Would You Report Me for This?

[cupquake]

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.

[TheCommuter, BSN, RN]

Hopefully the OP will return in a timely manner with more thoughts on this issue, especially in light of the illuminating feedback and responses received thus far.

[Tex.]

A pill is a pill is a pill. It shouldn't matter if it is a stool softener or a Norco. Watch her take it, or take it back to try again later. If she doesn't take it right away when you offer it again, then it should be recorded as a refusal. Cover your ***. Protect your yourself.

[heron, ASN, RN]

Well, since the OP mentioned needing to get through a large medpass quickly and that it included giving crushed meds via g-tube, I think it's reasonable to assume that the OP is not talking about outpatient, home care or assisted living. We also know there were visitors present, since the OP mentioned that it was another resident's visitor that reported her.

Did you know that one of the more common - and lethal - causes of childhood poisoning is Nanna's blood pressure pills? A small enough child with severe diarrhea or vomiting can be in real trouble in less than four hours.

I agree that some safety rules and policies we get stuck with are pretty laughable, but this isn't one of them. None of the chemicals we feed people are totally innocuous. Being sure that you are feeding a given chemical to the person who needs it and no one else seems pretty basic, to me.

[NanikRN]

I don't think your DON had a choice to not write you up. A family member came to her/him with a complaint that was clearly not best practice Are you the only one that does it? Probably not.

But you got caught... By a family member( and it sounds like an unfriendly one, at that)

[Anna Flaxis, BSN, RN]

Well, since the OP mentioned needing to get through a large medpass quickly and that it included giving crushed meds via g-tube, I think it's reasonable to assume that the OP is not talking about outpatient, home care or assisted living. We also know there were visitors present, since the OP mentioned that it was another resident's visitor that reported her.

It was LTC. In the dining room, at the dinner table.

Did you know that one of the more common - and lethal - causes of childhood poisoning is Nanna's blood pressure pills? A small enough child with severe diarrhea or vomiting can be in real trouble in less than four hours.

It wasn't Nanna's blood pressure pill. It was a Senokot.

Again, I agree that it wasn't wise, but I think disciplinary action is overkill, unless this nurse has a pattern that needs to be addressed.

[heron, ASN, RN]

I can think of any number of "typical" ltc residents or visitors who could be harmed by taking a senekot they don't need.

I've already said I probably wouldn't write it up. What I disagree with is encouraging the OP to consider it a trivial bit of micromanagement gone mad. It isn't trivial and I'm glad the OP had the sense to find out what all the fuss is about.

[Anna Flaxis, BSN, RN]

I never said it was trivial. Again, I think counseling is in order, but I would not write up the poster unless this is part of an ongoing pattern that needs to be addressed. I think we agree more than we disagree.

[Tex.]

Well, since the OP mentioned needing to get through a large medpass quickly and that it included giving crushed meds via g-tube, I think it's reasonable to assume that the OP is not talking about outpatient, home care or assisted living. We also know there were visitors present, since the OP mentioned that it was another resident's visitor that reported her.

Did you know that one of the more common - and lethal - causes of childhood poisoning is Nanna's blood pressure pills? A small enough child with severe diarrhea or vomiting can be in real trouble in less than four hours.

I agree that some safety rules and policies we get stuck with are pretty laughable, but this isn't one of them. None of the chemicals we feed people are totally innocuous. Being sure that you are feeding a given chemical to the person who needs it and no one else seems pretty basic, to me.

I think it's entirely plausible that she could be in an assisted living facility, and not likely that there are children around. However, I agree that there are safety rules in place for a reason, and we should follow them.

[flyersfan88]

Again, I agree that it wasn't wise, but I think disciplinary action is overkill, unless this nurse has a pattern that needs to be addressed.

Based on the OP's non-chalant attitude since the resident, ya know, totally takes their pills all the time, who knows where the line is drawn in what gets watched and what doesn't.

[SubSippi]

I can see how this could be confusing for a new nurse, because we are taught to do things a certain way in nursing school, then we get out in the real world and see rules being broken left and right.

Like someone else said, experience will tell you which rules you can break. In my opinion, the real lesson here is that you should always go strictly by the book if someone a family member or manager is around. Your manager HAD to do something because a visitor saw you breaking the rules.

[Anna Flaxis, BSN, RN]

Based on the OP's non-chalant attitude since the resident, ya know, totally takes their pills all the time, who knows where the line is drawn in what gets watched and what doesn't.

Maybe this resident does always take her pills. There isn't enough information to decide whether the OP's attitude is nonchalant or reasonable. Honestly, the family member sounds like a bit of a pill, but I do agree the OP could have handled the situation more professionally- and deserves counseling to that effect. But I'm not ready to believe there is a pattern of negligence here that requires a formal disciplinary action.

Also, I want to address this statement:

It is not within the scope of practice for an aide to ensure medication administration.

This isn't totally accurate. In some settings, CNAs can witness self-administration of medications. Home health aides do this all the time. They're not technically administering the medication, but simply reminding the client to take their medications and witnessing them doing so. I'm not certain that this situation was so terribly different.

[twinmommy+2, ADN, BSN, MSN]

I never said it was trivial. Again, I think counseling is in order, but I would not write up the poster unless this is part of an ongoing pattern that needs to be addressed. I think we agree more than we disagree.

But an ongoing pattern won't be established without the papertrail.