"Just Give Her the Pill"
You are a nursing assistant on a busy evening shift. A coworker, also a nursing assistant, is behind and asks you to "sign off" on the 1800 repositioning for two residents she has not turned, because the unit clerk is already asking for the flow sheets. Fifteen minutes later a resident's daughter catches you in the hallway holding a medication cup that the nurse poured and left on the cart while answering a call light, and says, "She's in pain - just give it to her, it's already poured, you'd be saving everyone time. The nurse won't mind." The resident is alert and asking for her pain pill.
1. Address the coworker's request to sign off on repositioning that was not done. What do you say and why?
Read the worked answer
Say: "I can't sign for turns that weren't done. If you tell me which two, I'll turn them with you now - we can split them."
Reasoning:
- Signing for care that was not delivered makes the record false, and repositioning schedules exist precisely to prevent pressure injuries. A falsified turn record doesn't just mislead - it hides the injury developing right now.
- It is also the fastest way for both of you to lose a license and a job, and it hides the real problem: she is over-assigned.
- Offer the practical fix first. Refusing without offering help turns a systems problem into a conflict between two aides.
- If she refuses the offer and the turns stay undone, tell the nurse that the turns were not completed. Her workload is a supervision issue; an inaccurate chart is not a solution to it.
2. Now the medication cup. What do you do, and what do you say to the daughter?
Read the worked answer
Do not administer it and do not hand it to the resident. Set the cup back down on the cart, out of the resident's reach, and get the nurse who poured it.
Say to the daughter: "I understand - I'll get the nurse right now." Then actually do it, and let the nurse give the medication and answer any questions about timing.
Reasoning:
- Administering medication is outside the nursing assistant role. Even where a Washington facility operates a nurse delegation program, delegated tasks require a written delegation agreement, training, and the delegating nurse's specific authorization - not a cup already poured for someone else's administration. Nothing in this hallway qualifies.
- The aide also doesn't know the drug, the dose, the last dose, allergies, or whether the resident is due at all. "It's already poured" removes exactly none of those unknowns.
- Explain the limits briefly and without lecturing. The daughter's real concern is her mother's pain, so the answer is speed, not a policy speech.
3. Both situations end with no harm. What do you report at the end of the shift, and what is the test for whether something belongs in a report?
Read the worked answer
Report to the nurse:
- That you were asked to sign for two turns that were not done - with times and the residents' names - so the nurse can verify skin and reassign work.
- That a medication cup was left unattended on the cart and that a family member asked you to administer it; you declined and located the nurse.
The test: Ask would the next person need to know this to keep someone safe, and would my silence hide something? Near-misses pass that test - an unattended medication cup and a falsified turn record are reportable even though no one was hurt.
Also report factually, not as a character judgment: "Aide A asked me to sign for turns not completed; I declined and we turned both residents together" is reportable; "Aide A is lazy" is not.
What you do not do: Decide the coworker's discipline, or handle either situation privately because reporting feels disloyal. Both concerns go up the chain, and the nurse decides what happens next.