fed up and set up - page 2

feel really fed up with work.learnt something today .dont just believe what you are told in handover. double check doctors orders.and if its not in writing it doesnt exist.Also upset the same nurse... Read More

  1. by   moongirl
    Quote from CapeCodMermaid
    Are you saying you double check EVERY doctor's order? If we did that, the 4 o'clock med pass wouldn't get started till 6! I'll check orders if they look out of whack to me, but none of my nurses would have the time to check all the new orders....especially on the days the docs do rounds...or ANY day on the sub-acute floor for that matter.
    wait.. I am a student.. I thought one of the " rights" before giving any med was to check the doctors orders against the MAR... you dont do that ???????????
  2. by   NurseLatteDNP
    We also have to check each med for each patient againt the doctors orders during our clinicals. I will keep doing it after I graduate, just to keep myself and the patient safe.
  3. by   nursemary9
    Hi

    I work an acute care med/surg--hem/onc Unit. We get 6 pt's each.
    We have computerized charting; I always check the orders & MAR sections before giving the meds; we also have to still check the paper chart because some of the attendings still don't enter there orders in the computer.

    I never take just the word on an RN in Re[port. Over 40 yrs has taught me that NO ONE is completely reliable. I just am a bit paronoid about things I hear from other nurses.

    I'll tell you, the computer has made life much easier & safer i n respect to giving meds. I'd say at least 99% are entered in t he computer.

    Makes for less transcription errors!! Definitely NO handwriting issues this way.

    With our Chemo drugs, we have to have two nurses check the orders & patient info & arm bands. we have to do a STOP__TIME-OUT for all chemo.

    We have a lot less med errors now.

    Mary Ann
  4. by   nursemary9
    Hi


    Sorry----I just noticed that this is the long-term care forum!!

    Well, you all have my opinion anyway!!

    Thanks
    Mary Ann
  5. by   TheCommuter
    Quote from moongirl
    wait.. I am a student.. I thought one of the " rights" before giving any med was to check the doctors orders against the MAR... you dont do that ???????????
    Look at the situation realistically. Many long-term care nurses have to pass medications to 40 patients within a limited amount of time alloted by the facility and the state. If my morning medications are due at 8am, they all must be administered between 7am and 9am. There is, in reality, no time to do a chart check for every single patient, especially when we have many treatments and tasks to do between the medication passes.

    If all long-term care nurses did chart checks for every single patient prior to passing their medications, it would consume an additional 2 hours of our time. In long-term care we do not have any time to spare...
  6. by   Elektra6
    When you work the same residents in LTC you see all their routine meds being continued day after day on the MAR. But I do check NEW DRUGS or strange orders entered on the MAR against the Dr's orders as I am pulling the meds. This may be only 4-5 residents a day so it's not a problem.
  7. by   ladside
    I truly enjoy LTC but I remain in med/surg because with the amount of medications given compared to the time allotted, it's impossible to "do the right thing". This time does not take into account the number of patients who refuse of have to be begged/coaxed or the residents that have 4 to 5 eye drops that have to be administered '5 minutes apart'. Can you imagine having to return to 3 or 5 residents every 5 minutes? Nursing school is a great learning environment. But on-the-job experiences is life.
  8. by   irish_std/n
    would sum1 mind explaining why you have to check 2 places to see if a drug is ordered. over here in ireland we have a prescription chart at the pts end of bed notes.... this is the only place docs write drug orders and is also where we sign them as given....your system seems complicated??
  9. by   NceGrl72
    Your patients lives are in YOUR hands. YOU alone are responsible for anything you do. My best advice is to develop a pattern so that you will be able to check orders, assess patients, document, etc. etc. and still get everything done without skipping lunch or staying after your shift. When I was a new nurse, I learned I HAD to get organized or I was going to burn out fast! I won't say that everyday goes smooth, but it is much better when you have a set pattern you follow. Hope this helps!!
  10. by   Daytonite
    Quote from thecommuter
    look at the situation realistically. many long-term care nurses have to pass medications to 40 patients within a limited amount of time alloted by the facility and the state. if my morning medications are due at 8am, they all must be administered between 7am and 9am. there is, in reality, no time to do a chart check for every single patient, especially when we have many treatments and tasks to do between the medication passes.

