I'm extremely slow at passing medications

  1. I'm a new grad RN. Tonight is supposed to be my 7th and final shift of orientation for my night shift job at a SNF/Rehab facility. Last night my trainer, who is an LVN, had me pass the evening medications without her for the first time, to see it I could handle it. With 24 elderly patients, most of whom have some level of dementia, I administered medications for 4.5 hours. Many of the residents have to have their medications crushed into liquid or into applesauce. They have to be roused to an alert state and then spoon-fed the medications. At midnight, I was still not finished administering the 8 pm medications! My trainer let me take a lunch break and finished passing the medications herself.

    So, I'm about to request a transfer to the rehab side of the facility where there are only 14 patients per nurse. Or I may just bow out of the job as gracefully as possible. I can't in good conscience be giving patients their pain medication three hours late. Also, I feel my shiny new RN license is at risk in this situation. I think 24 patients is way too many, but somehow the other RNs and LVNs manage it.

    A bigger problem is that this is the same thing that happened to me during my nursing program, just magnified now with more patients. When I was in a hospital setting with only four patients, I still had difficulty administering the medications within the expected time frame. Nobody likes a slow nurse - What am I going to do?
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    About Lemon Bars

    Joined: Apr '14; Posts: 113; Likes: 109
    from CA , US

    12 Comments

  3. by   meanmaryjean
    The more you do it the faster you'll get. (School is not really a good indicator) For example, is your cart fully stocked- or are you constantly having to go get more applesauce, water, cups etc? Are you engaging in a lot of chat with the residents? Are you having to go find them- is it hard to recognize them still?

    All of these things will get better with time- seven days orientation for a new grad is not much- but more than some get in facilities. Give yourself time.
  4. by   Aunt Slappy
    Everyone is slow and feels bad about it when they are new. I remember my first couple weeks in LTC. But know what? You really do start learning your residents and their routines and you get faster. Give yourself a chance. Once you meet this challenge, others will pale in comparison.
  5. by   Ashlyn11
    The longer you work in LTC the faster you will become. Keep going, you got this!
  6. by   VivaLasViejas
    You've got to give yourself more than a week to get a routine down. It takes weeks, even months, to learn the residents and their individual needs/quirks/wants when it comes to taking their medications. It takes even longer to become competent in nursing, so PLEASE give yourself a break and realize that the first year really sucks and you're going to feel nervous for a long time. It's OK. We all go through it. Hugs.
  7. by   hppygr8ful
    As others here have stated you will get better, faster with practice and experience. If you are using an EMR see if it has a function to prioritize your med pass. Point Click care does - so that it will start out with your Blood glucose and insulin, then move on the scheduled and PRN meds. This will help you stay organized. If you don't have EMR where you are then develop a brain sheet to help you prioritize. One week is not enough to see if you can do this. Don't give up yet. You don't learn or get better without challenging yourself.

    Hppy
  8. by   Chrispy11
    Better you be slow and correct than to go fast and make errors. It's your first pass, don't be so hard on yourself.
  9. by   Lil Nel
    How did your preceptor pass meds on time?

    Did you pick up tips from watching him, or her?

    You will get better with time and experience. In the meantime, learn from your peers.
  10. by   djh123
    You'll get faster, as others have said. 24 is a lot without a med tech, though. And watch out re: there 'only' being 14 on the rehab unit - that might help re: passing meds, but they're likely higher acuity over there too.
  11. by   amzyRN
    Never sacrifice safety to go faster. Always use your 5 rights. Your time management will improve with practice and you'll be slow in the beginning. What is paramount is safety.
  12. by   Neats
    It sounds like you did a great job. Nursing school is not a great measure of how things are all the time. Once you get to know the patients you will become faster. I admire nurses who take their time for direct patient care.
    I would really do some soul searching as to if this is the reason or are you discovering how hard and how you must rely on your assessment skills in a SNF and then factored in you are the one really in charge as the RN. Great responsibility for autonomy and, maybe you are becoming aware of this? What ever the reason tread carefully about your professional career pathway, and really discover yourself and what you want your future to be. Best of Luck.
  13. by   subee
    The first time I passed meds alone was Thanksgiving day and the corridors were filled with visitors. My husband picked me up crying at the entrance after a horrible stressful day. My first lesson was no time for chit chat. You will get your own rhythm. Tincture of time.
  14. by   melp718
    No!! Don't give up!! You got this!!

    As everyone has said before we all started out this way! You have been doing it such a short amount of time and it is no way an indicator that you are not doing well or going to get it. Its better to take your time and understand what you are doing and familiarize yourself with your patients rather than rush and make a mistake.

    When I started in the LTC I was the same exact way, I took VERY long giving meds and I was frustrated and upset that. I had a total of about 39 patients. It was my first nursing job as an LPN and I was so overwhelmed. I decided that I needed to help myself instead of tearing myself down. It took extra time in the mornings and even after my shifts but I went through the medex and I familiarized myself with each patient. I even made a cheat sheet for myself where I notated who needed applesauce, who needed crushed, who the GT tubes were, etc.

    As everyone said, the more you do the faster you will get and you will develop your own flow as well.

    During those early months of working in the LTC setting I would come earlier than my shift just to acclimate myself to my med cart. I would make sure that everything is stocked and loaded, make sure that it was clean and organized to how I worked.

    You can do it

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