Don't state surveyors know that med nurses (and other nurses for that matter) cannot possibly do everything the job entails? That it is impossible for one nurse to pass meds to 25+ plus patients within the 2 hour window "by the book"? That the facility basically puts on a show once a year when they arrive?
I especially feel for CNA's. Its bad enough to be on the bottom of the totem pole, so to speak, as far as pay and "status". Its such a difficult job, especially when there are so many patients to care of in an 8 hour period. What makes the department of health think its okay or feasible for one nurse to care for so many patients?
It almost makes me sick...it really takes a special and strong person to work in LTC's for many years. Okay...rant over!
I thought the same exact things last year when I heard our time to get surveyed was approaching. I've heard from people that have worked other places that the grass is not greener anywhere else. I stayed at my job and I'm glad I did. I love where I work. I love the residents and I think my co-workers are pretty great.
I think the quality of care can be terrible when we're at full census. I can't just walk away though, that doesn't solve the problem. I go in every day determined to get as much as possible done. I've made a ton of progress, I can get a lot more done than when I first started.
It's hard to ignore everyone complaining. Everyone thinks their own shift is the hardest. I keep most of my own complaints to myself. I need to keep a positive attitude to get me through my shift.
It's hard to find ways to speed things up that don't break rules, but here's what I've found:
My facility has put an emphasis on a safe med pass from the very start. They told me not to worry about time, just worry about getting meds out safely and to take as much time as I need. No one has noticed or said anything to me about starting meds as soon as I'm done with report. When you've got about 6 people that routinely ask for pain meds and 13 people that need blood sugars (and at least half of those need insulin) good luck starting at 7 and getting all that done. Sometimes night shift will stay a few extra minutes and do blood sugars, which is really helpful.
Teamwork- I don't know how I would've survived without a ton of support from the other nurses. Now that I've got a pretty good handle on my wing, I'm able to offer my help to them if they need it. We all need help sometimes.
Utilize your team. If I'm doing the med pass and someone has an issue with a catheter, I ask an RN to handle it. They've always had time. If someone asks for ice, a CNA can do that. It seems very simple to just go and get some ice, but it's never ever ever simple. The phone will ring, a family member will stop you, at least one resident will stop you. The hallway is like the Bermuda Triangle. I'm scared to go in the hallway without water and food rations because everyone and their mother is in the hallway and they are bound and determined to stop me. I figure I can answer call lights and fix problems myself after I'm done with the med pass.
The biggest thing that's helped me is I've learned to walk away from certain people while they are still talking. It feels so rude at first, but then you realize there are people that will not stop talking. There are people that will keep staff in their room for hours. Once you know they're fine and their needs are met for the next minute, then it's time to leave. There's always at least one person that needs constant attention and if you get more than one resident like that, you can get tied up incredibly easy. I've told the CNAs they can use me as a bad guy and tell a resident "we can only stay in here for a half hour, Nurse bathrobemom said so".
New residents can have a lot of questions about their meds and might just want to talk about what brought them to the facility. If they have questions about meds, I offer to print off their med list and I bring their med cards in their room so they can see exactly what they're taking. This cuts down on a lot of questions and confusion, saves time in the long run.
My facility is at low census right now and it's been really nice. I actually take breaks and have time to get everything done.
Long Term Care facilities and their employees should be at the forefront for resident advocacy and protection. If you see things happening it is our duty to report, use the Ombudsman's office if necessary. Our jobs as nurses are first and foremost to protect and cause no harm. What if this was your family in these situations? We call all say that my parents would never be placed, but never is a very strong word in a unforeseen situation. If you feel as though meds should be d/c'd and not necessary (vitamins), write a fax don't just assume it is ok not to give per order. It is very disheartening the way you speak of our population that deserves respect and protection. Doing the things I have seen on this post you are just as bad as the bad management you report. Hello, if you have that many bedsores it is obvious that nutritional screening isn't being done, repo schedules, or proper wound management. Unless of course they were admitted with these. And yes one person can make a difference for our elderly as long as we all treat them as if they were our own parents or grandparents. LTC should not be a dumping ground for those who just want a job, it is a passion. and Yes I worked in a 100 bed facility, short all the time. But what we did have for staff had a passion for our people under our care and NO we did not skip meds because we felt they were unimportant, and NO repo schedules were not missed. We had at most 1 in house at the max with a bedsore and that was usually a new admission from other homes or hospitals that did not follow protocol.
