Doing Without a P.O. Med Nurse - HELP!!!!

[soundsLikesirens]

I have recently returned to nursing after a 7-year absence. I've been on a busy med-surg/oncology unit for 3 and a half months now, and when I first began, it was great. Of course, I was learning (still am), but when I started, WE HAD A PO MED NURSE. In other words, it was still manageable - it was still reasonable - still do-able. Now, we get there and have 10, 11 patients, with all their po meds, piggybacks to give...IVs to check or start...orders to take off...admissions....patients' families to deal with, with their constant questions...the call light...people wanting coffee...water...on and on and on!!!! I work 7p to 7a and although I love my job, I am starting to get stressed out because I feel like I'm not able to give proper care. Usually, I'm in report from 7pm to 730pm...then I come out and start on the 2100 meds....and usually at 2300, I have 2 patients out of 11 who haven't had their 2100 meds, not to mention charting, etc, and all the other things screaming to be done. I had an admission the other night at 7pm, as soon as I got there....I went into report...well it got to be 1030 or 1100pm and she still hadn't had her meds yet. The people "in charge" know that all the nurses are going nuts...their "philosophy" is that it's "better" for the po meds to be given by the nurse, since we know what's going on with them....(supposedly)...and that it increases the time spent in bedside nursing...this is alot of bull and I think it's a smokescreen for them just trying to cut the budget. I want to stay where I am; I love med-surg but I don't know if I will be able to. But I can stand anything for 6 months. After that I can transfer within the hospital. Or, I may stay put for a year, then go to agency nursing as they make more money. But I know I'm not staying. Our unit manager sympathizes but her hands are tied...she said they've told her we are definitely NOT getting a po med nurse back. God, it wouldn't cost them that much! We're always short-staffed....the last few nights, I haven't been able to getoff the floor to do anything. Forget about noting orders or doing any paperwork...and everytime you go into a patient's room with their medicine, you have to UNWRAP their water pitcher and get ice and water. We have 32 patients and only 2 med carts, which we are not supposed to take down the hall. If they would let us do that, and take along water, cups, etc, it would save alot of time. God I am getting to where I hate to go to work....because I know I'm going to be overwhelmed. We never have enough CNAs...alot of time, we have 2 for 32 patients and they end up splitting the floor. Which means I am constantly doing floorwork...and no, I don't think I'm too good to do it because I'm an RN. It's just that when I answer call lights and the phone all night, and fetch and carry, I cannot get MY WORK done. HELP!!!!!!!!!!

[mustangsheba]

Hey, BoraBora, I would give a new Merck Manual to come and give you a hand. Not because your job is easier. I just love your part of the planet. Do you wear flowers in your hair when you go to work? I wanted to jump in here about med aides. They are essential! I worked with one MA, 5 cna's and another RN, 60 patients, some skilled, some alzheimers. I did the diabetics, treatments and tried to pick up the prn's, answered the phone - The RN is expected to pick up the slack. The aides and MA were pounded. I was trying to pass pain meds and get the diabetics covered when they came to recruit me to help feed. For the first time in my career, I refused. (They managed). Why is staffing always cut in the evenings? That's when families come in with 100's of questions. Sundowners abound. Constipation and diarrhea manifest. People fall. I know this happens during the day too, but generally there is more help -although still not enough. I worked at a wonderful little hospital last week that had a charge nurse and an extra nurse to do nothing but put out fires and cover the "unexpected". He was busy the whole time. With all due respect, I still contend that there would not be such a great need for the checker uppers if there were more help. Say what you will about doing it right the first time, by the time I end a shift like that, I can hardly think straight and yet I'm haunted by the needs unmet - the people who are so hungry for someone to sit on their bed for ten minutes and just be with them. It would be more therapeutic than all the pills in the world. Just venting. Thanks.

