Would You Report Me for This?

anewsns · Oct 2, 2015

I wouldn't write you up for that , but definitely I would swoop in to talk to you. Im not a family member or director, which is a completely different story. This was a senekot to a resident who will take it and an aide who will help. This is unlikely to harm anyone. But, as others have said this is not anywhere near the way we were taught in nursing school and you need to follow your ethics and best practice all the time for many reasons. The senna may have been dropped and swept up by the janitor and the lady may have had a Vaso vagal leading to an increase in bowel meds by the doc leading to loose stools and dehydration etc. That's dramatic but I still try to think in those terms. Doing that in front of a family member is a whole othet can of worms. If it is impossible to deal with your workload then I always try to fight for a better situation.

nurseactivist · Oct 2, 2015

I would not report you. I would try to educate as to why this is not an acceptable practice. Nasty, ugly discipline situations can often be avoided if staff nurses would just talk to each other in a caring respectful manner.

I was often in the position of representing nurses during disciplinary hearings. As the nurse's advocate, I would have argued for progressive discipline. You start with a verbal warning. Next occurrence is written warning, proceed on to suspension and last step is termination.

I did represent nurses in a case where a patient overdosed. Apparently the patient was cheeking the pills and nurses were leaving pills at the bedside. A search of patient's possessions found pills that appeared to have been cheeked and pills still in package. Hard to defend nurses who don't open the package. It was a big mess!

Also, the other problem on a dementia unit is a lot of patients are ambulatory. You have no way of knowing if another patient walks in the room and takes the pill.

I would sugget new grad learn from the experience and do not repeat the practice. Not necessary to beat herself up.

shermrn · Oct 2, 2015

As was said, the Director had to do a write up because of the family member complaint. If the family member were to mention it to the health department and they found no disciplinary action/counseling was done then the director would likely be in big trouble. I'm sure you figured out by now that you shouldn't leave meds but need to make sure they are taken.

I worked in LTC for many years and found the med pass to be nearly impossible at times. I've been out of LTC for 15 years now and still have nightmares about working there, especially the med pass. In my experience regulatory agencies would burden the LTC facilities with so many rules that it seemed like a horrible joke. Then when a facility was found out of compliance, the response from regulatory agencies was very punitive. With each new rule or regulation it seemed funding would get smaller and smaller with nurses, aides and other staff having to take on more responsibilities which leads to more rules/regulations broken simply due to lack of time and staff to follow through with everything. I'm guessing LTC facilities are no better now. For me LTC is the most difficult area of nursing to work in, I would likely quit nursing if I ever had to go back. Sorry I guess I should have started an new thread about LTC.

Anyway to answer the original question, if I were your coworker and saw you you leave the med I would not report you. I would talk to you about it and point out the error and potential consequences. If you failed to correct the problem, then I would report you.

anewsns · Oct 2, 2015

I for one am happy about your LTC rant.

tsm007 · Oct 2, 2015

As I'm watching her get raked over the coals I have to tell you in my short lived nursing career I have already witnessed several nurses do the same thing. In fact, I've seen some that leave all the medications. I have one resident who is a pain in the rear and will not take his lactulose unless I leave it in the room for him. He is the one and only patient I have ever left a med with and I did it the first time I encountered the situation. I made the decision that morning that he needed the lactulose. He was clearly not confused. He clearly wanted to be in control and in that moment I thought him getting the lactulose was more important than me following the rules. After a good night sleep and after further thought I decided though after that incident that next time I wasn't leaving the lactulose and I was going to CMA and just chart as a refusal. This was a good learning opportunity for me. I do think there is a way to care plan "self administering" of meds for patients like this and I am going to talk further to the staff at my facility about this. I do not think a patient with dementia is a good candidate for this though.

jadelpn, LPN, EMT-B · Oct 2, 2015

It is a lot of "depends on".....

IF you have CNA's who are also certified medication aides, that is one thing. Many LTC facilities do.

You can not discuss one person with another...meaning the "she won't take that" exchange can not take place. Privacy issue. So, I am not sure that the answer could be that any medication administration that happens at a table with a family member needs to wait until after supper, except for the family member's resident. Either they are given before or after...if they are timed medications, then you need to be within the time frame, but not at supper.

And each resident is different. Is it feasible that a senekot can wait until bedtime meds?

I guess my issue is that if a family member is hanging about at mealtimes, then the residents at the table do not have the privacy they are entitled to as far as medications. There are pot-stirrers everywhere--"I can pull my mother out of here..." (

I would counsel--"You may or may not have seen it done. You may or may not have been 'told' that this is the way it is done. However, our standard is that each medication needs to be administered by the nurse, and noted as taken, declined, etc. My expectation is that going forward, you follow that standard" And you could have discussion as to what the standard/policy is when a family member is at a table and you have to administer medications at the table, to ensure that you are not breaching privacy. Just as easy for the daughter of resident #2 to say "why did resident #1's daughter even KNOW that my mother takes a pill at dinner?!?!?! What is it her business?!?!?!"

Which, is also a valid point.

