Hi, I'm a new nurse at a LTC facility, and am orienting on a floor with 31 pts. I was told by several nurses to watch out for the nurse who is orienting me, that she can be tough. That's fine with me, nursing is a second career and I can work with most people. HOWEVER, she told me that she does one med pass for the 3-11 shift - everyone gets their meds sometime between 4-6, regardless of when they are scheduled, because otherwise she would never get everything done. She told me the order to do things, and send me off with the cart (I hadn't yet met any of these pts, and had no idea who was who). So, I did the first med pass "her way" with a lot of trepidation, in order to get it done. I made a new cheat sheet for myself so that I could see who got meds at what times, so that I didn't have to flip thru the hellish handwritten MAR every hour. Using my cheat sheet, I was able to get the med pass done in a fairly legal way, but probably would have had a hard time getting the documentation/notes/other stuff done if she hadn't done that for me while I was doing meds. I can work on speed, it will just take time.
Here's the problem: one gent said that he wasn't feeling well, was pale and diaphoretic, a bit nasueus; this was around 5 pm. I took his vitals, had normal BP, resps were irregular at 32, and HR was an astounding 185. I reported this to the nurse, and she said that he should be fine once his Coreg kicks in. I checked the MAR since I didn't recall giving it to him, and saw that it wasn't due until 9 pm. She said that he is a DNH/DNR, so I should just give him the Coreg since he's used to getting it at that time from her. I gave it, and his HR did go down to 110 about 30 mins later.
SO - while I obvoiusly want my pts to be well, I want to respect the unit's routines (two pts were angry when they got their meds at 9 pm, as they were already in bed), I also want to do the right thing. There are a zillion reasons for giving meds as scheduled, safety being the first, but there is not a unit manager who I can approach about getting meds rescheduled so that we are all on the same page. Any ideas? I'm new, and really don't want to alienate my coworkers or upset routine. Other than this, I really like the place where I am working; I think that most of the nurses give excellent care.
In our state we can write anytime(allowing proper spacing) if the order is for bid or tid. We can make that med 5 am, 1300 and HS. If the order is for a specific time we have to get another order from the doc if we want to change it.
Most of the elderly go to sleep when they want. That is what HS is for-hour of sleep.
I work dayshift. I give 3 med passes. Paper work comes last if at all. And I have told our Quality Assurance nurse just that. It's not true: If you don't document it, it didn't happen. If I wrote everything that happens in my day I would be there till my next shift the next morning. If Its a busy day and I don't get something written in that was important.....I make a late entry.
We have a wonderful lady in medical records who makes sure our meds are spaced properly and combined(if possible) to reduce our med passes. My big one is the am, of course. Then I only have like 8 at 11 and 4 at 13.
In our state we can write anytime(allowing proper spacing) if the order is for bid or tid. We can make that med 5 am, 1300 and HS. If the order is for a specific time we have to get another order from the doc if we want to change it.
Most of the elderly go to sleep when they want. That is what HS is for-hour of sleep.
I work dayshift. I give 3 med passes. Paper work comes last if at all. And I have told our Quality Assurance nurse just that. It's not true: If you don't document it, it didn't happen. If I wrote everything that happens in my day I would be there till my next shift the next morning. If Its a busy day and I don't get something written in that was important.....I make a late entry.
We have a wonderful lady in medical records who makes sure our meds are spaced properly and combined(if possible) to reduce our med passes. My big one is the am, of course. Then I only have like 8 at 11 and 4 at 13.
your state may allow it, but i have yet to see an institution that didnt have a p+p on when those times are to be....and any change needs to come from the doc....ask the doc for time changes with the rationale "to increase patient compliace"...i have run into those occassions filling in for those nurses who give the nines with the 4's.....pain in the butt...JUST GET THE TIMES CHANGED, or do it right
Specializes in Gerontology, Med surg, Home Health.
Here I am the Johnny One Note on medications. Most of the problem is these people take way too many meds. PUHLEEEEEZE..no 89 year old psychotic woman who HATES to take pills needs a multivit, calcium, zocor,etc etc. She has psychosis and HTN. Give her the antipsychotics and an antihypertensive. We and the docs need to get a bit more realistic in our medication administration.
