Recognizing Medication Side Effects

Today a hot topic in nursing efficiency and best standards in healthcare is maintaining corporeal integrity and patient health despite heavy medication orders.  Nurses administering medication therapy to patients need to be watchful for side effects. Harmful side effects can be fatal. Any nursing performing 24 hour triple checks should converse with charge nurses and consult communication logs to verify any symptoms of a problem with a new medication that may have appeared.

Nurses should not wait to be directed by other staff or pharmacy advisors but verify from administrators,  Internet resources or the drug literature what the potential side effects are. Patients have a right to know what these side effects are before the medication is administered for the first time. If there is a potential drug-to-drug interaction, a delay may be in order while the physician is notified. Another drug may be substituted to eliminate potential problems, side effects, and patient discomfort.

The obvious benefits of nurses maintaining a rapport with their charges become evident here. A caring treatment nurse or observant and communicative med nurse can know what condition the patient’s skin normally is, what skin products the patients use, and under what circumstances irritation or rash incidents arise. Is the patient a complainer or do they hold back complaints?  Do they follow the same bathing and skin cleansing regimen daily? Does the patient use water that is hard, too hot, or for too long a period? Nurses should work closely with nurse’s aides to make sure unknown skin problems do not arise in conjunction with new medication administration. Both problems happening at once muddle the waters.

Patients in hospitals and long-term care  facilities usually do not handle their medications and thus cannot read the warning advice. They may not have Internet access or know how to spell the name of the medication. It is irresponsible and unprofessional for a nurse to force, trick, or dispense new medication to a patient without advising them of these risks and getting their permission. Violation of these rights can result in oversight agency scrutiny,  facility citation, and/or a nursing  license revocation.

For these reasons, any nurse should be mindful of the potential side effects of new medications. And over time, patients may develop allergies or new unpleasant and painful drug reactions. Before nurses sign off on pharmacy memoranda detailing potential interactions with the medication, they should review the nurse assistant’s body check documentation as well as the licensed nurse progress notes from every shift since the inception of the drug’s administration.

While some people have faith in homeopathic medicine, medical science is predicated on conservative and well-tested treatment advice. Unless the patient is utilizing off-label benefits of the drug for conditions other than those initiating the drugs’ order, nurses should follow the exact dosages and administration schedules the physician recommends.

Patient healthcare involves ongoing maintenance of functioning body systems. This includes circulation and muscle support to the dermis, musculature, and epidermis.  These systems undergo changes when systemic alteration occurs. Drug administration via the vein, orally, or topically is encountered by the body as a systemic alteration. Patients receiving therapeutic care require new and additional surveys to maintain the integrity of the skin.

The skin is the largest organ in the human body. The color, texture, febrile nature, friable veins, diffusion of capillary circulation, and moisture content of the skin tells the story. Changes can be tracked and documented to show the progress of a treatment for a condition or illness.

Nurses learn anatomy to understand how the heart and muscles drive the circulatory system. These functions are involuntary. They also stimulate immune system responses that are designed to protect the body’s regular functions.  The response of the immune system and the hypothalamus is governed by genetic  rules which are predetermined at birth. Generally these operate for everyone the same way.

But due to the infinite variation between one human body to another, individuals will differ when a foreign substance, such as a toxin or strain of bacteria is inserted into the bloodstream. The body’s response should be reviewed for the things the patient can communicate, and the things that can be observed.

Thus,  Person A may have no response to ingesting plant spores. But Person B may have no tolerance for plant spores. This intolerance is not a cognitive communication. It is expressed by changes in body functions exclusive of other medical problems.

The body dysfunction  evinces itself in a set of symptoms visible to the eye. It might be a rash, bumps, and/or itchy patches of skin . Sometimes the condition will irritate the patient to comment. For nonverbal or inert patients, symptoms such as swelling, striations, “weeping”, bumps or other dermal eruptions may occur.

Patients may not be able to see what is going on. A full body check is in order at least daily, before and after treatment. These data items should kept well documented in the patients chart for physician review. Symptoms such as nausea, inflamed throat, vomiting, loss of appetite, rash, hives, unusual numbness of extremities and more should be noted carefully. Nurses suspicious of side effectsvof medications should chart an intervention in the patient’s care plan. Wellness should  be achieved without the above mentioned side effects. It is for the doctor to determine whether or not the benefit of such medication outweighs the irritation and discomfort the patient undergoes.

