Med pass followed by state...

[KJM-RN, BSN]

I am a new grad RN working in LTC (mostly in the short term rehab units, but I float to LTC as well). I will first admit that I do not want to be working in this field, but with an associates degree it was all I could land... now I really want out. I am consistently told by my supervisors (i.e. the NCC's) that I am doing extremely well and was even told by one that I am the best new grad they have worked with.

The DOH medicaid surveyors were recently in our facility, we have a 5 star rating. I was picked to have my med pass followed by one of the surveyors. After about an hour of being followed, the surveyor told me I did an excellent job, she wished me luck in my career, and left. A couple days later I was approached by the educator in our facility and handed a write up. He continued to berate me in his office that our facility could be cited for a mistake I made during the med pass. The surveyor stated that I didn't close the door of the patient's private room when giving an injection in their arm. I held back tears as I was being yelled at and handed a write up to sign. The educator told me I took the dignity of the patient away and this may cause them to be cited by the state. I was ok with the write up, but of course upset as I always try to do the best I can as a nurse and provide dignity for patients. I was "educated" and went on with my day. I will always shut the door when giving a patient an injection now, I learned from my mistake.

Since then I am constantly being watched by the educator and had no idea why, I could tell something was up because every time he walked past me he would have a comment about something I was doing. A couple weeks ago I was approached again by the educator and told my med pass was going to be followed, I got super nervous, but did what I was supposed to do as every move I made was being picked apart. "You really should wear gloves when you use the purple wipes to clean the glucometer" "You should put a towel down before you bring the glucometer into the patient's room" "Your box of gloves are too close to the garbage" (they were sitting on a shelf on the med cart above the garbage) "Your Ensure is expired" (it wasn't)...

I felt like he was out to fire me somehow, about a week later he's back again to follow my med pass. I asked why am I being followed so much. I was told that I can't accept constructive criticism if I'm asking that question. I have since found out that for 6 weeks my med pass is going to be followed and then each month there after (for I don't know how long).

Am I taking this too personally or is this serious overkill for education? I learned from my mistake and will never do it again; I am a fast learner, a diligent worker, and care about my patients. BTW, we weren't cited and are still a 5 star facility. Sorry this is so long, I needed to get it off my chest big time.

[amoLucia]

Your detailed, specific observatory med passes & counseling actions sounds like a POC (plan of correction) for a deficiency on the recent survey report. Not sure if it was a "true" deficiency or just an observation, but that's my guess for what has generated the scrutiny.

I truly don't know if you're being singled out for termination - admin would usually fire someone shortly thereafter. You're being retained with interventions. But corrective actions usually fly hard & fast after survey. There will probably be other remedial actions like Resident Privacy & Dignity inservices for staff and med pass observations of other nurses.

This kind of stuff happens all over - not isolated just to LTC. It sounds like you've been doing well so you've seemed to be fitting well into LTC. Please, don't misjudge the field because of something that is commonplace - it's tough that it just happened to be you on the receiving end this time. You're a newbie and we seniors have seen it freq before.

Hang in there and a big hug out to you.

[withasmilelpn]

It's a wonder why many talented nurses don't want to work in LTC, when something that simply requires a warning gets elevated to this extent. How absolutely ridiculous! I love my Residents, my hours and the staff I work with. The regs are ridiculous, the job is often impossible, given the sheer number of patients you care for, no matter how good a nurse you are. I think of leaving all the time. I'm so very sorry that you are being treated this way.

[Sam J.]

Rule number 1: Anytime a surveyor compliments you, be prepared for a warning, a write up, or to be terminated.

Rule number 2: Anytime you are warned, or written up, or terminated for not closing a door- consider it a compliment that otherwise you did an 'amazing' job on your med pass, and that in fact you ARE a great nurse!

[KJM-RN, BSN]

This is exactly my point. I get I did something wrong, according to their standards. I won't ever do it again, even though patients and residents get quite irritated when I have to wheel them back to their room and shut the door to give them insulin before dinner. Many argue with me about it, saying every other nurse just gives it to them in the dining room. I seriously just want to scream in the educators face that I get it, there is no need to follow my med pass constantly and pick at me for everything. There are just so many rules that really don't make much sense. I love nursing, but I don't know how people work in SNF for so long without losing their minds. I do enjoy my job on a daily basis except when the educator shows up weekly.

[morte, LPN, LVN]

I felt like he was out to fire me somehow, about a week later he's back again to follow my med pass.

I asked why am I being followed so much. I was told that I can't accept constructive criticism if I'm asking that question.

I have since found out that for 6 weeks my med pass is going to be followed and then each month there after (for I don't know how long)

.

that response was totally inappropriate, I would be extremely upset myself if someone took that tone with me. would a meeting with the adon/don and staff educator be possible? the staff ed person is being argumentative/rude/noncollegial, in fact hostile. good luck

as long as the patient was shielded, ie you are between the doorway and the hall, or privacy curtain pulled, what would be the point of closing a door?

[Sam J.]

that response was totally inappropriate, I would be extremely upset myself if someone took that tone with me. would a meeting with the adon/don and staff educator be possible? the staff ed person is being argumentative/rude/noncollegial, in fact hostile. good luck

as long as the patient was shielded, ie you are between the doorway and the hall, or privacy curtain pulled, what would be the point of closing a door?

I suspect the 'educator' is from the home office (corporate nurse consultant). If so, best of luck complaining about him to the DON, because he is likely a boss of the DON.

Those consultants wouldn't have a job if they didn't find problems to 'fix'. Again, the fact the poster is being harrassed over a single door being left open tells me she did a bang-up on the med pass, and maybe the educator wants to put her in her place. Sad, but to have a med pass watched over for 6 weeks will take so much time the nurse will surely be unable to complete all the other work in her shift, which might lead to further problems. It sure sounds extreme.