the sacred med pass

Specialties Geriatric

Published

Got a spanking today from my DON and am I steamed! God forbid that we run over the legal time limit for our med pass...ever......We have always been in compliance during our assorted inspections but sometimes our day to day morning routine is more like salmon swimming upstream to spawn...I am on a dementia unit and I think myself and the other 2 regular staff nurses have the pass down pat-we have worked hard to learn exactly how to encourage each one of our residents to comply....Our unit clerk is out for who knows how long-so the phone rings off the hook....The cna's ring the call bell constantly-they have not quite figured out that we are both on the floor working-not sitting at the desk....between other depts at the desk sucking the life out of us with endless questions and confused residents dumping juice on my MAR I was at my wits end....I was interuppted way too many times and that is a recipe for a mistake-but a resident's needs do come first-I can't let some poor gal stand up and fall over cause I have to get the meds out in time,can I? And then she threatens me with the 2 med cart scenario-not a good idea on this unit-our lobby area is where we place folks that need to be observed-if both nurse are out on med pass together what happens out front? Why does she not come to the floor on the days that the med pass f-l-o-w-s smoothly? I am proud of one thing-after all of these years I ahve finally learned to keep my MOUTH shut....Instead of debating all of this crap I just said " I will try to do better" and that was the end of it.....O I love my DON but about some things she is way out of date and dealing with dementia is not her forte.....She was on the unit one morning and call bells were going crazy-we were answering them at the desk but not getting a response...well-One of our gals was out there collecting them....My DON just could not understand how that could a happen! Anyway_ I am glad that I can vent here....I will have to not let myself be interrupted too much-I can always tell the other depts to go to the charge nurse(and pull her away from her treatments and such---she has all day to do them) and when a cna needs help with a quick lift I guess I can refuse....Sure....It's a loose-loose situation....argh!!!!!~

Specializes in Home Health.

I'm an agency nurse who frequents local LTC facilities. Last evening 3 nurses from my agency filled shifts at a facility that requires 5 nurses on 3-11. I'm still amazed how the staff nurses can get done 2 hours before we do and manage to find time for smoking breaks and even take their 30 minute dinner break.

We find Pole Bags not even opened from day shifts.

The thing that really gets me is when a double amputee patient can't even get a pain pill because someone is too lazy to sign out the med or document a few words of why he needed it.

I also commended one of my co-workers telling her I was amazed to see her bring the med cart down her hallway because when the regular nurse is on staff I never see him with his cart. How do you give meds without the cart??

My husband says I care too much...isn't that what nursings all about???

This thread has revealed the black heart of nursing homes. You all realize some ****er is laughing all the way to the bank while we care and juggle and lose sleep? Ever wake up bolt upright in a cold sweat and remember you forgot to do such and thus?

ORGANIZE NOW.

You owe it to yourselves and your patients.

No one can safely care for 40 people, no one.

The nurses that appear to breeze through are part of the problem not part of the solution.

Yep the regs are outdated.Here in CA they were written in the 70's when the average SNF pt was a little old lady with a pacemaker, not a vent in sight.The owners/corporate dicks know the antiquated regs work in their favor and hey it's all about the money right? "You're not happy move on" Heard that too any times.

I feel for you all and your pts.What a sucky way to live in one's twilight.

How many of you have wanted to tatoo DNR on your chests?

There is no such thing as caring too much.

ORGANIZE

Specializes in Gerontology, Med surg, Home Health.

Well,Sanakruz, I don't know where you're from, but here in Massachusetts, even the homes which are "organized" fare no better. The nurses aren't better, the patients don't get better care...what does happen is the union takes the dues and they are the ones laughing all the way to the bank. Change has to start with the regulatory agencies. We need to educate our patients and their families so they see as clearly as we do that one nurse can't care for 40 patients. In Massachusetts there is push by the MNA for a law that would limit the number of patients a nurse has in an acute care setting to between four and six....WE, as nurses who work in LTC, especially sub acute units, need to have the same sort of support for our concerns.

