fed up and set up

[knockandhello]

feel really fed up with work.learnt something today .dont just believe what you are told in handover. double check doctors orders.and if its not in writing it doesnt exist.Also upset the same nurse by refusing to physically restrain a resident so that a suppository could be given.feel really upset by everything at the moment.distressed by everything.

[ktwlpn, LPN]

The answers always seem easy when you are the full time day shift charge nurse in LTC and can make changes to the med pass and routines ad-lib (within facility protocol,of course) Usually the other shifts have very little input.In our LTC we generally have 3 nurses on each unit on days-2 on evenings and 2 or 1 on nights.Our larger units all have 2 med carts so both nurses are doing a large med pass.We carry all new orders on our shift report and nights does chart checks.I believe that some of the evening shift does check the new orders however many don't. In LTC the emphasis is on getting those meds out on time no matter what the heck else is going on. The minute you become complacent the Dept. of Health shows up and then you are in trouble.I have never see them spank us for not initiating a newly ordered med or treatment within a certain time period.We have a limited emergency supply and it takes awhile for pharmacy to deliver even stat meds.Most other meds get written on the MAR to start the next day.....Our residents are expected to be relatively stable -if they aren't then out they go .(that's another thread-sorry:deadhorse )

[ladside, BSN, MSN, LPN, RN]

this has not been my experience at all! perhaps it is because i came out of the acute hospitals where you had to constantly refer to the original record (the chart) frequently that it became such a habit. i could flip through the charts of my 40-50 patients just looking at the doctor's orders in about 10 minutes. i did it so frequently that a new order stood out like a sore thumb. also, because i was closely involved with reconciling the monthly mars and tars with the new month print-outs i pretty much knew my patient's orders by heart, so again, anything new or odd stuck out. sorry if it sounds like i'm beating on a dead horse, but if we all look at our job descriptions of what a charge nurse is supposed to be doing, confirming and carrying out doctor's orders is one of our priorities and it has to rank above the actual passing of medications. the reason is because the passing of medications, theoretically, is something that can be delegated; the care planning, which involves the incorporation of doctor's orders, cannot. the way i dealt with any problems that involved all the 9am medications not getting passed in the two hour period allotted was to change the administration times of certain medications that we could do that with in order to put us in compliance with the state laws and how we found ways to give us time to spare. there is nothing that says i can't administer some vitamins at 10 or 11am instead of 9am if that's the way my med pass is going day after day and it isn't contraindicated. i learned very early how to have the pharmacy service print out these administration time changes on the mars. bingo! we were back in compliance with med pass times. another thing we did was move some of the g-tube medication administrations to 5 or 6am on the night shift to take part of that huge burden off the day shift staff. this way we had all three shifts working together, doing their share to get all these medications given. there's always more than one way to skin a cat--one of the nice things about nursing.

a friendly fyi...night shift in ltc is not easy at all when you are dealing with several hypoglycemic residents that were given hs insulin by the nurse but not given hs snacks by cna. times like those are when one more tube feeder is the straw that broke the camel's back especially when there are already 20+ blood sugars (some with coverage) as well as early morning insulins to be done at the same time when most are being gotten up for morning care. it can and at times, has been a nightmare! remember when clinton forced a lot of people into the workforce? well, guess where they went? and our pioneers are the ones who are suffering because a lot of these 'forced employees' do not want to work...which creates more work and head/heartache for the nurse in charge. sorry for getting into the biggest pet peave in my life. i just love elderly people because they are why we are here and we destroy and break the spirit of history when we do not look after our old folks. this is an entirely different thread. sorry people!

[ktwlpn, LPN]

A friendly FYI...Night shift in LTC is not easy at all when you are dealing with several HYPOglycemic residents that were given HS insulin by the nurse but not given HS snacks by CNA.!

That's why we nurses give all the nourishments at the LTC I work in now.The cna's tended to just throw them away at the last LTC I worked in.Guess who was my surveyor on the first day of dept of health visit-The former DON from that poopy hole.She actually stated that she found it "hard to believe the nurses have the time to give out all of the nourishments and make sure each resident completes them" I had to bite my tongue to keep from really letting her have it.I felt like she was accusing me of falsifying records. I would NOT put a dog in that other joint-that's why I'm where I am now for goodness' sake.I'm lucky to work in a neat,clean,well organized ,well staffed facility with a good reputation in the community.When I worked at the other place I was ashamed to be seen in my uniform on the way home.I'm proud to say where I work now.

[TheCommuter, BSN, RN]

Remember when Clinton forced a lot of people into the workforce? Well, guess where they went? And our Pioneers are the ones who are suffering because a lot of these 'forced employees' DO NOT WANT TO WORK...which creates more work and head/heartache for the nurse in charge.

You hit the nail on the head. A good number of the CNAs I've worked with are welfare-to-work cases. They're not accustomed to punctuality or work ethics and many do not take pride in their jobs.

Imagine if you were a stay-at-home mother on welfare for many years with the ability to create your own schedule and wake up whenever you pleased? Now you've been sent to work against your will and, as a result, don't care about your job responsibilities.

[speckleddove]

yep, that's a fact.

checking orders is a hard task, especially when the doctors scribble.

i worked at a great facility years ago and this is how we handled the new orders.

first though, i must say; as a traveling nurse and having worked in a hospital, working in a hospital is no longer a goal of mine.

way too much room for error and way to much risk for hospital nurses.

as a ltc nurse all these years, i am use to being the main or only communication port.

meaning, i call the doctor, lab, pharmacy, family, etc. and i am paged to the phone regardless of what i am doing to receive new orders, lab results and family decissions.

in a hospital, they have a person manning the phones that may not have anu idea what the labs, x-ray results or dr.s orders really mean.

then such a stupid rule, they are not allowed eo leave the station to give that information to the applicable nurse!

what idiot came up with that rule?

i feel nothing but sorrow for nurses & patients in a hospital setting.

too risky for patients and satff.

any way now the tip, for ltc nurses on new ordrers -

1. we had one nurse go on rounds with the dr.