[nursejanedough]

To sirens and Mustang: I am glad I found this site. I didn't realize how much I needed to vent. Siren, in regards to that person that told you the more patients you have the better nurse you are - well, I can not print what I want to say, but that is like telling a teacher, the more students you have the better teacher you will be. She/he must not have ever been overloaded or he/she is delusional. And to Mustang, you are right about the 3-ll shift, esp. in LTC, with all the Sundowner's and families come to visit it can be a nightmare. I have worked all shifts and I still don't understand why they can't get the 11-7 shift to do more. Since that is the hardest shift to fill, I have a feeling that they are worried that if they give them too much to do, it might run them off.

[ratchit]

"Why can't nights do more?" Have you ever worked nights? Nights routinely has the least staff, the least margin for crises, and the least input into the unit. (Staff meetings- routinely 10 and 4- maybe 6pm. Never seen a day nurse required to wake up for a mandatory 2AM meeting- not once.)

HOPEFULLY there is a little downtime for nights- IF the patients are able to sleep. Doesn't happen, trust me. Nights is when they get confused, scared, ring the bell 1000 times, etc. Nights is when more of the sick emergency surgeries come out of the OR.

There is a little less planned activity on nights but we have to rush to clump those activities into the first and last 2 hours of the shift in an attempt to let the patients sleep. The little downtime that may happen in the middle is stuffed with scut work- chart stuffing, chart checks, whatever.

And of course, if a patient arrives sick or crashes in the middle of the night, we have minimal backup. Trust me, many MANY docs lean on us night nurses a lot more than they do on days. On days they are more likely to get involved- nocs, they don't want to get out of their warm bed. If days gets 4 admits, someone is calling around for more staff. (Trust me- I get those calls.) If nights gets 4 admits (after starting shorter than days), too bad. "We can't call people at 2AM..."

Yes, there is the occasional slow night shift. But at least in the hospital, not much more often than on days. And when all hell breaks loose, we are on our own.

Asking nocs to do more of the scut stuff is pretty insulting- makes us into techs and the day staff into the professional nurses. There needs to be respect between the shifts. If you think nights has all sorts of extra time, work a month of nights. Then let me know what you think.

[soundsLikesirens]

I couldnt agree more! I work 7p to 7a and I run, run ALL NIGHT LONG...less staff, too. The call light rings all night long...frequently, we find out they are sleeping in the daytime/up at night. And we get to reap the "benefits" (?). It's no party.

[tinkertoys]

11-7 should do more??? Come On !!! Contrary to popular belief, LTC pts don't sleep at night. They are lonely and scared, and needing attention, sore from PT and asking repeatedly for pain pills +/or hot packs, they need to pee (constantly), they're confused, disoriented, often combative. Strangely enough, the patients who are alert, oriented, and ambulatory during the day, can not seem to breathe without assistance, much less turn over in the bed. We have more patients per staff member, more treatments(since we have so much time!), and the same amount of documentation per pt as the day nurses. If we have an emergency, injury, or a patient codes, we have no one to call for backup help...what we see is what we've got! and we must always deal with the on-call Dr's (if they answer their pages). Yes, I imagine it does seem much quieter at nite, because all the "brass" and family members have gone home, but the night shift works every bit as hard as the others- and often has to do it on less sleep, because of the demands the 'daytime world' places on us as well.

[nursejanedough]

Oops, I see I hit a few nerves regarding the 11-7 shift should do more. I confess the only night shift I worked was on a psych unit with about 10 patients. Our biggest problem was figuring out what movie we were going to watch that night. Sorry, folks.

