Doing Without a P.O. Med Nurse - HELP!!!! - page 2

I have recently returned to nursing after a 7-year absence. I've been on a busy med-surg/oncology unit for 3 and a half months now, and when I first began, it was great. Of course, I was learning... Read More

  1. by   NurseLinda
    The SAD thing is that nurses are putting their licenses on the line DAILY!! I've done legal reviews for 10 years before I moved to the DOT COM world, and what Nurses don't have TIME to document now can "hang" them .... I remember the frustrated feeling well....It's scary to say the least, and I don't miss it at all...

    Linda/CMAS, BS, RN
  2. by   laurasc
    I remember doing that 15 years ago when I first started nursing. It was called "primary nursing" and you were really lucky when you only had 6 or 7 patients on days and 12 to 15 on nights. We were given usually 2 or 3 primary patients that we cared for from admission to discharge and we were soley responsible for the care that was delivered. We had to write the careplans and keep them updated, involve other departments PRN (dietician, physio, etc) and plan and prepare for discharge including arranging for home care. On top of our own primaries, we were also assigned other patients for the shift. We were responsible for all the care, all the meds (po and iv), and because this was a surgical floor, we also had to deal with pre and post-op care. (It's a real joy when you have two or three patients going for bowel surgery the next day and all needed tap water enemas till clear.) On day shift we were lucky if the ward aid made the beds for us. 12 hours is simply not enough to do all that you have to do and still maintain some sort of standard of care. I survived that for just under 5 years then I burned out. (Moved to ICU for a year and now I work in a pediatrician's office.) I won't go back.

    So I understand where you're coming from. For me, after a while, it stopped being nursing.

