Covert Medication Administration and the Competent Adult

I am a non-nurse manager at a long-term care facility that employs RNs as part of the health care team. We were recently in the process of completing the admission of a new resident. The resident care coordinator stated that she had been informed by the RN transferring care that in the previous facility the RN staff participated in “covert medication administration.” The resident, who has been deemed competent, would sometimes refuse to take the medications the physician prescribed; therefore, the physician asked the RNs to tell the resident it was something like a blood pressure pill that he would be willing to take, and the RN staff complied. I am being told by the care coordinator that this practice is considered unethical and does not follow best practices. Please help me understand the ethical and professional obligations for RNs in this situation.

• RNs are accountable and accept responsibility for their own actions and decisions (1).
• RNs challenge and take action on unclear or questionable orders, decisions or actions made by other health care team members (2).
• RNs support and empower clients in making informed decisions about their health care and respect their decisions (3).
• RNs practice in accordance with the current Code of Conduct (4) and utilize these principles while administering medications.
• RNs promote and protect a client’s right to autonomy, respect, privacy, dignity and access to information (5).
• RNs apply knowledge of pharmacology and principles of safe medication practice (6).
• RNs collaborate with clients and are sensitive to and respectful of their needs. To achieve this, RNs provide client-centered care, prioritizing clients’ health and well-being in the therapeutic nurse-client relationship (7).
• Professional boundaries are the spaces between the RN’s power and the client’s vulnerability and distinguish the parameters of the therapeutic nurse-client relationship. RNs demonstrate accountability by respecting the power imbalance, and by establishing and maintaining professional boundaries that are client-centered and meet the therapeutic needs of the client (8).
• RNs promote dignity and respect for the nursing profession by demonstrating professionalism and showing leadership. To achieve this, they report any errors, near miss, unsafe behavior, unethical conduct or system issue to relevant individuals including employers and/or regulatory bodies, whether or not harm has occurred. (9).
• RNs listen and respond to client concerns by collaborating with clients and any person or community the client wants involved in their care (10).
• RNs advocate in the best interest of the client to help achieve positive health outcomes especially when they are unable to advocate for themselves (11).
• Addressing this concern as a team will support the consistent practice of transparent medication administration with the resident. Developing a care plan that acknowledges the client’s right to refuse medications, while establishing clear monitoring and reporting practices ensures effective medication management. By sharing these responsibilities and best practices among all providers, the healthcare team fosters trust —both between the client and the team and amongst team members themselves — leading to improved collaboration and continuity of care. Deviations from this planned care may contribute to mistrust between the resident and the team as well as between team members.

  CRNS Resources

  Code of Conduct (2026)

  Registered Nurse Practice Standards (2026)

  Registered Nurse Entry-Level Competencies (2026)

  Medication Management Guidelines: Decision Tree (2026) page 11

  Professional Boundary Considerations for Nurse-Client Relationships (2026)