[Kthale81]

Venting??? You want VENTING? Passing PO meds is enough to drive me insane! I described it to my husband the other day...you think, well, I only have 2 little pills to give her - how much time can it take? Ha! You go in with the pills...well of course, they have to be repositioned/scooted up in bed, which sometimes takes the aid of another, and no one can be found...once you get them up in the bed, you reach for the water only to discover that THERE IS NONE. First trip to the pantry, to fetch water and ice, cups, etc. You get in there with it all and attempt to give the meds...well they have to fish it out of the medicine cup, which takes a while...they manage to find their mouth and rather than let you give them the water, they insist on holding it...only problem is, they're shaking uncontrollably...shake, shake....spill, spill...a gown change/bed change/who knows. Then once its in their mouth, you give the water......but hey, it didn't go down...another drink, and another...once they get a sure-enough lip-lock on that straw, they drink like a camel, as though they hadn't had water in 2 or 3 days.............then once the pill dilemna is over, you cannot leave the room - they need a blanket - trip to clean utility - they need the heat adjusted...they need to go to the bathroom....they need...THEY NEED!!!!!!!!!!!

Perfect picture of a busy day. All so very true. Why can't family (when visit) help out a little. Think nurses have to do every single thing, even the smallest things.

I had to assist a patient to BSC and after a bm, her husband was going to help...then the daughter told him to let me do it since that is what I get paid to do. How I wanted to tell her a few words! I replied no, I get paid for much more. Family members are a huge part of why I don't want to work the floor. Thinking about some things irritate me so much, I would have loved the chance to say a few words.

[KarynicaRN]

oh do I know the frustration of passing po meds. I feel your pain. I do know how you are feeling. You want to jump out of your skin and just scream. Every time you feel that you are done, patient/resident needs something more done. You can't just walk away.

I have had to pass meds for 2 halls, one of those an acute care wing. Many of the meds had to be crushed, put in applesauce..I had to do accuchecks, our CNA's are not allowed to do them. Plus we give the insulin and try to juggle all this on the time alloted. One time a nurse was written up for running 5 minutes late on her med pass..and the administrator was the one that wrote her up! She was doing the best she could with all the phone calls that evenings has to answer, family coming in asking questions, telephone orders, new admits, etc. It is enough to make you scream.

[SoundofMusic]

Venting??? You want VENTING? Passing PO meds is enough to drive me insane! I described it to my husband the other day...you think, well, I only have 2 little pills to give her - how much time can it take? Ha! You go in with the pills...well of course, they have to be repositioned/scooted up in bed, which sometimes takes the aid of another, and no one can be found...once you get them up in the bed, you reach for the water only to discover that THERE IS NONE. First trip to the pantry, to fetch water and ice, cups, etc. You get in there with it all and attempt to give the meds...well they have to fish it out of the medicine cup, which takes a while...they manage to find their mouth and rather than let you give them the water, they insist on holding it...only problem is, they're shaking uncontrollably...shake, shake....spill, spill...a gown change/bed change/who knows. Then once its in their mouth, you give the water......but hey, it didn't go down...another drink, and another...once they get a sure-enough lip-lock on that straw, they drink like a camel, as though they hadn't had water in 2 or 3 days.............then once the pill dilemna is over, you cannot leave the room - they need a blanket - trip to clean utility - they need the heat adjusted...they need to go to the bathroom....they need...THEY NEED!!!!!!!!!!!

LOL -- you are describing this to a T. I work on a stroke floor which can sometimes be more like a LTC facility and this is exactly how it is -- everyday. Except today I had one who did not want to take her pills. She wanted to refuse everything because it made her sick. I mean ... I was about to go out of my MIND.

[QuadraticQuahog]

The people "in charge" know that all the nurses are going nuts...their "philosophy" is that it's "better" for the po meds to be given by the nurse, since we know what's going on with them....(supposedly)...and that it increases the time spent in bedside nursing...this is alot of bull and I think it's a smokescreen for them just trying to cut the budget.

One of my first jobs as a nurse was passing out PO medication. I was responsible for two halls that housed a total of 64 patients. Even if you counted an hour leeway, Administration can do the math as well as anyone else; it couldn't be done within legitimate boundaries. I quit after two days of it and would never work for that particular company again. $$ is the deciding factor in budgeting staff; it makes all the difference in whether the DON gets their annual bonus or not and in some cases it is the deciding factor in whether a facility keeps its current DON.