the neverending med pass

rehab nurse · Oct 22, 2005

come work with me! although management is not great, the job is good and i make a difference to my patients. on my rehab floor, we have two nurses to nineteen patients, as well as two CNA's. not too bad, but i know what you mean about constant calls to the doc, irate families with no supervisor on sight, etc.

just to give you a picture of the ltc we are attached to: one unit with sixty beds, three halls. three nurses, each with 20 a piece, and is strictly long term care now. six aides. tried for a while to make that a skilled unit as well, and it proved disasterous. second unit, with 40 beds, two nurses, four aides.

they are not all bad....but it took me a long time to find this place!

HONEYBEAR · Oct 22, 2005

WOW!!!! I would love to work in a place like this. :rotfl:

come work with me! although management is not great, the job is good and i make a difference to my patients. on my rehab floor, we have two nurses to nineteen patients, as well as two CNA's. not too bad, but i know what you mean about constant calls to the doc, irate families with no supervisor on sight, etc.
just to give you a picture of the ltc we are attached to: one unit with sixty beds, three halls. three nurses, each with 20 a piece, and is strictly long term care now. six aides. tried for a while to make that a skilled unit as well, and it proved disasterous. second unit, with 40 beds, two nurses, four aides.
they are not all bad....but it took me a long time to find this place!

dekatn · Oct 22, 2005

I work days in LTC and have three med passes from hell. I think these time frames that are set up were put into place prior to all the magic meds we have now. If a pt. loses a pound or two or decides they don't want to eat everything on their plate, regardless if they are still way over the IBW, they are placed on an appetite stimulant. Vitamins out the wazoo. Tylenol scheduled, new alzhiemers drugs for pt. that are so far out in left field they won't ever find their way home again. It has really gotten way out of hand. A lot of it too, is now days we have to treat the families instead of the pt. If a family member sees a commercial on t.v. for a new miracle drug they want mom or pop to have it and the docs all comply. Put them on a med to constipate them, then give them a lax and stool softener, then immodium to stop the diarrhea. I could go on and on. I'm sick to death of LTC and nursing in general but I don't know how to do anything else. The docs around here are always adding meds but never take anything away. Some of my pt. have two drawers full of meds. It's ridiculous. Especially when you have to crush and mix they don't want to take it, who can blame them, I have a couple of little ladies that run the opposite direction when they see me coming with my hefty ole med cart!! I think LTC is way out of control and I don't see an end in site, ours is a for profit facility and the bottom line is the almighty dollar so our staff and just about everything else is cut to the bone. Nobody cares if we burn out they just place an ad in the paper and replace us with some other unsuspecting nurse. The rooms are so small you can't even get to the pt. to give care without moving stuff around. Nevermind, I get carried away. Sorry. Just wanted to let you know I definitely know where you are coming from, I'm just not sure where we are all going.

CapeCodMermaid, RN · Oct 22, 2005

Call a meeting with your medical director and your pharmacy rep. We have our rep do this once a month and recommend dc'ing useless drugs. Or if the person takes Colace 100 mg BID, change it to 200 daily. A lot of little changes like this can add up to minutes off the pass. And you're right...we hand out way too many pills

SandraJean · Oct 22, 2005

I tried working in a ltc facility, and the med passes were overwhelming to me. I am an energetic, organized person, so thought I could get a handle on it, but it was so horrible that I could hardly see straight! I had to pass meds for up to 30 people, most of them were crushed and had to be fed with yogurt. Each person had at least 6-7 mars to sift through each time and the drugs were located in at least 5 different places. Plus half the time, the meds had not been re-ordered, so had to look around to "borrow" from other residents. This was in addition to gastrostromy tube feedings, etc. I had hardly any time to even look at the residents and do assessments. Yuck. Why should a morning med pass go until 1:00 pm? After starting by 6:30 am? Not for me.

Jo Dirt · Oct 22, 2005

It is a horrible system, the way they expect you to pull a pill passing marathon. Amidst eye drops, ABO's, swish and swallows (and the list goes on) they expect you to do tx's and chart the same old crap shift after shift on the same patients until you run out of ink.

I have tried, I have really tried, and I was defeated. No matter how energetic or how good your intentions are there is just absolutely no way to get it all done. Half-a$$ed is the mantra of the nursing home floor nurse. And that doesn't make THEM the bad people, that's just the way it is.

I attempted to orientate a 3-11 nurse who insisted on doing it all by the book. After two weeks of staying until 2-3AM and a lot of frustrated tears she quit and went back to a quiet ICU.

Most nursing homes are hell and are just old people mills where they ship them in and haul them to the funeral home and ship another one in the bed before the sheets have been completely changed.

I hope I never have to be in a nursing home. I'd shoot myself first.

