I started a new gig, RN, nights, LTC and rehab. I alternate between two wings.
The 0600 med pass is impossible. Close to 30 residents get meds, at least 10 get BG readings and SS insulin, I have been frantic. I haven't been able to turn over the cart on time, nor do those who have been doing these passes for awhile.
My count was also off this morning, by one pill. The nurse coming on said she didn't want to involve the DON and I said we had to. And the DON was behind the door! Nurse was explaining that it could have happened on the afternoon or evening, I just stated that I had signed off on the count as correct and it was on me. I asked the DON, half kiddingly, if she wanted me to pee in a cup and she just laughed and said it happens once in awhile.
I also told her that I was never, ever going to finish the pass on time. She asked why and I explained that while there were a lot of meds there were also a LOT of diabetics and other monitoring. I suggested that we change half of the pass to 5 am which would give me plenty of time, and that I was not comfortable with giving dig without an apitcal, etc., even if they weren't required because I felt it was unsafe practice.
SHE IS CHANGING THE TIMES.
This group is so unlike any I've worked with. We ALL work together, RNs, LPNs, aides. When I told the aides on my wing tonight that I would be in the break room they thanked me! They like communication. When I toilet someone they thank me. When they help me - and Lord knows, they do - I thank them.
I can't believe I am working with such a great crew.
Specializes in Gerontology, Med surg, Home Health.
I'm a big proponent of less is more when it comes to meds. Is your medical director as much of a gem as the DNS? Can you shift a lot of the meds to the day shift? At one place I worked, many of the meds were given on 3-11 (not to say that isn't a busy shift) ...there is no reason a once a day med has to be given on the day shift.
As far as the blood sugars, the latest studies show that unless the resident is on insulin, doing daily or 4x's daily blood sugars don't improve the quality of life. And...if someone is getting coverage based on a finger stick, their whole insulin regimin should be looked at. I don't have all the answers, but we got cited once during survey because the lab tech came in to start her draws at 4am and that was only once a week.
Gotcha. I don't know about him yet. I do know that I have never seen an early pass like this one. I also don't know why everyone isn't on HS Lantus, but that could be an insurance thing. Looking at the levels, these folks mostly wake up fine and the levels climb steadily through the day.
I have one guy on a Jevity feed. HE is around 200 q am!
I'm going to lay low for a bit. I just want to nail this as is and then I can say something. The other thing, though, is that a lot of meds are Tylenol so people won't mind getting up, a couple of pain meds, lots of Synthroid, and some calciums, which I think bind with other meds.
I don't know enough about the residents yet to say much.
I am so glad that you landed in such a nice facility. I agree with you on apicals for dig even tho here in MASS it usually is not done. I also like the early chem BG's esp for total feeds and those brittle, dementia pts who don't care what time it is, they are going to eat their stashed cookies, steal 2cal off of the med cart, LOL.
There is something sad behind all of our comments tho. Why are we all so astounded that a LTC facility has a DON who doesn't get ****** off at a suggestion by a nurse? Staff actually helping one another? Not very common. Respect for all staff? Also not common. Isn't that so sad? I love the elder population and would have happily done LTC and sub-acute forever, but I can't cope with the Napoleonic egos of some of the mgmt types, the fear of drug seeking family members of pts and staff lying in wait for nurses coming off shift (happened to co-worker) or violent CNA running me off the road for having the misfortune of witnessing pt abuse by said CNA (happened to ME!!!) The elderly are so vulnerable and in too many cases nurses are just leaving the industry burned out, chewed up and spit out. You are lucky that you found what may be a rare and decent place. BTW, did you see the news about the 100yo woman, a&o in Dartmouth, MA? She was murdered in her bed at a LTC facility near here. Talked to a few former co-workers there and for some reason no of us felt very shocked or surprised. Now that is sad.
Maureen
PS- Sorry to be such a downer. Maybe I will find a great facility like yours and be happy again. Your situations does give hope.
Maura, I can't say that I am going to stay here forever. Even with a great DON with work load is still insane and my day extraordinarily task-oriented. There's no time to do any learning in LTC, and that's a shame.
But it's nice for now. We'll see. I make no promises and bear no loyalty to any employer any more. She's nice for now.