The facility I'm rotating in now charges between $5,000 and $8,000 per month per resident, yet there are only a handful of thermometers, blood pressure cuffs and pulse oximeters in the whole place. When we take vital signs we have to wait our turn because each hallway has many residents and only one vital signs cart. Also it's a long walk to find a dispenser for hand sanitizer. Seems like they cut corners everywhere. I sure hope I don't have to work LTC when I graduate as an RN.
I've had to bring my own APPLESAUCE to mix meds with, and when we were out of pill crushers, my DON told me to cut the fingers off of gloves and use those. I left on my lunch break to buy sandwich baggies, I refused to cut up valuable supplies.
Specializes in Oncology, Rehab, Public Health, Med Surg.
I will say that once you pass the same meds to the same people forever, you become familiar with them. I pass to 20/25 people. I always do my checks by the book. When I first started it was nerve wracking. But the way the system is set up, it makes it much easier but could be very detrimental for the lazy or busy nurse. The meds come in packets. For example, pt. Bob Jo Bologna has packets for each time/day. So 0800,1200,1800,etc are all separated into packets. So in the 0800 there may be MPAP, Metoprolol, Simvastatin and Lasix. They come in one packet. Printed on the packet is pt name, time, date, drug name, drug dose and description. Based on familiarity I can look at the pack and say "all is well" or "wait a minute, something is different". Due to human error, sometimes a meds details are on the packet but the med itself is missing. But with familiarity and proper checks against MARs, this is not very time consuming. My by the books pass, with no other interruptions, takes about 1-1.5 hour. Sorry for the wall of text. I love my job and do not feel like it is a joke at all.
I really like the idea of the packets. Is there a guide to which pill is which? When grandma takes 12 pills at breakfast and you have to take one out, which blue pill is it?
And do you have extra pills? What if the metoprolol is increased? How do you add in?
Yes so true and can you imagine being a new nurse like me and going through this? Its really stressful and I spent years being a nurse aide and this is a totally different ball game. I work nights and I am responsible for so many people......I want to cry sometimes.....I'm frustrated with the nursing home and I just started. I love my residents though....they're sweet.....but it's so many of them and one me.
The liquids cost more. Also, many times the docs order meds that should not be crushed, however, the resident needs crushed - but the nurse taking the order does not recognize that, so either meds end up given crushed that should not be....or the resident is given a whole pill he/she cannot swallow - until finally someone notifies doc of the problem.....
Seriously? How are the prescribers making money from the pharm companies? I've been prescribing in LTC and clinic for 12 years, and never once has a pharm company given me money....
I really like the idea of the packets. Is there a guide to which pill is which? When grandma takes 12 pills at breakfast and you have to take one out, which blue pill is it?
And do you have extra pills? What if the metoprolol is increased? How do you add in?
We switched to these packets some time ago and they are nice. Each packet lists the pills inside, their dose and a short description like "round, white with imprint xyz." If a med is changed/discontinued after the packets are already printed it is easy to pull the right pill and destroy it. If a new med is needed the machine that dispenses the packets also acts as a pyxxis so pulling an additional dose or a different med is a breeze.
These packets have not only saved tons of room on an overloaded med cart, I believe they also speeded up med pass by a lot. The only thing we need to store on the carts now are the OTC meds that don't come in the packets and odd doses, like 1/2 tabs that still come on cards. It even makes narc count go much faster as the meds are restocked daily so we are not counting multiple cards of narcs for each resident on them. Even prn's are pulled from the machine as needed, so no narc count required for those anymore. Overall we are very happy with the change to this system.
