What di I do, getting frustrated

[LegginMF]

Hi guys, I work in a alz/dementia assisted living facility. It currently has 52 residents with room for 66. The problem I am having is the other nurses not doing what they are supposed to do, making huge mistakes and it is scaring me to death.

The facility is one building three different locked courts. 1 LVN per shift for the entire building. 6-2 shift has 2 LVN's but the second one is the DRS, she doesn't work the floor.

These are the examples just for the last month.

All a.m. meds are marked on the MARS to be given at 8, how can you be in 3 different courts at once?

Not all meds are being given, I find cups of meds from the previous shift sitting in the top drawer of the med carts, and it's not being charted on the MAR as held or refused. They are signed off as given.

No orders for treatment are even gotten. If you are off of work and someone gets a s/t it stays on the alert charting form for three days. If you are off for 3 days or more you never see it and never know it is there. I have found three residents in the last 2 weeks with bandages that have not been changed in who knows how long. I found them by smell! Why? because no one bothered to get an order and put it on the MAR so everyone would be aware of it.

A resident had an order for Lamisil p.o. x 30 days. who ever copied it to the MAR forgot to put x 30 days. So she got the med for an extra 24 days. I discovered it by accident, because I was doing 30 day order updates to be faxed to M.D. for signatures.

A resident was given Rx for bactrim, I was off for 3 days and when I came back I saw it on the MAR. The problem? The bubble pack for the a.m shift was unopened, but 3 were missing from the p.m buble pack and the order date was from 3 days before. Meaning she did not get her a.m dose of ABT for the first 3 days she was on it.

I noticed a residents Zyprexa pill count was really low. I know when the family delivered the medication and how much was delivered, because it was given to me personally by the family member. I left a note on the MAR asking where is her zyprexa. It turns out the a.m nurse was giving meds by memory not MAR and was giving her zyprexa in the a.m. when resident is only supposed to have it in the p.m. So resident was double dosed for approximately 13 days. When I confronted said nurse she said "oh, just don't give her any for a few days she'll be fine"

I found phone orders from 8-o6 that had never been mailed to M.D. for signature.

I found 30 day orders from as far back as 4- 06 that have never been updated.

I find meds in the cart, usually cough medicine or vitamins that have been brought in by the family for resident use that are not on the MAR and there is no P.O for them and they are being given to the resident.

I found new phone orders for a resident who is now actively dying stating that he is NPO, all meds d/c'd except MS elixar etc..that were written 8 days ago and never transferred to the mar. The staff has been getting him out of bed for meals!

When I left for my 3 days off a resident had exactly four pills of ativan left. I told oncoming shift in writing that the family needed to be contacted for more. When I came back the med had never been ordered and there were exactly four pills left. Meaning that they were never given. This is a standing order.

I keep going to the DRS and she keeps telling me to fix it! I don't want to spend all of my fixing things.

I hate confrontation and because all of the other nurses are experienced and have worked ther for a 1-2 yrs ( I have been there for 4 months) they tend to blow me off. I have threatend to quit several times and my DRS begs me to stay, (guess they need somebody to clean up the mess).

Now mind you, these are just the mistakes I have found in the last thirty days! What do I do to make these people get with the program. I am scared to call the state as I am sure I made a a few mistakes in my first couple of weeks, (mostly charting, somebody forgot to explain to me about charting procedures, I was told that because it is assited living that they don't chart. So I didn't chart for the first 3 weeks I was there.) I am scared of losing my license but I am more scared of what may happen with the residents, I truly care about them and want to do my best to help them, this kind of treatment and uncaring attitude makes me mad!

[NICUrn2B]

My goodness! What state is this in? If I were you, I'd get another job and definitely call the state!!!!!

I don't understand why people (like those who work with u) become nurses when they dont have a compassionate heart.....

[LegginMF]

California, I would hate to beleive it is like this every where.

[Cherybaby]

As a paralegal for a number of years before becoming a nurse, let me give you some unsolicited advice. You need to leave that job. If someone from JCAHO or OSHA or some other government service comes in, you are putting your license at risk by being one of the nurses working for that facility. Everytime you put your name/initials down, you are condoning the actions of these nurses. You did the right thing by trying to report it to your supervisor, but obviously, they are not taking you seriously. There are anonymous "whistle blower" hotlines set up in every state. I suggest you utilize one as soon as you leave this facility. Also, upon leaving, I would write a letter to the Board of Nursing. If you want what is best for the residents, you need to report this facility. Nothing will ever change if you don't take action. By reporting these infractions, you are protecting yourself and the residents simultaneously. You can not bear the burden of fixing all of this on your own, because ultimately, you will fail. You cannot undo years and years of mistakes by yourself.

