CNA's passing meds

mboyce · Sep 6, 2002

I agree, nursing is exhausting; physically, mentally and spiritually . . . fortunately (and unfortunately) people depend on nurses to rise above the meanness and minimalization of others less willing to serve.

I believe that the need generates the energy for those who are nurses (not just practicing nursing) to step up.

I am very interested in hearing from people who have what they think are answers to improving medication administration practices (no matter who administers) and what the role of the nurse can and should be when they are freed from the passing of pills . . . especially in protocols, methods, practice, experience, habits, et al, of identifying and assessment patients/residents for response to chemicals.

NrseK · Sep 6, 2002

It is my firm belief, that there are multiple ways that the nursing shortage can be, maybe not magically or a "quick fix", but fixed; and these solutions I honestly believe would be long term.

In a lot of instances, nurses "eat their young". Impatience with young, inexperienced nurses, expecting top performances, no repeated instructions,(ie:"I already told you that once, my god!")and expectations of perfection, or near enough not to

matter, do not encourage.

How often do we, as a group, stand around, whine and complain and downgrade our own profession? How do you think this affects people that are considering entering the profession? Do we honestly believe that this behavior encourages people to WANT to do what we do for a living?? If we're constantly so miserable, why would they?

How often do we truly nuture someone elses budding career and help them to grow in knowledge and scope and how often do we worry more about how their advancement is going to effect our job description?

How often do we encourage LPN's/LVN's to become RN's? Isn't this often seen by some RN's as just more competition for wages and status?

All I'am pointing out, is that, perhaps, just perhaps, there are a multitude of things that can and should be being done by each and everyone of us to encourage new people to enter the profession, to nuture the young ones already in it, and look to ourselves for a least a good part of the solution, instead of saying "It's all the "suits" fault. If they'd just do this, if they'd just do that, all of our problems would be solved." I promote the idea that pay and working conditions are only a portion of the problem. The shortage itself is the issue to be dealt with.

Youda · Sep 7, 2002

I have to disagree. I'm not talking about nurse managers. I'm talking about the accountants and the MBAs and CEOs who know more about the function keys on a calculator than the "business" (if you'll excuse the pun) of nursing. Those who will push the envelope, the poor nurses, to the brink of extinction if it means another good day on Wall Street. What corporation do you work for? Check out the millions of dollars paid out by your X,Y,Z, corporation to campaign contributions and lobbyists in D.C. whose sole job for this money is to prevent legislation that would benefit workers (nurses) or any kind of healthcare reform. No, I'm not paranoid. These are facts easily obtainable about any of the major corporations who do the "business" of healthcare.

As for the whinning. ANY manager sets the tone for his/her company, group, unit. If you are seeing people whining and moaning, there is an atmosphere that started AT THE TOP somewhere that is disrespectful and demeaning to YOU. If you don't believe me, think back on the jobs you loved. What is missing now where everyone is whining? Respect.

Oh, yes, folks. The changes that are needed most certainly can be accomplished. But it means that the "business" of healthcare has GOT to change back to BEING about healthcare instead of "business."

Now, you went and got me riled.

Please don't talk about nurses criticizing each other when we are only responding HUMANLY to inhuman conditions and expectations. Sure, the coping mechanisms start to wear a little thin sometimes and come out in negative ways. But, do NOT put the demand of being Pollyanna on us all the time, as if we don't have enough expectations put on us already.

Youda

NrseK · Sep 7, 2002

Absolutely, absolutely! No doubt in my mind, that WAY too much emphasis is placed on the bottom line. No arqument there. WAY too much emphasis.

However, I still maintain, that, as members of a profession, not just a vocation, but a profession, it is part of our obligation to our selves and others to take accountability and responsibility for how we conduct ourselves in public forums and the perceptions that we give to the general public about the way we feel concerning our profession.

Every profession has it's problems, and there are very few that don't have money complaints.

There is no doubt that numerous aspects of nursing are incrediably demading, to the point of breaking, minds, spirits and hearts at times. Do we get the respect that we deserve all the time? Heavens no.

But, without expecting anyone to play Pollyanna( because believe me, I would not do well!

