Getting everyone else to sign their books

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how the heck do you do it? As you know I am on day 5 of my new job as a new unit manager at a LTC facility/Sub Acute Rehab and the biggest issue I see are the gaps. How do you get the nurses who give meds and do treatments and the CNA's to make sure the accountability sheets are signed? This is very frustrating. Of course this is a new month and I am sure that the nurse manager who was there before me did not do EVERYTHING because she couldn't of. How do you not get behind in ALL of the rudundant paper work? How do you deal with CNA attitudes? :uhoh21: I have tons of questions but this is all I feel like typing now. LOL:nurse:

MrsStraty

That's why I love the Bar Code medication Administration which is all computerized. We always complained about it, but it really is the best system. The pt's wrist band is scanned to make sure they are the correct pt who will to recieve the medications that come up on the screen then we scan the meds as we give them. At the end of a med pass we print out what they call a "missed med" sheet and all the meds that were NOT scanned that were due during the med pass will show up on the missed medication sheet so you must go back and correct the missed med. We print a final missed med sheet before we go home. If there are still any missed meds you MUST go back and correct them whether it was HELD, REFUSED, or GIVEN before you go home. We have zero missed medications every time. We also print out a PRN effectivness sheet which means every PRN that was given that DOES NOT have an effectiveness along with it will only show up on the sheet. Again we must go back and add the effectiveness before leaving. It's a very expensive system, but it's well worth every penny and in my opinion the system goes above and beyond pt safety, which is what every facility strives for. If you can afford it, by all means you should get it. You won't regret investing the facilities money on this system one bit.

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Specializes in Gerontology, Med surg, Home Health.

How much time does this add to your med pass? I can see using it if you have 15 or so patients, but if you are on a dementia unit and giving meds to 40?

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Specializes in orthopedics,geriatrics,med/surg.
I really want to implement a way to make sure that everyone signs their mars and tars but I'm afraid it will be like stepping on toes of people who have been there for years. :nono: I might have to resort to writing people up for med errors, which people will hate, but you know it is a med error because if it was not documented then you did not do it. And the PRN is horrible. The last place I worked if you gave a PRN there needed to be a nurses note to go along with that PRN, and here they don't do that. I am still in the sitting back and observing phase before I jump in and make changes. There is so much paper work. The last nurse manager would just fill in the gaps, forging the signatures, and they think that is FINE. I am NOT OK with that kind of practice. I hope I don't get fired for doing the right thing......because this seems to be the norm. :blushkiss

MrsStraty

PRN= patient receives none.

not an actual med error if med was given, more like a charting error. some places actually have forms for this. can cause problems when state comes in.

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I'm not above calling the previous shift at home to see if something was given or missed (not signed off).

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Specializes in acute care and geriatric.
I'm not above calling the previous shift at home to see if something was given or missed (not signed off).

I agree!!!

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Specializes in orthopedics,geriatrics,med/surg.
I agree!!!

I wish every one would do this before they jump the gun. I've had nurses write in the chart with my name that a med was given 2 hours late when in fact it was given 2 hours late because this same nurse didn't give her ABT at all so after consulting with the doc he wanted it given now and then mine and then resume the routine of ABT. I have had other med error's charted as med errors when in fact they were held waiting for doc's order and he didn't call back before end of shift. I just think it is better to call the nurse before starting WW3. It is such a waste of time getting called into the office then having to go back and read through the chart then go explain everything to the DON what was really the case. Most nurses would admit it if you call them and the med was missed. Just my 2 cents

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Do you ever wonder WHY it is that all the nurses dont sign their books? Could it be perhaps OVERWORK due to UNDERSTAFFING? Do managers somehow magically forget how it was out there on the floor ,Or God forbid they never worked the floor?!

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It is not the multiple documentations.......It is signing for meds that you give that I am having the biggest issue with. There are far too many gaps on the MARs and that should not be. If you give the med sign for it. I have worked several different places where the documentation is getting redundant....even in the hospital setting.....but that is no excuse NOT to do your documentation. And the other nurse manager was signing the nurses initials because she said that is easier than chasing around the nurses to sign on the MARS. It is my job as the nurse manager to see that all the MARS are signed correctly. I am not feeling ok about just initialing someone elses name and this seems to be common practice. :nono:

I agree a 100 %

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Do you ever wonder WHY it is that all the nurses dont sign their books? Could it be perhaps OVERWORK due to UNDERSTAFFING? Do managers somehow magically forget how it was out there on the floor ,Or God forbid they never worked the floor?!

Nurse basic 101. When giving a med you must sign that you gave it, other wise it is a med error. I am a unit manager and have not lost site what it was like to work on the floor, however most of my time is correcting things that are missed. I do have a job to do. I am a PPS nurse and if I do not do my job we loose money. I work hard to support are nurses to complete their job. I expect the same from them. Have you ever been a manager? My motto is " You do not know what is it like to walk in my shoes until you do it. " Under staffing is world wide in nursing. Until staff ratio is mandated, the issues we have will never be resolved!

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I always signed my meds and tx's , I got my work done , I got EXCELLENT yearly evaluations, I am not a slacker, BUT that also does not mean that I dont have empathy for the overworked, understaffed nurses who are doing the best they can in a REALLY tough environment. Yes managers and DON's keep up the good work and fire all those nurses out there that dont toe the line, maybe pretty soon the only nurses left in this field will be the DON and their management team.LTC is such a great place to work I bet the nurses are pounding down the door to get a job.

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There is nursing shortages EVERYWHERE, including the hospital setting. Still, nurses need to be held accountable for not signing their MARS and TARS! I just found one med error where a resident did not receive DILANTIN for a whole month, because it was not transcibed onto the turn over. Am I supposed to just cough that up to understaffed? Sorry, that is just plain slackfullness, not double checking your work. Thank God my resident didnt have any seizures. Also I had a nurse tell me, "Oh I was giving it to him anyways because I usually give it to him in the am." She didnt even notice it was not on the MAR! SCARY! :cool: Nurses and CNAs fail to realize that the Nurse Managers are responsible for their units 24/7. The DON and state are going to come to me, and make sure I am being proactive about things. Will I get in trouble for someone else, NO, but they will look to me to see what I have done to make sure it does not happen again.

I love LONG TERM CARE! I am there to make sure they get the proper care and respect that they deserve. Afterall, we are in their home, we go home, they do not. They are there to die, most of them. We need to remember that more often. It is NOT about us! We have a job as nurses, to ensure their saftey! NUR 101, is for ALL nurses!

MrsStraty

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Hello everyone. I am a new LPN. This is my 3rd month now at a LTC facility. I really like it and want to do good. I am feeling like I am constantly doing something wrong like with charting and writing orders and constantly worried that I'll do something wrong. I had a Pharmacy surveyor come in a couple days ago right before I went on my weekend off. I was so nervous. I felt kind of insulted. Why would they have had a surveyor out to watch me and not the others? Is that really fair? How does the facility pick who a Pharmacy surveyor watches for the day? I may be overreacting to this and be taking this too personally. That just bothers me that they would watch me and not the others who have been there longer. The other nurses told me they have never been watched before. I stay constantly anxious though which isnt good and I don't know if I need this the rest of my life.

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