Working for agency now - 3-11 LTCF. Very slow passing meds, finding patches, shots - everything is a problem. Everywhere I go it's always a new place. I am a fairly new nurse. As agency I get no orientation, no mercy.
Need tips on how some nurses pass their meds so fast - within an hour.
Each of us has about 30 patients or more. Some patients consume a lot of time when I try to hand them their meds -- the darlins just talk and talk, asking what each and every med is, why they have to take it, or basically just fuss a lot before I get them to take their meds, or they take their time to get positioned in their beds to take the meds, or three or four will ask for this med at this predise time - i'm not familiar with these pts enough and just throwing my pt sequence out of wack, and my speedy flow of med pass is lost. So tempted to combine the 4p and 8p meds to save time. By the time I'm done with the 4p it's already 7p, sometimes 8p - so close to the 8 meds. Small, if any, time frame difference anyway.?
In addition to the interruption on my med pass time the pts take, the aides interrupt with small things.
Doctors call, new admits come in, one pt who had surgery three days ago starts bleeding and in pain while another pt impatiently standing at the door demanding her med now. Patients sit by my cart and talk and talk to me while I'm trying to concentrate on med pass. Shift nurse at times failes to tell me finger sticks, so I have to look each one up, going thru the entire MAR - this is first thing to be done before dinner and already throws me off schedule. All this is time consuming. I am normally a very fast person in everything I do, but with all the delays/interruptions, I find myself going back over and over again just be sure of each med before I feel safe putting it into their cup.
Do a lot of nurses combine their 4p and 8p meds? Do some nurses just quickly throw the meds in the cup and mark the MAR after all meds are finished. Feel like writing up a sheet with their meds at 4 and 8, then just go down my one page list instead of paging through the MAR book. But this takes time too. Tried preloading cups clearly labeled in pts drawer, but a supervisor saw this and frowned at me. Where I worked before, I got the "system" under control because I became familiar with the pts and meds, but with agency its a whole new story. Afraid I didn't make a good impression on my first assignment. Feel very defeated, stupid, and not qualified to do the job. My supervisor says it will get easier in time - but every time it's a different place and pt, so don't see how. Finding things is part of the problem too. Any advise on how to control a fast med pass in a new place everyday? Agency hasn't called me with jobs for several days and am wondering if they're not too happy with my work.
Or is agency work just not my cup of tea. There's gotta be a way to conquer this - lots to do. The pay is great and I can pick when I want to work. Why one nite all I did was pass meds, no wound txs, no nursing notes, got the skilled notations, no notes for report - nothing but meds. please help, thinking this job is not for me. but really want to help people, especially the elderly. Advise? Tips? Encouragement? Down low.
Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS.
I have been an LPN for over 30 years. ;)I would never do agency work. I'm sure the money is good but the non-stop stress of new assignments and different places would surely kill me. I really do admire nurses who can handle that kind of constant stress but I would never make it out alive.
I agree! I tried it many years ago and decided it just wasn't worth the extra money. I admire nurses who can do it though.
