CNA's passing meds - page 7
I have heard tales that in some states the CNA's are the ones who pass meds. I was just wondering if any of you live in any of these states that supposedly do this and if the CNA courses are more... Read More
Sep 6, '02Solutions, solutions, solutions. Oh where are the solutions? If not med-aides, then what? If you're short 3 nurses, do you just continue to operate and HOPE that ALMOST everyone, gets ALMOST everything that they're supposed to get? Inclusive of meds?
Pay and working conditions are certainly issues, however, when you're fried from too many patients and not enough hands to enable you to give care at all in certain areas, much less QUALITY care, what are you supposed to do?
Sit back and let it continue, or use people that , while they don't have as much education as a nurse, ARE additionally trained, specifically in med. administration, enabling you, the nurse, to give as much quality care as is possible.
In our area there are simply NOT the nurses to meet the demands, regardless of the many nursing in the area, competitive pay and good working conditions.
You cannot hire and use people that do not exsist.Last edit by NrseK on Sep 6, '02
Sep 6, '02Come up with other solutions was the challenge. Well, heck. The ones I can think of aren't gonna get done. Like the excellent nurse who got burned out on staffing policies and got a job as a manager at a fast food joint making more money and less headaches, and doesn't kill anyone if she forgets the pickles. Would she come back to nursing? I doubt it.
A related problem IS the staffing shortages. If we had RNs lined up waiting to put in applications at LTC, and the pay was reasonable, would anyone use a CMT? If money wasn't THE issue, would CMTs be used at all? If there were plenty of RNs, would anyone use CMTs? I doubt it.
Mrs. Jones gets a new order for Lanoxin and goes into v-fib, dies, and no one notices and so I get sued. Will the BON say, "there, there, Nurse Betty. Don't worry about it. You did the best you could." No, the BON won't say that. They'll yank my license.
So, here's the problem, the cop-out if you prefer. I don't count beans. I don't get to wear a suit, and don't want to. I just take care of my patients. If I am so busy that I need a CMT to pass my pills, then it's time to find another job. Does that solve the problem? Nope. But, it keeps me safe and sometimes prudence is the better part of valor. At least the BON thinks so. How those problems get solved, is beyond my ability. I'm not a CEO, I don't set budgets, and I don't care if the investors on Wall Street are happy with their quarterly dividend check at all! So, all I can do is follow my conscience and refuse assignments that are unsafe. If you are comfortable with it, and you don't have a bit of doubt, and nary a pt. ever went without optimal care because of it, in your experience, then, Hey! Great! But, me? I pass my own meds, then I don't have to worry about doing an assessment AFTER a pill has taken effect. I can decide on the spot if it should be given at all.
Sep 6, '02Youda
Your posts on this subject express the concerns of many nurses. You get to the crux of the issue without being defensive. Thanks for speaking my mind so well.
Sep 6, '02With all due respect to those who want to blame these issues on administrators and money . . . these are only additional elements in a very complex situation. Many adminstrative staff including DNSs and administrators are nurses and a lot of research has shown that money really has very little to do with whether people get satisfaction from their work or is directly related to the quality of care.
We can all sit here on this bulletin board and find problems . . . thats easy. Surprisingly, so are solutions. A challenge is to find solutions and propose them here so that those who come here for help can take something away . . . not just get sucked into the whining and complaining. A difficulty is making the solutions work, e.g., in order to assure that medications are administered effectively it is necessary to monitor the administration practice for variance. This is to say . . . take the opportunity for poor practice out. Unfortunately this means that nurses have to monitor and report on other nurses practice (or on CMA practice). We are reluctant to do this because we know how difficult it is to do the work that we are monitoring (and we don't want others monitoring our work). So we complain that no one is doing anything when the people we are complaining about are ourselves.
We are a unique and funny group of people.
Sep 6, '02mboyce
Your point about oversight in the second paragraph of your last post is well taken and something I've seen problems with countless times. Could be topic for disc in it's own thread. But like you say, lots of problems presented, very few solutions. In a case or two (unrelated) I have seen solutions presented on the job where the response was almost insulting. I think these particular managers really want the status quo, that's why they promote it so strongly and beat down anybody who tries to make a positive difference. Just my on-the-job observations.
