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.

[Hoosier_RN, MSN]

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:

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.

In my state, in AL or LTC, it's a big no - no for a CNA to take part in the med administration process if a nurse is responsible for administration of said med. Only exception is a QMA, but that again is the only exception that I know of. I know it seems like nothing - only a Sennakot - but if anyone could administer or if resident could be depended on to take it all the time, the nursing role would not be needed in that facility, we simply would not get paid to do it, they could have office staff or whoever to pass meds. Case in point: state recently came to my prn job facility. Resident A always said I could leave her evening simethicon at bedside. I told her no, I needed to see her take it, she could put on call light and ask for me when ready. Other nurses left at her bedside. During state annual visit, they of course visit Resident A who so happens to open her top nightstand drawer half full of med cups full of simethicon tabs! Further questioning: all the nurses let me have so I keep them here in case I need them. Except mean old RNinIN, she won't leave anything with me!

This woman is lucid, no dementia. Guess who got in trouble? Not this nurse, that's for sure!

[Horseshoe, BSN, RN]

"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".

Everyone keeps referring to this family as "problematic." I see them as advocating for their loved one in the face of poor practice and a belligerent caregiver. I think there could be some debate about whose attitude is "hostile."

[Hoosier_RN, MSN]

Everyone keeps referring to this family as "problematic." I see them as advocating for their loved one in the face of poor practice and a belligerent caregiver. I think there could be some debate about whose attitude is "hostile."

I don't necessarily think OP is hostile, but maybe thinks because s/he is the nurse , s/he is controlling the situation (I see it frequently, and sure I have been guilty of it in the past myself). Remember, too, any guest at that table could be a nurse or other medical professional. They very well may know what our professional standard and obligation is. They may be practicing or non practicing. Never make assumptions. I know this is off topic, but could be part of the issue as well

[bloatedputti, MSN, RN]

Yeah, can't defend you on this one. Never leave any meds for patients to take when they please. Take your lickin with a smile and move on.

[donsterRN, ASN, BSN]

OP, I'm not going to beat up on you.

But.

You have to know that it's bad practice, for all of the reasons listed in all of the previous posts.

And.

I'm more than a little concerned with your attempt to minimize the seriousness of this. It really doesn't matter what the medication is, where your resident is located, and who is in the vicinity. It's wrong. Please know that.

Also.

If you learn from this, you are going to be just fine!

[NutmeggeRN, BSN]

.

The DON may just be concerned about appearances. She may have needed to document something in case this visitor makes a report to an outside agency.

There are pretty significant rules around medication administration and one of the biggest is that you NEVER leave a med, EVER!

So many reasons

1) there is a choking hazard, always

2) another resident could conceivably take it which could be lead to a choking hazard, interaction with another med or allergic reaction

3) Against the Rules including scope of practice for LNA and licensing regulations for the facility

She was correct in writing you up.

[SWM2009]

I work in LTC. I do not ever leave medication with a resident or ask CNAs to make sure the resident takes the medication. I wait for the resident to take the medication and I also make sure they actually swallow the medication before I walk away. If the resident is not ready to take their medication, I leave with the medication and return later to try again. In my facility, what you did would have resulted in a write up for sure.

OP, I know from working in LTC how insane the medication passes are and that waiting the extra time for that one resident (usually multiple residents) can put you behind but it's better to be safe than sorry IMO. I'd rather explain why I was late passing medications than why a resident was harmed by taking the wrong medication because I left said medication in a common area and they took it even though it was not meant for them.

[OrganizedChaos, LVN]

Unless the other person witnessing was a med aide or the resident was in a private room & was A&O x 3, I wouldn't have left the medication there. It doesn't matter if it was an OTC med or prescribed. It is your duty to give the resident the medication & make sure (s)he takes it, not the CNA.

I don't think I would've reported you for that incident, I would've just pulled you aside & talked to you about it. But if you did it again I definitely would've written you up.

But the way you handled the family member was wrong. You shouldn't have gotten into specifics about how you medicate other residents. Just keep your interactions with perceived problem family members short & sweet.

[Ryn RN]

Since you are the one documenting you administered the medication, if you do not actually see the patient take it, your documentation is false. Reason for dismissal in many facilities. As a new grad I'm sure you realize it is wrong but especially wrong with a patient family in room! Poor judgement.

[Ryn RN]

Since you are the one documenting you administered the medication, if you do not actually see the patient take it, your documentation is false. Reason for dismissal in many facilities. As a new grad I'm sure you realize it is wrong but especially wrong with a patient family in room! Poor judgement.

[anayo, DNP, APRN, NP]

Ive worked LTC, ER, and ICU.Yea. You cant leave medicine around without being present to witness they took it.I personally would have talked you and if you did it again, Id have no but to write u up. Cover your a**. If u were to go to court you would have lost. I know u are bummed up about it but moved pass it and learn from ur mistakes. Every nurse has made mistakes and any nurse denying this, is a poor liar. And guys, pls provide constructive advice. Thats what she asked for; not to be attacked by mean comments.

[heron, ASN, RN]

Anayo, how is any comment on this thread any meaner than what you just wrote yourself?

I think this thread has run its course.