the neverending med pass

[FROGGYLEGS]

I work 7p-7a and the 8p med pass went beyond being ridiculous a long time ago. Amidst the regular falls, elopement attempts, fighting (yes fighting), irate family members, and calling the MD routinely for the multitudes of problems every night, the med pass is often running over into 3rd shift.

I've worked LTC for a number of years now and while I don't think I'm super fast, I know that I can do my med pass as fast as most of the nurses I've worked with. I don't draw the meds up beforehand and I always work with the MAR. I do know the residents pretty well and know most of their meds so I'm not slowed down by that.

On weekdays there are two nurses to split the same med pass as I do alone on the weekend. They also have a supervisor in-house that can help with issues where we do not. I am the type of person who tries to do things "by the book" and this is really driving me batty because even on the very best of shifts there is no way I can complete this med pass within the required timeframe. I have made my frustrations and concerns with this known to the administration and have asked for help. They've told me they weren't aware that we were having these problems and would try to get some additional help at least for the hs med pass. So far nothing has happened, but I can't say I honestly believed that anything would. I really worry about what would happen if anything is ever said about the fact that some of my meds are late every night. I'm sure I'd be blamed, but I am doing the very best I can. I honestly don't believe it is possible to complete that med pass on time without some shady maneuvering.

I spent several years at one LTC that progressively deteriorated with revolving door management. I spent the last three years waiting on empty promises of improvements that were to be made. After I finally left I said I'd never waste my time with another job that made me miserable like that one did. Now here I am and while I have a nice salary it isn't nearly enough to compensate. I'm thinking of leaving, but I worry about getting labeled as a job-hopper too.

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.

ugh.....I'm not even sure if this is a rant or vent or what. I do apologize for the length though.:) Someone please tell me that there is at least one good LTC left out there.

[JB2007, ASN, RN]

I am so glad that I took the time to read this thread. So many of you expressed how I feel most of the time. All I do is pass pills and try to do everything else (assessments) between these horrible med passes. I am sorry, but there is more to nursing care than passing 20+ pills to 30 or more residents. I feel like a horrible nurse because I am not able to assess all of the things that need to be assessed, I am not able to monitor the CNAs work like I should, not able to follow up on the thousands of things that need to be followed up on, or just take the time to comfort someone the way I would like to. This some of the reasons I hate being a nurse in a nursing home.

When I go to management to try to work out some sort of plan so that my residents are getting the kind of care they should I get shot down. I get told to make do and do my best. In other words No matter how much you work on a solution or complain we will not work with you to fix this problem. They say that they care about skin break down, falls, and med errors, but they do not want to make the changes needed to help prevent these problems. Instead they just want to point the finger at the nursing staff that is cut to the min. and say that it is your fault that this is happening. Excuse me, but all I have time to do is run around from one problem to another trying to keep things from getting out of control.

I do realize that part of the problem is the government, but really management does have to step up some time and accept some of the blame for the horrible way that these nursing homes are ran. I am tired being reactive to these problems. Why will the management not let us be responsible nurses and try to prevent problems? When will they stop placing impossible demands on us?

[MJHarper]

I have been a LPN at the nursing home I work at for a little over 2 years and I love working with the elderly:redbeathe, but I feel just like everyone of you that wrote a message in this thread about the neverending med passes, stresses of the job and noone ever listening to you, feeling like a pill pusher, being overwhelmed and etc...

Point is too many patient's to a nurse and too much medicine, too little time to do a really thorough job like we want to do and not enough TLC to these elderly people who need TLC now more than ever. The thread that mentioned about when resident's pass how they just roll another resident in quick as they can to replace the former resident> it's really getting to be like a assembly line of resident's for the money.

I am scheduled to work a 8 hour shift, but I usually don't clock out until 9 sometimes 10 hours. I have anywhere from 30 to 35 people at a time and it is hard to get all the meds out on time, residents wanting their meds and you going hard as you can, tube feedings, hoping to be able to get to tx, residents wanting to talk but you don't have the time, someone falls-fill out incid. reports-call dr and family, a resident's condition changes you have to call the doctor, get paperwork ready if resident has to go to hospital-and you have to go to to give report, family members complaining or upset because you haven't gotten to their family yet and you have 30- 35 other resident's to care for on top of their loved one, or something else goes wrong it's impossible to be organized with so much chaos. It's overwhelming and so stressful then everyone wonders why there's a nursing shortage!

LTC should work with the nurses and listen to the nurses, so that by working together we can find a way to make the resident's daily lives better and the nurse's job less overwhelming and stressful so that we can give our resident's the best care possible. Sorry post was so long!

[ursus57]

I'm an LPN student, likely will end up in LTC, should I try some other area?

[CapeCodMermaid, RN]

You won't get a hospital job in Massachusetts as an LPN. I'm not sure about the other states but I've heard most hospitals elsewhere won't hire LPNs.

[217shana]

I have had to give meds to fifty patients on day shift. What eased it some for me would be that I would give the patients that were in bed or tube feeders there meds first and them I would park the carts near the elevators and catch the walkers and those in wheelchairs when they first returned to the floor. In another factility we had the med pass times changed to 9-1-5-9. Another med pass time that seems to work is to give BID meds at 8 & 8 or TID at 8-2-8. We have changed tube feeders meds to 12-6-12-6. When I run long with first med pass, I start the second med pass with the ones I got to first with the first med pass. You can always ask pharmacy to evaluate for unnecessary meds and make recommendations. Can some meds be changed to long acting or time released. Instead of tylenol every four hours can the tylenol arthritis be used that is given every 8, etc.

[MJHarper]

I'm an LPN student, likely will end up in LTC, should I try some other area?