I am a recently graduated BSN-RN that just received my license in September. I am having a lot of trouble getting my morning med pass done in a timely manner. I work 7a-7:30p and can rarely leave work until at least 8-10 after my shift ends. MY problem is that I work on a Rehab unit that involves Physical Therapy who wants their patients ASAP. Sometimes they try to take them downstairs before breakfast! I started working as an RN in November and I'm only about 6 days off orientation. After report and everything I usually don't make it to the floor to start passing my meds until close to if not 8am, so I am not finishing my med pass until around 11am. If we have a full house I have 24 residents, but the majority are geriatric. Therfore, it's not just in and out of rooms they take their pills and you're gone. One thing I learned was that we don't have to take BPs on everyone on BP meds unless there are parameters, so that slowed me down. I still tend to take BPs more often thant most nurses prob do, but if a pt runs low I get nervous and feel I should take it to be sure. I do the morning and noon med passes and I'm supposed to go to lunch after my morning med pass but then I have 11 & 1130 blood sugars, so by the time I take them it's time for meds again. So, basically the LPN who does treatments runs everything in the back and I have no clue what's going on with anything until roughly 1pm or so. Personally, I think since she's done with her treatments usually by 10 or 11 she should do the noon med pass since I'm the RN and ultimately responsible for the unit over her after my supervisor. Then there are days when I work with an LPN who works until 3:30 so I do all 3 med passes plus labs, admissions (which have been 5 in a day before). Typically, the LPN is supposed to work 8-4:30 and do the afternoon med pass. Then I can get in the back and do my papaerwork. I guess when you're the low man on the totem pole you get told things to make theri life easier because one LPN in particular always offers to do admission paperwork and says go ahead and do the 4pm med pass. I need to get a backbone and speak up I suppose, but I'm not the type of person who likes to step on toes since they have been there longer. I need help with something here I try to organize, I don't want to make med errors, and I'm really ticking off Physical therapy since it is a therapy unit. HELP! what can I do to be faster, I've only been working as a nurse for 2 months. PEople keep saying speed comes with time but when I have PT complaining that I'm not fast enough I'm worried I'll lose my job over this matter. My supervisor has been very supportive, but her hands are tied also. HELP HELP!
First and foremost, I don't believe that any new nurse should work agency. That is something you do when you have fine tuned your skills enough to be comfortable using an organization plan that you have developed for yourself at every LTC facility that you go to. I worked agency and I followed the same med pass pattern everywhere I went to, only changing minor things here and there to suit the facility. But if you aren't to a point where you have that down, then working agency is dangerous to patients and your license.
Agency nurses are expected to be experienced enough to walk into a facility and work without an orientation or training. If you are lucky, you might get a walkthrough....sometimes you do not.
Also, since many staff nurses may not offer information to you upfront, you need to already have a list of questions you ask at every facility the first time you go. Where is you med room? Where is your treatment room? How is your med cart set up? Crushes in applesauce? Where is you accucheck machine kept? (can't tell you how many times I couldn't find that damn thing.) Set your cart up, Do a quick flip of the MAR to find all of your blood sugars, tedious I know, but the day I rely on another nurse to tell me all of the blood sugars on the LTC floor I'm working is the day I make an error by missing one. Then you pass your meds. However, as a new nurse, you are less familiar with meds and this could make the pass take longer. For instance if a med usually comes in liquid form, being familiar to that is going to make you more likely to reach for the right drawer right away, instead of having to read an entire order before even looking for the med. Same with recognizing that certain meds that come in weening or increasing doses (prednisone, namenda) may be kept in a different type of packaging than a popcard, so you won't be staring at your popcards wondering where the hell that med is at. It's the little things like this that make the differences in your speed.
And do NOT combine med passes as tempting as it sounds. It's a med error and there's no two ways about it. Hell, some people even get the same med at 4pm that they get at 9pm. You can't give them both doses in one go. I worked with a girl who used to do that and you know what happened? They set up a camera to prove it and she was promptly fired.
My opinion is for you to find a staff job or at least work in facilities where you have less patients to each nurse. Hone your skills and then agency will seem far easier in comparison to what it is now.