:) ) I still maintain, that to blame nearly every negative aspect of our jobs, on these unseen faces of the "suits" is enabling them to make us look like all WE care about is the bottom line; and we all know that the vast majority of us are in this incrediably hard field because we truly love people and want to help them.

All I'am suggesting is that WE need to, within own ranks, encourage, promote, and lift up each other. Complaining etc., will always have a place. Everyone has to complain at times, or we'd just all explode!

:chuckle :chuckle

I just think that TOO much of it, and we only harm ourselves and the profession.

Youda · Sep 7, 2002

Yes, I do agree with you now that you've restated it. But, I also see complaining and venting as defensive coping mechanisms, particularly among those who do not feel empowered, who feel helpless. For some reason, usually a Machiavellian-type management, people engage in these behaviors when they do not feel they can take their concerns and problems openly up the chain and have those concerns dealt with respectfully and seriously. The morale starts to drop and there is complaining, backbiting, gossiping, and all the other behaviors.

Yes, there is a certain amount that everyone can do by conducting themselves professionally. Yet, I see behaviors such as you described as symptoms of an ineffective management, not a fault at all to those who are doing it. An individual, or a small group, simply doesn't have the leverage to confront these problems without risking their own livelihood. So, those problems are endured, turned inward to stress and depression, or vented among ourselves with the complaining and whining. In many ways, some of these negative behaviors, if not reactions to ineffective leadership, are simply mirroring the behaviors of management: nitpicking, lack of concern for the individual needs, bullying, cliques, fault-finding, etc.

I strongly believe that the only way any of these concerns and problems will ever be resolved is for each and every nurse to join their state nursing organizations, the ANA, and become involved so that positive changes can occur. And it is VERY possible for these changes to happen. See this news article and join me in congratulating the California Nurses Association. You can see what can be done, if we all work together. There is no doubt that California just put a HUGE dent in their nursing shortage and secured better care for their patients.

http://biz.yahoo.com/bw/020906/60230_1.html

LIZZIE57 · Sep 7, 2002

I WOULD NEVER BEGRUDGE ANYONE WHO HAS PUT TIME INTO LEARNING AND TAKING RESPONSIBILITY FOR THE CARE OF OTHERS. I HAVE WORKED WITH TECHS AND FOUND THAT IN THIS POSITION I SPEND MUCH OF MY TIME WORKING AS A TEAM, RATHER THAN JUST HANDING OVER THE CART AND NOT CHECKING IN ONCE IN A WHILE. MY WHOLE CONCEPT OF THE STAFFING SHORTAGE IS TO WORK TOGETHER AND LET EACH MEMBER KNOW YOUR EXPECTATIONS, WHAT YOU ARE WILLING TO DO AND WHAT MUST BE ACCOMPLISHED! THE BOTTOM LINE IS THE PATIENT AND I FIND THAT "BEDSIDE LEADERSHIP" SEEMS TO WORK THE BEST IN A LTC SETTING. THIS MAY SOUND IDALISTIC, BUT IT SEEMS TO KEEP STAFF FOCUSED AND PRODUCTIVE.

MY DAUGHTER, NOW A P.A. STARTED AS A PCA IN THE LOCAL HOSPITAL. HER FIRST DAY OF WORK(AFTER 3MONTHS OF ORIENTATION) CONSISTED OF STARTING A COUPLE OF IV'S, PUTTING IN FOLEYS, AND VARIOUS OTHER TASKS DESIGNED TO FREE THE NURSE FROM THESE DUTIES. SHE WAS NOT ALLOWED TO PASS MEDS. THIS PARTICULAR HOSPITAL DID NOT EMPLOY LPN'S, SO BASICALLY THEY USED PCA'S FOR CLINICALS AND PAID 9.50/HOUR.

I USUALLY MAKE IT CLEAR THAT IF A CMA WILL BE DOING MEDS THAT I AS THE "CHARGE NURSE" WILL NOT BE HELD SOLELY RESPONSIBLE FOR A MISTAKE OR SIDE EFFECT. THIS CAN BE CLARIFIED BY DOCUMENTATION THAT THE NURSE CAN PRESENT TO THE ADMINISTRATOR OR DIRECTOR.

