just venting. (long)

  1. I need to vent, but any constructive criticism would be appreciated.

    I am an agency LPN, working a mainly at a LTC facility, which I really enjoy. Most staff is great, and treat me as one of their own. I've been on every unit except one, which I was assigned to today. Here begins my woes.

    I took report from the 11-7 nurse, and began to get my cart ready. Checked out the accuchecks, started my med pass. I need to point out that at this facility, there's only one nurse assigned to unit, of approx 30 or so residents. There are usually 2 CNA's, and both were on today.

    I began my med pass, with some 7AM meds that needed to be administered, and had no real trouble until I got to my second hallway. There, I had a resident that absolutely refused to take her meds from me because I was a man. She proceeded to yell at the top of her lungs that she didn't want a man anywhere near her. This woman is deemed capable, and seems to be fairly stable of mind. She's in the facility for gait disfunction. After later checking her chart, I saw that she's done this to several other nurses, all female, and has had several psych reviews, which deem her capable and of sound mind. She's not on any psych meds at all, just anti-htn's and diabetics.

    I explained that I'm just administering her po meds, nothing invasive, nothing that requires me to see or touch any part of her anatomy that she may not want a man seeing or touching. Walked away after trying to give her the meds for the third time. At this point, every other resident in the hallway heard the commotion, and they all refused to take their meds also, as I was a man. They all suddenly wanted a female nurse. Again, I walked away, trying to give the situation a few minutes to calm down, and notified my sup. No other nurse was available to do my med pass, and frankly, I would have felt like a fool to ask one to finish it for me. After about ten minutes, I tried again, and was successful with the lady that began the rucus, after again explaining that it was a non-invasive procedure, just handing her the med cup and watching her take them. I had to continue this explaining all the way down the hall, and got done a 7 AM med pass at 10:45. It was "monkey see-monkey do" all the way down that hallway.

    I got the rest of my med passes done on time, but was totally frustrated by this episode. Am I wrong to feel that I was not only unsafe, because of the time this took to accomplish--7-8 AM meds given out at 9-10 AM-- but also illegal, putting my license in jeopardy should anyone have reported this to the state? I have never, NEVER encountered anything like this before in my career, and although I did let my supervisor know the circumstances, still felt VERY uneasy. The resident later called her son, and blew the whole thing wayyyy out of proportion. I had witnesses of the CNA's, and documented factually what exactly occurred, and also called social services to speak to the resident.

    Also, I made it known to both the sup and the scheduler, that should I enter the facility again, which I will be doing 5 days next week, and 5 the week after, and see my name posted to that unit, I'd be walking out and calling them from the parking lot to report off. I am serious, and would certainly carry thru on this. All other nurses are required to float, so there are other nurses that know that floor. The suggestion was actually made by another nurse (RN) to let the CNA's give these women their meds after I prepared them and put them in a med cup. NOT ON MY LICENSE! I was taught to administer only what I poured myself, and make sure the resident consumed the meds before charting that they were administered.

    I am a team player, and have a good rapport with other staff at the facility, and certainly go the extra mile for them, by always being available and taking all shifts offerred, but I refuse to work that unit again, because I feel I can't be effective as a nurse, and may even put the residents in danger by not completing my med pass on time. Am I foolish to feel as I do, or justified should the situation arise again? Thanks in advance for letting me vent, and all constructive criticism will be taken into consideration and appreciated!
    •  
  2. 16 Comments

  3. by   Fiona59
    I know how you feel and have had a day like that. After three shifts from hell on the unit, I had a chat with the scheduling office and requested that I not be called to work on that unit again. I lost a few days but it was never held against me. It's actually quite common in my area to have nurses say that they won't work on certain floors in LTC.

    Be proud of yourself that it only took the one shift to reach that decision.
  4. by   JohnBearPA
    Quote from Fiona59
    I know how you feel and have had a day like that. After three shifts from hell on the unit, I had a chat with the scheduling office and requested that I not be called to work on that unit again. I lost a few days but it was never held against me. It's actually quite common in my area to have nurses say that they won't work on certain floors in LTC.

    Be proud of yourself that it only took the one shift to reach that decision.
    Thanks for the kind words and the encouragement. The sup actually told me not to judge the unti by one bad experience. I wouldn't normally, but this was a HUGE bad experience, and I still feel justified. Thanks again for helping me rationalize my decision. As usual, this forum is great!
  5. by   CoffeeRTC
    Well, I wouldn't worry about the time factor. Yes, it is considered an error, but in LTC, I'd love to know how everyone gets their meds done on time all the time

    You did the right thing by refusing to go back to that unit. Too much of a hassle if you ask me.
  6. by   JohnBearPA
    Quote from michelle126
    Well, I wouldn't worry about the time factor. Yes, it is considered an error, but in LTC, I'd love to know how everyone gets their meds done on time all the time

    You did the right thing by refusing to go back to that unit. Too much of a hassle if you ask me.
    Thanks again for the positive reinforcement. I actually usually get my meds out on time, and really don't have a problem with being a little late, but the state has been to this facility lately, and could have returned that day, which spooked me a bit.