I've worked in LTC for 10 + years first as STNA then as RN. I look back now and wonder how I did what I did as charge nurse with 25+ residents and actually visiting and talking with families and residents. I use to feel like part of the "family". I left that for a Supervising position and eventually a Unit manager position in SNF. Working as a manager I felt I was always defending my nurses and staff to my DON. I was the first to defend them if it was felt they did something wrong. Everything always came down to the budget or family complaints . I know shortcuts are being taking to complete the med pass as soon as possible so they can get started on the treatments, wound rounds, attend the mandatory inservices ( that are conveniently scheduled at times of med passes and are way too long for floor nurses to be away), the skilled charting, the doctor calls, restarting IVs, trying to calm pissed off families ( so they wouldn't go to the DON ) and try and thoroughly assess any one of your unstable residents and maybe send them out. Oh and lets not forget attend care conference where the DON expects the nrses and STNAs to attend since they know the resident best. This of course was also the time when families released their attacks on nursing and you're left with feeling like you have not done anything right. This will all continue untill the States set safe staffing ratios for LTC- instead of leaving it up to facilities to do this.

By the way I left the manager's position after suffering extreme burnout and attacks from my DON that left me in tears questioning any ability I had. I was told I focused too much on the clinical and patient care . Kudos to the nurses who still hang in there on the floors.

:angryfire AgnewRN

Originally posted by agnewRN

By the way I left the manager's position after suffering extreme burnout and attacks from my DON that left me in tears questioning any ability I had. I was told I focused too much on the clinical and patient care . Kudos to the nurses who still hang in there on the floors.

WOW :eek: I could have written that post myself. Defending my staff, kissing butt with the families ect ect. The families depended on me to do the right thing and I tried my best to keep everyone happy and safe. I was burnt out and attacked too by my DON who I considered my mentor. I know she was grooming me for ADON position and I really pulled the rug out from under her when I resigned. She harrassed me from the minute I handed her the letter and it continued for the next 3 weeks. She kind of made it easier for me to go with her behaviors.

I was so very burnt and a little angry when I thought about how many hours I worked without compensation. I too say Kudos for the nurses who hang in there because being a nurse in LTC regardless of the position you hold is NOT EASY.

deb

It's not easy god bless you!

If you are organized you can at least speak with one voice about changing the regs. Many unions have paid lobbyists in the state capital pushing their membership's concerns into the forefront.(A reason dues are charged;lobbyists make the big bucks!!!)This is how the political process works. And this is indeed a political issue make no mistake.

Specializes in Home Health.

Sanakruz, I believe the organization thing works...for a while, anyway!!

I usually work 3-11 so after I got report...depending where I am...theres one unit where I have to wait for the nurse to sign off her MAR which she religiously starts at 2:30. Didn't we learn to do that after the med was given??

Then I go and check the TX book and gather up stuff for some tx's and clean some G-tube sites. I'll also try to pick up a couple charts and document some of those "required" blurps about why Mrs. Jones was depressed last week. Or why Mr. Smith smacked a CNA. By the time I do some of these It's time to stick a couple fingers. How about some of those new glucometers?? I still go to a facility that has one where you need a blob of blood the size of your keyboard "O". Then it says "WAIT" Don't they know we can't!!!

Then you start the almighty med pass....and the interruptions start!!!

Needless to say I felt good at the end of my shift when I picked up a chart that I have already documented on or when I went through the tx book ...Wow!! I already did that!!!

Stay focused, be happy and smile!!

Regarding the two hour med pass time limit: Some facilities are now scheduling half the med pass at 8am and the second half at 9am. You have one hour before to one hour after the med is due to give the med. So if you do this you actually have 3 hours to do the morning med pass which is traditionally the lengthy one. You can also give all the vitamins at another med pass which speeds it up. What patient in long term care doesn't get a vitamin! Many are giving Digoxin either at noc shift last med pass or on the evening shift. Coumadin should also be given later in the day after the PT/INR results are in, in case the dose needs to change. Just some suggestions to bring to administration. As long as it is in your policy that med times are 8, 12, 4, 8 for some rooms and 9, 1, 5, 9 for others it is okay.

Hi everybody, I'm new to this board (actually I've been lurking for awhile..nice board!) but I felt compelled to register and post my feeling here. I am an agency nurse working in geriatrics for most of my 22yr career. I've been working in for the same facility for several years. You MUST take shortcuts...and learn to live with them, if you want to survive in this type of nursing. I can honestly say that 100% of my patients get 100% their meds 99% of the time. But if the sh-t hits the fan and I must choose between giving a Colace or helping a patient, I'll take the patient everytime. I know someone else will come along and give that Colace.( or vitamin or whatever!) Sue

I'm with you Sueb, but have you ever noticed that all of the nursing assistants disappear when med pass starts and you can never find them if you need assistance.

Bumped up to the top , these are such good examples of how a typical med pass in LTC goes.Still the same three years later if not worse.

deleted

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