Feeling off about job

[Cmanursestudenta]

So I took a job working at a new LTC. I work there one day a week and pick up every other week. Just got an email about how they are unhappy about the narc count. Now it went out to all the nurses. Let me just say the Narcs there are difficult to count and we have 150  individual pills to count one by one and many narc cards are 1/2 pills and 1.5 pills up to 30. I generally have to use a calculator to count. It is easy to make an error there and while we are counting are interrupted constantly. I always stop counting and restart due to being interrupted while counting. I have told techs repeatedly I'm counting right now please come back when I'm done or write out your request. The off going nurse will not give meds while counting and I refuse to give any meds until after I count. The one time my count was off we got interrupted 8 different times. The email said we can be reported for diversion if the count is not correct. I never sign off on an incorrect count and am willing to recount as needed(one time we had to count 90 pills 4 times due to interruptions). Would it be OK to suggest to management that the techs be educated about not interrupting during count? Or maybe I'm being over sensitive as I'm not there often.

 

[caliotter3]

You are not being oversensitive and management should be educating all personnel not to interrupt count anyway.  They don't need anyone to suggest it.  This does not sound like a desirable situation for only one day a week.  You know who the designated goat is, don't you?  Look for alternative employment.  That is my suggestion.

[SmilingBluEyes]

I would look for alternative employment. This is a bad set up. And since you're not there often anything off will blamed on you. Being reported for diversion, even if untrue, is so serious!

[Cmanursestudenta]

Well this happened when I was not around and I've not worked for almost a week as I work every other weekend and two Tuesdays a month. I spoke to a supervisor and it appears to have been an issue with the Morphine and not the meds that have to be counted one by one. I did want to know what was up as the email was weird. 

[JBMmom, MSN, NP]

You're right, no one should be interrupting the controlled substances count. But there's also no reason you should have to count 90 pills individually. There should be a way to secure them in smaller batches that are sealed in groups of 10 or so. 

[JKL33]

5 hours ago, Cmanursestudenta said:

The email said we can be reported for diversion if the count is not correct.

I don't take well to this kind of threat at all. Experienced it once as a threat to an entire group of nurses, not individually, but that makes no difference to me. I will not be treated like a criminal while administration creates their special brand of chaos and continues their penny-pinching. Not much more to say about this except words that can't be printed here.

[Cmanursestudenta]

I flat out won't pass meds if they don't trust me. I honestly feel like if they need to make that kind of threat then well it's best if they have someone else pass the meds. It was not an individual threat but I still felt upset as 1. I do a double count and if I find any issues immediately self report to the charge nurse and we have recounted together at times. 2. I start over if interrupted in my count. 3. I refuse to sign off on an inaccurate count 4. have insisted on recount if my count is off. 

I think I might suggest that the charge nurse count the narcs with the med nurse after med pass. The narcs at this LTC are tricky and despite the low patient number much more difficult to count then I've encountered before. 

 

[Been there,done that, ASN, RN]

"The email said we can be reported for diversion if the count is not correct." You have been warned. Administration is ready to throw everybody under the bus. Reported for diversion will be a nightmare.

"Would it be OK to suggest to management that the techs be educated about not interrupting during count?" Management already knows what is going on.... they just don't  care. They would also be not inclined to listen to a part- time newbie.

 This position seems to be a lot more trouble than it's worth.

[londonflo]

On 3/31/2021 at 2:33 PM, Cmanursestudenta said:

Let me just say the Narcs there are difficult to count and we have 150  individual pills to count one by one and many narc cards are 1/2 pills and 1.5 pills up to 30. I generally have to use a calculator to count. 

I am just surprised there are that many Narcs at your LTC. Is there a large population at your facility or a large amount of narcs given?

[amoLucia]

Can some meds be dc'd? How about asking your pharmacy consultant for some suggestions. I believe the contract covers assistance.

[Cmanursestudenta]

The trouble is one very cheap patient. He refuses to use the pharmacy and insists on buying pills. Then he also won't let the meds be repacked. So we are left with 90+ pills to individually count. They don't have a lot of patients but a lot these patients take a lot of narcs. Sorry about not getting back sooner been working a lot lately.

[TriciaJ, RN]

On 4/7/2021 at 12:49 PM, Cmanursestudenta said:

The trouble is one very cheap patient. He refuses to use the pharmacy and insists on buying pills. Then he also won't let the meds be repacked. So we are left with 90+ pills to individually count. They don't have a lot of patients but a lot these patients take a lot of narcs. Sorry about not getting back sooner been working a lot lately.

Can the pills not be divided into batches of 30 and each batch hermetically sealed until it is needed?  Then you need to count only 30 individual pills each count.  Can you and your coworkers create a culture where interrupting count becomes a very bad idea for the interrupter?

The idea of counting 90 individual pills and constantly having to start over...

Um, no.