Hating the med pass

Specialties Geriatric


I work on a subacture/SNF floor. I typically have 18 pts, which I know should be totally do-able, considering so many have 30+. It is a pretty busy floor with quick turnover, IVs, complicated wounds, wound vacs, traches etc.

I love my patients. I love teaching, and I love interacting with people, from the 98 yr. old demented pt. to the 20 yr old s/p MVA with multiple trauma and fractures etc. I love doing wound care, I like traches and suctioning and general respiratory stuff, I like helping the CNAs when I can and enjoy most of my duties, I like communicating with the MDs and RNs and love to learn.

The thing that seems to be sucking my mind and soul are these never-endeing med passes. EVERYTHING else gets short-changed due to the med pass. I just get so frustrated sometimes.

I hate looking in a room, seeing the pt. sitting there, and pouring the meds. By the time the meds are poured, I go back in only to find...the pt. in the bathroom, the CNAs are now doing care, the housekeeper has the floor soaking wet and the doorway blocked with her cart, Pt/OT/ST is working in the room with pt OR has taken them around me and my cart and brought them to PT despite my polite request to please wait a few minutes and despite the fact that the PT/OT sheet says they aren't going for another hour and a half...

ONE or even a FEW episodes like this are okay, but when it seems impossible to get to almost anyone my blood starts to boil. I try to be very respectful of the therapy dpt, I know they are under a lot of pressure because they have to bill by the hour and need to get a certain number of hours for repayment etc. etc. BUT it seems like they have NO respect for what I have to do and see my role as nothing but passing meds. Sometimes they line people up at my cart...they don't understand, esp. with this pt. population, I have to do more than just shove pills in their mouth, I would like a moment to actually assess this person! Talk to them, find out about their pain, their needs, you know, listen to lung and bowel sounds, check dressings,etc. etc. )

Then there's the sheer amounts of medication. Starting with the pills...more and more and more pills all the time. Then it seems like just to shut people up the MDS prescribe more and more notions and potions...I have almost everyone on natural tears QID, then there's the ear drops, the creams, the inhalers, EVERYONE gets nose spray, EVERYONE gets lidoderm (I am the last people to want anyone in pain but I have so many Low back lidoderm patches to apply and so many of these people are dressed and up in a wheelchair by the time I get to them and it's a huge production or imposslbe to get the patch on) a lot of the time I can't even carry the pts. stuff in one trip (or I put the inhalers and stuff in my pocket). (We have tried making some of the patches 6am so they can be applied before the pt. gets up but 11-7 staff freaked out and got them switched back...also, I hate the "ShIFT WARS thing but so much I mean EVERYTHING is put on 7-3...new admit, every qd med is 9am aricept, flomax, and zocor included, EVERY dressing change and qd tx is put on 7-3 even all diabetic foot checks, right down to every pneumovax and PPD and they don't care if we get two-three admissions if everything isn't done {right down to a benign bandaid for a minor skin tear}they are livid--but then I get home and see them posting on facebook all night hmmm).

Even with the pts. changing up regularly sometimes I just feel like I'm in such a rut doing the same exact thing over and over and over everyday with the med pass.

The med pass from hell. That's what the daily LTC med passes were for me. Of course, the patients also chose to have their " falls" during the med pass. And of course, the constant telephone interruptions during med passes. It was a disaster every day. Total frustration every single day. I am so glad I left LTC nursing. I am doing private duty home care now. ;)

Wow. this sounds like my day too. I hate it. So I know exactly how you feel and what you are going thru. I pray my way thru the day. Look for new opportunities to open for me.

Specializes in Pediatrics and geriatrics.

Where I work at, we schedule patches (Scop etc) on the times the resident gets their shower, for example if they are a 3-11 shower, the patch gets changed on that shift. We also schedule nail trimming that way as well. We also get admits on 3-11 too. Nursing is a 24 hour a day job, there is no reason why one shift should get the brunt of the work. Also, is a skin tear happened on 3-11, the treatment would be scheduled for that time too.



Specializes in LTC, home health, critical care, pulmonary nursing.

I detest the med pass. Gotta happen though, and for me the only bad one is 0800, so I just grin through it and know that I have 10 more hours without that crap.