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 22, 2005

It is a horrible system, the way they expect you to pull a pill passing marathon. Amidst eye drops, ABO's, swish and swallows (and the list goes on) they expect you to do tx's and chart the same old crap shift after shift on the same patients until you run out of ink.
I have tried, I have really tried, and I was defeated. No matter how energetic or how good your intentions are there is just absolutely no way to get it all done. Half-a$$ed is the mantra of the nursing home floor nurse. And that doesn't make THEM the bad people, that's just the way it is.
I attempted to orientate a 3-11 nurse who insisted on doing it all by the book. After two weeks of staying until 2-3AM and a lot of frustrated tears she quit and went back to a quiet ICU.
Most nursing homes are hell and are just old people mills where they ship them in and haul them to the funeral home and ship another one in the bed before the sheets have been completely changed.
I hope I never have to be in a nursing home. I'd shoot myself first.

While I don't think I'd be quite that harsh, I have to agree. What I've seen so far has been far away from good nursing care, and it's NOT the nurse's fault.

night owl · Oct 22, 2005

I'm beginning to wonder. All the nurse ever does all day, evening and half the night shift is pass meds. The day shift passes meds from the time they get report until 1pm, takes a lunch break and then passes more pills until 3pm. They do treatments in between somewhere. The evening shift passes meds from the time they get report until 7pm, takes a dinner break, then passes more pills until 10 or 11pm and does some treatments in between somewhere. The night shift passes meds from 0430-0500 until report. God forbid someone has CP or falls or codes, you get so far behind that you're screwed. We have 60 residents when we have a full house and in 24 hours, our unit dishes out over 1400 pills of which just about every resident has to have their BP taken before giving their meds. That alone takes up a lot of time. Then the machine loses it's charge and then you have to plug it in, unplug it, plug it in, unplug it. WHAT A PAIN IN THE BUTT!!! You're pushing a 260 lb med cart and pulling the BP machine along with it. My shoulders are getting more painful by the day, but I can't pass meds until I take my Motrin, who by the way has become my best friend. It's getting so ridiculous! The docs put them on meds and never take them off, they order meds so that you have to go into the computer and chart it whether or not it was given instead of ordering it PRN. (ie) doc orders an inhaler "while awake." so at 0100 if he's peacefully sleeping you still have to go log on to the computer and chart it "held" because he was asleep. A waste of my time, but covering his butt. You ask him to order it PRN because the pt rarely ever needs it at 0100 and he looks at you like you have three heads. And then they order more meds. I hate to say it, but when a resident goes out sick to the hospital and he has a lot of meds, it lightens the load for awhile. Now they're on the old Nitro paste kick. What ever happened to modern technology using the patches??? I'm about ready to give up. And then they order more meds. Sheesh...........

night owl · Oct 22, 2005

Just a random thought, but tonight there were FOUR people making sandwiches at Subway. That just caused me to think about how messed up priorities have gotten. Subway has four sandwich makers and the
elderly share one frazzled nurse with up to 70 other people.

I don't know about you, but this is enough to make me physically ill and raving mad.:angryfire But what really irks me is that if something should go wrong they're blaming you, suing you, ready to pull your license, and ready to give you the boot. This country has gone to the dogs and no one really cares about the sick and the elderly. Darn it, it's all about the money. It's always been about the money and it will always be about the money and what they're saying is, "Screw you if you can't handle it."

FROGGYLEGS, LPN · Oct 23, 2005

I have 30+ residents on a locked unit and another 20 ICF/skilled. Unfortunately this isn't the worst ratio I've worked.

I really know where you're coming from with the comment about Aricept. The vast majority of all my Alzheimers patients have been on it regardless of how severe there condition had became. It seems the only way it is DCd is if the resident ends up on hospice.

In the brief instances that I actually have time to talk with my residents and to actually be their nurse I am happy and proud of what I do. Unfortunately most of the time I feel like a professional pill peddler and that is not nearly as rewarding. As far as the facility is concerned I think the only use I have is to get those meds out. I wonder what would happen if the talk of medication aides did come to pass, but that is an entirely different can of worms.

I thought LTC had a lot of problems when I entered it, but I swear it gets worse every year. I think the assignments I once hated would seem really good at this point.

The lawsuits and threats are sickening. I can't even count how many times I've had families and/or residents tell me they were going to sue. The first time I had a resident tell me they were calling Johnny Cochran I thought it was a bit funny...then I started seeing the Cochran firm nursing home abuse ads on tv and realized that their imagination wasn't running wild.

Thanks for the replies everyone. I really enjoyed reading them.

Oh and Nightowl.....you may be the official urine collector, but I am the magical insulin fairy. :)

doodlemom · Oct 23, 2005

My first nursing job was in LTC, but now I go into facilities as a Hospice nurse. A few years ago, in between jobs, I worked for an agency. I tried to work in a nursing facility and found it impossible to pass meds on a 3-11 shift. By the time 8 pm came around, I was passing 4, 6, and hs meds all at one time. There was only one working accucheck in the building and none of my patients had their blood sugar checked before dinner. Their were 12 tube feeders and 16 accuchecks. This was a different experience than I had years ago and it was a nightmare. I decided at that point that I would never work in a nursing home again - unless I was not working on the floor. I felt like my nurisng license was on the line. How does the state not come in and close these places down? Now I see mostly medication aides passing meds in facilities. I guess they figure they can pay 2 CNA's for the price of a nurse.