Don't You Just Want To Scream?

[CapeCodMermaid]

I've had it with nurses not doing what they are supposed to do! There was an order to 'encourage fluids every shift and monitor intake on Caretracker" For 3 days the nurses signed off the order, but not one of them documented or even looked at Caretracker. If I didn't think the DPH would have a hissy fit, I'd write in the MAR "Stand in the middle of the hall way naked and whistle the Star Spangled Banner". I'm sure they'd sign that off, too. What is the matter with these people? The nurse practitioner is 'surprised' we can do IVs??? Jeezlies Peezlies I want to smack 'em all upside the head and yell " WAKE UP.....YOU"RE A NURSE....DIDN'T YOU LEARN ANYTHING IN SCHOOL????"

Thank you for letting me vent.

[pixie120]

This is the way it was at all of the facilities I ever worked at. Most of the nurses didn't even bother to "paper" it either. They didn't care. They all knew that there would never be consequences for not doing the job very well.

So sad, really. It is just so very hard to hold these folks accountable, and so hard to get the managment above us, to support holding these people accountable. Really makes for poor patient outcomes,and in this economy, one would think the employees would be looking to improve their skills not worsen them, or increase bad behaviors. It seems backwards to me.

[katoline]

i do not feel like a nurse. no critcal thinking skills, if a res is sick we ship 'em to hospital

i agree with no restraints and pt rights etc. but i'm losing my skills. because of paper work and the fact when a res is sick we ship em out.

ltc may not be for me d/t paper work, no critcal thinking, losing my skills, no iv's, etc. any one in ltc have any advice.

polly, i think you may have answered your own question. go where you are happy. ltc is not for everyone. we each have our own nitch and i'm so glad we do. i'd hope to see you when i needed you at the hospital.

[debRN0417]

Looking at a MAR: (medication name) 50 milligrams BID 9 a.m. 9 p.m.

Right underneath this order and I mean right underneath the 50 mg order handwritten in the next space---couldn't miss it... (same medication name) 25 milligrams 9am 9pm

50 milligrams signed off for 9a and 9 p from 6/1 through 6/29/11 then D/Cd

25 milligrams signed off for 9a and 9 p from 6/24 through the end of the month.

Physician's order for D.C (medication name) 50 milligrams BID start (same medication) 25 milligrams BID order date 6/24/11 (not 75 milligrams BID)

Okay- so did the resident get the 50 milligrams and the 25 milligrams for 5 days BID? Both were signed off. Tell me someone didn't notice the orders and clarify that? Or is it that someone just signed off the medications for 5 days without paying one bit of attention to what they were signing???? What do you think...

I was amazed....

[itthybitthythpider]

Looking at a MAR: (medication name) 50 milligrams BID 9 a.m. 9 p.m.

Right underneath this order and I mean right underneath the 50 mg order handwritten in the next space---couldn't miss it... (same medication name) 25 milligrams 9am 9pm

50 milligrams signed off for 9a and 9 p from 6/1 through 6/29/11 then D/Cd

25 milligrams signed off for 9a and 9 p from 6/24 through the end of the month.

Physician's order for D.C (medication name) 50 milligrams BID start (same medication) 25 milligrams BID order date 6/24/11 (not 75 milligrams BID)

Okay- so did the resident get the 50 milligrams and the 25 milligrams for 5 days BID? Both were signed off. Tell me someone didn't notice the orders and clarify that? Or is it that someone just signed off the medications for 5 days without paying one bit of attention to what they were signing???? What do you think...

I was amazed....

That's scary 0.0

[CapeCodMermaid, RN]

Today we had 3 discharges. OKAY so there were 3 nurses on the unit plus the unit manager. The nurse sent Mr. Jones' meds home with Mrs. Smith. Can't you even read English you silly twit. That's what I want to say to this woman.

Then....there's an order, very clearly written to discontinue Lovenox when the INR is greater than 2. INR comes back 2.2 which is greater than 2. So....two nurses give the Lovenox! How do they make it through nursing school?

[SuesquatchRN, BSN, RN]

Today we had 3 discharges. OKAY so there were 3 nurses on the unit plus the unit manager. The nurse sent Mr. Jones' meds home with Mrs. Smith. Can't you even read English you silly twit. That's what I want to say to this woman.

Then....there's an order, very clearly written to discontinue Lovenox when the INR is greater than 2. INR comes back 2.2 which is greater than 2. So....two nurses give the Lovenox! How do they make it through nursing school?

You do INRs on Lovenox?

[CapeCodMermaid, RN]

We have a lot of ortho patients who come in on Coumadin & Lovenox. When their INR is greater than 2, we dc the Lovenox and continue the Coumadin.

[achot chavi]

So what do you do or say to these nurses who make these blatant (and dangerous) errors? How do we put the fear back into their practice? Do you make one into a scapegoat? Do you report them?

[kids]

I've become very embittered to these sort of things.

If they aren't going to do their job and do it safely replace them with someone who will. There are a lot of good nurses out there begging to work.

[AmyS,RN]

Part of our QA team has an inside joke, don't drink the water it causes stupidity. I hear the complaints and also am struggling with what do with it, inservice...maybe and results better for 3 days. My internal thoughts are can't really expect what I don't inspect/expect but on the other hand it seems that every day is full of fires to be put out and no time to for inpsecting. My sister, not in LTC, feels that I don't do enough re-assuring but on the other hand it feels like doing much 'supporting' you run into developing of non-critical thinkers.

It is a cycle, so what are others doing with what looks like stupidity x more than one situation, write ups?

[catlvr]

I am a floor nurse (LPN) in a five star SNF, and love my job and the pt population; 24 pt assignment is half ltc and half str. I can see both sides here: sometime we really have too much crazy CYA paperwork (and yes, I know why the state and feds mandate what they do, but it is still crazy). It is quite possible that the nurses are doing what they are supposed to do, but the documentation part is weak.

As for the errors that were described, I'd be frustrated as hell. We have them in our facility as well, and it drives me nuts - how can a new surgical incision change from "no sign of infection" on 7-3 to oozing purulent drainage when I do my rounds at the start of 3-11? Esp since the poor lady had spike fevers of 102 the night before - did the 7-3 RN have any curiosity about that? I catch errors in the MARs all the time - and since management doesn't want to admit that we might have a problem, they are "taken care of" - and those who made the error are deprived of the chance to learn and perhaps improve.

Seems like there may be room for change on both sides of the desk.

[DixieRedHead, ASN, RN]

Yes, I do want to scream. And crap like that MAR make me want to scream and scream and scream.

Read this: D/C YaDaYa 50 mg PO at 9a & 9p

Order Give YaDaYa 25 mg PO at 9a & 9p

Is that so hard, and is it so hard to D/C it on the MAR and write it correctly in another block.?

Don't have your meds? Hello, call the pharmacy, I don't have them in my pocket.

Don't have your labs? Hello, call the lab.

On and on.............Yes, I want to scream.

And don't tell me you don't have time, because when I was doing pharmacy recs at the station I saw you sitting with your hands in your lap while telling about your boyfriend.

And don't tell me you "forgot" your badge, again, when you remembered your cell phone.