
As long as you were there to witness the patient taking her meds then it should be ok, if you want to cover your butt even more, place the pills in the patients hand then the CNA and you can witness the patient take her med that way technically the CNA did not administer the meds since you placed the pills in her hand OR even have the CNA place the pills in the patient hand of course just make sure you prepared the meds.
It's better if you place the meds in the patient hand but I understand how some patients can be. Key thing is that you witnessed the pills were taken and look under tongue etc.
If this were observed during a survey the ship would be sunk. Your facility would get some tags.
A family member observing such actions is going to be concerned and likely (and rightly!) report them.
A nurses' practice of short cuts while understandable to the nurse and other nurses' may seem reasonable, the general public and management aren't going to see it that way. They are going to see it as unsafe, uncaring questionable and also as a regulatory, public image issue.
You got caught with your hand in the cookie jar. You get to take the lumps that come with it.
Yeah, I am aware the realties of best nursing practice and the real world. As a nurse, you learn to navigate it.
Sorry, this is too funny...I want to make a wise crack but won't...what part of medication administration do you NOT get???? Really, you got into a pee contest with a family member instead of just saving your butt and doing the right thing? What if a small child can into visit (one who was already sick, even) got a hold of that little yellow pill and ended up in the hospital for diarrhea and volume depletion????? You need to be thankful you weren't fired.
This is one of those situations where we know what we *should* do, but don't because there is an easier way. It's also the reality of nursing. We all take these shortcuts - and the nurse who says they would never DO ANYTHING like this, well - I find that hard to believe. hey
The problem with these shortcuts - is that while they work - is that when we get caught in the act we can't be surprised when we get the slap on the wrist. You know? Because it's truly not the correct way. Or the "safe" way.
Hope that makes sense. :)
(just read the rest of the responses, I should have just said "I agree with Ruas61" )
Don't beat yourself up. Technically, yes, any time you violate (meaning don't adhere 100%) to any specific policy, it is a potential write up. I don't know this DON and would have to see the way she talked to you in order to know if she was being overly harsh.
It is just a fact that you can be written up for violating a policy whether or not safety was at risk in the specific situation. Whether you will be depends on the attitudes of the admin and culture of the unit, and who notices that you violated a policy.
I hate to say it, but don't ever trust a family member. When I worked in LTC there were times when family members asked me to do something that violated a policy but didn't necessarily pose a lot of risk, then complained when I said that I could not violate policy. In a few cases, I saw a coworker say yes to the same request, only to have that thrown in their face by that family member when they asked for and didn't get the answer they wanted for something else.
It is so hard being new to nursing and trying to figure out how to get everything done and follow all of the rules at the same time. I've been a nurse for 17 years and there are times when I struggle with it myself. Shoot, I rarely have a day when I can do all the things I need to do, and am not tempted to cut a corner. There is just so much to do, it is easier in the moment to rationalize that senokot will not be the cause of death for this patient. However, if you cut corners, you will live in a state of constant stress, knowing that any one of those instances could come back and bite you in the a**. The stress of getting everything done is mostly temporary. You will never have to go back and repeat that day again, and can start over the next day. Easier said than done, but if you don't violate policies, you can detach and not worry about what happened that day once you leave work. If you break a rule, you will worry that someone will find out for much longer.
Hang on. It gets better. What seems like defensiveness, I am taking more as a sign that you are thinking "Why am I being forced to fit all of these duties into this short time span, there is no way!"
Find someone that gets their job done within the time given, and has a good reputation. Then tell them that you have noticed they manage their time well, and could really use some advice, tips, or help because you are struggling. Not all nurses eat their young- the ones that do are the ones that are hungry because they didn't get to eat lunch. Always team up with a nurse who takes breaks. They are less likely to munch on the newbies.
You can do this. You asked for feedback. That takes courage.
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
I would also agree that in some circumstances, this would be OK to do, especially with demented/paranoid patients who may respond better to a particular staff member or family member over the nurse. Nursing in SNFs/LTCs is its own unique environment, and that's where I see this practice more likely to slide.
But in no way does that mean the nurse can hand the CNA/family the med, say "OK, give it, I'll be back in 5" and leave the scene.