Specializes in Oncology, Rehab, Public Health, Med Surg.
We switched to these packets some time ago and they are nice. Each packet lists the pills inside, their dose and a short description like "round, white with imprint xyz." If a med is changed/discontinued after the packets are already printed it is easy to pull the right pill and destroy it. If a new med is needed the machine that dispenses the packets also acts as a pyxxis so pulling an additional dose or a different med is a breeze.
These packets have not only saved tons of room on an overloaded med cart, I believe they also speeded up med pass by a lot. The only thing we need to store on the carts now are the OTC meds that don't come in the packets and odd doses, like 1/2 tabs that still come on cards. It even makes narc count go much faster as the meds are restocked daily so we are not counting multiple cards of narcs for each resident on them. Even prn's are pulled from the machine as needed, so no narc count required for those anymore. Overall we are very happy with the change to this system.
I don't work LTC now but did about a million years ago, lol. These packets sound like they'd be the ideal solution
Thanks for answering I like to hear how other specialties do things.
bathrobemom, LPN
90 Posts
I thought the same exact things last year when I heard our time to get surveyed was approaching. I've heard from people that have worked other places that the grass is not greener anywhere else. I stayed at my job and I'm glad I did. I love where I work. I love the residents and I think my co-workers are pretty great.
I think the quality of care can be terrible when we're at full census. I can't just walk away though, that doesn't solve the problem. I go in every day determined to get as much as possible done. I've made a ton of progress, I can get a lot more done than when I first started.
It's hard to ignore everyone complaining. Everyone thinks their own shift is the hardest. I keep most of my own complaints to myself. I need to keep a positive attitude to get me through my shift.
It's hard to find ways to speed things up that don't break rules, but here's what I've found:
My facility has put an emphasis on a safe med pass from the very start. They told me not to worry about time, just worry about getting meds out safely and to take as much time as I need. No one has noticed or said anything to me about starting meds as soon as I'm done with report. When you've got about 6 people that routinely ask for pain meds and 13 people that need blood sugars (and at least half of those need insulin) good luck starting at 7 and getting all that done. Sometimes night shift will stay a few extra minutes and do blood sugars, which is really helpful.
Teamwork- I don't know how I would've survived without a ton of support from the other nurses. Now that I've got a pretty good handle on my wing, I'm able to offer my help to them if they need it. We all need help sometimes.
Utilize your team. If I'm doing the med pass and someone has an issue with a catheter, I ask an RN to handle it. They've always had time. If someone asks for ice, a CNA can do that. It seems very simple to just go and get some ice, but it's never ever ever simple. The phone will ring, a family member will stop you, at least one resident will stop you. The hallway is like the Bermuda Triangle. I'm scared to go in the hallway without water and food rations because everyone and their mother is in the hallway and they are bound and determined to stop me. I figure I can answer call lights and fix problems myself after I'm done with the med pass.
The biggest thing that's helped me is I've learned to walk away from certain people while they are still talking. It feels so rude at first, but then you realize there are people that will not stop talking. There are people that will keep staff in their room for hours. Once you know they're fine and their needs are met for the next minute, then it's time to leave. There's always at least one person that needs constant attention and if you get more than one resident like that, you can get tied up incredibly easy. I've told the CNAs they can use me as a bad guy and tell a resident "we can only stay in here for a half hour, Nurse bathrobemom said so".
New residents can have a lot of questions about their meds and might just want to talk about what brought them to the facility. If they have questions about meds, I offer to print off their med list and I bring their med cards in their room so they can see exactly what they're taking. This cuts down on a lot of questions and confusion, saves time in the long run.
My facility is at low census right now and it's been really nice. I actually take breaks and have time to get everything done.