the sacred med pass

  1. 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I just said " I will try to do better" and that was the end of it.....O I love my DON but about some things she is way out of date and dealing with dementia is not her forte.....She was on the unit one morning and call bells were going crazy-we were answering them at the desk but not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!!!!!~
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  2. 39 Comments

  3. by   adrienurse
    I hear you. S**t happends, especially on a dementia unit
  4. by   caliotter3
    Your post reminds me of one of the horror stories from my past. Our LTC was right in the middle of the inspection from hell, brought about soon after our DON walked off the job. You know, one of those things where they descended upon us knowing what to look for and where to look.

    A newly hired RN had been dumped on a floor with absolutely no orientation and the poor soul was caught by an inspector giving 7AM meds at 2PM. Well, the DON suspended him from his job for 6 days. When he came back she limited his duties to treatments and spent a shift following him around with a clipboard. The coup d'etat was that he cleaned up some poo before doing a tx rather than go out to tell a CNA to do it. The DON fired him on the spot.

    Here's the good news, tells you what kind of a working atmosphere this place had... several months later one of the nurses was bragging how she and the nurse who had called in "sick" that day had set this "stupid ------ nurse" up. She was laughing and really quite proud of herself. It was a well known fact that every time there was a survey in that place certain nurses knew when to call in "sick" and did so religiously. Another member of the clique also stated vehemently "I don't orient RN's ". She was an LVN who had worked there more than 20 years. How many times had she taken the RN boards (in her home country, of course, she was an RN with the required BSN). I learned a lot by listening and keeping my mouth shut. I knew my job was secure only so long as these favored ones did not target me. And I was targeted on several occasions when there was nobody else more fun to pick on.

    And saddest of all, the realization that the DON did not apply the same standards to her clique nurses, who could, and did, get away with anything they pleased. Any wonder why LTC facilites are the hell holes their reputations paint them to be?
  5. by   GPatty
    OMG Caliotter....
    How sad that nursing should come to this......
  6. by   cargal
    We always run over. I find it uncanny that the smoking nurses can finish the med pass by 10A. I take until 11 with out fail. I put up shades, put sweaters and glasses on residents and talk to them, and their families. Miss my break, too. Cannot work overtime due to exhaustion. Most days I am too tired to make dinner.
    As far as what caliotter3 describes, why am I not surprised? Nursing shortage, no shyte!
    It is ironic that it is the state that regulates the time perameters on the med pass, but also regulates the poor staff ratios. Are the ratios that are in place outdated from the 60's and 70's? Now residents live longer and are less stable, and more dementia.
  7. by   jones58
    In NYS, management can decide how much staff is required to safely care for residents. So they aim for what they think is adequate staffing, and accept even lower staffing. I think if management had to perform the care they might try to provide for more staff. The whole nursing staff where I work is understaffed
  8. by   aus nurse
    Oh my lord....in my 20 years of acute care nursing here in Australia, I have NEVER heard of a timed med pass. It can change day to day for all the reasons you mention, how on earth would they expect you to stick to a time limit? Who gets to set the time anyway? This blows me away.
  9. by   night owl
    Where I work in LTC, the computer sets the time limit. If you give a med late, a box pops up that says this med is so many minutes late and then you have to explain why it is late. If you don't, it won't record that it was given at all. I hate answering to stupid machines!
  10. by   ann31247374
    I work on a dementia unit in which there is no possible way you would get your meds passed on time. There are too many interruptions. You've got so many residents that are confused and standing over your cart. Plus I help pass trays for meals. It is very frustrating! I start med pass at 8:15 and usually don't get done until about 10:30-10:45. It's nuts.
  11. by   donmurray
    A bus driver doesn't take fares while he's driving, and I don't do anything else but pass meds during the med pass, for the same reason. It's too dangerous!
    People eventually learn not to phone, because it doesn't get answered. (at least, not by me!) and other interruptions are delegated or ignored till I finish, unless they are life or death, which equates with the importance of patients receiving the correct medications. Time is a little more flexible.
    First priority is patient safety, closely followed by protecting my registration!
  12. by   CapeCodMermaid
    Am new to this forum. Have worked in LTC for most of my career. Do y'all understand that the sacred med pass regs were written when the residents took one or two meds each? There is NO way that one nurse can safely medicate 20-40 patients on ANY kind of LTC floor whether it is a dementia unit or a subacute unit. The average resident at my facility takes an average of 8 medications...the ones on the subacute floor take an average of 14...not to mention IV's, GTubes, parameters. We, as nurses, need to be more vocal. It's time to change the regs...someone needs to do a scientific study...
  13. by   renerian
    You have such a hard job doing med pass on a demential unit. You must be very good!

    renerian
  14. by   cargal
    Originally posted by CapeCodMermaid
    Am new to this forum. Have worked in LTC for most of my career. Do y'all understand that the sacred med pass regs were written when the residents took one or two meds each? There is NO way that one nurse can safely medicate 20-40 patients on ANY kind of LTC floor whether it is a dementia unit or a subacute unit. The average resident at my facility takes an average of 8 medications...the ones on the subacute floor take an average of 14...not to mention IV's, GTubes, parameters. We, as nurses, need to be more vocal. It's time to change the regs...someone needs to do a scientific study...
    Exactly-- I was reamed by my administrator for saying as much- she stated that I did not understand that this was not acute care. She is a former RN. When does a RN take off her cap, so to speak, and become an administrator. BTW, I was expected to pass meds for 25 residents and be charge too. I love my residents and must say Adios!
    We must speak to our legislators about LTC staffing, too , or nothing will change.


    Blessings,

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