Here I am the Johnny One Note on medications. Most of the problem is these people take way too many meds. PUHLEEEEEZE..no 89 year old psychotic woman who HATES to take pills needs a multivit, calcium, zocor,etc etc. She has psychosis and HTN. Give her the antipsychotics and an antihypertensive. We and the docs need to get a bit more realistic in our medication administration.
Specializes in Gerontology, Med surg, Home Health.
I'm sure I'll get flamed for this but here goes:
One of the posters stated she is a 'good nurse' but doesn't always give MVI or colace because they are not life sustaining and her patients need hugs more than they need a multi vit....and I am paraphrasing.
Good nurses follow the doctors orders unless they are contraindicated by the standard of nursing practice. By your logic, if I didn't feel a med was really needed, I wouldn't give it.
I am in total agreement that people take too many meds but the right way to fix is it to have a discussion with the doctor and explain the situation. Don't say you don't have time to give so many pills because even though you might not, the doctor won't care. Show the doc the latest studies on supplemental vitamins (not only do they not really help, in some cases they are harmful) or tell them how much your residents hate to take pills and their lives are becoming miserable so wouldn't it be kinder and more patient centered to give them just the essentials and assess for any changes which would indicate the need for more meds?
I'm not a nurse but I hope you guys don't mind if I add. I take care of a lot of dementia patients, and getting them to take their pills is quite a task, I usually have to help the nurse because I have a good repoire with them. I would imagine that if they didn't give them all at once, and were coming at them numerous times with meds, they would have even less of a chance of getting them to take everything.
i work at a nursing center in oklahoma, and there is one resident who is hiv positive. which does make me a little un easy. is it wrong for me to want to refuse to do certian things for him? i mean i am newly married and i have a 3 yr old son. it's a scary thought! help! please
i work at a nursing center in oklahoma, and there is one resident who is hiv positive. which does make me a little un easy. is it wrong for me to want to refuse to do certian things for him? i mean i am newly married and i have a 3 yr old son. it's a scary thought! help! please
yes it is wrong to refuse to help the patient. read about hiv and maybe you will be more informed.
Specializes in Geriatrics, Hospice, Palliative Care.
My biggest problem though is the fact that you had an unstable pt with a hr of 185 and he was just given his dose of Coreg. If a patient had presented in triage of my ER with that hr he would have been taken directly to the resusitation room, and he would NOT be given a po med to get that hr under control.
Believe me, that was my biggest concern as well. Her point was that he is a DNR (but not DNH - and I was too green to insist that we call the supervisor for instruction, since this nurse has been there forever and knows what's what), and that nothing would be done for him anyway; while I certainly understood that, a HR of 185 really freaked me out. I rechecked his HR later, and she yelled at me that I couldn't spend my whole night with this one patient because I had to finish my med pass and get notes written and treatments done (I am not sure what she was doing at the desk, since I was doing her assignment, but I don't really care). I calmly replied that I was aware, just checking my patient to see if he was okay. She called me over and told me that I had better snap out of it right away and stop caring for the patients...that they come here to die, and that I should just focus on getting the work done and forget about trying to improve anything. Her attitude sickened me, but I politely thanked her for the input went on my way. FWIW, she's the only person at this facility who has this attitude, otherwise I would be out in a flash.
I'm still very upset about this situation: why wouldn't she just get the med time changed so that it could be given consistently? We have agency nurses quite frequently, and how are they to know that the pt may become dangerously tachy if he doesn't get a 2100 med at 1700, not to mention what other meds she gives her convenience without proper documentation?
Furwillfly
61 Posts
In our state we can write anytime(allowing proper spacing) if the order is for bid or tid. We can make that med 5 am, 1300 and HS. If the order is for a specific time we have to get another order from the doc if we want to change it.
Most of the elderly go to sleep when they want. That is what HS is for-hour of sleep.
I work dayshift. I give 3 med passes. Paper work comes last if at all. And I have told our Quality Assurance nurse just that. It's not true: If you don't document it, it didn't happen. If I wrote everything that happens in my day I would be there till my next shift the next morning. If Its a busy day and I don't get something written in that was important.....I make a late entry.
We have a wonderful lady in medical records who makes sure our meds are spaced properly and combined(if possible) to reduce our med passes. My big one is the am, of course. Then I only have like 8 at 11 and 4 at 13.