Question

During the change of shift, the oncoming nurse notes a discrepancy in the number of Percocet (Oxycodone) listed and the number present in the narcotic drawer. The nurse's first action should be to: A. Notify the hospital pharmacist B. Notify the nursing supervisor C. Notify the Board of Nursing D. Notify the director of nursing

Short answer

Answer: Notify the nursing supervisor.

Step-by-step solution

Understand the roles of each option

It's important to understand the roles and responsibilities of each option presented in the question. This will help in determining the most appropriate action to take in this situation. A. The hospital pharmacist manages medications and ensures safe and effective use. They can help with identifying the cause of the discrepancy. B. The nursing supervisor oversees the nursing staff and is generally responsible for maintaining patient care standards. They will be informed if any issues arise with medications or discrepancies. C. The Board of Nursing is responsible for licensing and regulating nurses in their jurisdiction. Issues such as discrepancies with controlled substances like Percocet may need investigation and may result in disciplinary action against a nurse if misconduct is involved. D. The director of nursing is responsible for overall administrative management and decision-making at the organizational level. They are not usually involved in day-to-day clinical activities.

Determine the most appropriate action

Based on the roles of each option, the most appropriate action would be to take the issue to someone who can address it within the immediate nursing team and has the authority required to handle any identified issues. In this case, the best option would be to: B. Notify the nursing supervisor. The nursing supervisor has the authority and responsibility within the nursing team to handle issues or discrepancies related to medications, as well as the ability to escalate the issue to higher authorities if necessary.

Key concepts

Nursing Ethics

Nursing ethics is a set of moral principles that guide the practice of nursing and ensure the highest standards of conduct. It encompasses a wide variety of issues, including patient care, confidentiality, and professional practice.

In the context of the given exercise, where there is a discrepancy in the count of a controlled substance, nursing ethics calls for immediate and appropriate action to ensure patient safety, accountability, and to uphold the integrity of the nursing profession. An ethical nurse would understand the significance of accurate medication administration records and the potential risks of discrepancies in controlled substances.

The principles of ethics in nursing, such as justice, nonmaleficence, and veracity, compel the nurse to report the discrepancy to the correct authority, while also preserving the trust within the healthcare team. Reporting to the nursing supervisor, as indicated in the exercise, adheres to the ethical standard of taking responsible actions when faced with potential errors.

Medication Management

Medication management is a critical aspect of nursing care, involving the safe and effective handling, administration, and documentation of medications for patients.

Proper management ensures that patients receive the correct medication, at the right dosage, and at the appropriate times. In handling discrepancies like the one in the exercise with Percocet, strong medication management practices require immediate investigation to prevent potential medication errors or misuse.

From the perspective of NCLEX-PN practice questions, candidates must understand the procedures for addressing medication discrepancies, including counting narcotics, documenting administration, and reporting any issues promptly to the correct authority, which in this case, is the nursing supervisor. Effective medication management protects patients from harm and supports the overall treatment plan prescribed by healthcare professionals.

Nursing Licensure

Nursing licensure ensures that nurses have met specific educational and practice requirements to provide safe and competent care. The licensure process is overseen by the Board of Nursing in each jurisdiction and is integral in maintaining public trust in the profession.

In the practice scenario provided, while the discrepancy in medication inventory is not directly a licensure issue, understanding the role of the Board of Nursing is essential. The Board does not handle day-to-day clinical incidents but is brought in when there's potential professional misconduct or practice issues that affect licensure status.

Should an investigation reveal that a licensed nurse intentionally misappropriated medications, the Board of Nursing would then be notified to take the necessary actions, which could range from reprimand to revocation of the nurse's license. However, the first step in the exercise—reporting to the nursing supervisor—aligns with the procedures set for addressing immediate clinical concerns before involving regulatory bodies.