Gaaaa....what a tangle...what to do...

[weirdRN, RN]

I have a problem on my hands and I am not sure how to fix it.

I work for a nursing home. Usually the three to eleven shift. I usually have in the neighborhood of 30 plus residents or so. I have two med passes. One at four and one at eight. I also have charting on eight to ten residents, and a number of treatments to do and sign off on. The med pass usually takes about two hours to complete, and then I have to help with feeding the residents.

The other night when I worked I had two situations at one time. I had a resident who bottomed out and had to be sent to the ER and another Resident who became aggressive and combative and had to be medicated. Both occured about 5 or so. I spent until 630 resolving both issues. Then I had a resident who had problems regarding his appointment scheduling for the next day. That took about fifteen minutes to fix.

Because I was so behind and so overwhelmed, I partially combined the two medication passes. I know not to give double medications, or incompatible meds and know that some things have to be given at certain times. so I took care of the people who had accu checks, insulins and thyroid meds. I still had treatments that I was responsible for, so I tried to do half of them before having to be in the dining room and the other half after I came back. I didn't take a lunch break, and I only got to the bathroom once that whole shift.

My DON called me Monday to ask me what had happened. She said she was told by a Nursing Aid that I had combined my four and eight o'clock med passes, which is a big no no at this facility.

This really ticks me off the whole way around. The aids were all standing around in the halls all night. If our policies weren't so restrictive, they could have been helping me instead of standing around watching me flounder.

Does anyone have any suggestions other than voting with my feet?

[Chaya, ASN, RN]

So what did you say to your DON? Where do things stand now?

[weirdRN, RN]

I told my DON what happened. The complete unvarnished truth.

It was a very humbling experience to have to admit that I pretty much couldn't do my job effectively.

I didn't say anything about the aides. I am just beginning to see how having too many patients and not enough hands to do the work can be detrimental not only to my patient care, but also to me.

What I am asking is how can I make this situation better. I doubt I could prevent it. You never know what might happen shift to shift.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

This is one of the reasons I no longer work LTC. If nothing goes wrong, I was able to get meds, treatments, feedings and charting done. I got a bathroom break. (Although rarely a lunch break or other break) However if one patient falls and gets hurt, or one gets sick, your meds are late and treatments dont get completed on time or at all. You wind up staying an hour past your shift (atleast) and don't get any breaks. No its not wise to combine the two med passes but I know you would probably get in trouble if all of the meds on the second pass were late as well, and would have probably been in trouble for staying late. And then you feel bad when residents refuse meds b/c they are sleeping and don't want to get up for them. It was too much stress for me, and I felt terrible everyday after leaving my shift. Maybe it was me, maybe I had poor time management. I don't know. But I rarely had to stay late when I worked med/surg and psych. I can't really help, but I wanted you to know that I understand your frustrations. Im sorry you had a bad shift.

[weirdRN, RN]

I have worked at this facility almost a year. I made the move from CNA to LPN and now, RN. I feel like the aides are jealous. I feel that I have been too lax in my supervisory duties, that I have tried to be their friend instead of doing my job. I feel that because I have been so lax, they feel that I do not know how to do my job and feel justified in complaining. That's fine, between now and the time I leave, I will simply enforce all the rules. I can't wait for the barrage of complaints then.

I wrote my resignation this afternoon. I plan to tender it mid May.

I wrote that I feel I need more med-surg experience in a hospital setting.

I am going to miss the residents, but I will not miss the stress, back stabbing or the gossiping.

[APP]

whimsiern: what did your don say when you told her the situation?

[weirdRN, RN]

My DON was very supportive of me when I told her all of my feelings on this whole situation. She said she felt like I could do this. She said that every time I have had to have a conversation with her regarding anything job related that I have always shown growth. She says she is proud of the job I have done and is encouraging me to stick with it just a while longer. She thinks that it will work itself out and I will be okay. She also said that it smacked of running if I just picked up and left now. She encouraged me to go out on my own terms and not let those aides run me off. She said she understood about them having been my friends but now it was time for me to pick up the mantle of responsibility and consider my patients needs.

I decided that I would stay on until the end of May at least, and depending on how things go then, then I might or might not stay on PRN

I am really fortunate to have such a wonderful supportive person as a supervisor. Just that alone is almost in and of itself enoguh to make me want to stick around. You don't get many supervisors who can be so great at not only managing, but encouraging and mentoring a young nurse.