fed up and set up

[knockandhello]

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 by refusing to physically restrain a resident so that a suppository could be given.feel really upset by everything at the moment.distressed by everything.

[twotrees2]

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.

[CapeCodMermaid, RN]

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.

[weasle3]

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.

[MimismomRN]

It would be great to have time to check all the charts and orders, but it has never been possible for me unless there is a question in my mind or problem. I have 12-15 patients as an LVN on a med surg floor and trust me most days I never look at the main chart only the bedside charts. I do however check the chart whenever I am in doubt about an order, etc. In a perfect world (not nursing) we would have time to check everything we would like to. Unfortunately when we are overloaded with too many patients we have to do the best we can to keep them safe. It's overwhelming to me most days just trying to get the meds out and not be 2 hours late. Lord help me.

[Daytonite, BSN, RN]

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 issue you a challenge! The next time you find yourself with some free time (I know, I know, it'll never happen!) or stay a few minutes at the end of a shift and clock yourself pulling all 40 charts, quickly flipping them open to the doctor's order page, looking for a doctor's order on the first page or two that hasn't been noted and signed off by another nurse, closing the chart and putting it back in the rack. Without interruptions--10 minutes, tops! Let me know your result.