fed up and set up - page 3

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   ktwlpn
    Quote from ladside
    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.!
    That's why we nurses give all the nourishments at the LTC I work in now.The cna's tended to just throw them away at the last LTC I worked in.Guess who was my surveyor on the first day of dept of health visit-The former DON from that poopy hole.She actually stated that she found it "hard to believe the nurses have the time to give out all of the nourishments and make sure each resident completes them" I had to bite my tongue to keep from really letting her have it.I felt like she was accusing me of falsifying records. I would NOT put a dog in that other joint-that's why I'm where I am now for goodness' sake.I'm lucky to work in a neat,clean,well organized ,well staffed facility with a good reputation in the community.When I worked at the other place I was ashamed to be seen in my uniform on the way home.I'm proud to say where I work now.
  2. by   TheCommuter
    Quote from ladside
    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.
    You hit the nail on the head. A good number of the CNAs I've worked with are welfare-to-work cases. They're not accustomed to punctuality or work ethics and many do not take pride in their jobs.

    Imagine if you were a stay-at-home mother on welfare for many years with the ability to create your own schedule and wake up whenever you pleased? Now you've been sent to work against your will and, as a result, don't care about your job responsibilities.
  3. by   speckleddove
    yep, that's a fact.
    checking orders is a hard task, especially when the doctors scribble.
    i worked at a great facility years ago and this is how we handled the new orders.
    first though, i must say; as a traveling nurse and having worked in a hospital, working in a hospital is no longer a goal of mine.
    way too much room for error and way to much risk for hospital nurses.
    as a ltc nurse all these years, i am use to being the main or only communication port.
    meaning, i call the doctor, lab, pharmacy, family, etc. and i am paged to the phone regardless of what i am doing to receive new orders, lab results and family decissions.
    in a hospital, they have a person manning the phones that may not have anu idea what the labs, x-ray results or dr.s orders really mean.
    then such a stupid rule, they are not allowed eo leave the station to give that information to the applicable nurse!
    what idiot came up with that rule?
    i feel nothing but sorrow for nurses & patients in a hospital setting.
    too risky for patients and satff.

    any way now the tip, for ltc nurses on new ordrers -

    1. we had one nurse go on rounds with the dr.

    2. a second nurse did nothing else that day but pull the charts off the cart as new orders were written, she would first fax to rx & copy them and put the copies on the appropriate med cart.

    then she would chart them, place the carbon copies in a plastic box with a lid - marked on the box is - new orders only.

    3. after rounds the nurse that went on rounds would go over the new orders and clarify any discrepencies - either of those 2 nurses noticed. then all 3 nurses would ensure the mars were noted / updated.

    4. at the end of shift we floor nurses, both oncoming and off going
    re-read the orders as we gave report and noted the new orders on the backside of our 24 hour report sheet.

    5. if we had time before the oncoming nurse arrived, we would record on a tape recorder inside the med room - new orders received on patients.

    working as a team everyone was out on their scheduled time and nearly zero medication or treatment orders had errors.

