Nothing is right about this...

[g07h10]

After searching for many months, I finally got a job in a clinic. The hours are great, the pay is what I need, but the conditions I work in are awful.

This clinic serves a very poor community. I'm trying to be as generic and anonymous as possible, so the best example of the type of nursing I do is a school nurse to adolescents and some young adults - some of which live on campus. The clinic is either state or government funded (I'm not sure which). I've only been an employee for a week now, and I've seen so many things that are so wrong. Because of the efforts to cut costs, medications that are prescribed for patients that live on campus that are not finished by the patient are kept in drawers in the office (like scattered in different drawers - no organization at all). If a patient comes in needing to see the staff doctor and is prescribed medication, rather than getting the new script filled, first the medication drawer is searched. If the drug is on hand, enough pills for the prescribed time is taken out of the original container (the container from the pharmacy when it was originally filled with the original patient's name on the outside of the container) and placed in an envelope for the patient to take. Controlled substances (ex: adderall, lortab, ritalin, strattera) are, for the most part, kept in a cabinet that does have a lock on it, but the medications are never counted, and I witnessed another nurse drop an ADD medication and not even bother to try and find it. I imagine it's still on the floor somewhere. The other day, I walked into the office, and sitting on the desk was a patient's prescription of adderall. Anyone could have walked by and taken it.

There are other things too, such as the cleanliness of the office and the giant mess of papers and charts everywhere, but I worry more about the medication issues.

I'm not sure what to do. I could quit, but I don't see that as solving the problem, and I really do like my job despite the lack of medication administration protocol. Where, or to whom, can I report the clinic to? What would you do?

[amygarside]

This is a very serious matter and thank you for sharing it. First of all, who is in charge of the clinic? Is the person someone that you can talk to about this? If you are not yet sure, then observe some more then write down what you see. Do you have colleagues that you can talk to? Try to find out more and document the things that you see. Also look for possible solution to the problems so that when the do ask you, you are also prepared for any action that can improve the situation.

[Frankreich]

Leave the ghetto clinic behind unless you are willing to make the changes needed to meet minimal standards that are lacking. If you stay you will be considered part of the problem and liable. Just remember money is not everything.

[oldntiredRN]

I had a similar problem this past summer. I had wanted to work in a underserved urban family practice clinic setting for the past 3-4 years as the patient population provides a nurse with an keen inetrest in Public/ Community Health and that spirit, a fabulous opportunity. I accepted a postion in a governement funded clinic as their first Telephone triage nurse to their newly formed call center. I had a few years telephone triage experience and loved it. The healthcare reform, I am 100%for. I had the support of managment(CEO and IT/record manager's and medical Director's)) as it was their baby so to speak and they gave me card blanc to"make it my own" They were very hospitable and enthusiastic. Unfortunately, that was not the case of the general staff- the staff RN's and LPN's and 1 unit secretary. I found serious breaches to the nursing practice act and cases of inappropriate nursing practice by UAP and underlicensed personel who had been allowed to do triage for years. The nursing management was not completely cognisant of what the role was or what it involved, the UAP and underlicensed staff were even less educated and in no way going to give up their out of character priviledges they had come to "enjoy". In my state only RN's are legally allowed to do triage. I witnessed the unit secretary triage pediatric patients(infants) over and over and over again. i nicely rminded her that it was my job and she continued, I went to the Peds nurse manager who reminded herin front of me very kindly what i was there for and the secretary proceeded to do it again, I went to the nursing supervisor. the secretary continued in addition to going to others in other departments to bad mouth me and make enemies before I had even been introduced to them. Needles to say, my time there was limited- 6 weeks. I formally, in writing, reported the particulars( patient names, Date of birth,date of occurance,and time) to my state's dept of Health/Licensing and inspection. The clinic was cited with a deficiency and was put on notice to have a plan to clean up it's act. When you make a complaint to the DOH, they do get back to you with the disposition of that complaint; That is their responsibility and accountability. Telephone triage is part of Nursing Informatics. I have since started back for my BSN completion. I have learned in an Informatics class what is needed to make a successful new program work. #1 is support of all involved- which was not there and Nursing Informatics is so far over the heads of most of the players in my situation, that there was no way this triage nurse position or service to the patients of that community was going to get off the ground. It is a shame, because I have worked in a situation where this triage does work and is quite an asset. This patient population needs all the patient education it can get, it is plagued by low health literacy and limitations to it's acces to healthcare. But unfortunately the healthcare staff(includingsome of the not so bright RN's, LPN's and the lack of formally educated secretaries) involved are going to keep these poor patient outcomes going because their egos are at stake. There are those out there who believe that poor of a community does not deserve quality care!! Some times it even comes from their own.

You may want to find someone in managment who you feel is in tune with what you were hired to do and confide in them. Be aware that the problem may not be you but, you have entities who are non nursing( anotherbig part of the mess) and through their ignorance of nursing and what is involved, will be blamed on you out of their own stupidity.Gotta love the "dumb it down " way of life in today's working world. Any one who is not a nurse will be put into an honorary nursing role because the business gods says it cheaper. They are the real morons and non nursingbackground prepared.

It sounds like you have a big clean up job to do. i would say- the first thing is to get those meds under control of lock and key and accountable narc sheets- That is a patient safety issue and liability for that school board whether they want to realize it or not.The next is the HIPAA violation of patient information all over out in the open. You may want to find a seasoned community/public health nurse or school nurse to confide in and help organinze your next steps to this clean up. "What is the plan? What is the goal? Where is this /your responibility/job function going with this mess? If this job is what you want, your going to have to dig your hels in, but heads and roll up your sleeves. Ther is not an abundance of common sense and smarts out there today.