I strongly suggest you leave this facility while your license and your integrity are still intact.

Cher.

[LegginMF]

I have been charting everything I find/fix in residents charts, including the fact that I notified the DRS. And yes I am looking for another job. What is the anonymous whistle blower number?

[Simplepleasures]

I have been charting everything I find/fix in residents charts, including the fact that I notified the DRS. And yes I am looking for another job. What is the anonymous whistle blower number?

There are oversight agencies in every state that do just that, it oversees nursing homes to see if they meet up to standards set by state or federal law. These agencies are usually a part of your state health and human services or whatever term they use in your state, or you could even contact the Ombudsman, and ask them to direct you to the correct state agency, plus you can tell the ombudsman about this facility.The Board of Nursing is the agency that liscenses nurses, doctors, etc, but does not inspect the facilities. What you want is the name of the agency that comes in to do the state surveys, you can call them, email them or even write them a letter. If your facility finds out you did this, be prepared to get fired, if they fire you for this reporting, some states have whistleblower retaliation protection laws, which means you would be protected from retaliation from your employer.Well, good luck, sounds like your facility is a tradgedy waiting to happen, hope the tradgedy doesnt happen to you.

[luv2shop19mall]

omg. i thought i was the only feeling so weird.. well i worked for a alzheimers unit also and let me tell you .. im a new grad and when i pass my meds i always sign the mar book well the nurse thats suppose to orientate me has no patience to orientate me and if i didnt ask her who she gave the meds too since theres no signature. !!! i hate it. its so disorganized and i dont understand why people are like that. i dont care. i am not like that. i worked for alzheimers and i see it this way. when i get older i wouldnt want anyone doing that to me.. thats why i am compassionate and i cant see myself like that. some people just go to get paid.. ;(

[luv2shop19mall]

i totally fee what you feel . i also care about my residents. just seeing them in the dining room i just go in there and start talking to them. im a new grad and i was passing my meds today. but i know how to read the MAR AND the nurses dont sign the medication right away. i feel bad and i deifnitely knw if osha was there.. shish.. it would be so bad . the residents dont even get changed and when they are walking and wandering around i can smell them.. they have no rn supervisor for 3-11 and one rn supervisor the whole day .. i dont know what to do. i feel strange also..i feel bad. ;(

[jelorde37]

i was in your shoes too acouple months ago. i found an order for abt that was ordered at 7am in the morning, when i came to work at 3 pm, i found that the t.o. wasnt sent to pharmacy and the patient has not recieved his abt. i dont know about other facilitys, but my facilitys protocol is to administer any abts within 4 fours from the time it was ordered. ive caught many things like that and i wasnt gonna get trampled on. i felt like the nurse before me was just passing along her work that shouldve been done within her shift. at first i was just taking the punishment like a man until my fellow coworker got fed up and told our DON. the DON talked to me and told me to tell the adon. my adon told me to report to her any kind of work that was being left behind and just like i was ordered, i reported to my adon. everytime the nurse before me left any work, she would get chewd out by the adon. eventually, the nurse before me stopped leaving work and i finally had to stop cleaning up after her. i suggest that you report it to the state because your drs isnt doing anything about it.

[canoehead, BSN, RN]

Well, does your unit have a photocopy machine?

I would start off every med pass every shift with a stack of postit notes and a stack of incident reports. Make yourself a postit for everything that needs to be followed up by you, jot on an incident report everything that needs to be reported up the chain of command. Complete your rounds with as much high quality care as you can, but document meticulously. Obviously these charts are going to be scrutinized eventually by TPTB.

Before you leave each shift give a written list of things that still need to be followed up on to the next nurse. You won't have time to solve everything during your shift. Make a copy of the to-do list for your own protection so you know you passed it on. Block out the name of patients on the incident reports with an index card, and make a copy of each one so you can prove you reported everything up the ladder. Go home with a clear mind.

TPTB may just ignore your reports, fine. Your coworkers may be annoyed, just tell them you are a by-the-book girl, and you have to at least go through the motions or you can't live with yourself. Besides, if you do all that follow up it's less for them to worry about...it'll save them some time, and you know how hard they work. You'll spend your life at work on paperwork, but you'll keep your license.

If you enjoy your job and your patients that is one way to go about it. If you need time to find another job there is no need to quit immediately. But I'd be looking, and be ready to get out quickly if start getting backlash because you are so careful. If they do fire you, well, don't you just have a huge file at home that will cover your ass six ways from Sunday? You are an excellent nurse.