2. a second nurse did nothing else that day but pull the charts off the cart as new orders were written, she would first fax to rx & copy them and put the copies on the appropriate med cart.

then she would chart them, place the carbon copies in a plastic box with a lid - marked on the box is - new orders only.

3. after rounds the nurse that went on rounds would go over the new orders and clarify any discrepencies - either of those 2 nurses noticed. then all 3 nurses would ensure the mars were noted / updated.

4. at the end of shift we floor nurses, both oncoming and off going

re-read the orders as we gave report and noted the new orders on the backside of our 24 hour report sheet.

5. if we had time before the oncoming nurse arrived, we would record on a tape recorder inside the med room - new orders received on patients.

working as a team everyone was out on their scheduled time and nearly zero medication or treatment orders had errors.

sounds like a lot of work but after once or twice, it was smooth sailing.

[speckleddove]

soo true!!

i would grab the snacks off the carts and administer the supplements with the meds to ensure patients actually got them.

if a cna said a patient refused, i would take it myself to the patient and ask them if they had been offered a snack / suppliment and ask them to drink it or taste it for me.

then i got even smarter and i would do a walking round just prior to shift change & check the trash cans.

if i found a full unopened carton, i wrote a note to my adon with the name of the patient and they would do an extra weekly weight on that patient.

cnas got to the point they hated me.

my loyalty is to my patients not to a cna.

other nurses soon followed my idea and that crap stopped and weights went up.

[speckleddove]

Yes, I had the unplesant experience of working with such a forced labor group as well.

What really Ticked us off was the fact those lazy jerks got paid more that the nurses and CNAs that had never been on welfare.

The government kicks in on their pay, so they got better pay then we did.

Now if that isn't a load of dirty crap!!

[speckleddove]

Here in the USA, at least where I worked; they stopped that due to patients friends & famlies reading the nurses and dr. progress notes.

Privacy, was the issue.

And then a few patients would hide them if they didn't want the new medications or mentally ill pt.s would tear them up or even try to eat the paper.

[TheCommuter, BSN, RN]

Yes, I had the unplesant experience of working with such a forced labor group as well.

What really Ticked us off was the fact those lazy jerks got paid more that the nurses and CNAs that had never been on welfare.

The government kicks in on their pay, so they got better pay then we did.

Now if that isn't a load of dirty crap!!

The welfare-to-work CNAs at my facility are only paid $9 per hour. However, they still receive their food stamps, medicaid, WIC vouchers, and housing assistance as well as a small welfare check.

[speckleddove]

you are so right on all accounts!

i worked midnights too and it seems like day shift wants all the diabetics done on midnights and evening shifts.

and tube feeders galore loaded on the midnight crew.

i always prefered 3 pm -11 pm shift because of my husbands work schedule.

we have less cnas and less nurses on the evening & midnight shifts, yet we get more done than all those overloaded staff day shifts ever do.

but do we ever get any pay increases or credit for our extra efficiency, heck no.

i worked day shift as prn too and i found more cnas and nurses hiding in patients rooms with the doors closed and i actually caught 2 cnas watching soap operas when the patient was sitting in the bathroom with the er call light on for 10 dang minutes.

one was in a chair and the other had the gall to be lying in a bed.

i took them to my don and not a dang thing was done!!

the don & adon spent most of the day hiding in their office talking about everything but the patients and eating their way to a heart attack, every dang day!

[LauraF, RN, ASN, CNA, LPN, RN]

a charge nurse has the responsibility of prioritizing his/her duties. for a subacute unit i would definitely prioritize the checking of newly written doctors orders over getting a med pass started. it would only take a few minutes to open each chart and make a quick cursory check of the new orders. i've done this many a time and returned after a med pass to finish taking orders off. i would hate to miss a stat order to the detriment of a patient's well-being, particularly on a subacute unit where the patients are most likely skilled patients.

maybe in a small setting this is possible, but not ltc for the most part. i work weekend shift. if i went through all 40 of my residents charts checked the new orders for the past week before i started my 8pm med pass (which by the way as it is does not get completed until 8:45 or 9:00pm) i would not even be starting that med pass until 10pm. i go by the mar for the first pass. after that i have a slow period where i can investigate questions, and check the new orders. but unfortunately that first med pass i have to rely on the mar. there have been occasion that i have meds in the box that aren't on the mar, or meds on the mar that are not on the cart. in those cases i give the meds that are on the mar and in the cart, then investigate when pass is complete. generally try and get the story from the resident before i start a big investigation, then after all figured out i come back to the resident and let them know what i have found.

[LauraF, RN, ASN, CNA, LPN, RN]

You hit the nail on the head. A good number of the CNAs I've worked with are welfare-to-work cases. They're not accustomed to punctuality or work ethics and many do not take pride in their jobs.

Imagine if you were a stay-at-home mother on welfare for many years with the ability to create your own schedule and wake up whenever you pleased? Now you've been sent to work against your will and, as a result, don't care about your job responsibilities.

Reading these comments make me feel so lucky to have such a wonderful bunch of CNA's working WITH me. They have seen these folks bottom out in the morning when they wouldn't eat their snacks at night. They ALWAYS make every effort to get our residents to eat their snacks before bed. Even today, I got stuck at work late because I had a guy do a floor vs. head. My CNA's, even through it was time for them to leave, we had all been there 12+ hours, asked if there was anything they could help me with before they left. They even went so far as asking me if they could leave. Sorry to have hijacked the thread there, but I had to say that. I really feel lucky!:)