Am I wearing a "Kick Me" sign?!

[HelenaHandbasket]

I'm a veteren LPN (17 years this month!) and have worked in many different areas of nursing. I'm pursuing my BSN slowly and went back to work full-time days after being a corporate nurse for 3 years and being laid off and a broke college student for 2 years!

I started on nights 24 hours about 2 months ago and just moved to full-time days this week. I'm working in this mystical position called "desk nurse" for a non-profit long-term/rehab center. Basically, I make all the Drs appointments, obtain TOs and transcribe those and any NP orders to a computer on one unit and paper on the other. I notify all the HCPs or family members. Fax all the orders. Chart on all the orders/notifications. I handle all the discharges and admissions. I have a Daily Work Book on each unit in which the nurses write various requests and updates on things that need following up on if they couldn't get to it. I am also called to assist the CNAs as needed (found myself up to my ankles in vomit and BM today!) I send residents out to the hospital and complete all their transport paperwork. I answer all the phone calls to the unit. Arrange all the transportation. Today I restocked med and treatment carts. I update care plans. If there is a crisis on the unit, I am the one who handles it so the nurse can continue their med pass. Everything has to be done NOW and it seems like I'm the only one who can be doing it as it all falls under this vague umbrella of "desk nurse".

I know it's been a coupla years since I hoofed it on the floor but back in the day, there was a unit manager, a supervisor and an ADON to help with some of this stuff, no? As a "charge nurse" I always did as much as I could on my own. That could be the control freak in me as well, but I have this "thing" about taking care of my patients and handling my junk. The Daily Work Book would be for anything I simply could not get done in my 10 hour day.

An example of what I've been asked to do. Some transcribed an order "Toprol XL 25 mg SR 24h PO bid". Whuck?

Right on the card from the pharmacy it had "metoprolol succinate SR 24h" underneath the Toprol XL 25 mg PO bid, same drug. The pharmacy would not have filled it if it could not be dosed bid, especially at a low dose.

The NP had written an order for parameters on "Toprol XL". Apparently there needed to be some clarification as to why a once a day med was being given twice a day and OMG was "metoprolol succinate SR 24h" different altogether than "Toprol XL". Was the NP even looking at the right patient?!?!

But because someone hybridized the brand name and generic name of the drug when transcribing the original order, no one could discern that Toprol XL was the same drug, even though the generic name was written underneath. It took me all of 2 seconds to call the pharmacy as ask "is it ok to administer this once a day medication twice a day?". Why yes, yes it is ok. "And you are a stupid nurse for asking as I would've never filled the medication without clarifying it myself when it was first ordered". Did I mention the patient had already been on it 5 days? It wasn't until the parameters were added did it come into question. I digress. Call the pharmacy ya dang self! It took more time to put it in the Daily Work Book than to just do it.

I think a lot of this stuff should be being handled by the nurses on the unit. I can get the order and fax it to the pharmacy, but you can transcribe it and call the family to update. I will do the admits and discharges. I will handle the unexpected. I will clean up the rough edges and make sure the "i"s are dotted and "t"s are crossed to the best of my ability. We all know that in LTC things happen. Transports get screwed up, families or Drs aren't notified, orders are missed and don't forget the passive-aggressive love/hate relationship between LTC and Hospice.

Right now, I am being yanked from entering orders into the computer to go get dressing supplies from which while on my way back I answer an MD call and oh, here's the admission we weren't expecting until 2p! Wait, did I ever finish putting in that order?! Did you get that labs off the fax yet? Do you have an order for Mr. Smite's coumadin? Mrs. Jone's daughter has a question about her podiatry appointment. HELP, Mrs Crow fell!! Where did I put the paper with the new order I just took off the phone? Crap, I forgot to ask him...Desk Nurse, did you ever ask Dr about? Why did you dip that urine on that hospice patient? Oh she is confused and pulled her F/C out for the 3rd time this week, can you reinsert it?

Failure is inevitable, no?

This is all supposed to end soon when our floor goes from 2 charge nurses and a desk nurse to 3 primary nurses. I cannot WAIT to have my own floor in which I do everything for my patients from soup to nuts!!!

[silverbat]

Somewhere there should be a written job description so you will know your exact job. If not, get with the DON and write one!!!