Please Help Me!! 50 pts med pass [New grad]

[medsurgcutie]

I am brand new to nursing I just received my license last friday. I landed a job right out of school and I thought great how lucky for me. I worked there as an aide until I passed the nclex and although its not a top of the line facility the staff seemed to care for the residents so I thought great.

Now that I'm on as a nurse they spring a 50 resident med pass on me. I gotta be honest that scares me. I don't really feel like I can safely do a 50 person med pass right now. I'm slow cause well I'm new and I don't know all the people yet and this is a behavioral unit so some of them can't tell me who they even are. I feel trapped because when I asked about nurse to patient ratio I was told at the most 1:28. The most meds I've passed at one time was to about 15 residents while in school, and now they place me on the behavioral unit and tell me to do a 9pm med pass to all these people. What should I do I desperately need help.

[cincin]

omg this sounds so familiar BUT i had 18 years as a lpn under my belt when they pulled this on me.. I did it for 8 months (50 resident med pass) and I litteraly(SP) was losing my mind and one day I went in the don office with the administrator present and let them know I was NOT going to do it anymore.. they hired more nurses AND I got a $1.00 raise.. So it pays to tell them honestly that you feel uncomfortable about it and if they dont make it better for you>>>> RUN!!!!

[powernurse]

50 patients for one nurse should be ILLEGAL. RUN - DON'T WALK.....

I have been there and have done that through a staffing agency b/c I could make $40/hr..... Let me tell you that NO AMOUNT of money is worth the GUILT of going home second guessing yourself if you forgot anything, the Guilt of feeling sorry that you didnt have the time to take an extra few minutes to listen to a patient when they were feeling down....

RUN..... RIGHT NOW..... take the advice of the person who said "get yourself into a new grad program"

DON'T RISK losing your license ....you just got it and ..... POOF!!!.... it could be gone!

[NCLPN1991]

Congrats to you... The first facility I was at after gradutation it took me 2 months to get a clue of the routine.. I dont even remember if I got an orientation..

[Joey52299]

I know what you are feeling. I have been a nurse for 8 years. My first nursing job was in LTC. It's very easy to get over your head. If you can find another job. If not take your time with the med pass. The more you do it the faster/better you will get. If it takes you an hour and a half then so be it. As long as the MAR is followed and 5 R's of giving meds is followed then you are a smart safe nurse. No facility could ask more of you or tell you to work faster. I now do ER nursing and flightnursing in the Air Guard. The assessment skills I learned in LTC have been my foundation to this date. Good Luck!

[NCLPN1991]

I know what you are feeling. I have been a nurse for 8 years. My first nursing job was in LTC. It's very easy to get over your head. If you can find another job. If not take your time with the med pass. The more you do it the faster/better you will get. If it takes you an hour and a half then so be it. As long as the MAR is followed and 5 R's of giving meds is followed then you are a smart safe nurse. No facility could ask more of you or tell you to work faster. I now do ER nursing and flightnursing in the Air Guard. The assessment skills I learned in LTC have been my foundation to this date. Good Luck!

I agree with you.. 14 1/2 years later I am still plugging along in LTC.. I see new grad nurses and old nurses in way over their heads at the facility I at now.. Had an RN who worked acute care be totally lost in LTC and it didnt help that when she was on first day of orientation another RN was yelling at her to hurry up cause she didnt want to be there all night.. 1st RN still there, 2nd RN fired a few weeks later.. I try to help out new nurses as much as I can cause I have literally been in their shoes.. My fellow shift nurses and I all try to work together cause some nights it's the only way that we can get things done...

[marylyric]

Well, you asked, so I will be honest....RUN!! GET THYSELF INTO A NEW GRAD PROGRAM STAT!

Let me tell you my position and maybe that will help you understand why I say that:

I graduated in 1999. By taking the 1st job offered (LTC) and given little orientation (2 days) I was in way over my head and asked to do things that required too much knowledge and experience for a newbie. (passing meds like you describe, supervising, etc.) By the end of 2 months I quit nursing altogether. I was frustrated, ashamed, embarassed, depressed, and guilty for "wasting" all those years in school. My family was baffled that someone who loved nursing school like I did couldn't hack it. The only thing that made it easier to swallow was that I was busy caring for my MIL who had CA and my 6yo BIL.

In hindsight, I was very young and not making smart choices. Had I went to a different facility with a nice long new-grad orientation program and taken a job with reasonable expectations of a new nurse I feel the outcome would have been 100% different. It seems those of us that entered a new grad program did/are doing much better than the ones that didn't. I have talked to several who had stories similar to mine as well as some who are now incredibly fantastic nurses. The first few months on the job really seemed to make the difference.

As for me, after much thought (and time) I changed my mind about nursing. I am currently enrolled in an RN refresher program (almost finished) and have applied for a new-grad position with a great orientation program. I am so excited about nursing, for the first time in years.

I wish you the best of luck!

Hello, I have a question. I work in a non medical detox. Had patient come in with about 20 drugs he was on. I sat down with the patient and went over the drugs, made up the mar and gave pts his drugs. I return the next day to the shift to find out the nurse that came on after me had documented that I had given pravacol and zocor together and the patient was only suppose to have one of those meds. She called the supervisor at 6am to let her know this. I would like everyone opinion please. I took the responsiblity because I administered the drug. according to the nurse the consumer told her he was holding on to the medications to the zocor to finish because he did not want to throw away because of financial reasons. Consumer never mention to me. I feel it was my responsibility to know. What does anyone else think.

