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

[CapeCodMermaid]

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.

[CapeCodMermaid, RN]

Then Oldmahubbard, lucky for you you don’t work in a SNF in Massachusetts

The regs are ridiculous- if someone is taking gabapentin as a psych med, a consent is required. If they’re taking it for peripheral neuropathy, no consent needed. Same med, same side effects. But we give insulin and warfarin without informed consent

[Oldmahubbard]

If I had to take a wild guess, the "informed consent" is not really happening, like a lot of other checkboxes we click on

[CapeCodMermaid, RN]

It’s happening when I’m in charge. If it doesn’t happen and the DPH finds it, they cite us

[Oldmahubbard]

I am very curious to know what the nurses are actually saying though. Is there a script that is provided for each drug, so everyone is on the same page?

Your SNF residents must be much higher functioning than mine, half of whom barely answer to their name.

[37changes, ASN, RN]

I have been thinking about this thread since I read it yesterday.

A couple of thoughts come to mind, which may or may not apply to your situation. But I'll throw them out there.

One is that I believe there is a disconnect between the way management perceives a job as a floor nurse to be, and the way it actually is for that floor nurse. What do your nurses tell you when you ask why these things aren't being done?

I know the correct way to do most things at both of the facilities I've worked at. I'm not stupid. But when I've got (what feels like) at least 10 different things simultaneously coming at me all day long, I can't always do things the correct way. Sometimes I forget. Sometimes I have to say screw it, because I am one person, and in my mind at that moment -- A, B, and C are more important than D. It sucks. And it doesn't fit well with my perfectionist personality. But it's the reality of me working in LTC.

I know, your mind may be wanting to go to "but my facility is different". No, it probably isn't. I'm working at a very nice place, relatively low acuity, only private pay and Medicare, staffing ratio about the same as yours most days. We do get more admissions and discharges, but the DON and ADON help out with those quite a bit when they are there.

My days still feel just as busy, and my mind just as full, as when I was working at the Medicaid facility and responsible for 28-35 residents each day. It's just a different busy. I encounter more family members on a daily basis, who are more educated and more involved in the resident's care. They ask a lot of questions. They have higher expectations. We also take WAY more vitals and daily weights, O2 sats etc that have to be put into the computer on a daily basis.

Also, when your residents are functioning at a higher level, they tend to want to converse and ask a lot of questions of their own. They show up at your cart and want their meds right now. Etc.

20:1 doesn't sound like a lot to some people who have worked in much worse conditions. But I'm here to tell you that the days can be just as full. I worked 11.5 hours on what is supposed to be an 8.5 hour job yesterday. No lunch break. Didn't eat all day, in fact. And I left without doing my Medicare charting AT ALL.

[CapeCodMermaid, RN]

I’ve been a floor nurse so I know what y’all do. These nurses have plenty of time to sit around the nurses’ station

The point isn’t about what the consent says. The point is they’ve been educated 5 times and asked to do it and they still don’t

[Oldmahubbard]

1 hour ago, CapeCodMermaid said:

I’ve been a floor nurse so I know what y’all do. These nurses have plenty of time to sit around the nurses’ station

The point isn’t about what the consent says. The point is they’ve been educated 5 times and asked to do it and they still don’t

My point is that they are totally unqualified to do it, and I don't understand how the providers are getting away with leaving this task to a nurse.

[Oldmahubbard]

I'm not trying to be argumentative. I am just very surprised by this

[chare]

2 hours ago, CapeCodMermaid said:

[...]

The point isn’t about what the consent says. The point is they’ve been educated 5 times and asked to do it and they still don’t

Perhaps their concern isn't what the consent says, or how to complete the form. Perhaps their concern is why they are being asked to obtain consent, rather than the prescribing provider. Has anyone explained this to them, why it is their responsibility to obtain the consent?

Have you listened to their concerns? Or did you, once again just tell them to do it? As you've given the impression here.

If one of your residents was scheduled for a knee replacement, and the surgeon told the nurse to obtain consent for the procedure would you expect her or him to do so?

If not, how is this any different?

[CapeCodMermaid, RN]

of course it’s been explained to them several times in the few months I’ve been there.

They also fail to complete the admission paperwork- please don’t tell me that’s not their responsibility.

[37changes, ASN, RN]

Still curious to hear what their explanations are for why these things aren't being done.

[CoffeeRTC, BSN, RN]

The floor nurses obtain consent for the psych meds in PA. It can be done over the phone with a family member too. I don't have the form in front of me, but it lists the class of meds and general side effects. We list each med and the targetted behavior/ reason for use.

I have never seen a DR get this or any other form signed by the resident. I guess we could have our psych CRNP do this when he comes in once per month if he is there when the med is prescribed and it isn't done as a verbal.

As far as getting things done or not... There is always going to be something that crops up and makes the shift a mess, but if things are not getting done on a consistent basis, then a conversation is needed with each offending nurse along with an education on why things need to be done.