Symptoms of side effects should be evaluated with reference to the patient’s normal condition and status. Failure to chart regular full body checks and regular medical examinations can cloud the issue. And only the facillty being alerted to signs of anaphylactic shock, observed by a nurse,  can save a patient when extreme side effects (akin to allergies) are present. Immediate medical attention is triggered by the predictive and denoted set of side effects described on the warning labels required by law to accompany all medications.

Patients receiving new orders for ongoing conditions or diseases with new symptoms must be protected from the natural occurrence of allergies and untenable side effects. Signs of side effects of given medications is nature’s way of making sure the body does not ingest any more harmful material.

Patient medication forms part of therapeutic intervention for serious conditions. Antibiotics are an accepted and highly recommended response by physicians to lab tests, clinical consultant, and referrals to a specialist. Antibiotics are adminiatered to the human body three ways, internally, orally, and topically. Creams, gels, sprays and powders can be applied directly to the skin or affected area. Oral antibiotics are administered  by mouth and sometimes by other means.

Infusion Vein therapy (Intra Venous therapy)  is administered by access to the vein. The needles’s access to a skin based channel allows direct systemic delivery of antibiotic material. Yet an etiquette prevails to ensure patient safety, operator efficiency, and an optimum outcome.

Dosages of antibiotics in the above mentioned methods are governed by strict standards. The I.V. medication is calculated by laboratory tests, “peak and trough” reports, creatinine levels and patient weight. Maintenance of kidney function is imperative.

Nurses who follow the signs of allergy, medication symptomatology of side effects and problems of specific medication types can offer their patients a wholly beneficial skill set that will enhance treatments and drug administration. Patients can enjoy greater quality of life,  without dosing errors, unnecessary discomfort,  or negative drug interaction.


