One hour before and one hour after

[Manofstone]

I need help with something.

I received a write up and one of the things it mentioned was that I need to administer a medication between one hour before the scheduled time on the mar and up to one hour after the scheduled time on the mar.

I work with dementia patients in memory care. I have about 45 patients that I have to pass meds too. I come in at 6am and I start the med pass at about 630am. About 60% of the patients need to be seen by 7am and the rest need to be seen by about 8am. On average they each have around 6 or more meds about very other one has a procedure that needs to be done. Most of the pills have to be crushed. And the patients can be slow in taking their medications. Right now it takes me about five hours to get that all done.

Prior to this I had worked on the other side of the building in assisted living. Over there I had about 27 patients. I would finish that in about 3 hours. At that time, they had a nurse in memory care that would finish memory care in about 3.5 hours. He did that for about a year and a half and then left and then they moved me over to take his place.

By the way, I can still give 27 patients in memory care their meds within about 3 hours...just like I did in assisted living. I'm just as fast as I was before for the last 2 years.

It's clear, to me anyways, that the nurse that finished in about 3.5 hours was still not able to meet the requirement of "one hour before and one hour after". I figure that each day he was there that he passed meds to about 12 people two hours after what was scheduled on the mar.

I've been over there for about three weeks. On my first week my boss mentioned "one hour before and one hour after". I pointed out that in my two years working there that I've never seen any nurse on first shift, in memory care, do that due to the volume of residents and how the mar is set up. I also asked if the nurse I replaced had received a write up every day, for a year and a half, for not meeting the "one hour before and one hour after". I was ignored.

I sent an e-mail to the director pointing this all out and she said she would take a couple days to go over my details and then talk to me.

Any advice?

[luvsltcrn]

It is true that you have to pass meds one hour before and one hour after time they are due to follow the regulation. What your facility could do to make it a little more obtainable would be to schedule medications at different times. For example the patients at the front of the hall due at 7:30, middle of the hall at 8:30 and back of hall at 9:30. My facility did this at one time and it worked really well. The nurses were t nearly as stressed out and there was less chance of being cited by dept of health for late medication administration. Just a thought.

[rnman99]

Sounds like something that got stacked on your writeup just to beef it up. When I was working the floor there was no way you could get the normal LTC med pass done in 2 hours.

[Kooky Korky, BSN, RN]

It's not possible to have all meds passed within 2 hours to that many patients, who need it crushed, who are slow taking it, and you having to stop med pass for other essential reasons. And the bosses know it. They are probably wanting you gone, for whatever reason.

Either try to figure out what the true lowdown is or start looking for a different job.

When you get one, shake the dust from your shoes and don't look back.

I am so sick of the hypocrisy in our beautiful profession. Auntie Florence, help!!!

BTW, don't stop to do anything the aides can do. No toileting, no feeding unless it's to get meds down, no nothing except an emergency, like a fall, choking, arrest. Don't help doctors, don't wait on anybody. And if someone refuses meds, just try to offer them later. Don't spend time discussing.

[amoLucia]

Just FYI - it was NOT your place to question if your predecessor was disciplined and that you sounded a bit cocky about it.

Also is your "boss' the same person as your 'director'??? If you've started up that chain of command, you've now prob made yourself a target and you might want to polish up that resume of yours.

Both actions were big faux-pas. Don't know if you work in an 'at will' state but ...

[KaffeineFiend]

Just FYI - it was NOT your place to question if your predecessor was disciplined and that you sounded a bit cocky about it.

I respectfully disagree

It all depends on how you said it, if you were cocky or rude then you messed up.

However, I feel it was appropriate for you to ask if you are being evaluated under the same criteria as the previous nurse. It's a fair question.

It seems you're being required something that you cannot achieve. Attempting to meet the time requirement would require extreme rushing to the point of negligence when checking your medications and patients. It would endanger those under your care, and it seems you still wouldn't reach their goal.