It sounds like your difficult med pass is made more difficult by an evening shift that does not want much responsibility. That's a matter for management to take up, and I feel for you. There is no reason to be giving Zocor and other evening meds in the morning! In fact, the prescribers should be made aware (nicely) that those meds are more effective when given in the evening. Hang in there!

Specializes in LTC, assisted living, med-surg, psych.

That's what I was going to say........cholesterol meds, Coumadin etc. need to be given in the evenings to be most effective. And I'm surprised that day shift gets most of the admits where you work; in every LTC I've worked, the 3-11 shift got the lion's share of them because the hospitals like to discharge after noon so they can get paid for an extra day. (Can you tell I've been an evening shift nurse for awhile? ;))

FWIW, I hated passing meds too......it was the most boring and repetitive part of my job, and I didn't enjoy it one bit.

I'd rather do medpasses than treatments. But then again, I like routine, I find it relaxing.

Specializes in LTC, home health, critical care, pulmonary nursing.
I'd rather do medpasses than treatments. But then again, I like routine, I find it relaxing.

Nothing routine about getting interrupted 800 times in 2 hours.

Specializes in LTC.

The med pass is terrible in LTC. They schedule meds for 4:30 yet there's

dinner at 5 and we can't pass meds during dinner so all I have time for after calling doctors, doing cna assignments, getting the desk somewhat together.. is the finger sticks and sometimes not all of those get done.

There was one night when I had to be the charge nurse.. I didn't even touch the meds until 6pm. I just did one big quick med pass. Take it or leave it. The only think I went back for at 9pm was the 4x a day meds and ambien.

Specializes in Med/Surg, Tele, Dialysis, Hospice.

The med pass is why I had to get out of LTC. My 8 PM med pass would take three hours for 25 patients on a good day. I hated having to crush up 5-10 pills, put them in applesauce, and try to force them on little old ladies who didn't really care if they lived to see another day. I would get so frustrated standing there and begging one after the other to "take just one little bite" while I knew that there were 20+ more that still needed their meds, and I knew that there had to be contraindications between some of the meds that I was giving, because there had to be with that many meds going in at one time, but none of my superiors seemed to care, just get them ordered and shove them in, that's all that seemed to matter. And of course, the two ladies who got bent out of shape if their pills were five minutes late always seemed to be at opposite ends of the hall, meaning I couldn't work in an efficient, chronological order, but had to skip around, hauling that big, old med cart with me. My sciatica, which hadn't bothered me in years, flared up, and I would get bad headaches from flexing my neck for so long while looking down to read the MARs and get the meds out and crush them.

I work in hospice nursing now and I love it so much. I will never go back to LTC. I don't know why people think that a LTC nurse is capable of giving decent care to so many patients, those kind of nurse to patient ratios aren't expected anywhere else. God bless anyone who can do LTC nursing for more than a couple of months. :yeah:

Specializes in Pediatric Private Duty; Camp Nursing.

It's sort of scary that I can read through all these posts and experience deja vu. I was telling my husband about this particular thread last night, that if he wanted to know how my day went, this thread tells it all.

I've been working LTC for a year, and ever since I've had that elusive 1 year experience under my belt, I've been thinking about moving to home care. I even signed up with an agency and worked several short shifts. Lately our facility has gotten more ridiculous than ever with our state visit last month and the measures to fix problems before they come back. Department heads have been scrambling to check for holes in MARS every shift (too cheap to computerize) and dumping tons of new work and documentation on us which seem like excercises in futility. All the while we are pathetically understaffed and my poor CNA'sare struggling with 12 to 15 residents each and my residents are sitting in their own filth, developing rashes and excoriations which will require skin sheets and treatments. Plus we get written up if we stay past our shift more than maybe once a week. Blah, blah, blah, I could write a book.

What were we talking about? The med pass? What drives me crazy is when I cannot find a med, but it seems as though every nurse for the last week has signed for it like it's been given out, but I call pharmacy and find out it hadn't been reordered and been missing out of the drawer for a while. Oh, and the kicker: there's no one else on that med to borrow from! (Which we aren't supposed to do but the emergency box is on another floor and requires more documentation and eats a ton of time out of the med pass.) But... the policy is, if something is documented, then it was unquestionably done. And if I report the extensive med error, not only do I get everyone written up and I make enemies, but I create a lot of extra paperwork... for myself! Ugh. Our facility is a hot mess. I better just leave it at that.

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