Drug Diversion Case Studies

The previous article on drug diversion explored the ways in which professionals in the nursing occupation respond to temptation by stealing medication from patients. This occurs when environmental security in a hospital, nursing home, or home health situation is not sufficient to detect and/or prevent this crime. Drug diversion is doubly dangerous because in some cases the patient suffers. The therapeutic value designed into the patients’ care plan is degraded severely by drug diversion.
Nurses who pocket or take medications cheat their patients of needed pharmaceuticals. But the nurses may also succumb to the near-universal lure of addictive pill-taking behaviors that impair their ability to think clearly and conduct their nursing activities responsibly. Opiate addiction is a global problem, and nursing can be a gateway career for addicts.
Drug diversion occurs when a nurse makes a decision to go against his or her better judgment. When this happens, day to day patient care is compromised. Since single-staff nursing plans don’t allow for auditing, the problem of pilfered medications will get much worse before it gets any better. Detection is the first method of arresting drug diversion. Symptoms of missed medications may blend with the patient’s pain spikes or be termed mood swings by distracted nursing staff.
Patients who vocalize extra pain or think that the nurse missed a pill may be disregarded.
Nurses who practice drug diversion may be in a position to target patients that nurses dislike and have no sympathy for. It may be some time before patient complaints are heeded and med counts correlated. And many nurses may move on before any official action can be taken.
Official complaints are the second step to take action against suspected drug diversion. Yet an official investigation by state or local nursing agencies is cumbersome and time consuming. And nursing homes go to great lengths to cover up their internal problems. When faced with legal liabilities a hospital may nullify patient lab reports or other evidence the patient’s care was impaired.
In instances when drug diversion takes place in home health scenarios, the abuse may never be discovered. The privacy and isolation of a home health environment are ideal elements for a nurse planning drug diversion. In any case, the patient will suffer. And the family members may never know why the patient is struggling for relief.
The third method to control drug diversion is peer policing. Nurses must take a stand from inside their community to cite and counsel nurses guilty of this crime. Leaders on every nursing staff should set an example of how to intervene and/or report drug diversion suspicions. Nurses who witness palmed medications should document what they see, and report the incident to the human resources director or the State Nursing Board. Anonymous complaints are allowed.
The most likely medication targeted by nurses for drug diversion is narcotics, painkillers, and opioids. These medications can alter mood and hinder feeling “down” effectively. Nurses practicing drug diversion are in fact trying to medicate themselves.
These pharmaceuticals are not only targeted for personal use. Drugs like Fentanyl, Dilaudid, Vicodin, Morphine, and others are highly marketable among addicts. Nurses may use pilfered drugs as currency among junkies with access to illegal street drugs. When a nurse is desperate enough for cash, students looking to maintain a high grade point average are good cash customers for diverted drugs. Students who reject shady contacts and promote a drug-free persona can utilize their nurse contact on the sly for ‘lifestyle enhancements’.
Case Study #1
Valery Gomez is an LVN working 4 days a week at a metropolitan hospital with high patient turnover. Valery started working six months and ago nursing is her first job. Her husband prefers her to have weekends off and her two children are taken care of on the days she works by her husband’s mother and family. Valery Gomez usually works the morning day shift.
Although initially Valery is bright, funny, and congenial, lately her personality when dealing with patients has changed. After twelve months on the job her nursing skills have not improved. Among the nurses hired in tandem with her, most have risen to supervisor or specialized posts. Valery’s peers have graduated to more complex work responsibilities,
It has been observed by the nurses on staff that Valery is often ” sitting doing nothing” and shoulders little of the actual individual tasks requied of desk nurses, and her charting and case load is usually poor or unfinished.
Lately several incidents with patients and Valery have brought unwelcome scrutiny to her employer from the County Health Department. The Ombudsman has received complaints about problems with Valery’s patient, problems that remain unresolved despite past counseling. Valery shows no remorse for causing great difficulty for other nurses and extreme physical stress to some of her patients.
Valery rarely lends a hand to any other nurses. She exhibits fits of temper when meds are requested and denys patients their needed painkillers without explanation. Valery makes a practice of hanging around the desk when the med-cart is adjacent and unattended. Valery recently has requested changes to her work assignments to shifts where the majority of staff wre gone.
While Valery made comments initially that she prefers a schedule with weekends free, now Valery has requested work on Saturday and Sunday. This is when most of the staff are gone. One of the patients, Nancy Lee, remarks that in private conversation Valery always told her that Valery’s husband wants her free on the weekends to entertain and care for the children.
Nancy Lee is a patient who recieves very heavy pain medication for multiple conditions. Nancy Lee has documented painful needle sticks from Valery. The Nursing Director has counseled Valery about not delaying Nancy’s med pass routine unnecessarily. The D.O.N. has repeatedly received complaints of Valery denying Nancy Lee her needed medication.
Valery alone of the many med-pass nurses resists the instruction to inform Nancy Lee how many Fentanyl she has left on her pain management precription. Mancy Lee has made complaints to the State Nursing Board about the matter.The local authorities have substantiated Nancy’s complaints.
Nancy Lee is articulate, alert, and ambulatory. She notices that paperwork in her chart written by Valery is inaccurate and incrimminating documentation concerning incidents with Valery has been removed. Nancy Lee hears from other nurses that Valery has refused to chart for them on occasion and also has refused to cooperate with requests from other nurses to perform tasks for them while they do her work.
Nancy Lee steps outside her roomn one day and observes that Valery Gomez visits the trash room frequently. Since the housekeeping staff normally do this, Nancy wonders why Valery alone of all the nurses disappears from the nursing desk floor while on duty. In the past, when Valery was Nancy’s nurse strange pills would be found in the floor. Nancy wonders why Valery avoids the closed circuit camera view so often.
In the past, Nancy Lee has noticed that many of the CNA staff hide in the supply room or the trash room and text to friends, play video games, or talk and use their cellphones. Nancy feels strobgly that Valery Gomez has been pilfering and experimenting with pain medications intended for the patients.
Nancy feels that Valery watches for opportunities to steal, hide, and ingest patient medication while on the job. Nancy has noticed that
Valery has lost weight and taken an interest in a handsome young nurse new to the facility. Nancy sees Valery drift through the weekend avoiding family responsibilities.
Suddenly it is found and told to Nancy that repeated impropriety concerning her pain medication has caused the med cart run out many months in a row. The pharmacy cannot account for the errors.