    Also, the diabetic meds were really pretty late, and not knowing the unit, I didn't know who recieved what med before i began my med pass.

    There were problems with staffing that need to be fixed according to the state. That's why I'm scheduled there so often.

    I go back in there tomorrow, so let's hope for the best, and send me any and all positive thoughts. I really do love this facility, by the way, just won't do that unit again.
  7. by   mariedoreen
    How are these med errors? You had patients REFUSING to take their meds. All people have free will. It's actually to your credit that you perservered through the hysteria and overcame it. I'm surprised you don't deal with situations like this more often in LTC.
  8. by   jahra
    Quote from JohnBearPA
    T

    There were problems with staffing that need to be fixed according to the state. That's why I'm scheduled there so often.

    I go back in there tomorrow, so let's hope for the best, and send me any and all positive thoughts. I really do love this facility, by the way, just won't do that unit again.
    Good luck tomorrow. Sounds like the facility has a problem with
    that floor and perhaps other issues. I agree with you, refuse that
    floor. I hope you can continue to work on other floors there since
    you like the facility.

    The beauty of agency nursing is you can move on if you see
    problems that are of concern...........

    Wishing you a wonderful day with cooperative patients and
    maybe a soft spoken challenging one because there is
    always at least one character to make it interesting
  9. by   anaknisupernurse
    John, I am a male LPN, too and encounter similar circumstances. I can only wonder what things the lady said for the other residents not to take medication from you.
    If the lady is deemed capable, and after you have explained to her what her medications are for, can't you just write down on the MAR and on the chart that she refused? I know those were some essential meds but having you attempt numerous times and arguing with her ended up making the whole floor refuse their medications. What you or your supervisor could have done was to call her son and inform him of her refusal. Occasionally, we've had the family member come to the facility to talk to the resident themselves. Sometimes having the family member talk to the resident on the phone works. But honestly, I don't think you are obligated to do this. If the resident is truly oriented and can decide for herself, then she has the right to refuse. Am I right?
    I am still puzzled why being male made the other residents refuse medication from you. Once in a while female residents refuse for me to change their diapers or clothes. But that's mostly it.
    I do hope you rethink the decision not to go back to that unit. What happens when something similar happens at the other station? You can't just keep crossing off stations on your list. I can understand your move to another station for a while but don't say you can't work at that first station in the future. You did not do anything wrong.
  10. by   moongirl
    can't help but wonder if they all just weren't acting like naughty children just to get some "action" going...
  11. by   banditrn
    Quote from moongirl
    can't help but wonder if they all just weren't acting like naughty children just to get some "action" going...
    :chuckle :chuckle Sounds possible to me!!

    John - this is not a med error!! Sounds to me like you did a good job, under the circumstances. As long as you charted the behavior, then you're covered.
  12. by   ktwlpn
    Sounds like a challenging day...I would have quietly offered her the meds 3times-if she continued to refuse I would have moved on.If time allowed I would have made one more attempt after the rest of my med pass was completed and then I would have documented her refusal and packed it in....As for getting a cna to assist I have done that when dealing with dementia residents but I always stand where I can watch.Sometimes you have to play "good cop,bad cop"to get the job done.As for the diabetic meds being given late were'nt the MAR's flagged so you could breeze through and get that done first? We flag ours and we also always carry our fingerstick results on our 24hr report so float and agency nurses don't miss anything. Good Luck
  13. by   JohnBearPA
    Quote from anaknisupernurse
    John, I am a male LPN, too and encounter similar circumstances. I can only wonder what things the lady said for the other residents not to take medication from you.
    If the lady is deemed capable, and after you have explained to her what her medications are for, can't you just write down on the MAR and on the chart that she refused? I know those were some essential meds but having you attempt numerous times and arguing with her ended up making the whole floor refuse their medications. What you or your supervisor could have done was to call her son and inform him of her refusal. Occasionally, we've had the family member come to the facility to talk to the resident themselves. Sometimes having the family member talk to the resident on the phone works. But honestly, I don't think you are obligated to do this. If the resident is truly oriented and can decide for herself, then she has the right to refuse. Am I right?
    I am still puzzled why being male made the other residents refuse medication from you. Once in a while female residents refuse for me to change their diapers or clothes. But that's mostly it.
    I do hope you rethink the decision not to go back to that unit. What happens when something similar happens at the other station? You can't just keep crossing off stations on your list. I can understand your move to another station for a while but don't say you can't work at that first station in the future. You did not do anything wrong.
    I did notify my sup as soon as i could have, about 20 minutes after the incident, and I didn't argue with the resident, just explained that it wasn't an invasive procedure, and didn't require me to see any part of her anatomy other than her hands and mouth, as she swallowed the meds. Never raised my voice, or showed my frustration, and quietly walked away after the third refusal.

