Dear Nancy,
I was working night shift as the medication nurse on my unit. When it came time to give meds early in the morning I was told to give medications like Synthroid and Prilosec at 7:30 a.m., but I refused because they were not due until 9 a.m. My charge nurse told me to give these medications and went back to report to the oncoming shift that I would not be giving these medications. Was I right in my choice about refusing to give these meds earlier? Our policy as well as our state nurse practice act states we have an hour after to an hour before to give medications. Some colleagues told me the request by the charge nurse was real world nursing.
Taylor
Dear Taylor,
Your refusal to give the medications as requested by your nurse manager was the correct decision. You were guided by two important guidelines on the issue: your facility policy and very importantly your state nurse practice act. Although it may be that fellow nurse colleagues see this as real world nursing, if such a breach were reported to the state board of nursing, whether or not there was an injury to the patient, the real world of professional licensure discipline will be experienced by those individuals.
A question arises as to why the charge nurse would want the medications given earlier. As a convenience to the on-coming staff? As a convenience to the patients? The request is odd indeed without a reasonable basis for the request. If the charge nurse wants these medications to be given earlier, the charge nurse should discuss his or her concerns with the physicians and advanced practice nurses who order the medications. Or, she can try and get the policy changed.
However your nurse manager decides to handle it, you are a licensed registered nurse in your state, and complying with the mandates of the state nurse practice act override such a request. You will be the one who must answer to a complaint about your nursing practice if one is filed with the board.
Remember, too, that your practice must conform to the ethical mandates of the Code for Nurses With Interpretive Statement (2015). At least two provisions of the code are applicable here: Provision 2 (The nurse's primary commitment is the patient, whether an individual, family, group, community or population) and Provision 3 (The nurse promotes and advocates for, and protects the rights, health and safety of the patient). Collaboration within the nursing profession and acting on questionable practice is essential. In your situation, you might want to consider discussing with the charge nurse the reason for giving the medications earlier than is required by facility policy and the nurse practice act. Depending on the charge nurse's response, you may need to share your concerns with those in nursing administration who can help resolve this issue for the benefit of both the patients and the nurses working in your facility.
You can read the entire Code. Click on the "Ethics" and then on "Code of Ethics" in the drop-down menu.
Sincerely, Nancy