  3. by   headnurse_deb
    Originally posted by soundsLikesirens:
    I have recently returned to nursing after a 7-year absence. I've been on a busy med-surg/oncology unit for 3 and a half months now, and when I first began, it was great. Of course, I was learning (still am), but when I started, WE HAD A PO MED NURSE. In other words, it was still manageable - it was still reasonable - still do-able. Now, we get there and have 10, 11 patients, with all their po meds, piggybacks to give...IVs to check or start...orders to take off...admissions....patients' families to deal with, with their constant questions...the call light...people wanting coffee...water...on and on and on!!!! I work 7p to 7a and although I love my job, I am starting to get stressed out because I feel like I'm not able to give proper care. Usually, I'm in report from 7pm to 730pm...then I come out and start on the 2100 meds....and usually at 2300, I have 2 patients out of 11 who haven't had their 2100 meds, not to mention charting, etc, and all the other things screaming to be done. I had an admission the other night at 7pm, as soon as I got there....I went into report...well it got to be 1030 or 1100pm and she still hadn't had her meds yet. The people "in charge" know that all the nurses are going nuts...their "philosophy" is that it's "better" for the po meds to be given by the nurse, since we know what's going on with them....(supposedly)...and that it increases the time spent in bedside nursing...this is alot of bull and I think it's a smokescreen for them just trying to cut the budget. I want to stay where I am; I love med-surg but I don't know if I will be able to. But I can stand anything for 6 months. After that I can transfer within the hospital. Or, I may stay put for a year, then go to agency nursing as they make more money. But I know I'm not staying. Our unit manager sympathizes but her hands are tied...she said they've told her we are definitely NOT getting a po med nurse back. God, it wouldn't cost them that much! We're always short-staffed....the last few nights, I haven't been able to getoff the floor to do anything. Forget about noting orders or doing any paperwork...and everytime you go into a patient's room with their medicine, you have to UNWRAP their water pitcher and get ice and water. We have 32 patients and only 2 med carts, which we are not supposed to take down the hall. If they would let us do that, and take along water, cups, etc, it would save alot of time. God I am getting to where I hate to go to work....because I know I'm going to be overwhelmed. We never have enough CNAs...alot of time, we have 2 for 32 patients and they end up splitting the floor. Which means I am constantly doing floorwork...and no, I don't think I'm too good to do it because I'm an RN. It's just that when I answer call lights and the phone all night, and fetch and carry, I cannot get MY WORK done. HELP!!!!!!!!!!
    I am an LPN working in LTC. With a patient load of (on a good day) 35 residents I can relate somewhat. Unfortunately I am also the PO med nurse. My 9a med pass takes me close to 3 hours. (What about the hour lee-way?) In my facility the nurses have to pass trays and feed at all meals, we do have CNA's but i have yet to figure out why WE have to do this. And med pass times coincide with meal times....needless to say we are always behind. I only wish that more hospitals would utilize LPNs as I am quickly on the road to big time BURN-OUT. I understand that hospital nursing has its dark side also, but I would love a change of pace.
  4. by   nursejanedough
    I have already vented before on this subject. Let me make this clear. I love nursing. I especially love working with the elderly. I had a horrible experience with Med/Surg floor nursing, then I went to Psych nursing. Was low stress but very strange and did not grab my heart. When my good friend talked me into working PRN at a local nursing home,(I had told myself I could never work in a nursing home!) But I tried it. One of my first patients asked for a Tylenol for a headache. She was lying there with this pile of white hair in a bun on top of her head and looked a little sad. I said, "Hey, you look like you need a hug." and I hugged her. She started crying, and said, "That is the first hug I've had in years." Well, that did it for me, I was hooked. I did go back and read her chart, she had no family left and the nursing home staff was her only "family". I love taking care of the elderly, the confused, the Alzheimer who is out there in never never land. I felt we were kindred souls somehow. (Possibly because I am getting close to never never land myself). But when I had to start choosing -either take care of my patients and not document what I am doing because they (boss) didn't want overtime. OR not take good, complete care of my patients and document what the (boss)said I needed to, of course, then you have to lie about the
    good, quality care (that you really didn't have time to do.) I was raised to be honest and moral. I chose to take care of my patients (did not have time to document everything) and therefore I realized I was going to get myself in legal trouble eventually. I no longer do LTC nursing, but I am looking for answers to this worsening LTC problem.
  5. by   willielpn
    it warms my heart that so many understaffed situations miss the med nurse as a team member. i have been an lpn for 12 years and although i have had several opportunities to do the rn thing have decided i really enjoy my place in the team. i like passing meds/pigs and starting iv's. in down time you have the opportunity to help your rn's with their work and your cna's with their work. i believe in the team approach as it is far less confusing. total pt care is such a hassle that you can easily loose sight of pt needs and miss important issues with that pt's needs. thank you for not forgetting the lpn as a great asset and ally on your team. we are like the middle child and often get forgotton. i have many rn friends, good friends that i have worked with that have hugged me coming and going on a busy shift. too bad the people that make the schedules don't get it sometimes. thanks again for validateing our skills. rumor has it that as the shortage goes on there will be classes available for us to learn to do more and i think that would be great. don't you?
  6. by   soundsLikesirens
    SPLITTING THE FLOOR....Lord have mercy! Well, last night we had an LPN who was "floating" - what THAT meant was that they were LITERALLY LEAPING at the chance to have a PO med nurse again (hallejuah!)!!! I entertained the slightly idiotic thought that my night would be steady, busy, but do-able....Lordy, Lordy....come 11pm and we have 2 CNAs, splitting the floor with 32 patients......which means........that I was basically on the floor all night. I swear, that call light rang, and rang, and rang...(don't they ever sleep?????) My CNA needed help, turning patients, changing their bed, etc....there wasn't anyone else to help...I ran all night long. Back tonight, for another dose of it...what bothered me was that I had a couple of patients with TID dressing changes that didn't get done - the one - she didn't have her supplies so in-between patient care I would call for it....I didn't know what to do...whether to do it after 7am, or what (into the next shift). I asked a nurse on days who'd been there 10+ years...she said that you try to do it all but if you cannot; then you cannot - that's basically what I thought, anyway.....I hate not being able to do something like that, that should be done...but one patient had a spell of chest pain...then 2 finger sticks that were "critical high"...then another patient's 0600 FS - "critical high"....on and on...we actually had a patient who was admitted with the DX of "abdominal pain, unspecified"...hx of Alzheimer;s, nursing home resident who they suspected of having a Fx hip - admitted with NO PAIN MEDS - not so much as a TYLENOL!!!!!!! (and the doctors don't want to be called through the night????????????)...........HELLO......
  7. by   soundsLikesirens
    NURSEJANEDOUGH: girl you are AWESOME!!! That little old lady in the nursing home, with the bun...that's what blows me away about nursing...what a privilege to be in the positions we are in - to come into someone's life when they are so vunerable - it's such an intimate, sacred thing.
  8. by   nursejanedough
    Hey, to SoundslikeSirens from Bora Bora. I love it. I don't know where Bora Bora is (isn't that a remote island somewhere?) but I do see most of the responses are from the north. I be in the south and I guess I be really stupid. I was an RN on a medicare skilled floor in LTC. I was the only nurse with 41 residents and we may have 4 CNA's on a good day. I did med passes, tube feedings, skin treatments, etc. and of course, all the required documentation required. (haha) Even our LPN's did this. We are way behind I think. When I get old and need my diaper changed I probably should think about moving north or at least to Florida.
  9. by   allevi
    The hugs and the being able to be there for someone who is down is why I love my job. I guess I am fortunate. I work LTC, but in the alzheimer's unit where there are only 12 residents with a cna and a nurse. I am creative with the hour leeway at times, but only because if it is too late, they won't take their meds. I do also work the floor occassionally, and don't like that as well, because there are sooo many pills and such a short amount of time. Many of the residents are used to the way a certain nurse does things and they like to keep it that way. Which can make it very frustrating. I do enjoy ltc, don't know why some people think that if you work in a nursing home that you aren't a real nurse, that irritates me.

