rant-the weekend

  1. Argh=I've got to get this out.I had the weekend from H#ll.Here it is-the 2nd week of September and we found not 1,not 2 but 5 major med/transcription errors on the MAR's on the unit I worked on this weekend (I am a full time float and I like it that way) The 2 nurses with me yesterday work on that unit full time and tried to focus blame everywhere but on themselves.By the time I found the 3rd,4th and 5th error they both had to admit their responsibility and one was crying and the other was throwing up...Both blamed everything on the 'lack of leadership" from the charge nurse .This is true-she did not want to be the charge-no one really does in our facility.There is no additiional pay but you get all the responsibility.And-our DON expects day shift to pick up the pieces always-we have been told numerous times if new orders are written over nite,prn psych drugs given etc,it is up to us to double check in the am that the proper documenation was done..I've learned to just" go and do"...These newer nurses seem to want to make the other shifts "do" and don't want to accept responsibility for anything.How can you pass meds for 9 days to the same 20 residents and not notice things like-and HS med being circled for 7 days in a row and noted as "unavailable" without taking the initiave to call the pharmacy? Not read the MAR and see that a resident is supposed to receive k-dur bid but is only getting it daily at 9a because no one ever wrote in 5p or 9 pm on the MAR? No one reads the entire order? They just open up the med drawer and grab one of everything? D/C a med and fail to remove it from the med cart or d/c it on the MAR? An anti-hypertensive,no less......It just went on and on...Meanwhile on Saturday myself and another prn nurse worked that floor while the full time regular nurse pretty much did nothing..I'm dreading going in toworrow because I don't want to end up on that floor....We have very few RN's in house-most of our charge nurses are lpn's....The main problem really seems to be the newer less experienced nurses...They seem to pick and choose where they want to work,what they are going to do-and everything is someone else 's fault...I feel sorry for the residents.....I'm praying that I don't have to give up my floating........
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  2. 10 Comments

  3. by   lvs2nrs3535
    Hi ktwlpn,
    I am a new nurse in a nursing home, and I can understand and share your frustration. I graduated in May, passed my boards in June, and I have been working at the nursing home for exactly 3 weeks now. I am now on my own. My training is officially over. :uhoh21:
    I was hired as a charge nurse, and there are 2 of us on the 7-3 shift. I take care of 24 residents, oversee 3 Cna's and 2 med-techs, and do all the treatments, narcs, insulin, coumadin, ect. (the other RN has the same responsibilities on 'her' half of the floor. and she does consider it HER half). I am still trying to just FIND things. And yet, I am responsible for those Mars, as you said. It is a very scary position to be in. I was ALONE Friday night, and terrified! No med errors, nobody died or had a heart attack, (one lady I really like had chest pain, though, YIKES!)
    I go nonstop from the time I walk in the door. I would never, however, not accept responsibility for my mistakes, and I am so sorry you have to deal with that. I am still learning how to properly do the mars.
    I keep coming back to what you said about being afraid for the residents. If we dont step up and report, document, make these nurses accountable for their mistakes and try to be positive with the training, ect., who will?
    I worked 2 12's this weekend covering another nurses military duty, and learned more from the nurse I worked with there than any other time.
    Maybe it is a lack of training for the nurses you are with? Or perhaps they just dont care, I am not there, I dunno.
    hang in there, somebody has to care about these residents, and it sounds like you really do. Maybe somebody else here on this forum with more experience can give you better advice.
    I guess I just wanted to sympathize. Good luck, I will send positive energy your way.
    Ours is a hard job...........we deserve the title NURSE!
    KristyBRN
  4. by   CapeCodMermaid
    I've been a nurse for a long time but I still can remember my first med error. The order was for 81mg aspirin every other day (except in those days, we wrote QOD). I gave the aspirin on a day the resident wasn't supposed to have it. I immediately told the nurse manager and burst into tears. I was still sobbing when I called the doctor to tell them the mistake. He actually laughed at me and asked why I was crying because "it was only a baby aspirin and she probably needed it every day anyway". EVERYONE makes mistakes but the really good nurses own up to it and try to figure out a way to prevent another mistake.
    Do you double edit your med sheets? I can't tell you how many mistakes I found when I first started working at my new facility. How do you see Aldactone 50mg BID and copy it as QD? Makes me nutty.
  5. by   jetscreamer101
    I have the same issues.
    You used the last of whatever med, there was no replacement, just where do you expect the next person who passes that med to pull it from? Pharmacy is avail. 24/7. They may not appreciate you calling at 8pm for a med they'll need in the am, but that's what they're there for. And you didn't give something cause it wasn't there? Again, pharmacy is avail. 24/7.
    Here's one I really like: "You forgot to write on order for the insulin you gave the other night....Did you say you didn't call doc for order.....So, you decided on your own they needed more insulin because of an elevated blood sugar......Oh, last time their sugar was elevated and you called that's the order the covering doc gave, so thats why you gave the extra insulin without calling the doc?" As I live and breathe, that's a conversation I had the other day.
    I also find the bid med with one admin. time listed, or q 6 hr med scheduled at 6a 2p 10p, a 600mg order (give 2-300mg tabs) and the nurse only gives 1, an antibiotic ordered for 7 days and at the end of 7 days still has a few left, new orders not transcribed on new med sheets at change over, etc.
    I get frustrated sometimes.
  6. by   leslie :-D
    not only is the shabby, it's downright negligence.
    and it's not just one nurse either.
    if a med is circled for sev'l days, w/no inquiries from other nurses and shifts, it's a system error.
    for other nurses NOT to question obvious errors is unconscionable.
    really ticks me off.
    i don't care whose job it is.
    it's everyone's job.
    period.

