LPN's Who Sign Off Med Passes But Dont Give Meds

CHATSDALE · Dec 8, 2006

i don't believe that this is more prevalent in the type of setting [hosp vs ltc] or the licensure of the nurse [rn vs lpn] this is accoring to the the quality of the nurse - or the staffing - or the amount of work required or perhaps all three

if you spend too much time coaxing a pt to take a laxative you take time away from a pt with a potenital life threatening disorder, a dressing change that is thrown over to the next shift, just look at their smiling faces when you tell them what wasn't done,

if they refuse too frequently see if the md will d/c it..but don't bet on it, they will think that you are just too lazy to take the time to give it

but you must be up front with what and what was not done, if mds and other shifts believe that meds/tx given they will think that condition of pt is due to reaction to meds

pagandeva2000, LPN · Dec 8, 2006

If you set people up in impossible situations, these and worse are the end results. And, people wonder why there is a shortage in nursing? It may be due to the stress, the guilt and the burden that nurses have begun to work under that made them say 'screw this'. You'd think that this would make nurses stick together more than hurt each other the way that they do.

I mentioned this story in another thread, but, there is an LPN I know and she told me that she went to work in this nursing home on an Alzheimher's floor where she had to medicate and treat 50 patients as a new grad (and agency worker, at that). There were no ID bands on, not many pictures in the MAR and the staff basically disappeared. By 5pm, she was still distributing 8am medications. She went to the RN and asked her what she should do, and was told "Do whatever you have to do". She said that she wasted the narcartics and the medications in the blisteks, signed for them all like she gave them all, and she walked out...never to return. Personally, I couldn't judge her...she literally did what she had to do to protect what she worked hard on, and then, she made the choice never to go back there. If the facility doesn't care enough about the patients to hire safe nurse:patient ratios, then, can you really trust that the doctors and owners will create a better atmosphere? I am a recent LPN...got my license in June, and I made a conscious decision not to ever place myself in such a mess. I expected to have a job in med-surg, but the Creator knew what was best when I was placed in a clinic and I have a weekend home case. A shame, but at least I can sleep at night.

Fiona59 · Dec 8, 2006

Well the LTC I worked in wasn't that bad. We had the meds LPN who passed meds for 45 and did the tube feeds. We had a treatment nurse who did the vitals, accuchecks, dressings, etc. BUT in the same facility on different units, you could wind up being the only LPN for 25 and had to do it all.

I work days and evenings in active treatment. Three patients on days and five on evenings. It's a busy, regional surgical centre. We can be short staff and have five on days and its hell.

There needs to be consistency within a facility. One of the main reasons I'll never return to LTC is managment lets it run itself and don't want to look into creating bath teams to handle the baths and showers. They just don't get that you can NOT medicate 25, do tube feeds, wound care, and get five people up and do tub baths as one person. But "xx" used to do it is a common saying, well, she never took her breaks, never put in for overtime, and oh, I forgot she's off with a bad back and stress.

pagandeva2000, LPN · Dec 9, 2006

Sometimes, it makes me wonder just how much "xx" really got done, versus what she actually charted. Not saying that all nurses are that way, but I have found that some of the miracle workers took major short cuts that they have covered for.

Well the LTC I worked in wasn't that bad. We had the meds LPN who passed meds for 45 and did the tube feeds. We had a treatment nurse who did the vitals, accuchecks, dressings, etc. BUT in the same facility on different units, you could wind up being the only LPN for 25 and had to do it all.
I work days and evenings in active treatment. Three patients on days and five on evenings. It's a busy, regional surgical centre. We can be short staff and have five on days and its hell.
There needs to be consistency within a facility. One of the main reasons I'll never return to LTC is managment lets it run itself and don't want to look into creating bath teams to handle the baths and showers. They just don't get that you can NOT medicate 25, do tube feeds, wound care, and get five people up and do tub baths as one person. But "xx" used to do it is a common saying, well, she never took her breaks, never put in for overtime, and oh, I forgot she's off with a bad back and stress.

**Elektra6, ASN, BSN, RN** · Dec 9, 2006

Honestly, I feel some of the fault lies with dieticians and physicians. I have told them over and over that >10 pills is too much for a some of my residents. After taking 3 or 4, they refuse the rest. Do we really have to give giant calcium and I-caps 3 times a day? How much can I-cap vitamins improve the vision of a 98 yr old man? I have been somewhat successfull in having med times adjusted to when the resident is more receptive, ie., my 3-11 shift versus early morning, and getting orders for liquid meds like vit c & multi. This has cut down on the refusals. Be persistant with the docs.

txspadequeenRN, BSN, RN · Dec 9, 2006

Oh I agree.. I had one patient once take 13 vitamins plus all her other goodies for a grand total of 27 pills. This lady was 92 years old and most of the pills were as big as a small dog...

Honestly, I feel some of the fault lies with dieticians and physicians. I have told them over and over that >10 pills is too much for a some of my residents. After taking 3 or 4, they refuse the rest. Do we really have to give giant calcium and I-caps 3 times a day? How much can I-cap vitamins improve the vision of a 98 yr old man? I have been somewhat successfull in having med times adjusted to when the resident is more receptive, ie., my 3-11 shift versus early morning, and getting orders for liquid meds like vit c & multi. This has cut down on the refusals. Be persistant with the docs.

allantiques4me · Dec 9, 2006

I cant believe how dangerous this could be!!I mean persons on BP meds( could stroke out)persons on antiseizure meds labs would be off,then the DR.would change the order,maybe causing a dangerous unsafe theraputic level when they would get thier meds as they should.How terribly sad!!And so,so dangerous!!

dream'n, BSN, RN · Dec 11, 2006

I also believe that this goes on more often than most could comprehend. When I worked LTC, there would be times that I would look everywhere for a certain medication and couldn't find it. I would circle it in the MAR, chart that it wasn't given and order it, but I would also notice that all the previous shifts had given it. Fast forward to the next shift I worked. Again, couldn't find the medication, but as before, everyone else charted it as given. This happened on several occasions. I would finally ask the on-coming shift since they were charting that they were giving the medication, "Where is it?" They would give a half-hearted search and say, "Well its disappeared, it was here yesterday." Yeah right... I would also find medication patches on patients that were really old, and where then was the current patch? Never anywhere to be found. I would find liquid medication bottles that I recieved from pharmacy never opened, when I returned to work for my next shift. And of course the medication was always charted as given by the previous nurses. I would NEVER chart that I gave a medication I didn't, I like to sleep at night and look at myself in the mirror.