Hello I Graduated In December 2010 and maintained high grades throughout the program. I passed my state board exam on my first attempt in February. A friend recommended me to a local nursing home where they agreed to hire me as an 8hr a week employee. Orientation was about 4 weeks where I mostly watched the regular staff scurry around and complete their duties. The facility has 4 units with 32 patients each. During days and evenings they have 2 nurses that care for 32 residents each and 3 nurses that care for 21/22 residents each. During orientation I was all over the facility and oriented different shifts with different nurses on different units without really much hands on time because the regular nurse on the floor needed to keep things going in order to do her job. I had the opportunity to pass meds a few times during orientation.
Orientation ended and I became a floating charge nurse. I work whatever unit or shift they need. As a new nurse without knowing the residents very well it is very difficult to do the med pass. On a couple of units, many residents require crushed medications and or thickened supplements and are difficult to feed. The regular nurse knows the residents well and has the ability to streamline some of their duties, for example, they put supplements on the resident's tables and the regular aids thicken them and feed the supplement with the meal. By the time I get to these rooms scattered throughout the unit, the meal is already over. It is difficult to know each residents needs because I do not work any unit or shift with frequency. Obviously nurses do not "follow the book" and do what they need to do in order to get their job done.
The facility utilizes paper Kardex's for medications and treatments. From my little experience it becomes evident that this method is problematic and prone to errors. Every medication is listed and during a med pass the nurse has to view each line identify which meds are to be given now, administer it, and sign for it in the appropriate square. When dealing with unfamiliar residents this takes much longer than it does if you know them. I can't help but notice all the unsigned squares. It becomes evident that the regular nurses that "forget to sign" simply fill in the squares the next day. In my opinion the floating nurse does not have that opportunity and is under more scrutiny.
After six months of employment, I have made 4 reported med errors. The first was that I recognized that a resident drank little of the juice I added her potassium chloride to. I poured it into a 30cc cup and decided to try to give it undiluted to the resident with the hopes of getting them to drink it all. I administered the other medications and some of the KCL was found 20 minutes later by the supervisor on their table. Error 2. I administer a narcotic scheduled at 8am. At 10:30 I administer another scheduled dose in error. It was not supposed to be started until the next day. I read the wrong square. Error 3. I enter a room and realize that the door resident is in the bathroom so I pour and administer the window resident's medication. With my cart facing so I can see into the room, I pour the meds for the resident in the bathroom. She has not left the bathroom and another resident comes in the hallway and asks for her medication. Without moving the cart, I pour her meds and turn to her and administer them. I then proceed to the bathroom door and knock. Enter the bathroom and administer the meds. I administered the wrong meds to the wrong resident. The door resident left the bathroom and the window resident went in. I noticed this right after I made the error and notified the supervisor of my error. No ill effects noted but in my opinion this was a terrible med error. I vow to myself to always know my patient and identify them prior to ever giving meds again. Error 4. Resident was to have a tooth extraction and was to receive an antibiotic 1 hr prior to the in house procedure. When told to give I looked for it, found it and administered one antibiotic and signed for it. The order was written for 2gms and I administered 500mg. These errors happened over a 5-month period. I am at fault for all the aforementioned errors. They should never have happened. Even though I never had the experience of giving multiple antibiotics at one time, I administered an incorrect dose. Obviously if I ever see a punch card with 4 antibiotics in it and a procedure is scheduled or a single dose of antibiotic is scheduled, I will check the order very carefully as I should check all orders. In school most people would envy a grade of 99. In nursing if you administer 5000 medications but only 4999 are correct, that is not good enough.
The director now wants me to work for 2 weeks with the day nurse on one unit. She does not have a regular position to offer me. So working on one unit will not be an option in the near future. I have however become somewhat familiar with a good portion of the residents. The director asked me what I needed to learn. I think what will be best for me is for this nurse to work at my level of not intimately knowing the residents and show me how to possibly get both med pass's done along with treatment notes, admissions, and all other duties. The unit is broken down so half the residents are scheduled to have meds at 8:30am and the other half at 9:30. I find that by starting at the first room and working my way around the unit, it is impossible to get this done in a timely manner especially when the nurse has to do finger sticks and coverage for diabetics, check B/P's & Apical for parameter medications, and get meds to people before PT or going out and identify each medication to be given going through the Kardex like a nurse that is not familiar with the resident would have to do?