Sep 6, '02I agree, nursing is exhausting; physically, mentally and spiritually . . . fortunately (and unfortunately) people depend on nurses to rise above the meanness and minimalization of others less willing to serve.
I believe that the need generates the energy for those who are nurses (not just practicing nursing) to step up.
I am very interested in hearing from people who have what they think are answers to improving medication administration practices (no matter who administers) and what the role of the nurse can and should be when they are freed from the passing of pills . . . especially in protocols, methods, practice, experience, habits, et al, of identifying and assessment patients/residents for response to chemicals.
Sep 6, '02It is my firm belief, that there are multiple ways that the nursing shortage can be, maybe not magically or a "quick fix", but fixed; and these solutions I honestly believe would be long term.
In a lot of instances, nurses "eat their young". Impatience with young, inexperienced nurses, expecting top performances, no repeated instructions,(ie:"I already told you that once, my god!")and expectations of perfection, or near enough not to
matter, do not encourage.
How often do we, as a group, stand around, whine and complain and downgrade our own profession? How do you think this affects people that are considering entering the profession? Do we honestly believe that this behavior encourages people to WANT to do what we do for a living?? If we're constantly so miserable, why would they?
How often do we truly nuture someone elses budding career and help them to grow in knowledge and scope and how often do we worry more about how their advancement is going to effect our job description?
How often do we encourage LPN's/LVN's to become RN's? Isn't this often seen by some RN's as just more competition for wages and status?
All I'am pointing out, is that, perhaps, just perhaps, there are a multitude of things that can and should be being done by each and everyone of us to encourage new people to enter the profession, to nuture the young ones already in it, and look to ourselves for a least a good part of the solution, instead of saying "It's all the "suits" fault. If they'd just do this, if they'd just do that, all of our problems would be solved." I promote the idea that pay and working conditions are only a portion of the problem. The shortage itself is the issue to be dealt with.
Sep 6, '02I have to disagree. I'm not talking about nurse managers. I'm talking about the accountants and the MBAs and CEOs who know more about the function keys on a calculator than the "business" (if you'll excuse the pun) of nursing. Those who will push the envelope, the poor nurses, to the brink of extinction if it means another good day on Wall Street. What corporation do you work for? Check out the millions of dollars paid out by your X,Y,Z, corporation to campaign contributions and lobbyists in D.C. whose sole job for this money is to prevent legislation that would benefit workers (nurses) or any kind of healthcare reform. No, I'm not paranoid. These are facts easily obtainable about any of the major corporations who do the "business" of healthcare.
As for the whinning. ANY manager sets the tone for his/her company, group, unit. If you are seeing people whining and moaning, there is an atmosphere that started AT THE TOP somewhere that is disrespectful and demeaning to YOU. If you don't believe me, think back on the jobs you loved. What is missing now where everyone is whining? Respect.
Oh, yes, folks. The changes that are needed most certainly can be accomplished. But it means that the "business" of healthcare has GOT to change back to BEING about healthcare instead of "business."
Now, you went and got me riled. <grin>
Please don't talk about nurses criticizing each other when we are only responding HUMANLY to inhuman conditions and expectations. Sure, the coping mechanisms start to wear a little thin sometimes and come out in negative ways. But, do NOT put the demand of being Pollyanna on us all the time, as if we don't have enough expectations put on us already.
Youda <----- stepping off my soapbox
Sep 7, '02Absolutely, absolutely! No doubt in my mind, that WAY too much emphasis is placed on the bottom line. No arqument there. WAY too much emphasis.
However, I still maintain, that, as members of a profession, not just a vocation, but a profession, it is part of our obligation to our selves and others to take accountability and responsibility for how we conduct ourselves in public forums and the perceptions that we give to the general public about the way we feel concerning our profession.
Every profession has it's problems, and there are very few that don't have money complaints.
There is no doubt that numerous aspects of nursing are incrediably demading, to the point of breaking, minds, spirits and hearts at times. Do we get the respect that we deserve all the time? Heavens no.
But, without expecting anyone to play Pollyanna( because believe me, I would not do well!
) I still maintain, that to blame nearly every negative aspect of our jobs, on these unseen faces of the "suits" is enabling them to make us look like all WE care about is the bottom line; and we all know that the vast majority of us are in this incrediably hard field because we truly love people and want to help them.
