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.
I don't think you understand my point. I'm not saying they owe me any details on anyone's performance. I'm just saying that if the claim is that you have to have 45 residents done by 9am and that everyone knows that no one has done that ever (even my boss tells me that)...then why blame me when I'm the new nurse in that section? A write is a way to help someone understand what they did wrong and what they can do to correct it. The write up I received just said I'm in the wrong with no details as to how to get 45 residents their meds by 9am...and during the write up my boss admits that no one has ever finished at 9am. If they view me as a non-conforming complainer then I can't help that when I've made it clear that I am willing to do what ever they want in order to do what they want...only...they are unable to verbalize how to do that.
Oh, how do I know my predecessor wasn't written up for this? Well, lets play with that idea. He worked back there a year and a half. He was always done by 10am. Now, where I work, if you get a write up and it's the same write up three times...you're fired. So, I know that he did not receive a write up ever day because he would have been fired on day three for being one hour behind on 12 people. He was there for over five hundred days minus his days off. So that, to me, is evidence that this was not an issue when he worked over there. Also, he wasn't fired, he found work elsewhere and left. And finally, he was the primary 1st shift nurse over there. On his days off there is a nurse that fills in. She usually finishes around 11am. She's worked there for over a year. So no, I don't see how it's possible that she's being written up every day for giving meds late to 24 people for over a year.
Oh, I am sure that the director will back up my boss. It's just I wanted to point that I expect management to help me see what it is that I need to do to meet the guidelines that they have in place while they also admit that no one has ever met those very guidelines (leading us back to the point that no one has been written up for this for every day that it occurred).
45 memory care residents? Wow, that's insane! No way is anybody getting that done in a two hour window. Not sure what advice to offer other than looking for a new job. If you are inclined to stick it out though, how about getting med administration times changed so that they are staggered instead of everybody being due in a small window of time. When you get to know the residents a little better you will learn which ones want their meds early, which prefer them later and which ones really don't care when they get them and the times can be adjusted accordingly.
Everyone passes meds late. It's a matter of basic physics, you cannot be in multipe places at once. Ive always wanted to ask the DON to work one shift with me shadowing to see how exactly they could pull off such magic. I tend to help cnas a lot. Falls must be prevented, and I do not have the heart to ignore people with legitimate concerns and requests. I called out one day, and the cnas told me how hilarious it was to watch the DON, ADON, and unit supervisor running around like chickens with their heads cut off trying to get all the meds done. I prioritize insulin, bp meds, Coumadin, narcs, and other meds that are very time/schedule dependent. Meds that were obviously unnecessary (a huge problem in ltc especially) and vitamins, eye drops, and other less dynamic meds were saved for last and were often late. You just do your best to keep everyone alive and safe. Unless theyre stupid and naive, that is all they can expect from you.
I had a visit with a state surveyor a couple of years ago--our yearly visit. She was watching me at my med pass and asked why certain people were hi-lighted in red. I told her that those were late meds. She knew that I was the only nurse in the facility after 1800 with 45-52 residents (some rehab-to-home beds) to medicate. She straight up told me that technically she should tag me for those, but wasn't going to because she knew that it was impossible to get it all done within a 2-hour time frame. I used to help the CNAs more than I do now, but I still am typically not getting done with the med pass until 2130. We had a pool/agency nurse call in sick one evening, and the 2 day nurses stayed late and a third day nurse came in, and the 3 of them, working together, were able to get it all done on time. The last time the DON was forced to fill in on a noc shift, she was passing my meds until 2330 and typically the agency/pool nurses are finishing the evening med pass between 0030 and 0130. It was pretty insane! I did change the times on some of the meds, so that they are due at 2100 rather than 2000 and that made a bit of a difference, but it's still a pretty heavy med pass.
In order to get it done as fast as I was, I was dipping into some rather unsafe practices and caught myself on the verge of a couple of pretty big med errors, which is one of the reasons that I no longer work at that particular facility. Management was not looking at any other options to help with the evening med pass--though now that I've left and they have only pool/agency nurses covering all noc shifts (and the DON is the only RN employed by them now), they are looking at adding another nurse from 1800 to 2100 to help with the med pass.
...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...
When I first started working as a nurse, part of our orientation was to work in the LTC and Dementia Unit. This was to have back-up for nurses who worked there full time and had to call out for some reason.
When I did it, there was no way that I could see that one nurse could pass so many meds within the "one hour before; one hour after". So, if iI ended up passing meds late, I wrote the reason why. Can't exactly remember my terminology but the med was late due to being the only nurse working with a whole bunch of patients. "Med given late due to . . . ".
It really bothers me that one pm nurse is expected to handle what two or three nurses handle during the day. The idea that the patient are sleeping and therefore there is less to do is bogus.
I've seen corners cut in dangerous ways. Sometimes the nurse will just hurry to get started on the med pass at the beginning of shift and miss out on order changes and also they won't chart the meds in the MAR at the time they give them but go back and chart after med pass.
I've had hospice patients in LTC where I've been called in due to pain issues and when I looked at the MAR to see the last dose of ordered pain meds, I saw that the nurse hadn't written anything. I also saw that the nurse gave a med that had been d/c'd earlier that day.
We are setting up nurses to make med errors.
I think because I refused to cut corners, the powers-that-be decided not to ask me to work LTC/Dementia Unit anymore.
Maybe we end up shooting ourselves in the foot because we go along with unsafe practices?
I finally got to talk to the Director and she let me know that they are making changes to address the one hour before and after. She understands that no one has ever met that goal and no one will. And they are removing verbiage from my write up. I got the impression that they are leaning towards having "1st shift meds", "2nd Shift meds", "3rd shift meds" as the "time" for giving. I would think there would be some additional notes regarding giving the med early in the shift or late in the shift while some meds will have to have a time. Anyways, it was a good talk.
Manofstone
42 Posts
I don't think you understand my point. I'm not saying they owe me any details on anyone's performance. I'm just saying that if the claim is that you have to have 45 residents done by 9am and that everyone knows that no one has done that ever (even my boss tells me that)...then why blame me when I'm the new nurse in that section? A write is a way to help someone understand what they did wrong and what they can do to correct it. The write up I received just said I'm in the wrong with no details as to how to get 45 residents their meds by 9am...and during the write up my boss admits that no one has ever finished at 9am. If they view me as a non-conforming complainer then I can't help that when I've made it clear that I am willing to do what ever they want in order to do what they want...only...they are unable to verbalize how to do that.