Expecting too much??? - page 2

OKAY...I've been told I expect too much of my nurses. I need some opinions. Subacute floor--40 patients(not all subacute by any means). One nurse for meds and treatments on each wing and a nurse... Read More

  1. by   tarachristamom
    well here's my 2 cents. I manage a 45 be unit-23 Med A 22 LTC . WE have 5 nurses on days(12) hour shifts This is broken down into a charge nurse, 3 for the med A patients( grp of 7, 8, 10) and one for the remaining 20 LTC. I have personally worked the groups and think those on the skilled groups are spoiled. I have experienced the same frustations - running out of meds because someone didn't order refill., hearing patients complain in a meeting they had to wait for the pain med until the nurse got to them and find it all disgusting. MAny of my new nurses simply don't seem to care, or be able to think critically at all. It is'e the residents who seem to suffer. It is very frustrating
  2. by   CapeCodMermaid
    Quote from anne74
    Wow - 40 patients? That seems unfathomable to me.

    Anyway, I think there is always more to the story than the nurse is incompetent, lazy or doesn't care. Is she/he forced to work with inefficient systems? Does the pharmacy not keep their inventory up to date? (For example, why were you out of the patient's oxycodone? If it was stocked in the first place, there never would be an issue.) Is there poor communication between docs/nurses? Are the nurse's resource people not caring out their responsbilities? Or maybe she/he isn't trained properly? Or is the ratio just not realistic? I would look further than the person - usually problems can't be traced to any one source. Give the person the benefit of the doubt first and take the time to really find out what's going on.

    Granted, there are some bad apples, but I think most nurses want to do a good job and provide good care for their patients. If they stray from that, there's usually a good reason for it. Unfortunately, some managers just complain and blame their employees. If managers are willing to do their homework and make some changes to improve conditions for their employees, they'd be surprised at the benefits.
    40 patients total...each nurse has 20, there are 5 CNA's. Probably only 10 -12 residents could be called subacute...they've all been trained ...we can't 'stock' any kind of narcotics. We get the amount the MD writes on the script. I've looked at the systems and have come to the conclusion that these nurses have an attitude that the only thing they should be responsible for is meds. They don't even think they should have to do treatments....
    45 patients and 5 nurses?!?!?wow...my nurses would think that was heaven!
    Last edit by CapeCodMermaid on Sep 22, '06
  3. by   nurseangel31_03
    We have much the same problem at are facility no one wants to take the time to be responsable for anything. I come in to work and go check things before i start and have to tell the nurse why is this not done. Me and the DON had to make a policy that no medaction is ever unavalable. The nurse here think they should just leave every thing for the next shift. The DON ask a nurse one time why some thing wasnt done and her answer was that she didnt know anything about that and The DON said your the charge nusre why dont you know and her answer was just because I am charge nurse dont mean I know everything . That was very upsetting to hear because as a charge nurse you are to know every thing.

    I dont know about other places but we are a 33 bed LCT we do 3 shifts a day, Days has 1- charge nurse 1- medaide or second nurse for meds and treatments 4-CNA 1- Bathaide 1-2- Restorative Aides, Evenings has 1- Charge nurse and she does meds and treatments 4- CNA, Nights has 1- Charge nurse and she does meds and treatments 2- CNA

    I feel tis is good staffingand fell upset when things aren't done and no one knows why.
  4. by   nurseangel31_03
    If your nurse manager does all of that she doesn't have time to order meds for the floor nurses. I think your floor nurses are taking advantage of her. She or someone needs to tell the floor nurses that they are expecting to much of the nurse manager. It should always be the job of the one giving the meds to order them.
  5. by   tencat
    Ummm.....I don't understand the nature of LTC. 20 patients per nurse????? Some on hospice and subacute care???? Isn't that a bit of a daunting overload???? Good grief. If anyone could function successfully with that kind of expectation, my hat is off to them.
  6. by   Markthemalenurse
    When I worked in a LTC and seen that a person was either low on meds or out completely, I would phone the pharmacy and get the refill, then I would tell the charge nurse what I did.
  7. by   Markthemalenurse
    Quote from nurseangel31_03
    If your nurse manager does all of that she doesn't have time to order meds for the floor nurses. I think your floor nurses are taking advantage of her. She or someone needs to tell the floor nurses that they are expecting to much of the nurse manager. It should always be the job of the one giving the meds to order them.