    sounds like a lot of work but after once or twice, it was smooth sailing.
  4. by   speckleddove
    soo true!!
    i would grab the snacks off the carts and administer the supplements with the meds to ensure patients actually got them.
    if a cna said a patient refused, i would take it myself to the patient and ask them if they had been offered a snack / suppliment and ask them to drink it or taste it for me.
    then i got even smarter and i would do a walking round just prior to shift change & check the trash cans.
    if i found a full unopened carton, i wrote a note to my adon with the name of the patient and they would do an extra weekly weight on that patient.
    cnas got to the point they hated me.
    my loyalty is to my patients not to a cna.
    other nurses soon followed my idea and that crap stopped and weights went up.
  5. by   speckleddove
    Yes, I had the unplesant experience of working with such a forced labor group as well.
    What really Ticked us off was the fact those lazy jerks got paid more that the nurses and CNAs that had never been on welfare.
    The government kicks in on their pay, so they got better pay then we did.
    Now if that isn't a load of dirty crap!!
  6. by   speckleddove
    Here in the USA, at least where I worked; they stopped that due to patients friends & famlies reading the nurses and dr. progress notes.
    Privacy, was the issue.
    And then a few patients would hide them if they didn't want the new medications or mentally ill pt.s would tear them up or even try to eat the paper.
  7. by   TheCommuter
    Quote from speckleddove
    Yes, I had the unplesant experience of working with such a forced labor group as well.
    What really Ticked us off was the fact those lazy jerks got paid more that the nurses and CNAs that had never been on welfare.
    The government kicks in on their pay, so they got better pay then we did.
    Now if that isn't a load of dirty crap!!
    The welfare-to-work CNAs at my facility are only paid $9 per hour. However, they still receive their food stamps, medicaid, WIC vouchers, and housing assistance as well as a small welfare check.
  8. by   speckleddove
    you are so right on all accounts!
    i worked midnights too and it seems like day shift wants all the diabetics done on midnights and evening shifts.
    and tube feeders galore loaded on the midnight crew.
    i always prefered 3 pm -11 pm shift because of my husbands work schedule.
    we have less cnas and less nurses on the evening & midnight shifts, yet we get more done than all those overloaded staff day shifts ever do.
    but do we ever get any pay increases or credit for our extra efficiency, heck no.
    i worked day shift as prn too and i found more cnas and nurses hiding in patients rooms with the doors closed and i actually caught 2 cnas watching soap operas when the patient was sitting in the bathroom with the er call light on for 10 dang minutes.
    one was in a chair and the other had the gall to be lying in a bed.
    i took them to my don and not a dang thing was done!!
    the don & adon spent most of the day hiding in their office talking about everything but the patients and eating their way to a heart attack, every dang day!
  9. by   LauraF, RN
    Quote from daytonite
    a charge nurse has the responsibility of prioritizing his/her duties. for a subacute unit i would definitely prioritize the checking of newly written doctors orders over getting a med pass started. it would only take a few minutes to open each chart and make a quick cursory check of the new orders. i've done this many a time and returned after a med pass to finish taking orders off. i would hate to miss a stat order to the detriment of a patient's well-being, particularly on a subacute unit where the patients are most likely skilled patients.

    maybe in a small setting this is possible, but not ltc for the most part. i work weekend shift. if i went through all 40 of my residents charts checked the new orders for the past week before i started my 8pm med pass (which by the way as it is does not get completed until 8:45 or 9:00pm) i would not even be starting that med pass until 10pm. i go by the mar for the first pass. after that i have a slow period where i can investigate questions, and check the new orders. but unfortunately that first med pass i have to rely on the mar. there have been occasion that i have meds in the box that aren't on the mar, or meds on the mar that are not on the cart. in those cases i give the meds that are on the mar and in the cart, then investigate when pass is complete. generally try and get the story from the resident before i start a big investigation, then after all figured out i come back to the resident and let them know what i have found.
  10. by   LauraF, RN
    Quote from TheCommuter
    You hit the nail on the head. A good number of the CNAs I've worked with are welfare-to-work cases. They're not accustomed to punctuality or work ethics and many do not take pride in their jobs.

    Imagine if you were a stay-at-home mother on welfare for many years with the ability to create your own schedule and wake up whenever you pleased? Now you've been sent to work against your will and, as a result, don't care about your job responsibilities.

    Reading these comments make me feel so lucky to have such a wonderful bunch of CNA's working WITH me. They have seen these folks bottom out in the morning when they wouldn't eat their snacks at night. They ALWAYS make every effort to get our residents to eat their snacks before bed. Even today, I got stuck at work late because I had a guy do a floor vs. head. My CNA's, even through it was time for them to leave, we had all been there 12+ hours, asked if there was anything they could help me with before they left. They even went so far as asking me if they could leave. Sorry to have hijacked the thread there, but I had to say that. I really feel lucky!
  11. by   twotrees2
    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.

