Is this common?

[sistasoul]

Hi all,

I have been a nurse on a med surge floor for 2 years. I am always the last nurse to leave in the evening. I work from 3 to 11. I can not chart until after I give my report 95 percent of the time. I do not take lunch or breaks. I am always out on the floor with my patients or calling MDs, etc. I look around me and see the other nurses charting and able to take a break or at least chart and eat at the same time. I figured these nurses had a system or some knowledge that I did not posess for time management. I asked most of the nurses on my shift how they were able to get out on time and most evenings get a break. I was surprised at their answers. The overwhelming consensus was that they lumped their med passes together. One nurse told me that if she had 1700, 1800, 1900 and 2000 meds due she would give them all at 1830. Another told me she would give her 2000, 2100, 2200 meds all together. Most nurses would gather all of their patients meds together at the beginning of shift so they would not have to walk back and forth to the med room. I am not criticizing or bashing anyone here but does this not go against what was battered into our heads over and over in nursing- namely the 5 rights of med administration and patient safety?

I fully understand why these nurse do this. We have computers on wheels that are cumbersome and time consuming to drag in and out of the rooms to scan the meds and the patients ID bracelets. It is very time consuming. These nurses want to go home to their lives and do not want management on their backs about OT.

I thought all of this time I was a lousy nurse with poor time management skills. I am doing my job in a safe way and I get good comments from the patients but I get spoken to by management all of the time about overtime.

The nurses who take shortcuts are perceived as the "good" nurses because they rarely get OT. Even the per diem nurses who float to different units pass meds this way. I get stressed out most evenings about OT. I had a nurse tell me just last night that I take a long time because I am doing things the right way. I think there is something wrong with the system if you are told you are takeing too long because you are doing things the right way. Even thinking about passing medciations the way these nurses do makes me feel guilty. I am sure if there was a med such as an antibiotic due at a certain time that this medication would certainly not be "lumped" together at a convenient time for the nurse.

The only nurses that do not do this are third shift nurses because there are not many meds on that shift or brand new nurses. Is this a common practice? Is this how nurses get done on time?

[klone, MSN, RN]

Everything I've learned is that it's wrong to give the med more than 30 minutes before or after its "due" time.

That said, I would say that there is something wrong with your time management if you're staying after 95% of your shifts to chart, and not finding time during your shift to chart (or eat, or sit down for a break, ever).

[netglow, ASN, RN]

If you are totally electronic... pyxis and scan patient/med, I guess they would be hitting over-ride or something. Doesn't the system see the wrong admin time? Or, with over-ride, nobody cares.

[sistasoul]

Everything I've learned is that it's wrong to give the med more than 30 minutes before or after its "due" time.

That said, I would say that there is something wrong with your time management if you're staying after 95% of your shifts to chart, and not finding time during your shift to chart (or eat, or sit down for a break, ever).

These nurses are telling me that I am late because I am giving the meds at the appropriate times and not lumping them together. I know this is "wrong". I was asking if this is a common occurrence? I am not sure if nurses would admit to this if asked. The nurses on my unit know that I would not say anything to management about how they pass meds and this is why they admitted to me that they did this.

[ckh23, BSN, RN]

I lump 2000 2100 2200 meds together at 2100 as we have an hour prior and after to give the med. It doesn't make much sense to go into a patient's room every hour to deliver the meds. If you are doing it that then it is no wonder why you get out so late because I can't imagine you have time for anything else. I'm pretty sure that this is common practice. However I thinking lumping together meds from 1700 to 2000 is pushing it.

[klone, MSN, RN]

Well, I don't as a matter of course. Rarely, I will forget a med, and then it's late. But I don't work in M/S where there are a ton of scheduled meds to give, so I can't answer that question.

But giving all 2000-2200 meds doesn't seem unreasonable to me.

It seems unreasonable that a patient would be ordered a med at 2000, 2100, and 2200 (unless it's various IVPB meds that obviously wouldn't be hung simultaneously). That seems to be a system issue that should be addressed.

[BrookeeLou_RN]

I was taught one hr either way with meds.. perhaps you should sit down with NM or whoever is over the unit and discuss adjusting meds times with pharmacy and MD involvement...Some meds is makes no difference others timing does matter.. But it would be best for the unit as a whole to address timeliness of meds and reasonable ability of nurses to pass them. Some places I have been have 5p med pass and 7 or 8p med pass, then sleepers get passed whenever appropriate per pt or usually 9p.

If the system does not really work for anyone which is what you are saying it is best to fix it entirely.

That said the number of meds is the same so you should still have time for charting somewhere other than OT 95% of the time. Look at the rest of your care and see if you are getting hung up somewhere.

[sistasoul]

Thank you all for the replies. I am going to bring this up at our next meeting. It is crazy the way some of these meds are scheduled. Some have scheduled meds at 1600, 1700, 1800. 2000, 2100, 2200 and 2300. If we have to give a med out of the half our window we do have to override the system. It is monitored but I have never heard anything said about it by management.

[Mulan]

Don't you just love it? Nurses are OVERLOADED and then told they have poor time management skills.

If other nurses are doing this, and that is the only way they can get out on time, then something is wrong.

I think part of your problem is the shift you are working. 3-11 is a horrible shift. I bet if you worked days or nights you would be able to get out on time.

[shoegazer]

Where I work we have an hour before and after to admin. meds. So I lump as much together as I can for the sake of time management. I will stagger certain meds such as pain medicine or BP meds if BP or RR is an issue though. Is there anyone you work with that you respect and think does a great job? ask what they do.

[mentalhealthRN]

yeah I will combine if someone has a 2000-2100 and 2200 but not the 1700. Unless of course the 2000 and 2200 are pain meds that are q2 for some reason. Or if they have a 1700 and 2100 pain med I wont give the combined later pass until 2100 so the pain meds are not too close. But yeah I gotta agree that having a med listed for just about every hour for a patient is just rediculous. And don't feel bad--when I worked medical I was always out last/late too. Gets frustrating I know. I found that many other nurses did a lot of things I would not--short cuts with more then just meds. So yeah something is wrong with the system. The charting for one thing.....talk about charting stuff in like 7 places!! lol (ok not literally--but ....) Getting the docs on the same page as the nurses to know that there are standard med pass times and they need to order them as such as much as possible. I know sometimes it can't be helped but still.

[Sun0408, ASN, RN]

Sometimes it is Pharm that sets the times and they do not understand "care" that they also have a 1800, 1900 and 2000 med.. I will send them a message to add that med to 1900.. Less trips to the pts room..

And to answer your question, yes I will lump meds together. No sense in going into a pts room 3 times to give meds unless it is pain meds or ABX.. Some meds need a 30 min to 2 hour separation so of course those are safety issues and I will not give them together..

Talk to your NM or send pharm a message and see if the meds can be changed to 2100 as an example.. I have had many pts with meds due every hour all night long. So I will do the 2000 and 2100 meds at 2030..

Also how many times do you go into the pts room a night for assessments, dressing changes and med pass.. Lump as many duties together so you go in only a few times.. Then the rest of the evening you can just check in on your pts :)