I'm a new grad, and just got my first nsg job in a LTC facility. I've been there 6 weeks; I'm working overnights. At this point, I still have a 'mentor' (I'm using the term loosely here) - she is someone I can go to with a question, but basically, I have my own side of the unit, am responsible for a med cart, and am passing meds for 22 patients. At night, our only scheduled med pass is 6am, which is when, imo, you are at your most tired (shift ends at 7:30) and you are trying to get everything done so you can count narcs at 7 with the new shift and report off, etc etc.
After the first night, I asked the mentor if it's okay to 'pre-pour' the meds. I was thinking that you know, I have all this down time between pretty much 0100 and 0400 in which to get ready for the 0600 pass. She replied, "Absolutely - I can't tell you to do that, but we all do, and it helps quite a bit. Although, if a supervisor comes in, throw them out and start over."
Of course I gathered from this that it's against policy. However - why? Is it against JCAHO rules? And do any of you do it?
If some nurses are pre-pouring and whizzing through the med pass, then we can't get things changed. Management will just say, "Well, Mary and John always get it done on time". If everyone is always running late because the med pass is too heavy for the allotted time, something has to change to maintain compliance.
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I think this is such a great point
- when we cut corners, the problems remain with staffing.
Thanks everyone for all the tips - nurses at our place use straws and paper clips to mark their meds, and I have to say I'm not crazy about it b/c if you hit it the wrong way, one of them will fall out, and then you're back to square 1. I'm going to get some post-it color tabs.
I've been using my own cheat sheet - I put a circle next to a name that gets a BS chk, the time of the med, how they take them, do they get up early and leave the unit, etc - but I've been getting bopped around to different units and so it's hard to remember each resident - esp b/c I only work p/t.
I love the tip of getting your whole med cart completely organized at the beginning of the night - I am DEFINITELY doing that next time I work, b/c I couldn't find insulin for one pt the other night and it ended up in a different drawer than where it should have been.
As far as leaving this place - it is not just nurse-pt ratio. I have received pretty much no training, just have been thrown onto the med cart and told to go ask another nurse who has her own whole unit to work on if I have any questions. It's getting better, but only b/c I'm self-teaching. Maybe this is normal in LTC, but all my former classmates who got jobs in hospitals have had weeks of classroom training before they even saw a pt.
I have received pretty much no training, just have been thrown onto the med cart and told to go ask another nurse who has her own whole unit to work on if I have any questions.
This "no orientation" seems to be a growing trend in the corrupt world of LTC. You should have received at least 4 weeks of training before ever having the med cart by yourself. Some people say 3 days is all they got, and that too is insufficient. It clearly demonstrates a lack of care and concern for the nurses and the patients. Remember you can always refuse any assignment you feel to be unsafe. I was forced to do so numerous times in LTC as they are willing to ask you to take impossible loads in hopes that you will be dependent enough on your job to take it. They dont care how overwhelmed you are and really dont care if the patients even receive proper care. Administrations like this one deserve to be in jail. Stick around and you will find that the lack of orientation is only the tip of the substandard iceberg.
Maybe this is normal in LTC, but all my former classmates who got jobs in hospitals have had weeks of classroom training before they even saw a pt.
It is. LTC is a difficult place to work. The residents are becoming more and more needy and the reimbursement rates do not adequately reflect the care they require so nurses and aides become more and more burdened.
The thing was for me in Ltc was that after awhile I felt like a trained chimp baging out meds from blister packs. Yeah, sure I have time to look them all up and check every med popped against the bracelets that they don't wear because it's a "home." Yeah, that's why they wore anti-escape (excuse me, elopement) anklets and the doors are alarmed.
I do think that setting up medications ahead of time can be safe in certain settings as long as safety guidelines are followed... such as clear labeling and a tamper-proof method of storing the meds prior to administration. However, even if it may be done safely, it shouldn't be done if it's against policy.
Spidey's mom, ADN, BSN, RN
11,305 Posts
Originally Posted by Thornbird