Going forward, don't ever leave a pill. Additionally ask what the protocol is.

nursingaround1 · Oct 2, 2015

You shouldn't be written up for this. You're a new grad, and a talk about what to do in such instances is the best thing. I have left pills at patients' bedsides, but they were mentally intact, but generally I would not recommend anyone do this, and I would not do this now. Too many things can go wrong. I've also learned to avoid having to trust others for doing things when possible. It's a bit sad it's become this way, but after temp nursing i London for a number of years, you had no idea the ability of the assistants you were working with, or who to trust. Many were great, but some not so, and one assistant was discovered to be making up blood pressure results, and copying the BP from the obs done before.

What I find works, especially with mentally intact patients, is I don't just give them their pills, but sort through them, saying eg the blue one slows and strenthens the heart, the red one is your blood pressure, the yellow is to get rid of the extra water and will make you pee etc. It actually took me longer to do this, but we discovered a number of mistakes doing this, sometimes by the prescribing doctor. A patient would say, 'I take that at night at home, not in the morning' or 'I only take one pill, not two' - often this is because the junior docs would copy the medications from their med card from their last admission, and this card has not accounted for changes a local family doctor may have made, or changes the patient made themselves. I've even caught a mistake I've made myself, and saved myself from giving a patient the wrong dose of a medication. It also made me really familiar with the meds.

So, I think a quiet word with you about this would suffice, and not to be written up.

BuckyBadgerRN, ASN, RN · Oct 2, 2015

This wasn't left bedside though. It was at a table in a common dining room with other residents in it.

Yes, I would have.
On my unit, if we have patients who insist on bedside meds being left- we get a doctor's order for it.

Jory, MSN, APRN, CNM · Oct 2, 2015

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.

You want the truth, here it is: You are not understanding the concept of dementia.

First of all, it is your responsibility to manage the medications. Not the resident, not the family member. YOURS.

What if it was a medication for high blood pressure and another resident with low blood pressure came and took it? That could have caused someone to bottom out.

Yes, you should have been written up with a final warning. You also did not listen to the family member who appropriately expressed concern and it was more important for you to leave the pill than it was to witness the swallow. It doesn't matter if she was rude...what she saw really looked like laziness and it probably caused the family member to question the quality of care in general. Patients get pulled out of facilities because of issues just as this.

Sorry, I back the facility.

bluegeegoo2, LPN · Oct 2, 2015

This is pure speculation, but I think that the practice of leaving a medication is what prompted the write-up, notthe type of medication. While tempting, I agree that it is poor practice to leave meds with any resident at any time unless they have a MD order that allows it.

On a side note, I also agree that when there's family around (even family that's perceived to be "cool" with staff) always, ALWAYS follow the rules. It's just safer that way.

OP, try not to take the disciplinary action personally, rather, use it as the learning tool it was meant to be and move on. You (and I, and everyone here) will make mistakes now and then. It's what we learn from our mistakes that makes us better nurses. Well, in theory anyway. :up:

JustBeachyNurse, LPN · Oct 2, 2015

Was this a written memorialization of a formal verbal warning? Or a written disciplinary statement with a specific corrective action plan with a deadline?

Did you argue with the DoN and deny personal accountability that resulted in a higher level of reprimand than if you said "I'm sorry, I didn't follow the standard of care here is how I can fix that next time..."?

You were wrong for leaving a pill for a patient known to have dementia not only next to the patient but also in a common area. In some places disclosing the protected health information/plan of care to someone without a need to know (as you discussed the patient with dementia with the other patient's family member in a common area) would escalate a verbal warning for a slight on policy to a written disciplinary action.

While you gave a lot of information still just shy of enough.

So...

if you left the pill and I (in a position of management or administration) caught you, verbal warning on the spot documented per HR policy

If you argued and refused to take accountability, it might escalate to a formal verbal warning for failure to follow the standard of care and insubordination.

If a family member reported it, there must be documentation of the corrective action even if verbal warning documented.

If patient's daughter over hears patient B's family member discussing her father's plan of care for medication administration and reports it plus you left the pill, written warning, possibly mandated corporate compliance retraining for HIPAA and now that two family members are involved possibly retraining on med pass protocol.

If I were a coworker and saw this. I'd pull you aside quickly remind you not to discuss with visitors and suggest to hold the med and come back later or flag a med admin tech to assist or at least monitor the pill (assuming facility protocol and state guidelines permit CNAs to work as med admin techs. In my state only allows CNAs with a PCA credential that includes medication admin to hand out medications/watch dosing in assisted living not legal in LTC. In home health RN must fill pill box and CHHA can do nothing more than hand the patient the box and remind them to take the med.

midnight766 · Oct 2, 2015

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.

Although not a fellow nurse (yet), even I know that the proper procedure for medication administration was not followed. I would imagine you would get written up for something like that, or have to review the policies and procedures that were in breach.

Also, dementia is an insidious illness. The family members are relying you to provide the best care possible for their loved ones. Though they may have a history of being difficult, I can see why they would have been annoyed. Sorry, that is my honest opinion.