All I'am suggesting is that WE need to, within own ranks, encourage, promote, and lift up each other. Complaining etc., will always have a place. Everyone has to complain at times, or we'd just all explode!
I just think that TOO much of it, and we only harm ourselves and the profession.
Sep 7, '02Yes, I do agree with you now that you've restated it. But, I also see complaining and venting as defensive coping mechanisms, particularly among those who do not feel empowered, who feel helpless. For some reason, usually a Machiavellian-type management, people engage in these behaviors when they do not feel they can take their concerns and problems openly up the chain and have those concerns dealt with respectfully and seriously. The morale starts to drop and there is complaining, backbiting, gossiping, and all the other behaviors.
Yes, there is a certain amount that everyone can do by conducting themselves professionally. Yet, I see behaviors such as you described as symptoms of an ineffective management, not a fault at all to those who are doing it. An individual, or a small group, simply doesn't have the leverage to confront these problems without risking their own livelihood. So, those problems are endured, turned inward to stress and depression, or vented among ourselves with the complaining and whining. In many ways, some of these negative behaviors, if not reactions to ineffective leadership, are simply mirroring the behaviors of management: nitpicking, lack of concern for the individual needs, bullying, cliques, fault-finding, etc.
I strongly believe that the only way any of these concerns and problems will ever be resolved is for each and every nurse to join their state nursing organizations, the ANA, and become involved so that positive changes can occur. And it is VERY possible for these changes to happen. See this news article and join me in congratulating the California Nurses Association. You can see what can be done, if we all work together. There is no doubt that California just put a HUGE dent in their nursing shortage and secured better care for their patients.
http://biz.yahoo.com/bw/020906/60230_1.htmlLast edit by Youda on Sep 7, '02
Sep 7, '02I WOULD NEVER BEGRUDGE ANYONE WHO HAS PUT TIME INTO LEARNING AND TAKING RESPONSIBILITY FOR THE CARE OF OTHERS. I HAVE WORKED WITH TECHS AND FOUND THAT IN THIS POSITION I SPEND MUCH OF MY TIME WORKING AS A TEAM, RATHER THAN JUST HANDING OVER THE CART AND NOT CHECKING IN ONCE IN A WHILE. MY WHOLE CONCEPT OF THE STAFFING SHORTAGE IS TO WORK TOGETHER AND LET EACH MEMBER KNOW YOUR EXPECTATIONS, WHAT YOU ARE WILLING TO DO AND WHAT MUST BE ACCOMPLISHED! THE BOTTOM LINE IS THE PATIENT AND I FIND THAT "BEDSIDE LEADERSHIP" SEEMS TO WORK THE BEST IN A LTC SETTING. THIS MAY SOUND IDALISTIC, BUT IT SEEMS TO KEEP STAFF FOCUSED AND PRODUCTIVE.
MY DAUGHTER, NOW A P.A. STARTED AS A PCA IN THE LOCAL HOSPITAL. HER FIRST DAY OF WORK(AFTER 3MONTHS OF ORIENTATION) CONSISTED OF STARTING A COUPLE OF IV'S, PUTTING IN FOLEYS, AND VARIOUS OTHER TASKS DESIGNED TO FREE THE NURSE FROM THESE DUTIES. SHE WAS NOT ALLOWED TO PASS MEDS. THIS PARTICULAR HOSPITAL DID NOT EMPLOY LPN'S, SO BASICALLY THEY USED PCA'S FOR CLINICALS AND PAID 9.50/HOUR.
I USUALLY MAKE IT CLEAR THAT IF A CMA WILL BE DOING MEDS THAT I AS THE "CHARGE NURSE" WILL NOT BE HELD SOLELY RESPONSIBLE FOR A MISTAKE OR SIDE EFFECT. THIS CAN BE CLARIFIED BY DOCUMENTATION THAT THE NURSE CAN PRESENT TO THE ADMINISTRATOR OR DIRECTOR.
THANKS FOR LISTENING!
Sep 7, '02I disagree I don't feel powerless nor feel intimidated. I honestly could care less who passes meds just don't expect nurses with licences to take the fall. I work in NICU and I know that will never happen but for those who work in LTC watch out! Protect protect protect.