    if all long-term care nurses did chart checks for every single patient prior to passing their medications, it would consume an additional 2 hours of our time. in long-term care we do not have any time to spare...
    this has not been my experience at all! perhaps it is because i came out of the acute hospitals where you had to constantly refer to the original record (the chart) frequently that it became such a habit. i could flip through the charts of my 40-50 patients just looking at the doctor's orders in about 10 minutes. i did it so frequently that a new order stood out like a sore thumb. also, because i was closely involved with reconciling the monthly mars and tars with the new month print-outs i pretty much knew my patient's orders by heart, so again, anything new or odd stuck out. sorry if it sounds like i'm beating on a dead horse, but if we all look at our job descriptions of what a charge nurse is supposed to be doing, confirming and carrying out doctor's orders is one of our priorities and it has to rank above the actual passing of medications. the reason is because the passing of medications, theoretically, is something that can be delegated; the care planning, which involves the incorporation of doctor's orders, cannot. the way i dealt with any problems that involved all the 9am medications not getting passed in the two hour period allotted was to change the administration times of certain medications that we could do that with in order to put us in compliance with the state laws and how we found ways to give us time to spare. there is nothing that says i can't administer some vitamins at 10 or 11am instead of 9am if that's the way my med pass is going day after day and it isn't contraindicated. i learned very early how to have the pharmacy service print out these administration time changes on the mars. bingo! we were back in compliance with med pass times. another thing we did was move some of the g-tube medication administrations to 5 or 6am on the night shift to take part of that huge burden off the day shift staff. this way we had all three shifts working together, doing their share to get all these medications given. there's always more than one way to skin a cat--one of the nice things about nursing.
  11. by   banditrn
    Our facility has 'nurse servers' at every room where the chart and meds are kept, so it's not a simple matter of checking things at a central point.
    When a new order is written for anything, the pink copy is put into the MAR and kept there for a period of time to alert everyone that something has changed.

    Day shift can be over-burdened - some of the things I've initiated on nights is to do all the skilled vitals - they must be done every 24 hours - and assessments on my shift. I coordinate this with patient turning so that they aren't awakened unnessarily.

    I now do all eye gtts that were ordered on the first day shift med pass - this was started after talking with the day nurse. I also make sure that the med cart is stocked completely with everything she might need.
  12. by   ktwlpn
    The answers always seem easy when you are the full time day shift charge nurse in LTC and can make changes to the med pass and routines ad-lib (within facility protocol,of course) Usually the other shifts have very little input.In our LTC we generally have 3 nurses on each unit on days-2 on evenings and 2 or 1 on nights.Our larger units all have 2 med carts so both nurses are doing a large med pass.We carry all new orders on our shift report and nights does chart checks.I believe that some of the evening shift does check the new orders however many don't. In LTC the emphasis is on getting those meds out on time no matter what the heck else is going on. The minute you become complacent the Dept. of Health shows up and then you are in trouble.I have never see them spank us for not initiating a newly ordered med or treatment within a certain time period.We have a limited emergency supply and it takes awhile for pharmacy to deliver even stat meds.Most other meds get written on the MAR to start the next day.....Our residents are expected to be relatively stable -if they aren't then out they go .(that's another thread-sorry:deadhorse )
  13. by   ladside
    Quote from daytonite
    this has not been my experience at all! perhaps it is because i came out of the acute hospitals where you had to constantly refer to the original record (the chart) frequently that it became such a habit. i could flip through the charts of my 40-50 patients just looking at the doctor's orders in about 10 minutes. i did it so frequently that a new order stood out like a sore thumb. also, because i was closely involved with reconciling the monthly mars and tars with the new month print-outs i pretty much knew my patient's orders by heart, so again, anything new or odd stuck out. sorry if it sounds like i'm beating on a dead horse, but if we all look at our job descriptions of what a charge nurse is supposed to be doing, confirming and carrying out doctor's orders is one of our priorities and it has to rank above the actual passing of medications. the reason is because the passing of medications, theoretically, is something that can be delegated; the care planning, which involves the incorporation of doctor's orders, cannot. the way i dealt with any problems that involved all the 9am medications not getting passed in the two hour period allotted was to change the administration times of certain medications that we could do that with in order to put us in compliance with the state laws and how we found ways to give us time to spare. there is nothing that says i can't administer some vitamins at 10 or 11am instead of 9am if that's the way my med pass is going day after day and it isn't contraindicated. i learned very early how to have the pharmacy service print out these administration time changes on the mars. bingo! we were back in compliance with med pass times. another thing we did was move some of the g-tube medication administrations to 5 or 6am on the night shift to take part of that huge burden off the day shift staff. this way we had all three shifts working together, doing their share to get all these medications given. there's always more than one way to skin a cat--one of the nice things about nursing.
    a friendly fyi...night shift in ltc is not easy at all when you are dealing with several hypoglycemic residents that were given hs insulin by the nurse but not given hs snacks by cna. times like those are when one more tube feeder is the straw that broke the camel's back especially when there are already 20+ blood sugars (some with coverage) as well as early morning insulins to be done at the same time when most are being gotten up for morning care. it can and at times, has been a nightmare! remember when clinton forced a lot of people into the workforce? well, guess where they went? and our pioneers are the ones who are suffering because a lot of these 'forced employees' do not want to work...which creates more work and head/heartache for the nurse in charge. sorry for getting into the biggest pet peave in my life. i just love elderly people because they are why we are here and we destroy and break the spirit of history when we do not look after our old folks. this is an entirely different thread. sorry people!

close