Nancy wants the D.O. N. to order a drug test for Valery after a weekend where the nurse repeatedly goes into the trash closet. Nancy sees Valery glaze over while another nurse is calling her name. Nancy sees a pill hit the ground after Valery comes out of the trash closet. When the good looking male nurse calls in sick, Nancy notices that Valery loses all interest in her work, snapping at peopke and gruffly answering the phone.
Does Nancy have the right to do this? How should the D.O.N. respond? How should the other nurses at the facility act at this time? Who should act, what should they do, and when does this become an investigative problem for police? How do the three methods to limit drug diversion, as outlined above, operate here?
Case Study #2
In a large hospital near Los Angeles, one of the patients in the SNF Alice. has noticed something disturbing. In the morning at 5:45 a.m. every day moans and screams start rising from the patients in the other rooms. The nurses tell this patient that many of the other patients are addicts who start yelling for their opiates and pain drugs too early. The nurses say that if they start giving out the pain medication for other patients too early, the next day the same thing will happen again and the patients will use up all their pain medication too early. The patient observes that there are no general administrator on duty at this time of the day.
After three months,the same thing happens very day. The patient notices how the exact same staff work the 11 to 7 a.m. shift daily even though alternates regularly appear on the other two shifts. Alice notices the call lights and alarm sounds series at this time, unlike at any other time, are often allowed to build and be ignored. The charge nurse responsibilities are shared beteeen a close knit group of nurses.
Soon the patient believes that the hospital does not know anything about how bad this problem seems. After months of different patients coming in and out the sane phenomena occur. On the day and afternoon shift the moans and screams do not recur as they during the “dawn patrol”.

Over time the patient fears that the hospital has suppressed recording this issue. Alice thinks that these SNF patients acting in this manner and reporting pain is being concealed and not documented so that their staffng acuity will not shift. This appears to be a cost cutting measure administered when no officials, visitors, or ancillary hospital staff can witness the outcry at dawn.

What questions should the hospital adminstrators be asking about why so many patients in the SNF are demonstrating this scale of pain indicators without a investigation or compassionate care response? What responsibilities does the facility have to monitor quality of care?

The Changing Vision of Nursing

†Today nurses face challenges in the nursing world their predecessors never did. The slightest mistake can end up on YouTube. A crotchety patient might become a vexatious litigant. And worst of all, you could make a career ending mistake.

Newly licensed LVN nurses and RN nurses can safeguard their careers by following the best practices of their facility and the standard operating procedure of conventional nurses.For nurses to stay ethical and keep their noses clean, vigilance and propriety are necessary.

Good manners toward patients is the best practice. But for peers and other staff as well. Managers can appreciate the benefit of a new hire who is a good example. The spectrum of nursing careers can always include a nurse who is polished,perfect, and professional.

The stereotype of s nurse can be from a TV show or from examples people see over time. A paunchy, chain-smoking nurse tapping away at their phone is dividing their attention span before they clock in. The oversexed stereotype nurses who spends most of heir time socializing will often end up the subject of complaints.And nurses given supervisory roles when their performance is substandard will always suggest unfounded favorirism.

Additionally, nurses can look for good ways to stay motivated and meet personal goals. The stability that a career in nursing can offer provides financial security, as well as a few “chicken soup for the soul” experiences.These are often priceless insights into the human condition.

The payoffs of a career in nursing can be concrete and financial in nature or they can be as abstruse as angels dancing on the head of a pin.But each nursing professional needs to decide for themselves where monetary goals stop and vocational goals begin.

Many nurses find their vocation in helping people. Others ate looking for a way to migrate to another career, such as teaching or business. But the toll that care giving occupations take is becoming more difficult to ignore. Statistics on addiction, drug abuse, Petty crime and white-collar crime in the field of nursing is a well kept secret. Nurses often admit to feeding an addiction while on the job. Nurses fight smoking habits made deadly by their sheer casualness masking a dependence. Nurses can have delayed reactions to many of the experiences by they see and encounter PTSD later.

