You said it all when you stated how much you need your job. I had almost the exact same experience with my first full time position in a LTC facility as an LVN, on the night shift. I would come in for noc shift and certain call lights would be ringing to break the electrical system for the residents to get their drugs. The CNA's would come and tell me, I couldn't even finish getting report from the offgoing nurse. It got under my skin after awhile. One of the little old ladies refused to utter a word when I repeatedly asked her to verbalize pain, point to the area of pain, or show any kind of objective or subjective need for her prn pain med. It did not take long for me to figure things out and the CNA's knew too. So I would tell the resident exactly what I was charting, and why I was charting it. And I got the same if looks could kill expression on her face every time. I also made it known to her when I was by necessity, called to a higher priority situation first. I charted everything to the best of my ability, each shift. I discussed this situation with my co-workers, who were more experienced than I was at the time. Some of them told me that MD's would prescribe vicodin as a "sleeper" at the other facility where they worked. So my question to them was, "Well, since Dr. So and So is the MD for this patient why doesn't he just prescribe the med the same way?" "Why doesn't anybody see that this happen?" A talk with the supervisors elicited the same inaction. You know you, as an individual, can only do so much. You are not Florence N. reincarnated. Continue to do what is right. Do not waste energy trying to change everything, unless you have that energy to change one situation at a time. When you get a chance, try to talk to the doctor about the patient, and their response to treatments, interventions, and medications, but insure that your documentation backs up your assertions. And always remember, you need that job, so don't expect to be able to accomplish everything by yourself. You will suffer for it in the long run. I know. I've been there, done that.