You could try LTC and see how you like it as you'd never know unless you worked in it to see and then decide what you want to do. It can be hectic job and you will stay busy from the time you clock in until the time you clock out and the med pass is busy busy, and you never know when something is going to happen to add even more to the list of things to get done, but all in all it is about caring for and making the resident's lives as comfortable as we possibly can and giving them a smile and asking how they are doing can make all the difference in the world to them even though we don't have a lot of time to talk with them for long and get our job done. But always remember this: always treat each resident as if that were your family member or you there being cared for.

[vsink]

I have been a LPN in a nursing home for almost 3 months! I just put in my two weeks notice! The med pass is making me nuts!

[LEN-RN]

I don't see how any of you get any nursing responsibilities done passing meds! All our meds are totally passed Med Techs. The nurses have more than enough to do in 8 hours WITHOUT passing meds. She literally never stops (I'm the ADON) and if she had to pass meds no one would ever get any care.

Thats just it, nursing responsibilities get sidelined and thrown in between. Thats one reason nurses dont take breaks.

Its about money. And there is always another unassuming or eager nurse waiting to be hired, so most management does not care that there is a problem. I have seen one floor supervisor hide in her office all day, until the administrator stops in, then she is out and about acting like she cares, then goes back in her office when he leaves the floor. During a snow storm a HUGE snow storm, where people were stranded at work, do you think she even called in to see how everyone was doing??? UMMMMM noooooooooo. She could have cared less. She is worthless. And after than same snow storm, administration gave each floor supervisor $100 gift cards to be given out to the staff who stayed(slept in empty rooms on the floor) but this floor supervisor did not pass out ONE gift card. Unbelievable.

[kmr2828]

I have now hit my 3 month mark in a Long term facility . I am really trying to hold out for 6 months & I will begin sending out my resume to a few places that I heard have better working conditions & a more manageable nurse to patient ratio . I have a unit manager who is "suppose " to do the treatments & answer the phone ,however she has told me that passing meds to 32 people (7-3) is Not a full time job & she expects me to do all 32 treatments & dressing changes, wound care etc for all of the residents. I have lots of feeding tubes & neb treatments, finger sticks , coverage etc.

I still cannot seem to get it all done. I have doctors, infection control ,psych, pt , Aprns , dietician, speech therapist, hospice nurses all come & track me down while I am attempting to pass my meds. . The Rn on the floor sends them to me. She takes several breaks to smoke & eat for lunch the extra sandwiches that the kitchen sends for the diabetic residents - meanwhile I am running around like a absolute fool . with no break & many times no lunch . She will even come find me down the hall while Im in the middle of passing my am meds to tell me I really need to make sure I remember to go check the residents skin when an aid is giving a shower (in CT an LPn is not suppose to assess anything, so they changed the name to a skin audit.. pretty darn sneaky ) .... like I have time for that. I took the advice from BoopetteRN & reviewed my meds however the unit manager would not let me change the time to 5pm , but let me move some of the 8am & 9am to 10am and I noticed a few could be dc'd & I mean 2 .

I love the cna's & I love the residents . I know the residents know I do really care for them . I have received compliments from families that it is much better since I have been there.. I feel these residents deserve more better care. I was told today that I cannot work past my shift 3pm , which I have been doing since I have to also chart on each resident , do the 24 report for the dos , fill out the I&O's , bm's and skin audit forms as well as Adl assessment sheets ever day in addition to the medications & treatments for all 32 residents . I would love to see the unit manager or the DON attempt to do all I do . I know they are licensed to do it , but sure would not be done by 3pm.

I do not beleive that any nurse who has 50 plus residents for 7-3 shift could honestly say that she is not cutting corners or taking "shortcuts" , especially if she is doing medications & all of the treatments. I really do not believe that anyone could possibly be doing everything by the (state guidelines) book ... I would have to see it to believe it !

[Bokyo]

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.

lol......

oh well...we're in the same shoes!!

but i still love it............

[Bokyo]

I would love to see the unit manager or the DON attempt to do all I do . I know they are licensed to do it , but sure would not be done by 3pm.

I do not beleive that any nurse who has 50 plus residents for 7-3 shift could honestly say that she is not cutting corners or taking "shortcuts" , especially if she is doing medications & all of the treatments. I really do not believe that anyone could possibly be doing everything by the (state guidelines) book ... I would have to see it to believe it !

I had once did it...the on call for that weekend was the DON....ok, i told all the Nurses not to work if ever they will call them...let her work her @$$ on the floor, i didn't work that night...then the next day....i ask her if she could add one more Nurse in the Night shift....she just simply say "YES".

Ask your DON and Administrator to have a Tx Nurse...that way your load will be lessened.

[mykrosphere]

i worked in long term care and its the hardest job ive ever had.

most of our long terms were on vents, even.

its pretty sad when most of the patients dont even really care about the pills, they just want someone to talk to.

i work in an ltac now and its a bit easier with less patients, and i wonder how i ever got through taking care of 20 vent patients in a nursing home.

(nevermind having to hang all the ivs because i was the only rn working at night some nights, and doing staffing, and yadda yadda)

it makes me sad that older people are not better taken care of.

we try our best and still go home feeling like we didnt do enough.

its awfully stressful

and the med pass is a joke.

working 7p-7a you have the first med pass of "hs meds" that takes roughly 3 hours (on a good day)

then around 11 or so you have the second round of "hs meds" (people who are a/o enough to not want a sleeping pill at 9pm. (about an hour)

then minimal charting, then its time for the 4am med pass, and after that, the 6am med pass.

throw in some accuchecks, patient falls, random codes, and you have 12 plus hours of nonstop "action"

for as hard as long term care works you, its amazing the pay is the lowest ive ever received.

getting to know the patients is really rewarding.

and i respect all honestly decent nurses who work in ltc.

(old people are the best)