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.
