the sacred med pass

Specialties Geriatric

Published

Got a spanking today from my DON and am I steamed! God forbid that we run over the legal time limit for our med pass...ever......We have always been in compliance during our assorted inspections but sometimes our day to day morning routine is more like salmon swimming upstream to spawn...I am on a dementia unit and I think myself and the other 2 regular staff nurses have the pass down pat-we have worked hard to learn exactly how to encourage each one of our residents to comply....Our unit clerk is out for who knows how long-so the phone rings off the hook....The cna's ring the call bell constantly-they have not quite figured out that we are both on the floor working-not sitting at the desk....between other depts at the desk sucking the life out of us with endless questions and confused residents dumping juice on my MAR I was at my wits end....I was interuppted way too many times and that is a recipe for a mistake-but a resident's needs do come first-I can't let some poor gal stand up and fall over cause I have to get the meds out in time,can I? And then she threatens me with the 2 med cart scenario-not a good idea on this unit-our lobby area is where we place folks that need to be observed-if both nurse are out on med pass together what happens out front? Why does she not come to the floor on the days that the med pass f-l-o-w-s smoothly? I am proud of one thing-after all of these years I ahve finally learned to keep my MOUTH shut....Instead of debating all of this crap I just said " I will try to do better" and that was the end of it.....O I love my DON but about some things she is way out of date and dealing with dementia is not her forte.....She was on the unit one morning and call bells were going crazy-we were answering them at the desk but not getting a response...well-One of our gals was out there collecting them....My DON just could not understand how that could a happen! Anyway_ I am glad that I can vent here....I will have to not let myself be interrupted too much-I can always tell the other depts to go to the charge nurse(and pull her away from her treatments and such---she has all day to do them) and when a cna needs help with a quick lift I guess I can refuse....Sure....It's a loose-loose situation....argh!!!!!~

Originally posted by CapeCodMermaid

Am new to this forum. Have worked in LTC for most of my career. Do y'all understand that the sacred med pass regs were written when the residents took one or two meds each? There is NO way that one nurse can safely medicate 20-40 patients on ANY kind of LTC floor whether it is a dementia unit or a subacute unit. The average resident at my facility takes an average of 8 medications...the ones on the subacute floor take an average of 14...not to mention IV's, GTubes, parameters. We, as nurses, need to be more vocal. It's time to change the regs...someone needs to do a scientific study...

Exactly-- I was reamed by my administrator for saying as much- she stated that I did not understand that this was not acute care. She is a former RN. When does a RN take off her cap, so to speak, and become an administrator. BTW, I was expected to pass meds for 25 residents and be charge too. I love my residents and must say Adios!

We must speak to our legislators about LTC staffing, too , or nothing will change.

Blessings,

I don't know how you all do it, working in LTC, passing meds, getting everything done within regulations, putting up with ppl who don't show up on purpose, unsafe conditions.. it's really sad being a student and knowing these problems exist. :o

Specializes in ER.

If the DON has a problem with not finishing on time some of the "daily" meds can be staggered throughout the day so everything doesn't have to be done in the morning. Daily meds could safely be given at lunch or supper.

This is my first post, but I have been lurking for almost a year, and would like to say that this is the most supportive board I have ever come across on the Net.

I felt compelled to respond to this post. I graduated in June, and passed PN boards in September. I now work in LTC. I work part-time, and got a total of 14 days orientation, spread out over the course of 5 weeks.

I love my job, but the med pass is killer. I have 40 residents, and do the 9am and 1pm med passes, all the treatments, and what seems like a ton of paperwork. A big problem is that each time I work, I am on a different unit and don't know any of the residents. The few times I have been lucky enough to be assigned to the same unit for a few consecutive days, I felt so much more comfortable. At least I knew who the residents were, and that in itself saved me a lot of time.

Every time I go to work, it's like my first day. New residents (or residents I worked with one time a few weeks ago), new meds, new RN Supervisor, new CNA's, new places to look for supplies and forms...you get the idea. I graduated #1 in my coursework and clinicals, and consider myself a quick learner, but feel like a complete moron every time I go to work. A med pass that takes all the other nurses 2 hours, takes me 4 hours. I never take breaks and usually take a 20 minute lunch. I try to take shortcuts, but am afraid of making a med error.

Thanks for listening.:confused:

This is my first post, but I have been lurking for almost a year, and would like to say that this is the most supportive board I have ever come across on the Net.

I felt compelled to respond to this post. I graduated in June, and passed PN boards in September. I now work in LTC. I work part-time, and got a total of 14 days orientation, spread out over the course of 5 weeks.

I love my job, but the med pass is killer. I have 40 residents, and do the 9am and 1pm med passes, all the treatments, and what seems like a ton of paperwork. A big problem is that each time I work, I am on a different unit and don't know any of the residents. The few times I have been lucky enough to be assigned to the same unit for a few consecutive days, I felt so much more comfortable. At least I knew who the residents were, and that in itself saved me a lot of time.