    it is not so easy a job as you describe for someone who works part time or less and is shifted from wing to wing - especially in our facility- i have worked there for over a yr and have tried to get this changed however none ever does anything - the new meds are not put on the original order sheet which means one has to search the whole orders section to find and confirm if or when and order was written or not - the only place they write the new order is the mar - which though i do try to keep up on orders on occasion one may get by me and it sure is scary - i will keep pushing to get them to change the system - as i have for over a yr - everyone complains it takes up to much time to have to write it also on the original order sheet however if its kept in one spot it saves much more time than having to look through a whole section of orders especially those that get frequent order changes - even just taking the time to check the charts of unfamiliar orders or new residents that i have not met cause i haven't worked there in a week would be so time consuming cause id be doing everybody and every page - in my facility for me it realistically can not be done - however i do read over all charts that are pulled and set aside with faxes and double check if its been taken care of or not and i do check the last weeks nursing report ( which is supposed to have any changes of orders in ) and check them as well - we need a better system by us so we can do more checking than mar to med to resident. it even frustrates the docs when they call and ask what the orders of so and so are cause we have to hunt down every order change from the original cause it is not on the original just on the phone order sheet or fax that it came on -

    i notice you say a charge nurse is supposed to do the checking etc- my input there is it isn't the charge nurse who should be responsible for all the residents - the wing nurse is quit capable of doing the job it is the charge nurses role to be sure she did so. if that were the case there would be a lot of ticked off charge nurses as they may as well just med pass everyone. not to mention the fact that after 3 or 4 days we should be able to trust our coworkers that they did their job right and have done their orders ( though it has been known to be found by some i know they dont do it and its still sitting on the chart when i come back a week later unaddressed!!! i do report this when i find it cause there may be once in a while you dont get to a order ( say labs in 2 weeks ) that isn't urgent so it got left but it really ticks me off coming back a week later and its still not done is outrageous - cant tell me 7 days of 3 shifts couldn't have found time to fit it in.

    also at our facility - i try hard not to put a lot on the night shift cause i know they ofetn have one nurse for 80 residents ( i am told its legal as long as they have enough aides but i dont feel its ethical especially when many have a bunch of meds or tube feedings or whatever - ) honestly i dont know ho they get away with the numbers they do ( it was explained in depth to me but i still dont get it - just dont seem right - they do it to all shifts - counting people who dont even do patient care as part of their "staffing" so the numbers look good but really there isn't enough staff. id love a thread on how they can do this as it just dont seem right. ) at any rate - i know its not based on acuity ( like joe is jumping out of bed nightly to the floor and mary nightly has seizures and susie runs off naked every night and jill is on the light constantly for anything every five min and ......... you get the picture. just dont seem right.
  12. by   CapeCodMermaid
    TwoTrees-
    I'm not sure I understand what you are saying about writing the meds in so many places. I've worked in 6 facilities and the process has always been the same..you write the telephone order on an interim order sheet and transcribe that order to the med sheet. That's it. Nothing goes on the original order sheet except the original orders. The new orders would be added to the NEXT month's order sheet at edit time. Seems you are making more work than needed and we all have enough as it is. My suggestion when the doc wants to know what meds the patient is on is to read them off the MAR instead of trying to look through the interim/phone orders. We have residents on our subacute unit with 15-20 new orders a week and it would be a nightmare to go through each one of those pages when we are on the phone with the doc. Do your 11-7's do 24 hour chart checks? Make it a practice and you'll find fewer mistakes.
  13. by   weasle3
    Quote from speckleddove
    you are so right on all accounts!
    i worked midnights too and it seems like day shift wants all the diabetics done on midnights and evening shifts.
    and tube feeders galore loaded on the midnight crew.
    i always prefered 3 pm -11 pm shift because of my husbands work schedule.
    we have less cnas and less nurses on the evening & midnight shifts, yet we get more done than all those overloaded staff day shifts ever do.
    but do we ever get any pay increases or credit for our extra efficiency, heck no.
    i worked day shift as prn too and i found more cnas and nurses hiding in patients rooms with the doors closed and i actually caught 2 cnas watching soap operas when the patient was sitting in the bathroom with the er call light on for 10 dang minutes.
    one was in a chair and the other had the gall to be lying in a bed.
    i took them to my don and not a dang thing was done!!
    the don & adon spent most of the day hiding in their office talking about everything but the patients and eating their way to a heart attack, every dang day!
    amen!! it's amazing what can be accomplished when the staff works together as a team .

    regarding new medication orders, if it is transcribed incorrectly then it's a problem that needs to be written up. another reason i work the 11p-7a shift, so i can have the time to check on new orders. i know this isn't always possible for everyone.

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