I work at the worst LTC facility ever.

CNA's can do creams/powders in some facilities. What is your policy on that? What kind of tx's are they doing?

Loose meds in the cart? Clean them out and dispose of them according to policy.

Borrowing meds? Take inventory of who is out of meds and order them from pharmacy so that they have their own supply available.

For the residents who get their morning meds at night, investigate. Is there a solid clinical reason behind doing so? If so, alert the MD and see if the med admin times can be changed so that the meds will be given in compliance.

Problems solved. :)

Med times on 11-7 are tough. It is such a BUMMER to have to wake up pts but sadly, it's a necessary evil. I'm thinking THYROID meds. They HAVE to be given early BEFORE breakfast. Some pts are sooooo hard to wake up, esp if they're in a deep sleep. I tried to catch pts when the CNAs did their last end-of-shift rounds.

Other meds, like q6 hr antibiotics and q8 hr seizure & BP meds have to be given on 11-7. As much as we'd like to consider NHs as HOME, they're still institutions. And institutions deal with numbers of pts on a schedule. Aren't really too many ways to work around the system.

It sounds like some things have become very sloppy where you are. What you're experiencing is the reality of sloppy facilities and they do exist all over. There are some very good places and some not so good.

As for malpractice, make sure you have your own insurance. Malpractice means that you've done "BAD practice. You follow good techniques that you've learned in school, you follow your instincts, you question things when you're uncertain.

If this helps, don't strive for "perfection', aim for 'EXCELLENCE'. That's realistic.

Good luck.

Time to start making changes. Take your med cart and own it. Most places nights are responsible for cleaning the carts. Dig in and waste those loose pills. Reorder medications, call pharm and find out why the heck they aren't sending reordered meds.

A lot of places I've worked aides to apply creams and powders. Doesn't take much more instruction than, "Put this powder on Mrs. B's groin." Check the facility policy and if you aren't comfortable with this do the treatments yourself. I personally like to do some of my creams and powders on occasion to see how a yeasty groin or alligator legs are coming along. When it comes to aides (non-TMAs) giving pills I've only done this a couple of times when I was right in the room with the patient, I've had difficult/demented patients who would only take their oxycodone/pudding cocktail from someone who wasn't me. Is this good or legal practice? No, but the patient needed their oxycodone, if it were another medication I may have held it, but some you just can't hold.

What kind of morning medications are you seeing given at night? There are certain medications that need to be given x amount of time before specific medications or food. If it continues to be a big problem, talk to the primary (or see if days can) and see if you can get an order, "May give synthroid at 8am with AM medications."

The biggest thing I can say is you're the nurse, take control of your residents and med cart.

Try working in mine! We have 70 residents (plus I am responsible for the 37 Assisted Living tenants attached to our building, if they push their life line pendant). We have 2 nurses and 2 aids. ONLY the nurses are required to have CPR and some nights they staff just one nurse and 3 aides for the building. It's all for the bottom line profit of the owners.

Is there any facility that is not like this?

I'm a new LPN. I just did my first night shift in LTC a couple nights ago. I understand that the real world is totally different than what they teach us in school. Rules are sometimes bent, but this is out of control.

There are loose pills in the med cart drawers of God only knows what, "borrowing" of medications, CNAs do the treatments with no formal training, just to name a few. They also give some morning meds at night to the residents who are hard to wake.

All I can think is malpractice. I don't want to go back. If this is "the real world" then I don't want any part of it. Super discouraged.

Is there any facility that is not like this?

The one I'm doing clinicals in right now is nothing like that. It's actually changed some of my opinions on LTC. In spite of nurses being required to wear all white I'd be willing to work there from what I've seen.

Patient is admitted to facility at 2pm. At 9pm resident is to receive psychotic med at 9pm - pharmacy has not delivered medication yet. What do you do?

I guess that you can notify md to hold but can you really do this everytime this happens. is that realistic?

The one I'm doing clinicals in right now is nothing like that. It's actually changed some of my opinions on LTC. In spite of nurses being required to wear all white I'd be willing to work there from what I've seen.

Hopefully only important meds are given at on night shift. As others have said the q6 h antibiotics need to be given then. We often also give pain meds at 0600 so they are comfortable when they get up. Also nitro patches but those are easy to slip on a sleeping resident. Parkinson meds are also something I've given on a night shift as it was q3 h. I don't give thyroid meds but they are scheduled for 730 and my shift ends at 0630.