And some nurses worry about if there will be a nursing field in the future. Technical issues are turning the field of medicine into an adjunct of the insurance industry. How much nursing benefit can decades of dialysis provide? How can pacemakers and stints and implants improve the quality of life?

Decisions are being made every day to extend and lengthen life using equipment and materials foreign to the body’s natural makeup. The safety and longevity of many of these methods requires backups of conventional nurses to oversee and treat complex medical conditions.

This type of scientific leap forward will always need development and monitoring by medical professionals. And as long as people age and have health crises, a nurse ( or several hundred thousand) will be needed. Therefore the future of any nursing career is wide open.


When Nurse Training Makes a Difference

Nurse qualification by degree is a choice each nursing student must make. Many nursing curricula organize the classes by degree goal. A bachelor’s nursing degree will set up a nurse candidate for positions of greater prestige and greater longevity. But nurses intent on long term career longevity can groom higher aspirations by achieving higher benchmarks from the outset. Institutions looking to recruit nurses with bachelor’s degrees can expect more fluid patient response’ and more intelligent care plan response.

There has been a significant blurring of the lines between candidates who have achieved an assistant of science in nursing and a bachelor’s degree in nursing. The ability to operate at a higher technical level is what some institutions need. The breakout requirement in the performance capacity is what a health care facility depends on when wards fill up with heavy need patients. These caliber professional performance levels are what hiring managers look for when screening applicants.

Nurses should not put patients into panic mode. A professional attiude is key. They should do everything the can to secure the patient from any feelings of pressure, worry, or discomfort. By charting interactions and vitals, nurses begin to document the case. A care plan for the patient’s outlook is indicated as noted in the charts. For follow up, nurses then can refer back to these notes. Progressively senior nurses should be able to handle multiple patients per shift managing these dynamics.A thorough knowledge of resident care plans encourages the nurse on duty or med nurse to interact with the patient in a beneficial way.

But all too often the hospital wards or long term care floors are filled with anxious and confused patients who have been left to sit or lie down for hours or even days without clarification or proper addressing of certain problems. Patients who feel ignored by their nurses will file complaints and tell visitors their nurses are slacking off. Senior nurse staff should make sure these patients do not feel “lost in the mix”. Inexperienced nurses might be able to miss certain details but peer nurses and managers will notice and hear about patients who have been left by the wayside.

A nurse knew to the facility might miss important cues. Sometimes this can be too late. Hidden bruises, unusual lesions, draining ulcers, and stiff or numb extremities must be noted. Is the color worsening? Is the affected area becoming larger? A nurse should watch the way a patient walks around or gets up from the bed, transfer to the wheelchair or toileting apparatus.

The physician must be notified and the Change of Condition filed in the patient’s medical chart. Nurses need to keep a weather eye on patients who may hide their symptoms. Patients who fear their treatment due to pain or physical discomfort will take their bead from nurses. If the nurse comes off as too busy or distracted they may drop or suppress medications, palm them, even mix them up. This is fraud. Nurse cannot depend on patients to put them straight. Hyper-adrenalyzed patients can collect the medications and trade or sell them on the street.

Sufficiently trained nurses will watch their patients consume all ordered narcotics and medications and closely observe their effects. A professional nurse does not leave unconsumed medications at the bedside or anywhere near a patient without witnessing their intake. For example, a patient consuming multiple painkillers should display drowsiness and lethargy. Trained nurses should take away patient’s own medication. Patients undergoing narcotic and other pathologies of medical care will lose track of what personal medications they may take, confusing displayed symptoms.

On the job training and experience will progressively groom a nurse to deal with such patients.. Sometimes another nurse may be more effective for caretaking goals. Patients may hide problems and nurses can only tell by examination and assessment what is going wrong. progressively trained nurses should be able to observe changes in hygiene, outlook, and mental condition. Perfectly normal patients sitting in a room all day can turn manic after induction of medications and excitement.

Nurses who are properly trained can skip over important details in haste. So when re-checking patient conditions and vital statistics over time nurses can catch a problem with a patient or even a machine. Nurses can pick upon failure in machines or other technical problems only with usage experience on patients and issuing of improper results. If a nurse is trained to assess both the patient condition and the readings, they may simply report inadequate readings.

