I am a LPN in a skilled nursing facility who was told I would have to work a med cart. I am the MDS and care plan nurse and have never been trained as a med nurse in this facility. I began working at this facility about two years ago. I asked to be properly trained, and then I would gladly accept a med cart. My employer only wants me to train an hour or one day at the most. I am not comfortable with the short training period. Do I have a right to tell them I will not accept a med cart until properly trained and comfortable?
Dear Nancy replies:
You are well within your rights to refuse an assignment that you believe, in your professional judgment, will be a risk to the residents. As a licensed LPN, you are accountable and responsible for your own decisions and the care you provide to residents in the facility.
It is assumed that the med cart work requires you to know what medications you are administering, to administer medications to the residents, to properly document medications administered, to take responsibility for controlled substances that are under lock and key on the cart, and to know the residents to whom you are administering medications. To do all of this without proper training creates a clear, potential risk to the residents and to you, if done improperly.
You might want to try suggesting you not only receive additional hours of training on the med cart but that another LPN who has worked the cart, or even better still, an RN in the facility, act as your preceptor during your training so you get immediate feedback and any instructions as needed. This is a reasonable request and would help both you and the facility with any alleged negligence accusations that might be raised if a medication error occurred.
You should also check your state nurse practice act to identify what the act and/or rules require of an LPN who administers medications. Is RN supervision, either on-site or available by telecommunication of some sort, required? Does the LPN need to take a board-approved medication/pharmacology course before being able to administer medications? You can easily obtain this information by going to your state board of nursing’s website for the actual act and rules. Also possibly listed would be Interpretive Guidelines passed by the board, Standards for Medication Administration, and other helpful information.
If any mandates are required before you can work the medication cart, you also need to bring this to the attention of your DON and the facility administrator so there is no violation of the act or rules, which, in the long run, is something you will need to answer to.