    The reason the rest of the ladies on that hallway refused were probably that they heard this resident yelling that I was a man, trying to get her to take pills, and I must have some private agenda to drug her and take advantage of her. She stated that she never took any pills before, from anyone, and wouldn't be starting for me, because I was a man and just wanted to drug her. The other residents heard her, and since most have alzheimers and/or dementia, did the monkey-see-monkey-do thing. I never raised my voice, and walked away after three attempts to persuade her, even showing her the MAR and explaining what each med was for. A sup wasn't available to come and talk to her until several hours later, but social services did come about 45 minutes later and talk with her and her son, over the phone. Also, upon having the time to read her chart, she's done this before to female nurses also, so this is just a behavior of hers. It's been looked into, with no change. I didn't know that until after the med pass tho, because no one warned me ahead of time.

    It took three attempts, and a full explanation of each med to the rest of the ladies on the hall to get my med pass done successfully, which is why I was so late in completing that med pass. I sorta' blame the regular nurse on that unit, as she seems to have an anti-male attitude, and I have personally heard her degrade a male CNA for even attempting to care for a woman resident who usually has male care-givers, but for some reason that day refused a shower from that male caregiver. I can fully understand that, but to degrade a man, saying that "yeah, he shouldn't be trying to see ladies naked", and hinting that he just wanted a cheap thrill, when this nurse was the person who assigned that lady to him is just WRONG on soooo many levels. In my opinion, this nurse has persuaded many of the residents on that unit that men don't belong in nursing, and that's what made it so hard for me that day.

    I've heard, either myself, or from other nurses and CNA's, this nurse make other anti-male comments, and really think there-in lies the problem. Also, they have both a 7AM and 3PM med pass, that the day-shift is responsible for. Never encountered that one before. Seen an 8AM and 2PM, but never right on 7 and 3. This nurse I've mentioned writes most of the orders in the MAR, so I'm guiessing that's her doing.

    I return to that facility this afternoon at three, and again tomorrow for a day-shift, but am assigned to another unit tonight. The reason I won't go back is because I really don't need the aggravation, and also don't really want to upset this woman resident again, and the other residents within earshot of her. Hopefully all goes well, as it usually does for me. I have a positive attitude, and will make it thru the day whatever happens. Wish me luck guys and girls!

    PS,,,, I'm only working in PA for another month or so, until my FL license comes in and I move south. That means only 4-6 more weeks of this facility, and then a move that I'm really looking forward to, so I really have a positive attitude that I can take whatever I have to until I move. Of course, I hope the last month here will go smoothly, but hey, it's all in the game, right?!?!
    Last edit by JohnBearPA on Aug 23, '06
  14. by   skye1
    Boy do I know how that day went for you! This was an everyday occurence in Worthington,Ohio at the assisted living facility I worked for. The 3rd floor is Alzheimers and there were days when the chain reaction was endless. I was the ONLY nurse on the floor and after 8p I was responsible for the building next door as well that housed advanced Alzheimers residents. This tallied to 90 residents at one time.(unsure of the patient-nurse ratio in Ohio) A dementia res. and his wife roomed together on the 3rd floor and he accused me and others of not giving his wife her pills. Half the time he was in his room and she was wandering the halls so he didn't always see us give her the crushed pills . YET..he would call his son and tell him that he wasn't being treated right and he made numerous complaints that I wasn't spending enough time with him. Fact is, he was actually allowed to take his own meds,we just handed them to him.(With the time limit on a med pass I couldn't just stop and CHAT when he wanted and he found this offensive and threatened to have me fired. )I felt I was doing something wrong because he would often put them in his pocket and take them to his room. On numerous occassions the executive director would say *if you can't get them to take their pills let me know* I would let her know and she would take the pills from me and attempt to give them herself. Now, this woman has NO medical background and intimidated me into giving her the meds to give the residents. If I ever told her anything that would correct her if she were wrong about a res. medical condition I could expect a write-up soon thereafter! In the end, I was terminated. I was told to give the care managers the pills and let them try to give the meds,once again, the executive director told me to do this. The care managers in this facility aren't even state tested CNA's they are people who walk in off the street and decide they want to work in long term care! I have been a nurse for 14 years yet I was terminated for trying to do my job correctly! I could go on but I better not..Thanks for helping out!

close