I feel so bad, because the other nurse found it and I did not.

[melanie1126]

I hope that you are able to find something with a more appropriate orientation for a new grad. Whatever you decide to do, if you end up having to pass meds for this facility take your time and do it right. Don't worry about how long it takes you. You worked too hard for your license to hand it over now b/c a 1:28 ratio is acceptable to your facility. It's also not worth hurting someone else b/c you gave a med without knowing what assessments to make, side effects etc. We all have to start to somewhere and over time you will build a knowledge base, but right now while you're having to learn so much at one time, I think I'd keep my drug book by my side, look everything you don't know up, and insist on patient identifier's. (pics, confirmation from other nurses, etc.- Your facility probably has a written protocol on identification.) If your peers get upset b/c it's taking you too long or they get tired of you bugging them for confirmation of ID, then so be it. Tell them to let someone else do it.

[jen620]

This sounds like a nursing home. It is not totally out of line to have to pass meds to 50 patients. I've worked nursing homes off and on over the years. Once you learn the patients, you learn how to get all the meds passed. There are tricks to it. You pass as many meds as you can while the patients are grouped together in the dining room, for instance. Giving medications from the cart at the nursing station as the aides wheel the patients by on their way to places in the morning is another way. We scheduled meds for the patients with tube feedings at times other than the other patients because of the time involved in crushing and getting the meds down their tubes. It also helps save time when you get to know (memorize) what medications each patient gets, what they look like and just where they are in the med cart. Another way to stay in compliance is to change some of the times on medication administration, but I wouldn't recommend doing that until you get to know the patient's really well. Believe it or not, it is doable. It will take you about a month or so to get acclimated to this and start to feel like you might know what you are doing.

No matter what nursing home you go to, you are going to find a very similar situation. That is just the nature of this beast. So, just keep plugging along. Always think about ways to make your med passes more efficient and faster. Don't expect that you will be 100% "speedy nurse" for a few months though. I worked in several fine nursing homes in the Dayton area and the number of patients I had to be responsible and pass meds to and do treatments for was the same. And, these were very good homes. You might find it less stressful to work on the 3-11 or 11-7 shift where the med passes are not as intensive as they are on the day shift.

I have worked in LTC for MANY years, the worst thing to do is memorize the meds you are giving or pull meds from a remembered place- you are asking for a med error which will lead to more problems like loosing your license! There is a good reason they give you an MAR!

50 pts is too high a number to safely pass meds on. You made a wise decision to move on. The facility will eventually get into hot water with this issue! Another thing - and this may just be a rule of my company, but we cannot pass meds in the commons areas(dining room) due to privacy laws and confidentiality.

[pinkRN23]

UMMM what state is this in ??

this sounds crazy.

You need to be in a new grad program (6-8 weeks of orientation & training)

Don't put up with this !

There are way too many jobs and training programs available these days to put yourself & your patients at this kind of risk...

be strong !!

[Debbie G]

You say you do not know the patients yet? Good, I hope you never do! ALWAYS check the name band for two passive identifiers, name and ID number or date of birth. Wrong patient errors are very common among new grads and experienced nurses alike. If you patient is missing a name band, refuse to give the meds until identified and banded by the other staff. You have enough to do with just giving out meds! Sounds like you are working in a team, and you are the "med nurse". Prioritize which meds are time sensitive and which are not. Not the end of the world if a patient gets a daily multivitamin at 1pm instead of 9am, but a problem if the AM insulin dose is delayed! Know what you are giving any why!

Good luck!

[CseMgr1, ASN, RN]

Trying to pass meds to 50 patients is not only unrealistic, but is downright dangerous.

I was a new graduate LPN thirty-some-odd years ago on an extremely busy surgical floor, when my partner and preceptor, a seasoned ex-military LPN quit and left me holding the bag with the same amount of patients. I had just taken the Boards and was scared OUT of my mind as it was even before he left. Luckily our unit was run by a proactive and caring RN, who came to me immediately and calmed me down. "Don't quit", she advised. "I'm already interviewing another LPN and will help you get your meds out, until I hire a replacement".

She kept her word, working doubles until the new LPN was oriented and put in place. That spoke volumes, for there would have been NO way I would have stayed, otherwise. Get OUT of there ASAP, if they refuse (or can't) offer you the same support. Easier said than done, I know, but it's YOUR license and your patients' LIVES which are at stake...and NOT your bosses'!

[jess1206]

I too have taken my first job as an RN in a LTC facility. One thing I have been taught has helped me on the not one, but two rounds of passes that are done in a shift. If your MAR is in a 3-ring binder, start at the beginning, pass that pt's first round, then move their MAR over a hole so it is flagged out of the book (if they have a second round coming later). Do so for each pt. Then, for your second pass, move the MAR back to its original place in the book. This way if you go back and forth out of order from pt. to pt. the finished ones are out of the way and you are left with the flagged ones that still need passing. Also, the pt's who only have one pass do not have to be thumbed through again unecessarily... Good luck!