    leslie
  7. by   CoffeeRTC
    I totally understand where you are coming from. I only work every other weekends, so I come in with the "fresh eyes" and see all of these errors that everyone is talking about. At my other job,I float so I see the same.

    What needs to happen is a write up or med error. Yah...like I want to fill them out, it would take half of my shift. GRRR.

    What kills me is that it was in our plan of correction a few yrs ago to to have our mars, etc double checked every month....is it being done? no and I've even asked to come in to do it!!
  8. by   ktwlpn
    and then,of course,I made an error this week...At least I "manned up" to it and didn't make excuses or try to blame someone else....
  9. by   banditrn
    Quote from ktwlpn
    and then,of course,I made an error this week...At least I "manned up" to it and didn't make excuses or try to blame someone else....
    Yep, that's the ONLY way to do it. I've never made a serious med error, but every one taught me something - mainly that I was becoming complacent and not paying as much attention.
  10. by   marjoriemac
    I can sympathise, I have started working in a nursing home where they uses MARS sheets here in UK, in my last home I was responsible for the individual order and processing of all seperate drugs. Nobody has showed me how to use the MARS system when drugs are brought into the home and nobody seems willing although they ***** when I have to leave the order out for the next nurse. More importantly however they do not seem to have the initiative to question long standing PRN drugs that have not been used in years, they give PRN drugs repeatedly without asking for a regular prescription. They routinely give lactulose everyday (even if the person has diarrhoea) because it is prescibed. They do not bother marking in wound dressings or creams even though they are included in the drug audit. In my last post if somebody was on digoxin, we recorded their pulse daily before giving the dose - they don't. They don't even document the blood sugar of a diabetic resident daily. I was always told to write the dose of a drug as pharmacy may send up a new batch of tablets, so what if a resident is on a batch of tablets say 10mg daily and presently the stock you have requires you given 2x 5mg tablets - what if pharmacy use a manufacturer that can give 10mg tablets? The 2 tablets daily (which is how they would document it) is now 1. I am thorough with my medication round but I cannot say the same about other staff including managers!
  11. by   banditrn
    In my facility, pharmacy ISN'T available 24/7 - and the main pharmacy that supplies us is 2 hours away. We have to fax them before noon for anything needed. And they don't deliver on the weekend.:uhoh21:

    When I work, I try to do an inventory of things that are getting low and get them ordered so that we don't run out, but I only work part-time.
  12. by   Simplepleasures
    Instead of pointing the finger of blame at each other and continously fighting amongst ourselves, why not wake up and smell the coffee?UNDERSTAFFING and being totally overwhelmed with work causes these and much worse senarios, why have we nurses been so willing to treat our fellow nurses so poorly, when the blame lies directly on the GREED of the LTC facility owners. The ONLY way to change this is to gain strength in numbers and UNIONIZE, not some weak namby pamby ineefectual union, but a STRONG nation wide union, see California Nurses Assciations plans for NATION WIDE UNIONS. Its way past due.

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