Hi, I'm a new nurse at a LTC facility, and am orienting on a floor with 31 pts. I was told by several nurses to watch out for the nurse who is orienting me, that she can be tough. That's fine with me, nursing is a second career and I can work with most people. HOWEVER, she told me that she does one med pass for the 3-11 shift - everyone gets their meds sometime between 4-6, regardless of when they are scheduled, because otherwise she would never get everything done. She told me the order to do things, and send me off with the cart (I hadn't yet met any of these pts, and had no idea who was who). So, I did the first med pass "her way" with a lot of trepidation, in order to get it done. I made a new cheat sheet for myself so that I could see who got meds at what times, so that I didn't have to flip thru the hellish handwritten MAR every hour. Using my cheat sheet, I was able to get the med pass done in a fairly legal way, but probably would have had a hard time getting the documentation/notes/other stuff done if she hadn't done that for me while I was doing meds. I can work on speed, it will just take time.
Here's the problem: one gent said that he wasn't feeling well, was pale and diaphoretic, a bit nasueus; this was around 5 pm. I took his vitals, had normal BP, resps were irregular at 32, and HR was an astounding 185. I reported this to the nurse, and she said that he should be fine once his Coreg kicks in. I checked the MAR since I didn't recall giving it to him, and saw that it wasn't due until 9 pm. She said that he is a DNH/DNR, so I should just give him the Coreg since he's used to getting it at that time from her. I gave it, and his HR did go down to 110 about 30 mins later.
SO - while I obvoiusly want my pts to be well, I want to respect the unit's routines (two pts were angry when they got their meds at 9 pm, as they were already in bed), I also want to do the right thing. There are a zillion reasons for giving meds as scheduled, safety being the first, but there is not a unit manager who I can approach about getting meds rescheduled so that we are all on the same page. Any ideas? I'm new, and really don't want to alienate my coworkers or upset routine. Other than this, I really like the place where I am working; I think that most of the nurses give excellent care.