There was a great suggestion bout changing the med times in order for the nurse to meet the requirement.

It seems like the best option, changing the order times will allow you to be compliant with policy.

Bring it up to your supervisor along with an explanation of how leaving it up to you to play catch up equals lack of patient safety.

If you see they are beyond unreasonable with you, then their real intentions will be more obvious. In that case you can look for another job before being unemployed.

[rnman99]

BTW, don't stop to do anything the aides can do. No toileting, no feeding unless it's to get meds down, no nothing except an emergency, like a fall, choking, arrest.

That's a whole 'nother thread by itself.

I might stop to help someone *after* the resident has taken their meds and I've charted them, but do not interrupt me while that cart is open, unless it's a code, etc. I've seen too many errors happen because someone stopped a nurse right in the middle of drawing up the meds, or while they were in the process of taking them to the resident.

As an aside, when I hear griping about lazy nurses not helping their aides, when it's not warranted, I remind them that while I might be able to do their job, they can't do mine.

[Manofstone]

No, my boss works for the director. My point is that if this is a valid reason for a write up then why is it allowed? It must be allowed if no one can finish by 9am and the best nurse back there was finishing at 10am for over a year and a half. Not trying to sound cocky, just trying to understand why it's allowed except when I do it.

[Manofstone]

Oh, and by the way, when I asked my boss about the best nurse finishing at 10am she told me that it was probably because he wasn't doing everything he was suppose to. Interesting confession. Interesting that it was allowed for over a year and a half.

[cecile9155, BSN, RN]

Where I work we have a time range. So for example the HS meds are to be passed to the residents between 19:00 and 23:00. Plus I still have the hour before and after. I'm still new so I'm slow but I refuse to cut corners. I've caught potential med errors before making them because I am careful.

[amoLucia]

Oh, and by the way, when I asked my boss about the best nurse finishing at 10am she told me that it was probably because he wasn't doing everything he was suppose to. Interesting confession. Interesting that it was allowed for over a year and a half.

To OP (and KaffeineFiend) -

Again, this further validates my earlier comment that management DOES NOT owe you any explanation re others' disciplinary issues.

Your predecessor is no longer employed with your agency. Doesn't that tell you something?? Management has NO obligation to inform you if his leaving was voluntary, a mutually agreed-upon separation or a de facto termination. Personnel issues like discipline and terminations are PRIVATE and PROTECTED. YOU certainly won't want details of your write-up and evaluations made general knowledge to anyone who just asks management. And BTW, how do you know that your predecessor HAD NOT been also written-up and just didn't disclose it to you?

To further expand on your predecessor's job performance/practice, perhaps his non-compliance was a negative issue that was brought to the attn of your boss & the director. Maybe a pharmacy consult identified it as a survey deficiency possibility. Or maybe it was a real survey citation. (Have you seen the last survey report?) Thusly, your boss could very well be responding to something that has existed but unaddressed for too long.

I would not be surprised if there soon will be an overall facility-wide med pass evaluation of all staff just to check things out. Your speedy peer will prob be under the spotlight now also. IMHO, your best defense at this time would be to identify any timely progress you've made. Also be able to provide some alternative ideas how to speed up med-pass but to still maintain pt safety & keep errors down.

And just so you're not surprised when you next talk to your director - administration will support administration IN FRONT OF YOU. They may have their differences behind closed doors, but they will usually almost always present a unified front in front of line staff. But you presented the director and boss a pix of yourself as a non-conforming complainer. May be tough to change that image to them.

[CapeCodMermaid, RN]

That one hour before/after has been around since the residents got a colace and an aspirin and it was possible for one nurse to medicate 30-45 residents. Now it is impossible. Talk to your pharmacy consultant or medical director. You can write daily meds to be given in the AM...that gives you from 6 am to 11:59 am to be in compliance. There is more to life in a nursing home than med pass. I would never write a nurse up for being careful and making sure the right resident got the right med. This business is getting worse by the minute. I'm glad I'm close to retirement.