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  1. Section Editor(s): Salladay, Susan A. RN, PhD

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After working 20 years as a hospital staff nurse, I accepted a management job at an assisted-living facility. The switch hasn't been easy. Last week, when a staff member didn't show up for work, I arranged for one of the night nurses to work a double shift to pass medications. I thought I'd handled the situation well, but the director of nursing (DON) called me on the carpet because the nurse had to be paid overtime. The DON said that I should have passed medications myself and that, as a supervisor, I should be willing and able to do the work of any staff member who doesn't show up.


I'm unfamiliar with many of the drugs these residents receive, so I believe it would have been unsafe for me to pass medications. Several medication errors have been reported in this facility, and I don't want to become part of the problem. Am I on solid ground or thin ice? -P. F., FLA.


I'd say thin ice. Moving from staff nurse to manager is a big change, but that's only half the problem. The other half involves differences between an assisted-living facility and a hospital. For example, an assisted-living facility functions with different staff/resident ratios, and both staff and managers may wear many hats.


You're entitled to a current and comprehensive job description, which you should have received and reviewed when you applied for the position or during new employee orientation. If you don't have one, request it before you continue to work. You should also have guidelines on how the facility expects you to respond when a staff member calls out or fails to report to work.


No matter what the clinical setting, safe practice is essential. Ethically and legally, you're obligated to become familiar with all medications administered to residents. If you feel your orientation was inadequate and you can't perform all of your responsibilities competently, ask the DON if you can shadow another supervisor who's willing to act as a preceptor or mentor.


Finally, what about those medication errors? Quality improvement-in this case, reducing medication errors-may be another one of your management functions. Instead of worrying about creating more problems, make yourself part of the solution. Get involved in determining why errors occur and how best to prevent them. Taking the initiative to learn and grow in your new position is the best way to step up from thin ice to solid ground.