I said I would come back and eat humble pie if it wasn't truly a wonderful place to work, and these are my thoughts.
Been there a month. Been on my own for a little over a week, so I basically got about 3 weeks orienting with some of the days the nurse would be at the front desk for me to find to get a feel if I could handle it. I was ready for this challenge I thought and honestly none of the patients were that demanding care wise.
I do still rotate between daylight and evening and learned that besides personal reasons, I much prefer daylight as I love the interaction and the residents being "up" and doing their activities like making dog bones! I don't much care for the "sundowning" that occurs especially the couple of residents that make evening charting really trying.
As I read on another thread, and didn't want to threadjack...I'm seeing what many are in terms of getting the med pass done on time. It seems no matter the 3 halls that I've worked, the daylight one goes smoother and the evening one goes downhill because of the short time between getting report and dashing down the hall in basically an hour to get it all done for dinner trays etc..
I also have issues with meds I'm sometimes giving, but that's my personal belief system...however when I watch someone with recurrent UTI's and the overuse of antibiotics....anyway I struggle with this. I guess too, because I was blessed that although both my parents are gone...they went fairly healthy...certainly not to the degree I see in my work.
My bigger issue is although I love the place, I don't like the politics, which is why I always figured no matter where I am, I probably won't stay beside longer than 10 years maybe even more like 5, but that's a different topic! I don't like the med pass from hell. I don't like the shortcuts I'm being told to take, I don't like the combining 4's and 8's meds b/c it's "easier" than dealing with a combative or seriously lethargic resident at 8p. I don't like that I don't feel like I have enough time to do proper care in dealing with dressing changes or just looking at a resident, I received no tips on assessing the patient by a quick look, we only do vitals on the certain few.
Even though I'm willing to work any hall...I'm being told that's shooting myself in the foot as I'd do better focusing on one and getting down a system. After last night I can agree! The floor I'm on has 3 halls and I do know pretty much all of them but none of them great or super efficient, mostly b/c nightly we are getting new residents in a more critical state.
This has caused more and more unhappiness with the staff as they're tired of the overtime (at least we don't get griped at for using it) and the don't feel we're appropriately staffed for the acuity of some. They are no longer taking much of the long term as they are focusing on the more critical as it's better money as I understand it.
I need some tips in organizing my day as much as I thought I was good at this from a previous job, nursing is a whole 'nother ballpark.
Right now, I have 24-26 patients. (as soon as one leaves one comes in) One needs a daily BS for 430p only and just coverge which she always needs. Another gets her BS only on Tue and Thur at that same time, usually coverage and the third is on a feeding and her BS's are qid. I have one patient on a continuous feeding as well as o2 and monitoring her compression glove and making sure she's mummy wrapped as she likes to pull her g-tube out:eek: A little over 1/2 are crushed meds, mostly with pudding but one needs serious time consuming cajoling at 8pm with ice cream.
So prior I was just getting the BS's as I went, I see that didn't work too well. Last night I tried to do the 2 blood sugars 1st, but since there's a long distance between the rooms that need them, I decided I'd be better off trying to pass some of the "faster" meds in between. Well this might have worked in theory except I had to handle the doctor's calling back on 2 patients that o2 sats tanked and take orders, (which I've never done) and then find out another spiked a temperature in the dining room so I was running back and forth!
Would it be better to grab all the BS's first on any given day? I get told that it's better to grab them as you go otherwise I'm wasting steps. What about the vital signs? Only a few need them on any given day and some are full some are just TPR sometimes the aides will get them, often not (days the aides always get them) 2 of the suppositories that were left from daylight had to be done but I figured that could wait until the 8pm rounds as they aren't as intense.
I loved what I read on the other thread about doing it "right" all the time instead of just when state is there but how? Confused residents are milling about in the halls which is where some meds/eyedrops get adminsitered and it all feels very chaotic.
We have a print out of the residents name going down a 8x11 sheet with about 1/2 inch of space to write inbetween what's going on. So I take additional sheets from the daybook which are at least blocks of space to write in, but I find I get so busy I can't really find the time to chart in them! Some nurses tell me they don't chart anything in the MAR until they're done with the pass but they "look" at the MAR to make sure the meds are still correct. I tried that on just 2 patients and felt overwhelmed, but I do feel it's time consuming to intial the boxes so what to do?
Sorry this is ridiculously long...but I wanted to give an update and really, really need some help :bowingpur:
No med cart? Geezum crow! I can't imagine. With an attached lock box for narcs.
Nope, only one med cart and that goes with the CMT! The CMT's aren't allowed access to the narcs at all. When I oriented, and I oriented with an excellent RN...she passed straight out of the narc cabinet too. Our facility has had trouble with nurses taking narcs for their own personal consumption. Every time pharmacy delivers, 2 nurses have to sign in any new cards of narcs. When a card is empty, 2 nurses have to sign the card and then put it under the DON's door. The DON's check our narc cabinets daily. Also, they have increased our urine screenings as well. If anything is amiss, even if one nurse signed an empty card, not 2 nurses, we all get **** tested and the one nurse that signed gets wrote up.
One evening shift, and this is another learning experience for me, I was the only RN in the building. There were 2 LPN's on the other 2 units. The station 3 LPN came to me and told me that the CMT on station 1 had called her to assess a patient b/c the LPN in charge of that wing wasn't doing it. They ended up sending that patient out. After the station 3 nurse assessed her, then went to the actual LPN in charge and told her he was very ill. I went to talk to the LPN in charge of that station b/c at that time, I thought she was an excellent nurse very in tune with her patients and this lack of concern was concerning ME. She acted very strange and seemed really out of it. I went to the station 3 LPN and asked her if she thought we should test her urine. We decided we would leave a note for the DON and let her take care of it. Only a DON can conduct a urine test. Come to find out, several days later, that specific LPN was found with a card of Lortab and was immediately fired. The station 3 LPN and I chatted and have decided if it ever happens again, we are notifying the DON pronto.
As I said, you live, you learn! I have done more learning at this facility than ever!
mondkmondk
336 Posts
Nope, only one med cart and that goes with the CMT! The CMT's aren't allowed access to the narcs at all. When I oriented, and I oriented with an excellent RN...she passed straight out of the narc cabinet too. Our facility has had trouble with nurses taking narcs for their own personal consumption. Every time pharmacy delivers, 2 nurses have to sign in any new cards of narcs. When a card is empty, 2 nurses have to sign the card and then put it under the DON's door. The DON's check our narc cabinets daily. Also, they have increased our urine screenings as well. If anything is amiss, even if one nurse signed an empty card, not 2 nurses, we all get **** tested and the one nurse that signed gets wrote up.
One evening shift, and this is another learning experience for me, I was the only RN in the building. There were 2 LPN's on the other 2 units. The station 3 LPN came to me and told me that the CMT on station 1 had called her to assess a patient b/c the LPN in charge of that wing wasn't doing it. They ended up sending that patient out. After the station 3 nurse assessed her, then went to the actual LPN in charge and told her he was very ill. I went to talk to the LPN in charge of that station b/c at that time, I thought she was an excellent nurse very in tune with her patients and this lack of concern was concerning ME. She acted very strange and seemed really out of it. I went to the station 3 LPN and asked her if she thought we should test her urine. We decided we would leave a note for the DON and let her take care of it. Only a DON can conduct a urine test. Come to find out, several days later, that specific LPN was found with a card of Lortab and was immediately fired. The station 3 LPN and I chatted and have decided if it ever happens again, we are notifying the DON pronto.
As I said, you live, you learn! I have done more learning at this facility than ever!
Blessings, Michelle