My back is against the wall... what should i do now?

[NurseLoveJoy88, ASN, RN]

A while ago I posted a thread about passing meds for 60 plus residents and refusing the assigment. Well now I was told that there will come a time when I would have to work as the med nurse and pass meds for 60 plus residents. I explained that even though I would only be responsible for the med pass I still can't see myself getting it all done. I work with alzheimers residents and sometimes it takes 20 min. Just to find them. Then we have 20 plus residents that take ensure, some meds must have vitals, some are crushed, some residents have to be encouraged for 20 min. To take their meds. Sometimes its a nightmare. I see nurses pass meds hours late and make many mistakes due to med errors. I just really don't want to be unsafe , behind or stressed. I don't have any option but to comply or I will become another new grad with no job. What should I do? I feel stuck .

[NurseLoveJoy88, ASN, RN]

When I did pass meds it would be for 30 res. Plus care. The units were split between two nurses. Now its a charge nurse and med nurse. Med nurse is in charge of passing meds only, for 60 plus demented residents.

[caliotter3]

How badly do you need the job? Most people just go in and do the best they can. What else can be expected of you? Don't make yourself sick over something that you cannot change.

[leslie :-D]

i'm sorry, but i would rather be a new grad w/o a job, than a new grad risking her pts and her license.

that is just plain nuts and dangerous!!

leslie

[SuesquatchRN, BSN, RN]

I certainly wouldn't spend 20 minutes hunting someone down, nor cajoling someone into taking his meds. Ask twice then mark them refused.

[cmonkey]

I certainly wouldn't spend 20 minutes hunting someone down, nor cajoling someone into taking his meds. Ask twice then mark them refused.

Interesting. Can demented pts refuse meds, or are they considered incompetent d/t their dementia, and therefore cannot refuse? When I did my last night of CNA clinicals, I don't think I saw any of the pts who refused be left w/o meds. That night was on the locked ward, though, so I just assumed the nurses were under orders to pass meds regardless of the pt's desires. I can understand not cajoling or forcing a pt who is A&O, but it's a little grey for me if they aren't.

[SuesquatchRN, BSN, RN]

Interesting. Can demented pts refuse meds, or are they considered incompetent d/t their dementia, and therefore cannot refuse? When I did my last night of CNA clinicals, I don't think I saw any of the pts who refused be left w/o meds. That night was on the locked ward, though, so I just assumed the nurses were under orders to pass meds regardless of the pt's desires. I can understand not cajoling or forcing a pt who is A&O, but it's a little grey for me if they aren't.

So how do you get them in? Hold his nose until he has to open his mouth to breathe and shove them in? God knows, I've been tempted.

[CT Pixie, BSN, RN]

From your mouth to God's ear Sue I'm right there with ya!

But you know if we did that, we'd get the meds in and in 0.3 seconds, we'd be wearing them.

[Whispera, MSN, RN]

Even in mentally challenged patients have the right to refuse meds unless there's a court order to force them. I think I'd spend some time trying to figure out why they don't want them and dealing with that though. Within time restraints!

[RN_Canada]

Interesting. Can demented pts refuse meds, or are they considered incompetent d/t their dementia, and therefore cannot refuse?

Shouldn't the issue be can the demented patient give consent?

I would really like to know who ordered those medications and who gave consent! But that is another thread!

Just in regards to the original posters concern, I think there may be something seriously wrong in this facility.

Most patients with dementia do better on no medication at all and so these patients should be reviewed with a view to eliminating as many medications as possible. Once you are over 4 medications you are likely not getting the maximum benefits from any one of them.

The issue must be on patient care NOT on passing medications. It is not the medications that must be looked after it is the patients.

Surely there are other people in the facility that can give out medications? This is not a protected nursing task. Patients who are low risk and on regular maintenance doses of medication could have their meds administered by other care staff so that the nurses could deal with the higher risk patients.

It seems to me that the nursing administration in this facility is not concerned with looking at the best way to get the work done and the most efficient way of using personel and meeting patient needs.

You have the opportunity here to bring some new ideas and be an agent of change in this facility.

Having said that you may not be prepared to take on that role - it can be a tough one, especially if the organization is more concerned with getting the work done than improving the way the work is done or providing quality patient care.

[SuesquatchRN, BSN, RN]

Surely there are other people in the facility that can give out medications? This is not a protected nursing task.

It sure is in New York State.

[MvfRN, ASN, MSN, RN]

Its easier to get a job when you have a job. Do the best you can do for now. In the meantime, look for employment elsewhere. The current company you are working for does not value patient care and safety, otherwise it wouldn't be practicing nursing like this. Since you recognize and are concerned about these safety issues, it obvious that your beliefs and values regarding nursing do not align with this company. You will never be happy at this job - so get out as quick as you can.