    :yeahthat: :yeahthat: :yeahthat:
  8. by   CapeCodMermaid
    Quote from tencat
    Ummm.....I don't understand the nature of LTC. 20 patients per nurse????? Some on hospice and subacute care???? Isn't that a bit of a daunting overload???? Good grief. If anyone could function successfully with that kind of expectation, my hat is off to them.
    TenCat-
    Since you come from 'the land of enchantment'....20 residents on a subacute unit in a LTC facility is pretty standard here...some places have 18/nurse, some 22...and I'm talking day shift. The place I'm at now has 2 nurses for 40 residents for all three shifts, but the last place had 1 for 40 on the 11-7 shift.
    And to agree with the posters just before this....you are right. The nurse manager can not be responsible for ordering meds when she is responsible for so much else. (I sometimes wonder how these people who can't seem to order meds on time can go home and run their houses...do they make a list or all of a sudden does it dawn on them that they are out of dish soap {get it????dawn on them....dish soap })
  9. by   donmomofnine
    Spoiled! Mine are two with an assignment of 22 residents, a unit manager, a unit clerk, someone to do treatments. All they do is pass pills with a computerized (faster) med system and chart.

    I'm back. Thanks for checking in on me!
  10. by   banditrn
    Capecod - I wish we had the staffing that you do at our facility - that said, maybe you need to review their duties, and as the DON, make it their job.

    I work 11-7 in a 40 bed facility - I get 1 CNA, so a lot of my time is taken up doing direct care like putting people on the bedpan, etc. that the other shifts don't do. And I still have a lot of nursing things I have to do.

    I also try to go thru and order all meds at nite that we're getting low on, as does the other nite nurse. It seems like it would be easier for the person who is giving them to know what you need, and to take care of it, if that makes any sense.
  11. by   thsnursluvsgeriatric
    Quote from jetscreamer101
    We do reorder meds when they get low, but espec. with PRN's, we don't order soon enough, or maybe the reorder sticker never made it to pharmacy, or it was ordered too soon. Whatever the reason, pharmacy is avail 24/7. When you run out of whatever med, we can call and have a med sent from a backup pharmacy. It may take a little while, but if you call after giving the last pill, there is usually enough time to get something in in case it's needed. I DO NOT accept excuses for a res. not receiveng any of their meds, and I've told my staff I will no longer except excuses like this anymore. (Just not too long ago I had a nurse when directly asked about not giving a med, say "I don't have any to give her" So I asked if I could check her med cart. She got snippy and said "I already had someone else check, it's not there" so I said humor me. I unlocked her cart, reached in and pulled out the medication from her cart and set it on the cart. Now, if it were an odd med, like drops or patches or inhalers and you weren't sure where they were at I might see that, but this was a liquid, in with all the other liquids, exactly where it was supposed to be. And it was accuratly labled (not an excuse it was generic name and I'm used to brand name) with the res. name and drug and prescription info.) Now, I'm not perfect by any means, but this frequently happens, it not an isolated event. And even if she couldn't "find it", she hadn't called to get it. I think I'm way to irritable right now and these things are starting to get to me. But I never ask them do do what I wouldn't/couldn't. I expect myself to obtain whatever med I need to care for my res. and do frequently have to call myself to obtain needed meds.
    Sorry for the rant, I don't think the standards under which I myself work are unreasonable. I may need to stay over a bit sometimes, but I guess that's my choice.

    I understand why these things get to you. You will go the distance, others get alittle 'lazadazzacal' (lack of the ideal word). 20 patients are easily managed if you only do meds and treatments. Are the professional staff doing hands on care, adl's, and thereby getting distracted? Are they agency nurses and not there routinely? Personally I make notes with asterics so that I can't forget to do certain things. I do follow through and like you get very frustrated when my coworkers do not. Good luck in sorting things out. Maybe a class on prioritizing would help?
  12. by   jodyangel
    I work 7pm - 7am and have only 30 until 11:15pm. Then I have the whole floor, 60.
    I Know its too much to handle and I know its unsafe. But thats their staffing and I have little choice, as they are the only facility with a weekend incentive program and I'm in school for my RN.

    I can't wait to leave there...
  13. by   Simplepleasures
    20 patients a piece , that is pretty good, no reason not to be able to get their own MD orders.

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