Should I be able to walk into a unit that I seldom work and proficiently get the job done? How can a nurse in my situation follow procedure and timely administer medications to 32 residents many that are crush with parameters while doing finger sticks? What happens when I get to resident 32 and realize that they are diabetic and need insulin before breakfast and it is now lunchtime? Supposedly in a couple of weeks they are changing to a computerized system that I would think would help isolate the meds to be given eliminating all the time of looking through all the orders that are not relevant at any particular moment.
Am I a loose cannon a bad nurse? I always thought I was meticulous. My errors indicate otherwise.
I agree that this is an overwhelming situation, still 4 med errors in 6 months are a lot of errors...and those are the ones you are aware of...I would just say, please be more careful and take more time with your med passes and like the other poster said...she would rather be slow and careful than make errors.
I def have to agree w/ OP, it's hard being a new nurse floating from floor to floor. I don't float (yet) but day 4 of orientation, I did better w/ my med pass. By better I mean instead of it taking me 3.5hrs to pass meds to 12 pts, I was able to up it to 23 out of 30. Still over the window of opportune time BUT I did it slow and correctly. The other nurses were getting a little ansey that I was slow, I dont care. It's my job, license, and integrity on the line. As for trying to do anything else that goes along w/ the territory of job duties, I don't know what to do at this point. I truelly do not believe that I will give good pt care, med pass, paperwork, admissions, falls/ incident reports, checking up on aides, assessments, etc. if I spend my WHOLE shift on the med cart. I figured out in my head that the max amt of time you can spend w/ a pt for your med pass w/ 30 people is approx 4 mins. Can someone pls tell me how this is humanly possible? You dont know the pts so you have to look up every med. And forget it if one person takes like 10 meds you are in deep dodo. Or if you have to "borrow" a med from another resident because yours does not have theirs in their drawer. I'm going off orient. in a week and I'm already burnt at the idea of tackling this ginourmous mt of problems. Sorry OP for taking over but I feel your pain and frustration and its so disheartening to feel like we new nurses are not cared for by mgt or the companies. And the sad part is they spend so much time telling us how the pt's come first, it's all about the pt. If that was the case someone would have had a lightbulb moment a long time ago.
Specializes in Professional Development Specialist.
It sounds to me like the facility you are working at is at least willing to work with you instead of just firing you straight out. Is the entire facility LTC? So even if you float the residents are pretty much the same over time? Making yourself a brain for each unit with the diagnosis as well as little idiosyncracies of each resident might help. Then whenever you get there you can print off said brain and be one step ahead. We adopted this idea a few months ago and frankly none of us can remember how we functioned without it.
First of all, everyone in LTC knows if you can get all the meds done within the timeframe then you are cutting some serious corners. 4 hours is the norm in our facility. When the national DON asked why we couldn't get the med pass done in the 2 hour window, I told her it was mathmatically impossible and many other nurses said the same. Some facilities locally have switched to "am, mid day, afternoon, hs" scheduling just for the sake of being honest and allowing pts to have personal choice. I know I can't take 20+ pills on an empty stomach. Asking when you get report who the diabetics are, who has IV abx, who is a gtube, who has a complicated wound dressing, etc will help. Hopefully the nurse you are taking over for has some knowledge of the patients. A lot of the PRN nurses I work with flip through the MAR quickly at the beginning of the shift so they can plan the diabetics, etc.
If you can find another job, then maybe it's time to do so. But sometimes it's take what you can get, or work at McDonalds. Good luck!
diva rn, BSN, RN
963 Posts
I agree that this is an overwhelming situation, still 4 med errors in 6 months are a lot of errors...and those are the ones you are aware of...I would just say, please be more careful and take more time with your med passes and like the other poster said...she would rather be slow and careful than make errors.