I am a recently graduated BSN-RN that just received my license in September. I am having a lot of trouble getting my morning med pass done in a timely manner. I work 7a-7:30p and can rarely leave work until at least 8-10 after my shift ends. MY problem is that I work on a Rehab unit that involves Physical Therapy who wants their patients ASAP. Sometimes they try to take them downstairs before breakfast! I started working as an RN in November and I'm only about 6 days off orientation. After report and everything I usually don't make it to the floor to start passing my meds until close to if not 8am, so I am not finishing my med pass until around 11am. If we have a full house I have 24 residents, but the majority are geriatric. Therfore, it's not just in and out of rooms they take their pills and you're gone. One thing I learned was that we don't have to take BPs on everyone on BP meds unless there are parameters, so that slowed me down. I still tend to take BPs more often thant most nurses prob do, but if a pt runs low I get nervous and feel I should take it to be sure. I do the morning and noon med passes and I'm supposed to go to lunch after my morning med pass but then I have 11 & 1130 blood sugars, so by the time I take them it's time for meds again. So, basically the LPN who does treatments runs everything in the back and I have no clue what's going on with anything until roughly 1pm or so. Personally, I think since she's done with her treatments usually by 10 or 11 she should do the noon med pass since I'm the RN and ultimately responsible for the unit over her after my supervisor. Then there are days when I work with an LPN who works until 3:30 so I do all 3 med passes plus labs, admissions (which have been 5 in a day before). Typically, the LPN is supposed to work 8-4:30 and do the afternoon med pass. Then I can get in the back and do my papaerwork. I guess when you're the low man on the totem pole you get told things to make theri life easier because one LPN in particular always offers to do admission paperwork and says go ahead and do the 4pm med pass. I need to get a backbone and speak up I suppose, but I'm not the type of person who likes to step on toes since they have been there longer. I need help with something here I try to organize, I don't want to make med errors, and I'm really ticking off Physical therapy since it is a therapy unit. HELP! what can I do to be faster, I've only been working as a nurse for 2 months. PEople keep saying speed comes with time but when I have PT complaining that I'm not fast enough I'm worried I'll lose my job over this matter. My supervisor has been very supportive, but her hands are tied also. HELP HELP!
Try to get to work at least 15 minutes early to organize yourself. I will read over the written report real quick before I get the verbal. Look at and note any appt that your pts have. Get a list of therapy pts and if your PT dept provides a timed schedule write that down. An hr for report is much to long for 24 pts. See if they can make it shorter and get out on the floor quicker. Try starting off with the PT patients and give them their meds first that way you aren't hunting them down. Then I would give meds in a few different ways. I'd mostly target the pts that were sitting up and awake and could take thier pills the quickest then give to the ones that took longer. Just don't go down the hall in a row. (some might argue that it is better until you get to know the med pass) I'd try to get the residents that you know get up and leave the room early too.
Make sure your cart is loaded up before you start the med pass. Running around for things takes so much time.
Is PT giving nursing a list of pts and the time they need to be ready? If not..tell them you need it!
Doing a med pass at ANY LTC is a finely tuned art. I have discovered this. I'm still a WIP myself, but doing agency four months after graduating has taught me A LOT, honed my skills, and helped me to have the ability to "hit the ground running." Difficult? Yes. Endangering to my license? Never.
You will always find a shortcut or several that will work for YOU, and once those become habits, and you get into that "med-pass mindset," things will start to flow a bit more smoothly.... no matter what though, it's always a pill-pushing fiasco.
Some tips that work for me:
Sometimes you'll have a patient who's on eyedrops, inhalers, liquid meds, pills, and a f/s.... plus U need to bring them in something to drink. With a patient like this, I use my clipboard as a "tray" to carry everything in, so that I'm not juggling and/or making multiple trips in/out of room.
I ask the patient if they need anything for pain or need anything for PRN.... this can help avoid those moments where U finish a patient, are moved on to the next one, and then the patient calls out "Can I have a pain pill?"
If I bring in a drink for the patient (i.e., water) and they request something else (i.e., apple juice, cranberry, etc.) I say sorry, this is all I have. (I feel bad- but- if I dumped out whatever I had brought them, and went back for something else, for everyone that asked.... and have 30+ patients..... time's a tickin', folks.
I'm not afraid to write "patient refused" on MAR. I see nurses who beg, plead, and cajole with certain residents to take their meds..... and spend 15 minutes in the room..... then just end up throwing the med out and still marking it off as "given." This is BS. If I have a fussy resident who won't take meds, I ask "Should I come back later?" or I'll try again and if still no- I mark them as REFUSED and put on 24 hour report....
I used to start with the "easy" patients first, then do the hardest ones last.... But now I just go in room order, parking med cart from door to door. If I see a wanderer or passer-by, I flag them down and give them theirs. Also, If I have someone I truly dread giving meds to (biter, GT with 20 meds, etc.) I do them first to have it out of the way.
Hope these help and if not, at least provided some amusement.....
sharlynn
318 Posts
I agree! I tried it many years ago and decided it just wasn't worth the extra money. I admire nurses who can do it though.