THANKS FOR LISTENING!

Teshiee · Sep 7, 2002

I disagree I don't feel powerless nor feel intimidated. I honestly could care less who passes meds just don't expect nurses with licences to take the fall. I work in NICU and I know that will never happen but for those who work in LTC watch out! Protect protect protect.

oldgirl, RN · Sep 7, 2002

Mario notes that he doesn't have contact with meds in his acute care setting-"except for the ones left by Pt's in the white cups" Patients not taking what you have signed off giving them is a BIG med error where I come from. This is another example of what happens when RN's are rushing and trying to do too many things at once. Not saying techs are the answer, but we are kidding ourselves if we think RN's are doing it right all the time.

monkijr · Sep 10, 2002

Originally posted by LIZZIE57
I WOULD NEVER BEGRUDGE ANYONE WHO HAS PUT TIME INTO LEARNING AND TAKING RESPONSIBILITY FOR THE CARE OF OTHERS. I HAVE WORKED WITH TECHS AND FOUND THAT IN THIS POSITION I SPEND MUCH OF MY TIME WORKING AS A TEAM, RATHER THAN JUST HANDING OVER THE CART AND NOT CHECKING IN ONCE IN A WHILE. MY WHOLE CONCEPT OF THE STAFFING SHORTAGE IS TO WORK TOGETHER AND LET EACH MEMBER KNOW YOUR EXPECTATIONS, WHAT YOU ARE WILLING TO DO AND WHAT MUST BE ACCOMPLISHED! THE BOTTOM LINE IS THE PATIENT AND I FIND THAT "BEDSIDE LEADERSHIP" SEEMS TO WORK THE BEST IN A LTC SETTING. THIS MAY SOUND IDALISTIC, BUT IT SEEMS TO KEEP STAFF FOCUSED AND PRODUCTIVE.

I USUALLY MAKE IT CLEAR THAT IF A CMA WILL BE DOING MEDS THAT I AS THE "CHARGE NURSE" WILL NOT BE HELD SOLELY RESPONSIBLE FOR A MISTAKE OR SIDE EFFECT. THIS CAN BE CLARIFIED BY DOCUMENTATION THAT THE NURSE CAN PRESENT TO THE ADMINISTRATOR OR DIRECTOR.

any comments??????

Dakasha · Sep 10, 2002

Where I worked before, as a Asst. Community Nurse, I dispensed meds, because I did it when I was training in the hospital under supervision, but when I went out in the Community to work I dispensed meds for years, I was restricted from administering certain meds though, I got accustomed to that;and what I didn't understand I would refer to my drug reference bookwhich we always kept updated in the clinics, and what I did n't understand I would ask the pharmacist. That is how I handle that situation. The CNA's just need the right training and they would be able to do it.

Youda · Sep 11, 2002

I USUALLY MAKE IT CLEAR THAT IF A CMA WILL BE DOING MEDS THAT I AS THE "CHARGE NURSE" WILL NOT BE HELD SOLELY RESPONSIBLE FOR A MISTAKE OR SIDE EFFECT. THIS CAN BE CLARIFIED BY DOCUMENTATION THAT THE NURSE CAN PRESENT TO THE ADMINISTRATOR OR DIRECTOR.

any comments??????

Unfortunately, it isn't up to you or your administrator who is responsible. Most Boards of Nursing make it very clear who is responsible, and it's you. Check with your State BON to be sure. But, I don't think a letter or statement protects you in the least little bit. In fact, in a court of law, such a statement could be used against you to mean that you knowingly allowing a situation to exist that you felt was dangerous, but accepted the assignment anyway. Again, I'd call your State BON for advice about this before you feel too secure.:stone

Teshiee · Sep 11, 2002

Oldgirl

You are right I am sure RN's aren't perfect some bad habits may be picked up along the way but it is his/her license that they may be putting in jepordy. But behind some unlicensed individual I think not!!!!!!!!!!! Accountability! I have worked in LTC and I know a charge nurse is doing many things but if an aide is passing a med he/she didn't follow through and inadvertently harmed a patient they are going to go after that nurse. So screw that mess! I am suprised BRN is even going for that.