Overdue Suppository, a Borrowed Signature, and a Ballgame
It is 7:15 p.m. on a 24-bed unit with two aides caring for 22 residents. The RN is in a room managing a bleeding catheter site and calls to you, 'Mr. Doyle's suppository is overdue - just take it in and insert it, I'll sign for it later.' Ten minutes later, aide Renee says, 'I never got to Mrs. Kim's shower. Sign the flow sheet for me so we don't get written up.' Then Mr. Doyle tells you he does not want to go to bed yet; he wants to watch the ballgame in the dayroom, although his care plan lists an 8:00 p.m. bedtime.
1. How do you respond to the RN's instruction about the suppository?
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Decline the task, not the resident.
Say clearly and briefly, 'I'm not able to insert a suppository - that's outside what I'm trained and allowed to do. I can help you by setting up supplies or covering your other resident while you do it.' Then tell the charge nurse or supervisor if the RN insists.
Do not insert it 'just this once,' and do not accept a signature later as if you had. Do not leave Mr. Doyle without telling someone what he needs - the care still has to happen, by a licensed nurse.
Reasoning: medication administration, including suppositories, is a licensed act. Accepting it puts the resident at risk and puts your certification on the line, and a nurse's signature afterward does not make an unlicensed act legal. Being short-staffed is a system problem, not a scope change.
2. Renee asks you to sign that she gave Mrs. Kim's shower. What do you do?
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Refuse, and report it.
Say, 'I can't sign for care I didn't give,' and do not initial, backdate, or 'help out' by charting it as done. Chart only what you did and saw; if you learned the shower did not happen, you may document the resident's actual condition and that the shower was not completed.
Then tell the nurse or supervisor what was asked of you and that the care was missed, so Mrs. Kim can be bathed and her skin checked. Do not argue with Renee in front of residents or at the desk.
Reasoning: a false entry is falsification of a medical record. It hides missed care, denies the resident what the care plan promises, and exposes both of you to discipline or loss of certification. The record must reflect reality, and late entries should be marked as late.
3. Mr. Doyle wants to stay up for the ballgame. How do you handle it?
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Treat the care plan as a default, not a cage.
Ask why he wants to stay up, and support the choice if it is safe: prop him comfortably in the dayroom, keep his call light or a way to signal nearby, check on him often, and make sure the lighting and floor are clear. Offer a compromise - the first inning, or television in his room at the same time.
Tell the nurse so the care plan and bedtime can be adjusted and so the next shift knows where he is. If he is unsafe to be up (dizzy, unsteady, on a new sedative), say so and get the nurse involved rather than physically forcing him back.
Reasoning: residents have the right to make choices about their own routines, and a care plan is updated, not enforced. What you cannot do is leave an unattended, high-fall-risk man alone in a dark dayroom because he asked.