The patient then has inappropriate and inaccurate readings reported to the physician and to their chart. This can really impact negatively the care plan for that patient. Nurses assigned to different patients in the same room cannot pick up the slack. They sometimes may switch working machines for technically unproductive machines without the nurse’ knowledge. The timing of dealing with these machines may be more than the nurses can handle.

Therefore a properly trained nurse is required for patient care because they can determine the difference between a technically accurate vitals reading from an erroneous one. But only highly trained nurses capable of independent thought processes and independent decision making can achieve these top notes of nurse duty performance. Otherwise patients suffer in silence. And supervisors wonder why their feedback card ratings are declining.

Later, when the nurses determine a problem with the machine, they will need to retake those readings and then commit them to the patent’s chart. This can make a window of doubt into the patient’s care because these missing readings are not present in the records. This prevents a physician from following the path of a treatment plan or set of medications results. The pathology of this error may be lost but it has a negative impact on a patient.

But how will they know? This is just one of many problems that occur during a busy shift and may not even be detected until the next shift when nurses begin their vitals readings on rounds. This can be hours into the next shift, creating problems for every patient’s care plan. The regression backwards over time affects different patients in varying ways. For every patient struggling with mood disorders, over-medication, untreated pain, burgeoning infections, and multiple organ failure, the gap in sloppy nursing allows a documentation blindness.

Nurses at the desk will discuss various cases and verbally update each other with observations. This patient is sick. That one is still coughing. This one isn’t sleeping so well. That one is not walking straight. This way nurse bounce the patient symptoms off each other, reporting and seeing what other nurses think at the same time. Without such communications, there is a temptation to ignore the problem or conceal it. A more professional nurse grooms her co-workers to recognise a problem and deal with it.

The other detriment of such practices is to the entire nursing ward or health care facility. Healthcare systems and HMO businesses are the most stringently planned budgets in the world today. The patient stay in the hospital becomes longer because problems in the care plan need to be changed and the patient stay extended. These costs can add up and change the health care approach of an entire facility. These are the far reaching consequences of poorly trained nurses.

3 Toxic Patient Scenarios-Study Tips

Three Examples of a Toxic Patient- Nursing Study Study Guide
[Use this section as a discussion guide. Consider and argue how it would be best from a nursing point of view to handle the following cases. Support your case with guidelines, advice from nursing hotlines, or hospital or facility policy manuals. ] Real examples of a “toxic patient’ follow.
(a)In a major metropolitan county hospital, one ward included a patient who yelled in the early morning hours about his transportation. Although it was only 2 or 3 a.m. in the morning, the patient got into his wheelchair and sat in the doorway of his room, bellowing about how the nurses needed to call the doctor’s office for the car to come and get him. His howling distracted nurses and completely disturbed any peace of mind for any resident for 500 yards in any direction.
In all of these circumstances, consistent reporting to the physician, explicitly detailed note taking habits, and attentive observation could have prevented anxiety and stress to all parties concerned. But some shift nurses didn’t bother to take the time to document correctly the times and frequency of the incidents. Many other patients complained but were discouraged by nurses uninterested in documenting problems with their part of the hospital. Escalating the matter to senior administrators might have cut down on the amount of total time this patient caused stress and anxiety to staff and patients around him.
Study Questions for Toxic patient Example A: Nursing Study
(1) Should the Director of Nursing have forwarded this case to the resident psychiatrist?
(2) Should one of the nurses have called the whistleblower hotline for the Ombudsman?
(3) Why wasn‘t the patient shifted to the floor of the hospital specifically for Psychiatric patients?

