If I say "how stupid are you" will they take it as a challenge??

[CapeCodMermaid, RN]

I'm am the DNS of a beautiful SNF....20:1 staffing with no clinically complex patients. WHY can't the nurses remember to do the basics like , oh, signing out meds when they give them???? Getting an informed consent before starting a psychotropic medication? Documenting target behaviors on the MAR???

We get maybe one admission a week. Why can't they do their jobs the right way? It certainly isn't for lack of education and/or explanation of why we need to do these things. I am at the end of my rope and if I could, I'd fire the lot of them.

[TheMoonisMyLantern, ADN, LPN, RN]

Sometimes people don't realize how good they have it. I think every nurse at some point should work in an utter hell hole for a while so that they can appreciate the good jobs when they get them. Ironically some of the worst jobs I had were also some of the ones I learned the most from.

[brownbook]

Sounds awful for you. Probably won't help but maybe therapeutic open ended questions, active listening, with each nurse when the mistake is discovered.

Tell me why patient X's medication wasn't signed out? What changes could we make so psychotropics are never given without patients consent?

Are incident reports being generated? How about three strikes and you're out?

[Oldmahubbard]

Please tell me nurses are not required to get informed consent on psychotropic medications

[brownbook]

2 minutes ago, Oldmahubbard said:

Please tell me nurses are not required to get informed consent on psychotropic medications

I wasn't sure about this either. It seemed odd. The whole post is odd. Why not incident reports, especially if medications aren't signed out? Maybe it's a troll?

[CapeCodMermaid, RN]

I’m not a troll and of course nurses are supposed to get consents signed for psychotropic meds.

[chare]

1 hour ago, CapeCodMermaid said:

I’m not a troll and of course nurses are supposed to get consents signed for psychotropic meds.

Why are the nurses getting consent for anything?

If your facility requires consent prior to beginning psychotropic medications, why isn't the prescribing MD, DO, NP, or PA doing this?

ETA: While I was aware that you were a long term member, reading the title of this thread and the last sentence of your original post certainly makes it appear that you are.

[amoLucia]

I've been retired for some time now, but before that, time, we never had to get informed consent for the psychotrops. Is that some Massachusetts thing?

We did the psycho med monitoring and AIMS periodically with routine documentation. And summaries, etc. But not consents. Altho there were places where we did have to notify families of ANY new med or increases in another med.

CCM - maybe it's time to start a paper trail with the errant nurses. Not with the intention to really, really fire them. But to shake them up with the realization that you are SERIOUS about their lax. As supervisor, I would write up problems as a 'counselling', kind of like a PRE 'verbal warning,

BTW, am glad you've found something new. I always enjoyed your postings. Alas! Massachusetts was too far to commute!

[CapeCodMermaid, RN]

We’ve been required to get informed consent for at least the past 6 years... and God help you if you change the form the Massachusetts DPH sent out!

[amoLucia]

Like I said, I've been off the grid for a while now. Who knows? Maybe NJ has joined those ranks (it has long been heavy R&R). I do know our psych hospitals had to get consent. That was late 1980s. I think it was a result of a lawsuit 'Rennie vs Klein' - psychohtrop was ordered but the pt experienced side effects if I remember.

[chare]

5 hours ago, CapeCodMermaid said:

We’ve been required to get informed consent for at least the past 6 years... and God help you if you change the form the Massachusetts DPH sent out!

Again, why is it the nurse's responsibility to obtain thegconcent?

[Oldmahubbard]

The idea that a nurse would be responsible to get consent for the huge class of "psychotropics" , which are many different classes of drugs, that may potentially cause sexual and reproductive problems, HTN, changes in weight and appetite, elevated blood sugar, elevated cholesterol and triglycerides, hypotension, sedation and falls, liver and kidney failure, nausea, vomiting and diarrhea, dependence and addiction, bone marrow suppression, tardive dyskinesia, myocarditis, and metabolic encephalopathy, early death in dementia, to mention some possibilities, not an exhaustive list, is entirely ludicrous to me.

Entirely ludicrous.