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

OC_An Khe · Dec 12, 2000

You said a lot in your post and were able to do a significant amount of venting. This is a perfect example of the philosophy of doing more with less carried to its ridiculous extreme.

When I think about your statements what becomes obvious is that its not the loss of a PO Med Nurse that's your problem; but rather, that you are extremely short staffed. Not only with RN's but also CNA's.

Our facility has worked without med nurses for almost a decade and it does work, provided you have adequate staffing at all levels appropriate to the acuity of the patients under your care.

mustangsheba · Dec 12, 2000

Sirens (love your name!) I hear you loud and clear! I work do agency work and I have refused to go back to some facilities because it takes the whole shift to pass PO meds, often with overtime (not always paid). It is a nightmare. When I first started doing this, I was sent to a rehab. I didn't realize that all the insulins were in the treatment book instead of in the med book. Right in there with the dressing changes - go figure. I usually work 12 hour shifts, but when I pass PO meds, I'm exhausted in six hours. One of the CNAs I worked with the other night said I was "nicer" than most RNs and the families were constantly apologizing for interrupting me while I was tied to the med cart. That's outrageous! I know if I worked at this facility all the time in the evenings I would end up with med errors or resort to being "not so nice". I really wasn't being nice - I was doing what nurses are supposed to do, which is give some bedside care. We had an elderly patient who was dying. In the past, someone would have been with him. There was no time. We did check on him often and did comfort measures, but not the one most important - holding his hand and easing his passing. I don't know the answer. Like you, I can handle everything else but the time consuming passing of those meds. It is a full time job. And, I agree, a med aide is not going to be a significant expense - less than $150 per shift,I calculate. Most facilities spend ten times that amount in their machinations to avoid spending that much. Peace!

soundsLikesirens · Dec 12, 2000

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!!!!!!!!!!!

prmenrs, RN · Dec 12, 2000

I know you're frustrated, you all gave me a laugh describing this. Reminds me why I never want to see another grown-up pt as long as I live!!! In the NICU, I have a rule: nobody over 15 lbs!!

PREMIES RULE!!

Zee_RN, BSN, RN · Dec 13, 2000

Sirens, you describe med-surg nursing PERFECTLY. That's exactly how it is. Limited help available to you. And a trip into a patient's room is NEVER a simple visit.

That's why I'm now a critical care nurse--although short-staffing has hit there too; we're supposed to have 2pts:1RN ratio with a unit clerk and an aide but we always have 3pts:1RN and rarely an aide working. Families drive ya nuts there too.

nursejanedough · Dec 13, 2000

Originally posted by 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!!!!!!!!!!

nursejanedough · Dec 13, 2000

It's getting worse and worse. Try working in a nursing home. One nurse with 42 residents with at least 15 to 20 meds at least. I tried to tell the administrators that it was physically impossible to give this many meds for one nurse per shift. They said "Just do the best you can." The CNA's would tell me, "You are the only nurse still giving meds at end of shift." (and some of those were 9 AM meds!) I finally realized that I was the only nurse not shortcutting somewhere or lying somehow. I thought I was just spending too much time with the residents, etc. But I did my own test. Just opening up the 9:00 AM pre-packaged meds and putting in cups (and giving most important meds to certain residents) and opening 1:00 pm meds (they are all packaged where I work) still took me all day, with barely enough time to chart important info (forget about spending time with the residents). I finally decided to "shortcut" also because I felt that the residents "needed" me. There were a lot of "horrible, mean" nurses that worked here (told to me by residents and CNA's) and from what I witnessed. I eventually went to a "paper-pushing RN job". I don't think I will ever go back to floor nursing. I love taking care of patients and family, spending time with care, etc., but I don't think there is such a job anymore.

Wizard of Alz · Dec 13, 2000

Oh Jane you hit the nail on the head. In long term care med passes can be awful. I once worked on a unit similar to your experience with 41 pts. with mid to late stage Alzheimer's disease. Talk about distractions during med pass. We had med sheets ripped from the MAR, meds spit at you, combative pts and just plain confused folks you had to convince to take their pills day after day. It was only by Divine intervention that we all survived with no major errors. Luckily for me the facility wised up and split the unit in two. Now we have 22 pts. and all early stage Alz. I can't imagine ever going back. Unfortunately when they decreased the number of pts. they added more paperwork (MDS), so it still is a busy unit. Also the phenomenal amount of charting "for state" can be overwhelming. I realized today for every PRN pain med we give we have to document in 4 different spots. Front of MAR, Back of MAR, Nurses notes and pain assessment record. It gets a little ridiculous after a while. I pray no one falls, that can tie you up for an hour even with no obvious injury. We have to take full vitals and neuro- checks for 24 hours, fill out 3 page incident reports, document in nurses notes,update the care plan, call the doctor, call the family and inform the supervisor . Honest this is what our regulations demand . Anyone else experiencing this ?

JillR · Dec 13, 2000

I do not work long term care, although our med/surg unit feels like it sometimes, oh heck, most of the time.

Anyway, we were required to do a LTC preceptorship in school, were we worked with the RN, passed meds and gradually took on the resposibilities with the RN watching a guiding us. I was lucky to have a wonderful RN that precepted me and by the end of it I was doind all of it, even calling the docs with her listening in.

I quikly found out that med pass took an eternity. The shift started at 6:00 AM and I would start med pass at 7 and not get done until 9. That was with her helping me on most days because I would not have got it done until noon otherwise.

It felt like as soon as I would get done, I would have to start again.

All of you RN's and LPN's that work LTC, you are truly angels from heaven. I thought that LTC was the hardest rotation I did as a student and it was truly an eye opener for this former LTC CNA.

Jill

soundsLikesirens · Dec 13, 2000

Btw....it isn't just me. Even the nurses who've been there ten years (especially the nurses who've been there ten years) are bitching and kvetching about the staffing, or lack thereof. They're all threatening to leave. The other night, the part-time House Supervisor stopped by and asked how "things" were going....I thought I was going to have a nervous breakdown right there as I spewed out my frustrations...allright, yes I'm being a bit dramatic but...she said she'd "pass it on" (like they don't know). I see why everyone is leaving....God I dread going back to work, because people aren't getting care and there's no way to do it, not with the patient load. Every night, practically, I have ten or eleven patients. It's physically impossible, as the other nurse said. "They" ought to have to come to the floor and do it...I'd like to see them do it. And, I like med-surg but after I can transfer, I will.

soundsLikesirens · Dec 13, 2000

Oh, another thing: we only have 2 LPNs that work third shift, and one of them is going to second shift, because of her home situation. Lord, I don't know WHAT we'll do then. I have no idea!!!