Every time I go to work, it's like my first day. New residents (or residents I worked with one time a few weeks ago), new meds, new RN Supervisor, new CNA's, new places to look for supplies and forms...you get the idea. I graduated #1 in my coursework and clinicals, and consider myself a quick learner, but feel like a complete moron every time I go to work. A med pass that takes all the other nurses 2 hours, takes me 4 hours. I never take breaks and usually take a 20 minute lunch. I try to take shortcuts, but am afraid of making a med error.

Thanks for listening.:confused:

Oh jeez. Sorry for the double post. I'm still not sure what I'm doing with this thing. :imbar

Specializes in Gerontology, Med surg, Home Health.

LOL...Nursula...They all show up twice the first time. Sorry you're having such a horrible first job. All the administrators like to sit around and ask why they can't keep help..seems they don't have a clue. Give yourself some time...better to be slow with the pass and do it the right way...

I have to say I feel the same way. I love where I work, but being the only RN for 32 patients and with no med tech is hard. I feel like all I do is pass meds from the start of the shift until the end..I am scribbling notes at 11:00pm so I can leave. I am the only RN in the building with two cna's..NO one else..so that makes me charge. I don't think it's right or fair. I truthfully do not understand how the other nurses at my facilty have time to do anything!

When we run short on time we are suppose to ask the sv for help. Hah hah, if I ask for help she spends 15 minutes telling me how to do things faster. I'll muddle through alone, thank you.

Reasons it take so long to finish med pass:

1. Interruptions from the telephone that no one else can answer but the nurse.

2. Too many pts, too many meds.

3. A request for a pain pill from the other end of the hall.

4. A pt. who has to go the bathroom right now, and has been asking for 20 minutes and her family is looking at YOU.

5. A 5 minute discussion over every pill that is in the med cup. "What is it?" "What is it for?" "Should I take it?" "This pill makes me feel sick".

6. The wrong temperature water. "Too cold".... or "I hate water".

7. The drawer for that med is empty. Look around and borrow the right med.

And the list goes on.

It's just a big race, every night.

ON your mark, Get set, Go!

Those times are crazy. I am very rarely done in the time limit. Not enough nurses to do it in a timely manner. This gets me thinking about something else to: I called the state once, asked them about staffing ratios. I was told there aren't any. (I am in IND) They told me it is up to the facility to adequately staff the building, and unless something happens they cannot do anything about low staffing. Which makes no sense! They set ridiculous time limits on med passes,tx's but then they don't specify how many staff it takes to do this????? ktwlpn:you have more strength then I do, I would have told my DON that I would like for her to go with me and show me the correct way of getting meds done on time, because obviously I am doing something wrong and would like her input to correct it.

Originally posted by Nursula

Every time I go to work, it's like my first day. New residents (or residents I worked with one time a few weeks ago), new meds, new RN Supervisor, new CNA's, new places to look for supplies and forms...you get the idea. I graduated #1 in my coursework and clinicals, and consider myself a quick learner, but feel like a complete moron every time I go to work. A med pass that takes all the other nurses 2 hours, takes me 4 hours. I never take breaks and usually take a 20 minute lunch. I try to take shortcuts, but am afraid of making a med error.

Thanks for listening.:confused:

Nursula, you are NOT a moron ;)

My first position as LPN was floating in SNF- they had 8 units/40beds and the stress/confusion can be overwhelming. I kept a list of the names and rms on each unit. Alot doesnt change so at least I knew who had TF, insulin,who wants crushed or only OJ to drink ect. and just jot down stuff. You have to really hustle and sweat it out just to get done and one med pass just rolls right into the next.

The nurses who finish these horror med passes are NOT giving all the meds and Ive gotten some phony textbook VS too !! Short cuts abound and they will just skip a few pills and go sleep well at night !!?? My last unit was 51 beds and the med pass was disgusting and honestly not doable "in time". I took a charge positon that let me off the med pass (gave me tx's !)and then became manager of the unit that was to say the least unmanagable. I resigned last month after 8 yrs there.

They should call any LTC nurse a JUGGLER instead because all the crap you deal with is mind boggling and it just about sucked the life out of me thats why I left........

good luck CYA :kiss

deb

Specializes in Gerontology, Med surg, Home Health.

In my facility we have 3 units...one is a 60 bed long term care unit. There are 2 nurses there who are expected to do EVERYTHING....meds, treatments, MDS,care plans.....They never get done with the med pass on time. It is a physical impossibility. What they do is give the right med to the right patient etc with as much care as they can. The patients do not suffer from getting a QD med at 11am instead of 9am. If the administration doesn't like it. let them come do the pass...or hire more help

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