  10. by   BethanyMaya
    Hi, Im a nurse in England and Ive never heard of a meds nurse before.Ive just left a job in a 56 bedded nursing home and it was a nightmare doing a med round on a morning, it could easily take 2 hours, without many interuptions. Ive just started a new job on a 15 bedded rheumatology ward and cant believe how much time is taken up doing meds, (Ive been out of hospitals for several years)
    Why cant you take the med trolley with you?
    Im soooooooooo jealous of places with med nurses.It must make the job a hell of a lot easier and safer.Although I prefer primary care it is not always feasible with staffing levels.

  11. by   soundsLikesirens
    I was talking to another RN last night...she said her unit director made the ridiculous claim that the more patients each nurse had, the better care they received!!!.......HELLO.........
  12. by   mustangsheba
    Hey, BoraBora, I would give a new Merck Manual to come and give you a hand. Not because your job is easier. I just love your part of the planet. Do you wear flowers in your hair when you go to work? I wanted to jump in here about med aides. They are essential! I worked with one MA, 5 cna's and another RN, 60 patients, some skilled, some alzheimers. I did the diabetics, treatments and tried to pick up the prn's, answered the phone - The RN is expected to pick up the slack. The aides and MA were pounded. I was trying to pass pain meds and get the diabetics covered when they came to recruit me to help feed. For the first time in my career, I refused. (They managed). Why is staffing always cut in the evenings? That's when families come in with 100's of questions. Sundowners abound. Constipation and diarrhea manifest. People fall. I know this happens during the day too, but generally there is more help -although still not enough. I worked at a wonderful little hospital last week that had a charge nurse and an extra nurse to do nothing but put out fires and cover the "unexpected". He was busy the whole time. With all due respect, I still contend that there would not be such a great need for the checker uppers if there were more help. Say what you will about doing it right the first time, by the time I end a shift like that, I can hardly think straight and yet I'm haunted by the needs unmet - the people who are so hungry for someone to sit on their bed for ten minutes and just be with them. It would be more therapeutic than all the pills in the world. Just venting. Thanks.
  13. by   nursejanedough
    To sirens and Mustang: I am glad I found this site. I didn't realize how much I needed to vent. Siren, in regards to that person that told you the more patients you have the better nurse you are - well, I can not print what I want to say, but that is like telling a teacher, the more students you have the better teacher you will be. She/he must not have ever been overloaded or he/she is delusional. And to Mustang, you are right about the 3-ll shift, esp. in LTC, with all the Sundowner's and families come to visit it can be a nightmare. I have worked all shifts and I still don't understand why they can't get the 11-7 shift to do more. Since that is the hardest shift to fill, I have a feeling that they are worried that if they give them too much to do, it might run them off.