(b) In another scenario, a male patient over eighty years of age was admitted to the nursing home by his family members after a brief hospitalization. He was documented as having entered the rooms of other female patients in the nursing home and acting in a socially unacceptable way. Despite his frequent habit of wandering all around for years, the staff of the facility grew used to him being up dressed and out of his room, unsupervised, at all hours. They simply grew too used to his walking back and forth and stopped keeping track of him.
One day the patient simply wandered out the front door to the street, and down the sidewalk. By the time a nurse noticed he was missing, the four nurses he had walked by couldn’t even remember what he had been wearing to describe to police. The security guard set by the door had been fired to cut costs. The housekeeping staffer they had appointed for that position had been called away to clean a shower upstairs. The long term care facility (nursing home) was on the hook for the incident. The nurse who was scheduled to be supervisor on duty was made redundant (fired), for cause.
Even though the nurse was busy doing ten other things at the time, and the situation was completely normal, institutional responsibility was suffering. Technically the nurse was at fault for failing to direct other staff to prevent this calamity. The nurse should have told others under her supervision to watch the person, follow him, or secure the door. Even though the facility had allowed the situation to deteriorate to a point where the nurses were no longer vigilant, the nurse on duty that day was termed responsible.
If the nurses previous to this incident had completed their shift with documented letters to their supervisors, or copied the Director of Nurses on their notes reporting such incidents, the ongoing risk would have been noted and set into the patient resident care plan. Except that high turnover allowed even veteran nurses to forget the poignancy of such a risk and go about their other business as if it were no longer their problem to watch this man and where he went. The Certified Nursing Assistants blamed the nurses for not reminding them. The nurses were blamed for not reviewing (and updating) the situation in the licensed nurse progress notes.
Study Questions for Toxic Patient Example B:
(1) was the nurse to blame or the nursing supervisor for the shift?
(2) Should the nurse (or the housekeeping employee turned security watcher) have been fired instead?
(3) Does the nurse who was fired have a case with the State Nursing Board to have the case reviewed for Unfair/Illegal Termination Without Cause?
Toxic Patient Scenario C – Nursing Study
At a nursing home several nurses have been alternately assigned to “Jane Marx”, a patient who has a lot of complaints and irritations. “Jane Marx’ has gotten a bad rap from the newer nurses, while the nurses who have been employed a longer period of time have a much better grasp of the patient’s individual maladies. The older nurses know, for example, that the patient’s health had changed and that the patient had gone through a lot of painful operations and suffered through many unforeseen difficulties.
But ‘Jane Marx’ has a habit of putting complaints in writing to the facility administrator about problems that crop up. One of the problems she talks about is that one of the nurse consistency sleeps on the job, and watches TV and surfs the Internet watching Youtube. This nurse is older, and should know better. Other nurses have been fired for using their cellphones and none of the female nurses ever sit on the desk watching TV. ‘Jane Marx” was the patient who reported them. The current Director of Nurses has never lectured the sleeping nurse or cut his hours.
Recent staff shortages make the nurses recall other employees who quit recently. The staff discuss a very good nurse who left the facility months earlier, who got lectured by the Director of Nurses for being constantly late. Yet this male nurse gets to arrive late and wind the clock down doing nothing to ‘make up his time.” “Jane Marx “ has observed the elder male nurse staying late at night, while working nurses were busy, ‘to make up his time on the clock”. No other employee simply gets to arrive late, ‘Jane Marx” maintains, and stay after, doing nothing past their scheduled time in lieu of real work during their earlier scheduled time.
The nurses learn that ‘Jane Marx” has been raising the topic of the sleeping nurse in her care plan meetings. She has been consistently catching this nurse napping at night at the desk. No other employees of the facility ever sleep on the job. “Jane Marx” has been told that some of her treatment options are too time-consuming to pursue. Every night that “Jane Marx” comes out and find a nurse asleep, or twiddling his thumbs to “make up his time”, she argues there is time for her treatments and that the facility is not organizing its staff resources properly.
But “Jane Marx” argues that as long as nurses can “hang around watching TV” there should be enough staff to get the extra stuff done. The nurse in question often drifts around nibbling snacks and reading, waiting for the clock to wind down. Many employees dismiss the complaints of “Jane Marx’ on this topic due to her other many complaints. The day the Department of Health came around, asking questions, many nurses were startled. The agency was taking note of all this patient’s reported sightings of the sleeping nurse. The nursing home was cited and fined.
Study Questions for Example C, Toxic patients, Nursing Study
1. Why Couldn’t Peer Pressure have kept the nurse from sleeping on the job?
2. What steps should the Director of Nursing have taken to prevent this situation from happening?