There is something sad behind all of our comments tho. Why are we all so astounded that a LTC facility has a DON who doesn't get ****** off at a suggestion by a nurse? Staff actually helping one another? Not very common. Respect for all staff? Also not common. Isn't that so sad? I love the elder population and would have happily done LTC and sub-acute forever, but I can't cope with the Napoleonic egos of some of the mgmt types, the fear of drug seeking family members of pts and staff lying in wait for nurses coming off shift (happened to co-worker) or violent CNA running me off the road for having the misfortune of witnessing pt abuse by said CNA (happened to ME!!!) The elderly are so vulnerable and in too many cases nurses are just leaving the industry burned out, chewed up and spit out. You are lucky that you found what may be a rare and decent place.
Very well stated. Other than getting run off the road by an angry CNA, I've pretty much experienced everything you mentioned. I think I could have been happy, too, working in LTC for much longer than I did but I could no longer take the disrespect I felt from management. We had staff who attacked each other verbally; it almost seemed like a game sometimes to see if the oncoming day shift could make the night staff cry. There were problems with gossip and the DON would preach about maintaining professionalism and not talking about each other. Yeah, right. She was the worst, gossiping about some staff during meetings! Then she'd turn around and blame the staff for poor morale.
My former DON once was responsible for a med error and she actually changed someone else's documentation to cover her backside. There were other incidents as well. I could not believe the lack of ethics. Shoot, I've written myself up for making a med error---it's not fun but it's the right thing to do. I am still outraged that the person who was supposed to be the nursing leader of the institution could not admit to an error, potentially put residents at risk and yet saw nothing wrong with changing someone else's charting so she could appear infallible. I could not handle the CYA mentality and ended up leaving a short time later.
The saddest thing is, it's the conscientious nurses who leave and the little Napoleons who stay. I left. Several CNAs left at the same time. The facility loses at least two staff members per week. They are advertising again for more help. Those who are left are working harder and getting even more burned out than they were before. The DON could care less. She sees nothing wrong with hiring and firing capriciously, with signing on staff who won't stay and outright lying to new staff about their work hours and expectations.
This really hits home for me because just yesterday I visited with a former resident who told me how much she appreciated the care I gave and how she wishes I'd return to LTC. I can't. I've been far too burned and don't want to ever repeat the experience I had at my former institution. I had thought maybe I was just at a very bad place but I'm afraid that the bad places far outnumber the good. It should not be that way.
Ultimately, care suffers. And that's the saddest part of it all.
yup, take your time, proceed with caution....etc.....when you have the time...lol.....perhaps you can check out a patients meds and see a place to suggest a cut back....or other change......tiny little changes do add up in the end.....what is the ratio on the day shift? this is often (in my experience) the problem that impacts the noc shift....if days has too many patients per nurse, stuff gets shifted back to nocs....good luck
yup, take your time, proceed with caution....etc.....when you have the time...lol.....perhaps you can check out a patients meds and see a place to suggest a cut back....or other change......tiny little changes do add up in the end.....what is the ratio on the day shift? this is often (in my experience) the problem that impacts the noc shift....if days has too many patients per nurse, stuff gets shifted back to nocs....good luck
It's 20 - 1 on days. morte, one of the things here is that I have never seen people - almost all of them - on so many meds. And constant finger sticks, bp's q shift, lots of monitoring.
Another thing that happens here - a lot - is bad staffing management - literally forgetting to schedule nurses. We are supposed to have 2 on days and on one wing they scheduled 1, who called in. So I know that wing and helped the mandated nurse with her 8 am pass. But this is unacceptable.
CapeCodMermaid, RN
6,092 Posts
I'm a big proponent of less is more when it comes to meds. Is your medical director as much of a gem as the DNS? Can you shift a lot of the meds to the day shift? At one place I worked, many of the meds were given on 3-11 (not to say that isn't a busy shift) ...there is no reason a once a day med has to be given on the day shift.
As far as the blood sugars, the latest studies show that unless the resident is on insulin, doing daily or 4x's daily blood sugars don't improve the quality of life. And...if someone is getting coverage based on a finger stick, their whole insulin regimin should be looked at. I don't have all the answers, but we got cited once during survey because the lab tech came in to start her draws at 4am and that was only once a week.