Expecting too much???

  1. 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 manager who does the admissions, care plans, care plan meetings, morning report....
    Nurse manager is at care planning for hours today. Gets back to the floor and one of the nurses says...oh 'YOU need to call the doc to get a script for Mrs Jones' oxycodone". ??????????????????? YOU???? The first nurse counted the narcs at 7am and knew since then that we were out of the pt's oxycodone, but she waited till 2:15 and then told the nurse manager to do it.
    I think these nurses are spoiled beyond the pale if they think the nurse manager should be the one ordering drugs. They expect her to call the docs with everything and think they should only be responsible for meds, treatments, and charting.
    Am I expecting too much? When I worked the floor I had 30 subacute....5 IV, 6 Gtube, trach care, and 3 people in the end stages of HIV and I managed to get everything done...including ordering my own meds and calling the docs with updates and labs...
    What do all y'all think?
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  2. 26 Comments

  3. by   meownsmile
    Are you talking LTC? or hospital? Opps sorry just picked up on the forum. I would think that any nurse could call and get narcs reordered. However have they been told that it is the nurse managers job or been chastised for doing it when maybe the nurse manager wants to be the one to do it? I dont know,,
    but ya maybe 30 with the care of those you described seems quite a bit for one nurse.
    Last edit by meownsmile on Sep 19, '06
  4. by   CapeCodMermaid
    These nurses only have 20 patients each --at least half of whom are long term.
  5. by   banditrn
    Quote from CapeCodMermaid
    These nurses only have 20 patients each --at least half of whom are long term.
    And what are the other half? By sub-acute, do you mean skilled? Our 'skilled' patients need assessed every shift with vitals, and charting.

    Yes, it seems to me that the nurse could have called the doc for the meds, but I don't know the whole story about why she didn't.
  6. by   Marie_LPN, RN
    Are yu sure that you weren't actually doing too much before?
  7. by   jetscreamer101
    I expect my nurses to do whatever needs to be done in order to care for their residents. It burns my butt when I see things left undone and the resident suffers from it. I have in the past come across situations that have really bothered me. Like, telling a res. that they can't have their percocet right now because we are out of it (at 9am) and you'll have to wait till in comes in tonite. Haven't received Diovan for 6 days cause it wasn't here. Refusing to give vicodin that res. has asked for, giving tyl. instead to see if that works first even after the res. has stated that tyl. doesn't work for her nerve pain. I could go on, but I wont. I never ask my staff to do something that I couln't/wouln't do. my 2 cents
  8. by   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.
    Last edit by anne74 on Sep 19, '06
  9. by   txspadequeenRN
    I see you have a nurse manager and a treatment/med nurse , now is there another nurse . Im getting confused a little , you say they each have 20 patients but I dont see you mention a 3rd nurse and what her duties are. I know the nurse manager does not take patients right. Tell me this 20 patients are LTC and the other are they medicare or hospice ???? Then how long is your shifts 8's or 12 hours . How many CNA's do you have for the 40 patients? As far as the med ordering goes that should have been ordered several days before so the patient would not run out. It is just not right for a resident to run out of pain medication PERIOD!!!
  10. by   txspadequeenRN
    40 patients in LTC is very common , now it becomes a overload if these are medicare and/or hospice. the stock in LTC is generally ordered by the nurses upon running low. And since these medications require triplicates it makes it even more important to keep things in a organized manner since ordering/receiving could be prolonged.


    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.
  11. by   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.
  12. by   leslie :-D
    i don't know why a nurse mgr is ordering meds.
    i suppose every facility is different.
    the noc nurse did the weekly med orders q sun noc but nurses did their own ordering inbetween.
    either way, someone should have done something when count was done.
    but even if it's not in one's job description per se, it's pretty shabby to let the resident suffer because of these attitudes.
    sounds like a notice needs to go out to all nurses, bringing attn to this and other matters affecting pt care.

    leslie
  13. by   HeatherLPN
    You don't have a c-box at your facility?
  14. by   CoffeeRTC
    Quote from CapeCodMermaid
    These nurses only have 20 patients each --at least half of whom are long term.
    No. You were not asking too much. I work in a LTC that could possibly be classified as sub acute...I have 26 pts and do all the meds treatments and doc calls. If a med runs out or is needed, common sense (esp if it is a pain med) tells you you need to order it ASAP.

    I just dealt with an issue like this at work last night. I had 6 meds on a few pts..ativan, vicodin oxy ir and phenobarb. It was faxed the night before and should have been delivered by 4pm at the latest. They weren't. I had to make calls upon calls to get the meds delivered asap and until they were delivered I needed to call the docs to get different pain meds to cover them( ones we did have in our E Box) Soooo for an entire 7-3 shift and part of my shift...these res went without painmeds. Grrrrrr.

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